'It's very values driven': A qualitative systematic review of the meaning of compassion according to healthcare professionals

AIMS AND OBJECTIVES

To explore the meaning ascribed to the concept of compassion by healthcare professionals.

BACKGROUND

Compassion is universally regarded as the foundation of healthcare, a core value of healthcare organisations, and essential to the provision of quality care. Despite increasing research on compassion in healthcare, how healthcare professionals understand compassion remains unclear.

DESIGN

A systematic review of qualitative studies was conducted and is reported following PRISMA guidelines.

METHOD

Medline, Emcare, PsychINFO and CINAHL were searched to November 2021 for qualitative studies in English that explored healthcare professionals' understandings of compassion. Included studies were appraised for quality before data were extracted and thematically analysed.

FINDINGS

Seventeen papers met the inclusion criteria. An overarching theme, 'It's very values driven' underpins the four main themes identified: (1) 'It's about people and working with them': Compassion as being human, (2) 'There is this feeling': Compassion as being present, (3) 'If I don't understand them, I won't be able to help': Compassion as understanding, (4) 'Wanting to help in some way': Compassion as action.

CONCLUSIONS

Healthcare professional participants reported compassion as motivated by values and inherent to humanistic healthcare practice. The meanings healthcare professions described were varied and contextual. Qualitative research should further explore healthcare practitioners' experiences of compassion as part of their practice to inform health professions education, policy, and practice.

RELEVANCE TO CLINICAL PRACTICE

To practice with compassion, healthcare professionals require supportive and humanistic organisations that honour each person's humanity and encourage people to be human and compassionate to each other as well as to patients, their families and/or carers. Healthcare professionals need to reflect on what compassion means to them, how it is situated within their unique practice context, and how compassion can enhance clinical practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review had no patient or public contribution.

Escape Rooms in Nursing Education: A Systematic Review

BACKGROUND

Escape rooms (ERs) are being increasingly used in nursing education as an active and game-based learning method.

PURPOSE

To conduct a systematic review to synthesize evidence on the current use of ERs in nursing education.

METHODS

A mixed methods systematic review was performed to identify and synthesize existing literature. Five databases were searched in July 2023. Descriptive and thematic analysis were used to synthesize quantitative and qualitative data, respectively.

RESULTS

A total of 333 studies were found after searching 5 databases. After 2 independent reviews, a total of 57 studies were identified across 5 countries. There were 16 qualitative studies, 34 quantitative studies, and 7 mixed methods studies. Four main themes were identified.

CONCLUSIONS

ERs are widely used across different topics and settings in nursing education and are enjoyed by the majority of participants; however, more rigorous research is needed to confirm whether ERs improve learning outcomes.

Co-designing formal health professions curriculum in partnership with students: A scoping review

There is growing evidence of the value of co-design and partnering with students in the design, development, and delivery of health professions education (HPE). However, the way in which students participate in co-designing HPE remains largely unexplored and there is little guidance on how to embed and strengthen partnerships with students. Using scoping review methodology, we identified and aggregated research reporting studies in which students were active partners in co-designing formal curricula in HPE. After searching five databases and screening 12,656 articles against inclusion criteria, 21 studies were identified. We found that most of the research was based in medical programs (n = 15) across Western contexts. Studies were mostly descriptive case reports (n = 10), with only three studies utilising participatory/action research designs. The co-designed outputs were mostly classroom-based learning on challenging HPE topics, for example, ethics, health inequities, racial and sexual bias, global health, and Indigenous health. Detailed descriptions of student-faculty partnerships and underpinning approaches were lacking overall. To optimise co-design methods, HPE and research require deeper engagement with critical research and pedagogical approaches and more robust evaluations of the processes, outputs and outcomes of co-design. In pedagogical practices, this necessitates challenging institutional structures, teaching and learning cultures and relational elements, such as through creating formal roles and opportunities for students as active co-design partners and fostering more equitable student-faculty positioning in HPE.

Factors influencing decision-making processes for intensive care therapy goals: A systematic integrative review

BACKGROUND

Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must better understand decision-making processes and factors influencing them.

AIM

The aim of this study was to explore factors influencing decision-making processes about implementing and limiting intensive care therapies.

DESIGN

Systematic integrative review, synthesising quantitative, qualitative, and mixed-methods studies.

METHODS

Five databases were searched (Medline, The Cochrane central register of controlled trials, Embase, PsycINFO, and CINAHL plus) for peer-reviewed, primary research published in English from 2010 to Oct 2022. Quantitative, qualitative, or mixed-methods studies focussing on intensive care decision-making were included for appraisal. Full-text review and quality screening included the Critical Appraisal Skills Program tool for qualitative and mixed methods and the Medical Education Research Quality Instrument for quantitative studies. Papers were reviewed by two authors independently, and a third author resolved disagreements. The primary author developed a thematic coding framework and performed coding and pattern identification using NVivo, with regular group discussions.

RESULTS

Of the 83 studies, 44 were qualitative, 32 quantitative, and seven mixed-methods studies. Seven key themes were identified: what the decision is about; who is making the decision; characteristics of the decision-maker; factors influencing medical prognostication; clinician-patient/surrogate communication; factors affecting decisional concordance; and how interactions affect decisional concordance. Substantial thematic overlaps existed. The most reported decision was whether to withhold therapies, and the most common decision-maker was the clinician. Whether a treatment recommendation was concordant was influenced by multiple factors including institutional cultures and clinician continuity.

CONCLUSION

Decision-making relating to intensive care unit therapy goals is complicated. The current review identifies that breadth of decision-makers, and the complexity of intersecting factors has not previously been incorporated into interventions or considered within a single review. Its findings provide a basis for future research and training to improve decisional concordance between clinicians and patients/surrogates with regards to intensive care unit therapies.

'You don't see what I see': Co-designing simulation to uncover and address cognitive bias in healthcare

EDUCATIONAL CHALLENGE

Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required.

PROPOSED SOLUTION

We used participatory action research to co-design an innovative, interprofessional simulation based on 'real world' clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice.

POTENTIAL BENEFITS AND NEXT STEPS

To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify 'real-world' health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.

Pre-Registration Nursing Students' Perceptions of Digital Health Technology on the Future of Nursing: A Qualitative Exploratory Study

BACKGROUND

Health informatics competencies, digital health education, and nursing students' perceptions of technology are critical to ensure a future digitally capable health care workforce.

PURPOSE

To explore preregistration students' perceptions of digital health technology impact on their role as nurses.

METHODS

Using a qualitative exploratory approach, students from 2 Australian universities were purposively sampled. Data were collected through photo-elicitation from 3 focus groups and thematically analyzed. Photo-elicitation provided reference points to encourage more in-depth exploration.

RESULTS

Themes included fear of the unknown and who am I? Nursing in a digital world. Human interaction was fundamental to their nursing role and digital health technology could depersonalize care, creating tension around their reason for choosing a nursing career.

CONCLUSIONS

Educators should prepare students to redefine their nursing identity by exploring how digital health technology augments their practice and critical thinking skills, while addressing fear of a perceived threat to the future of nursing.

How midwives facilitate informed decisions in the third stage of labour - an exploration through portraiture

PROBLEM

Midwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems.

BACKGROUND

Previous research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma.

AIM

To explore midwives' experiences of facilitating informed decision-making, using third-stage management as context.

METHODS

Five midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits.

FINDINGS

Five individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; 'informed decision-making is fundamental to midwifery practice' 'the system', and 'navigating the system'. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and 'navigating the system' - contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery.

DISCUSSION AND CONCLUSION

Midwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.

What does consumer and community involvement in health-related education look like? A mixed methods study

Consumer and community involvement (also referred to as patient and public involvement) in health-related curricula involves actively partnering with people with lived experience of health and social care systems. While health professions education has a long history of interaction with patients or consumers, a shift in the way consumer and community engage in health-related education has created novel opportunities for mutual relationships valuing lived experience expertise and shifting traditional education power relations. Drawing on a mixed methods design, we explored consumer and community involvement practices in the design and delivery of health-related education using the capability, opportunity, motivation and behaviour framework (COM-B). In our results, we describe educator capabilities, opportunities and motivations, including identifying barriers and enablers to consumer and community involvement in health-related education. Educators have varying philosophical reasons and approaches for involving consumers and community. There is a focus on augmenting student learning through inclusion of lived and living experience, and on mutual transformative learning through embedding lived experience and co-creating learning. How these philosophical positionings and motivations shape the degree by which educators involve consumers and community members in health-related curricula is important for further understanding these educational partnerships within universities.

Impact of deep brain stimulation (DBS) on olfaction in Parkinson's disease: Clinical features and functional hypotheses

Deep brain stimulation (DBS) is a surgical therapy typically applied in Parkinson's disease (PD). The efficacity of DBS on the control of motor symptoms in PD is well grounded while the efficacity on non-motor symptoms is more controversial, especially on olfactory disorders (ODs). The present review shows that DBS does not improve hyposmia but can affect positively identification/discrimination scores in PD. The functional hypotheses suggest complex mechanisms in terms of cerebral connectivity and neurogenesis process which could act indirectly on the olfactory bulb and olfactory pathways related to specific cognitive olfactory tasks. The functional hypotheses also suggest complex mechanisms of cholinergic neurotransmitter interactions involved in these pathways. Finally, the impact of DBS on general cognitive functions in PD could also be beneficial to identification/discrimination tasks in PD.

What Do Students' Questionnaire Responses Tell Us about Their Language around Person-Centred Care? An Exploratory Sentiment Analysis

There is a global movement for health and social care to be person-centred: supporting people's active participation when making health decisions and considering their opinions, beliefs, and needs. The World Health Organization recommend the inclusion of person-centred care in health and social care provision. This research aimed to explore Australian health and social care profession students' language around person-centred care. Final-year health and social care professions students, attending one of two Australian universities, participated in an online questionnaire. Responses were analysed and themed to an existing person-centred care framework, then a sentiment analysis was applied to each response. Of the responses collected from 90 students, 235 statements were linked to the four core values of the person-centred care framework: cultivating communication (44%); respectful and compassionate care (35%); engaging patients in managing their care (20%); and integration of care (<1%). Within these, 24 statements were positively aligned (10%); 100 statements were neutral (43%); and 111 statements contained negative sentiments (47%). Almost half of the responses were not aligned with the core values of person-centred care. This suggests that many of the final-year students are not yet conceptualizing care using a person-centred approach.

The relatives of people with depression: A systematic review and methodological critique of qualitative studies

Being a close relative of a person with depression can take a heavy toll on the former, but these relatives are increasingly made responsible for taking on extensive carer roles. Research on relatives of people with depression is currently dominated by a focus on "carer burden" and although such a focus can explain many relatives' experiences and daily lives, it provides very limited insight into the everyday life of a person living with someone with depression. Therefore, we scoped qualitative research on people who are relatives of people living with depression and identified knowledge gaps caused by explicit or implicit theoretical or methodological assumptions. We conducted an exhaustive literature search in CINAHL, PubMed, PsycINFO, Sociological Abstracts, and Eric. In total, 34 publications were included, their quality evaluated and their findings mapped and summarized. We identified four interrelated and overlapping themes that dominated the findings of the publications: (a) recognition of "depression", (b) emotional responses, (c) interruptions of relationships, and (d) a staged psychosocial process. The vast majority of studies presented de-contextualized and underinterpreted analyses assuming a homogeneity of (illness) experiences and disregarded the important influence of social contributors to social relationships, connectedness, and mental health problems.

A snapshot of Australian primary health care nursing workforce characteristics and reasons they work in these settings: A longitudinal retrospective study

AIM

This article aimed to provide a snapshot of demographics and professional characteristics of nursing and midwifery workforce in Australian primary health care (PHC) settings during 2015-2019 and factors that influenced their decisions to work in PHC.

DESIGN

Longitudinal retrospective survey.

METHODS

Longitudinal data that were collected from a descriptive workforce survey were retrieved retrospectively. After collation and cleaning, data from 7066 participants were analysed using descriptive and inferential statistics in SPSS version 27.0.

RESULTS

The majority of the participants were female, aged between 45 and 64 years old and working in general practice. There was a small yet steady increase in the number of participants in the 25-34 age group and a downward trend in the percentage of postgraduate study completion among participants. While factors perceived most/least important to their decision to work in PHC were consistent during 2015-2019, these factors differed among different age groups and postgraduate qualification holders. This study's findings are both novel and supported by previous research. It is necessary to tailor recruitment and retention strategies to nurses/midwives' age groups and qualifications to attract and retain highly skilled and qualified nursing and midwifery workforce in PHC settings.

Holding Hope: Co-producing eating disorders education that integrates the lived experience voice to inform best practice

WHAT IS KNOWN ON THE SUBJECT?: Eating Disorder (ED) education is predominating taught through a DSM-V diagnostic criteria and clinically focused lens devoid of lived experience expertise. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Current clinically focused ED education may be shaping health professional misunderstandings of EDs, influencing the therapeutic relationships between health professional and consumer which is key to the recovery process. Integrating the lived experience voice through co-produced, humanities-based ED education deepens understandings and honours the complexities of EDs by bringing a much-needed, alternate perspective to health professional learning, practice and research. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Reframing mental health education towards a more strengths-based, trauma-informed and recovery focused lens has the potential to upskill the health workforce in how to hold hope, space and learn to walk the fight with people living and recovering with an ED.

Student Health and Social Care Professionals' Health Literacy Knowledge: An Exploratory Study

Health literacy is essential for shared decision-making and improved health outcomes, and patients with inadequate health literacy often need additional support from health and social care professionals. Despite global calls for developing tertiary-level health literacy education, the extent of this in Australian health and social care professional degrees is unknown. This research explored students' health literacy knowledge across five health and social care professional disciplines. A web-based questionnaire was disseminated to student health and social care professionals enrolled in one of two Australian universities. Questions explored students' factual and conceptual health literacy knowledge, and responses were inductively themed and reported descriptively. Of the 90 students who participated, the depth of health literacy knowledge was low. Students frequently identified understanding as components of health literacy; however, most students did not identify health information access, appraisal and use. Additionally, students' knowledge of helping patients with inadequate health literacy was limited. Adjusting patient education to their health literacy level and evaluating patient understanding was poorly understood. Without a solid understanding of fundamental health literacy principles, newly-graduated health and social care professionals will be poorly equipped to facilitate patients' health literacy-related challenges in the community. Further exploration of health literacy education is urgently recommended to identify areas for improvement.

Qualitative insights into the palliative care experience of a hospice-based sensory room

BACKGROUND

The use of multi-sensory rooms as a form of engagement with art in Palliative Care is largely unexplored.

METHOD

This practice-based report discusses a qualitative study exploring the experiences of hospice-based inpatients receiving end-of-life care and their carers who immersed themselves into a multi-sensory room.

RESULTS

Findings demonstrate that the room provided a safe space for reflection and reconnection that counteracted challenging times during their end of life. It fostered healing and wellbeing by alleviated suffering through respite and sharing of treasured memories with loved ones. Key considerations for future iterations are also discussed.

'You have to have a level of trust': Consumer-described health literacy barriers and enablers to engaging with health care professionals

ISSUE ADDRESSED

Health literacy - the degree to which people can access, understand and use health information - is essential for shared decision-making and improved health outcomes. Health consumers' ability to engage with health care professionals (HCPs) is influenced by their health literacy capabilities. This research sought to understand health literacy-related barriers and enablers to engage with non-physician HCPs as experienced by consumers.

METHODS

A qualitative descriptive approach was undertaken. A semi-structured interview guide was used, incorporating five health literacy domains described in the Health Literacy Questionnaire that related to consumers' engagement with health professionals. Audio- or digitally-recorded interviews were conducted with Australian health consumers, and transcribed and themed using the Patient-centred Access to Care framework as a template.

RESULTS

Interviewing 30 consumers revealed that HCPs' clinical skills often enabled consumers to seek engagement; however, during active engagement their interpersonal skills became a key enabler. Conversely, a lack of developed interpersonal skills in HCPs was frequently seen as a barrier to consumer engagement. Barriers to engagement were also created when HCPs' information did not match what consumers discovered from other sources. However, consumers self-reported that they were unable to appraise health information at least some of the time.

CONCLUSION

Barriers and enablers to consumers' engagement with HCPs were identified across each of the five relevant health literacy domains. SO WHAT?: HCPs should be aware of the importance of interpersonal skills and clear health information suitable for consumers with lower health literacy. Additionally, time dedicated to educating consumers on information appraisal could act as a further enabler to effective engagement.

Belonging in high acuity settings: What is needed for newly graduated registered nurses to successfully transition? A qualitative systematic review

BACKGROUND

A worldwide shortage of nurses providing clinical care, coupled with an increase in severity of illness of hospitalised patients has led to newly graduated Registered Nurses being placed into high acuity settings, such as the emergency department, intensive care unit and operating theatre. The feeling of belonging in these settings impacts on successful transition of newly graduated Registered Nurses, their learning, and may lead to high attrition rates.

OBJECTIVE

To comprehensively synthesise qualitative research on newly graduated Registered Nurses' experiences of belonging, while working in high acuity clinical settings.

DESIGN

Elements of the Joanna Briggs Institute (JBI) systematic review protocol were utilised. The Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to conduct the review. Data were analysed using thematic analysis.

DATA SOURCES

Ovid Emcare, PsychInfo, CINHAL, Proquest and Scopus.

METHODS

The PICo (population, interest and context) strategy was used as a guide to develop search terms. Published literature from January 2007 to April 2021 was searched. Screening, selection and data extraction were performed by two authors independently. All discrepancies were resolved through discussion with a third reviewer.

RESULTS

A total of 506 studies were identified following the systematic search; after duplicates were removed, 440 were screened by title and abstract and 29 by full text. Six articles were included in this systematic review. Methodological quality was assessed utilising the JBI critical appraisal checklist, and discrepancies ratified through team consensus. The themes; emotional lability, structured program design, preceptors' influence and acceptance were identified.

CONCLUSIONS

Newly graduated Registered Nurses in the high acuity setting feel emotionally insecure related mainly to their educational unpreparedness. They have need for a structured program, inclusive of both theory and supported practice. The role of the preceptorship team is vital in enabling a feeling of belonging, as is acceptance by nursing staff of the learning journey.

Fostering uncertainty tolerance in anatomy education: Lessons learned from how humanities, arts and social science (HASS) educators develop learners' uncertainty tolerance

Uncertainty tolerance, individuals' perceptions/responses to uncertain stimuli, is increasingly recognized as critical to effective healthcare practice. While the Covid-19 pandemic generated collective uncertainty, healthcare-related uncertainty is omnipresent. Correspondingly, there is increasing focus on uncertainty tolerance as a health professional graduate "competency," and a concomitant interest in identifying pedagogy fostering learners' uncertainty tolerance. Despite these calls, practical guidelines for educators are lacking. There is some initial evidence that anatomy education can foster medical students' uncertainty tolerance (e.g., anatomical variation and dissection novelty), however, there remains a knowledge gap regarding robust curriculum-wide uncertainty tolerance teaching strategies. Drawing upon humanities, arts and social sciences (HASS) educators' established uncertainty tolerance pedagogies, this study sought to learn from HASS academics' experiences with, and teaching practices related to, uncertainty pedagogy using a qualitative, exploratory study design. Framework analysis was undertaken using an abductive approach, wherein researchers oscillate between inductive and deductive coding (comparing to the uncertainty tolerance conceptual model). During this analysis, the authors analyzed ~386 min of data from purposively sampled HASS academics' (n = 14) discussions to address the following research questions: (1) What teaching practices do HASS academics' perceive as impacting learners' uncertainty tolerance, and (2) How do HASS academics execute these teaching practices? The results extend current understanding of the moderating effects of education on uncertainty tolerance and supports prior findings that the anatomy learning environment is ripe for supporting learner uncertainty tolerance development. This study adds to growing literature on the powerful moderating effect education has on uncertainty tolerance and proposes translation of HASS uncertainty tolerance teaching practices to enhance anatomy education.

Embedding Indigenous knowledges and voices in planetary health education

Internationally, the health-care sector has been slower than many other sectors in reducing its carbon emissions and broader environmental footprint. Incrementally, tertiary education institutions are changing their focus to integrate environmental and social objectives, including planetary health, into teaching, research, and how the campus is operated. Planetary health and sustainable health-care are emerging topics in the education of health professionals. However, they have largely been limited to specific knowledge rooted in western epistemology with ad hoc curricula that do not consider the complex interdependence of ecosystems and human health. Because of the need to prepare the current and future health-care workforce for planetary consciousness and related practices, in this Personal View we provide an innovative case study that uses Indigenist health humanities (eg, narrative portraiture) and arts-based education strategies to offer a different way of seeing, knowing, and understanding planetary health. Embedding Indigenous knowledges and voices into planetary health education is an important first step in decolonising learning in health professional education.

Impact of art and reflective practice on medical education in the emergency department

OBJECTIVES

There is heightened intrigue surrounding the application of arts-based pedagogy in medical education. Art encompasses multiple forms of expression and is used to convey specific meaning and emotion, whereas provoking critical reflection. Our aim was to explore the effectiveness of art and reflective practice in medical education, in the context of the ED.

METHODS

Longitudinal methodological study design. Prior to the first, and after the final clinical practicum, medical students watched a 3-min film: 'The Art of the ED'. Written reflections focused on changing perceptions towards the film during their medical education programme. Data were thematically analysed.

RESULTS

Three themes were collected from 25 written reflections and included: 'professional growth' exploring personal and professional development across the medical programme; seeing 'patients are people'; and the purpose, structure and function of an ED exposed in 'the reality of ED'. Results highlight that arts-based pedagogy can facilitate meaningful and critical reflection in medical students, whereas also fostering professionalism. Reflecting on the film broadened their perspective into a realm of new possibilities, challenging them to identify implicit bias around ED, and promote professional identity formation.

CONCLUSIONS

The combination of art and reflection in medical education enhances reflective learning and can lead to transformative change, including the development of core doctoring values of service, empathy and respect for patient. There are clear benefits to medical education incorporating more arts-based pedagogy that promotes reflective exploration and interpretation of the psychosocial context of health and illness, delivery of more holistic models of care and their role as doctors.

Partnering with healthcare organisations to teach pre-registration health professions students about quality improvement: A systematic review

AIMS AND OBJECTIVES

To describe what higher education and healthcare organisation partnerships can be identified in the published literature to teach pre-registration health professions students quality improvement and the impact of these partnerships.

BACKGROUND

Quality improvement has been gaining traction in the Western world and has been incorporated in varying degrees into the curricula for pre-registration health professions students. Providing quality improvement education in partnership with healthcare organisations has been found to be a valuable experiential learning solution, but the impacts of higher education and healthcare organisation partnerships have not been explored.

DESIGN AND METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was undertaken using the Ovid MEDLINE, Emcare, CINAHL, Scopus and Eric databases. Studies were subject to quality appraisal using the Critical Appraisal Skills Program validated tools and a thematic analysis and narrative synthesis was undertaken.

RESULTS

Eight studies were included in this review. Features of existing quality improvement partnerships included experiential learning, time pressures and barriers to successful quality improvement partnerships. The impacts of quality improvement partnerships were demonstrated by an increase in quality improvement knowledge and understanding, students leading change and the implementation of quality improvement projects.

CONCLUSION

Several key elements were identified that may act as barriers or enablers to successful implementation of quality improvement partnerships. This review advances understandings of the need for a shift in focus that pays attention to the culture of teaching quality improvement in education partnerships and how this can be achieved in a mutually beneficial way.

RELEVANCE TO CLINICAL PRACTICE

The development of quality improvement partnerships has been found to increase student knowledge and understanding, potentially improving patient outcomes, systems performance and professional development. More research is required on the establishment of quality improvement partnerships and the benefit these collaborations have on students, staff and patients.

The hunter and the lion: Amplifying health care consumers' voices in health care education

This commentary discusses ways in which we can amplify healthcare consumers' voice by co‐designing healthcare education to teach dimensions of professionalism.

Pre-registration nursing students' perceptions of their baseline digital literacy and what it means for education: A prospective COHORT survey study

BACKGROUND

To build complex digital skills and capability required by digitally-driven work environments, we must first understand nursing students' baseline digital literacy if educators are to develop a fit for purpose curriculum underpinned by digital health technologies.

OBJECTIVE

To determine first-year pre-registration nursing students' perceived baseline digital literacy before their first clinical placement.

DESIGN

Prospective cohort study.

SETTINGS

Two universities in Australia in 2020.

PARTICIPANTS

Students enrolled in pre-registration nursing programs at Bachelor's and Master's level.

METHODS

Participants (N = 205) completed an online 27-item survey composed of a Likert-type scale, forced-choice items, and open-ended questions. Data were analyzed with descriptive statistics.

RESULTS

Participants engaged with digital technology early in life, with 49.75% students using some form of digital technology before ten years of age. Students reported the highest daily use of technology to search the internet for information (92%), online social networking (68.3%) and watching videos (67%). Most students expressed the least confidence in identifying different types of portable storage devices (24.1% Master's students; 41.7% Bachelor's students), describing the advantages of a digital camera (39.3% Master's students; 48.3% Bachelor's students), and totaling numbers in spreadsheets (22.8% Masters students; 48.3% Bachelor's students). No statistical differences were observed between the two universities or the two cohorts in terms of perceived confidence in using technology and software applications to support their learning. Interestingly, 24.7% of participants expressed high confidence in using electronic medical records without prior training, which may reflect positive attitude towards engaging with unknown digital technologies.

CONCLUSIONS

Nursing students are frequent internet and social media users. However, despite positive attitudes to digital technology and widespread presence of digital technology in students' lives, deficits in students' confidence in using digital technology and software required for learning persist. Targeted digital literacy education interventions are needed as part of foundational nursing studies to improve nursing students' baseline digital literacy before commencing clinical placement. These should be scaffolded across the program to ensure an effective transition to nursing practice in evolving digitally-driven healthcare environments.

Factors Associated With Undergraduate Nursing Students' Academic and Clinical Performance: A Mixed-Methods Study

Background

There is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice.

Objective

To identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course.

Design

Mixed methods study utilizing a retrospective cohort and a qualitative study.

Setting

Monash University, Melbourne, Australia.

Participants

Longitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed.

Methods

Retrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed.

Results

More than two-thirds of the students were aged 18–20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance.

Conclusions

A supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

AIM

To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing.

BACKGROUND

Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings.

METHODS

Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process.

FINDINGS

Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system.

CONCLUSIONS

Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare.

RELEVANCE TO CLINICAL PRACTICE

Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.

Transition experiences of newly qualified registered graduate nurses employed in a Neonatal Intensive Care Unit

OBJECTIVE

To explore the experiences of newly qualified registered graduate nurses' clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU).

METHOD

Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses' accounts via semi-structured interviews, conducted between January 2018 - January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit.

SETTING

In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited.

FINDINGS

Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout.

CONCLUSION

In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.

The development of nurses' foundational values

BACKGROUND

In the ever-changing and complex healthcare environment, nurses encounter challenging situations that may involve a clash between their personal and professional values resulting in a profound impact on their practice. Nevertheless, there is a dearth of literature on how nurses develop their personal-professional values.

AIM

The aim of this study was to understand how nurses develop their foundational values as the base for their value system.

RESEARCH DESIGN

A constructivist grounded theory methodology was employed to collect multiple data sets, including face-to-face focus group and individual interviews, along with anecdote and reflective stories.

PARTICIPANTS AND RESEARCH CONTEXT

Fifty-four nurses working across various nursing settings in Indonesia were recruited to participate.

ETHICAL CONSIDERATIONS

Ethics approval was obtained from the Monash University Human Ethics Committee, project approval number 1553.

FINDINGS

Foundational values acquisition was achieved through family upbringing, professional nurse education and organisational/institutional values reinforcement. These values are framed through three reference points: religious lens, humanity perspective and professionalism. This framing results in a unique combination of personal-professional values that comprise nurses' values system. Values are transferred to other nurses either in a formal or informal way as part of one's professional responsibility and customary social interaction via telling and sharing in person or through social media.

DISCUSSION

Values and ethics are inherently interweaved during nursing practice. Ethical and moral values are part of professional training, but other values are often buried in a hidden curriculum, and attained and activated through interactions during nurses' training.

CONCLUSION

Developing a value system is a complex undertaking that involves basic social processes of attaining, enacting and socialising values. These processes encompass several intertwined entities such as the sources of values, the pool of foundational values, value perspectives and framings, initial value structures, and methods of value transference.

A dis-ordered personality? It's time to reframe borderline personality disorder

WHAT IS KNOWN ON THE SUBJECT

Integrating strengths-based, co-produced, consumer-driven resources into mental health workforce education has the potential to dissolve hierarchical mental health care relationships.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Humanities-based pedagogy that draws from photography and multi-voiced narratives is a powerful reflective learning tool to bridge clinical and human experiences of Borderline Personality Disorder (BPD). The Depth of Field reflective learning methodology aims to provoke, prod, reveal and challenge assumptions and/or unconscious bias towards BPD and stimulate raw and reflective discussions that have the potential to inspire critical reflection and move health professionals towards more humanistic, recovery centred models of mental health care.

WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING

At the core of co-production in research, education and practice lies a reciprocal, transformational learning experience. This relationship needs to be further explored in order to reframe mental health education that honours and legitimizes consumers as experts of their own lives and recovery experiences.

A research approach for co-designing education with healthcare consumers

CONTEXT

Community and consumer involvement in health professions education (HPE) is of growing interest among researchers and educators, particularly in preparing health care graduates to effectively learn from, and collaborate with, people with lived experience of health issues. However, to date there has been limited direction on methodological approaches to engage health care consumers in the research and co-design of HPE.

APPROACH

In this paper, we describe the background to our work with health care consumers including the five core principles for successful co-design (inclusive; respectful; participative; iterative; outcomes focused) and how they can be applied as a research approach in HPE. We introduce the use of arts and humanities-based teaching methodologies including engagement, meaning-making and translational education strategies to illustrate how this research approach has been applied to reframe mental health education and practice in Australia. Furthermore, we share some reflective insights on the opportunities and challenges inherent in using a co-design research approach in HPE.

CONCLUSIONS

For the consumer voice to be embedded across HPE, there needs to be a collective commitment to curriculum redesign. This paper advances our understandings of the educational research potential of working with health care consumers to co-design rich and authentic learning experiences in HPE. Co-design research approaches that partner with and legitimise health care consumers as experts by experience may better align education and health professional practice with consumers' actual needs, an important first step in transforming hierarchical health care relationships towards more humanistic models of care.

"I teach it because it is the biggest threat to health": Integrating sustainable healthcare into health professions education

BACKGROUND

Steering planetary and human health towards a more sustainable future demands educated and prepared health professionals.

AIM

This research aimed: to explore health professions educators' sustainable healthcare education (SHE) knowledge, attitudes, self-efficacy and teaching practices across 13 health professions courses in one Australian university.

METHODS

Utilising a sequential mixed-methods design: Phase one (understanding) involved an online survey to ascertain educators' SHE knowledge, attitudes, self-efficacy and teaching practices to inform phase two (solution generation), 'Teach Green' Hackathon. Survey data was descriptively analysed and a gap analysis performed to promote generation of solutions during phase two. Results from the hackathon were thematically analysed to produce five recommendations.

RESULTS

Regarding SHE, survey data across 13 health professions disciplines (n = 163) identified strong content knowledge (90.8%); however, only (36.9%) reported confidence to 'explain' and (44.2%) to 'inspire' students. Two thirds of participants (67.5%) reported not knowing how best to teach SHE. Hackathon data revealed three main influencing factors: regulatory, policy and socio-cultural drivers.

CONCLUSIONS

The five actionable recommendations to strengthen interdisciplinary capacity to integrate SHE include: inspire multi-level leadership and collaboration; privilege student voice; develop a SHE curriculum and resources repository; and integrate SHE into course accreditation standards.

The Physiology of Teaching: Getting the Balance right

This article was migrated. The article was marked as recommended. Using three human body systems as a metaphor, this paper will discuss how the art of teaching, including the conditions in which students thrive can remedy longstanding curriculum diseases. Based on the concept of a living curriculum, the importance of curiosity, exposing vulnerability, social and collaborative learning, communication and reflective learning processes in transforming teaching and inspiring learning will be explored.

Using MRI art, poetry, photography and patient narratives to bridge clinical and human experiences of stroke recovery

Integrating co-produced humanities-based pedagogy into patient and workforce education is of growing interest. The aim of our Depth of Field: Exploring Stroke Recovery project grew from a strong commitment to use patients' lived experiences as a voice to educate new stroke patients and the health professional staff who will care for them. The aim of the initial Quality Improvement project at a West Australian Stroke Rehabilitation Unit (SRU) was to co-produce a reflective learning resource with stroke patients and their families to help navigate the stroke recovery journey. A series of artefacts (documentary-style photographs, audio-narrated vignettes, MRI images and poetry) were collected from four stroke patients and their families at differing stages of recovery over 12 months as they recounted the honest and raw reality of what life is really like following a stroke. These artefacts were used in a pilot qualitative project to explore new stroke patients, their families and SRU health professional staff perceptions towards the artefacts in order to inform the final educational resource. These findings enhance our understandings of how we can use art and patient (healthcare consumers) voice to widen the lens of stroke recovery and provides a valuable template to co-produce peer-to-peer and health professions education reflective learning resources to promote more human- centred approaches to care.

Expanding worldview: Australian nursing students' experience of cultural immersion in India

Abstract Increasing cultural diversity and a sense of global community has necessitated the introduction of cultural competence in the education of health care providers. Some institutions have utilised cultural immersion programmes to address this need of cultural competence. Studies have not yet described what this experience is for Australian nursing students. The purpose of this study is to describe the immersion experience of a group of senior Australian nursing students who participated in a 5-week cultural immersion programme in India.

Do photographs, older adults' narratives and collaborative dialogue foster anticipatory reflection ("preflection") in medical students?

BACKGROUND

In changing higher education environments, medical educators are increasingly challenged to prepare new doctors to care for ageing populations. The Depth of Field: Exploring Ageing resource (DOF) uses photographs, reflective questioning prompts, older adults' narratives and collaborative dialogue to foster anticipatory reflection or 'preflection' in medical students prior to their first geriatric medicine clinical placement. The aim of this research is to explore whether photographs, narratives and small group collaborative dialogue fosters reflective learning, enhances reflective capacity and has the potential to shift medical students' attitudes towards caring for older adults.

METHODS

This study used a mixed method evaluation design, measuring attitudes using pre and post questionnaire responses and individual written reflections drawn from 128 second year medical students, exploring their perceptions toward older adults.

RESULTS

Quantitative and qualitative data indicated that the DOF session generated reflective learning that resulted in positive shifts in medical students' perceptions towards older adults. The qualitative reflections were captured in four main themes: the opportunity provided to Envision working with older adults; the Tension created to challenge learners' misinformed assumptions, and the work of Dismantling those assumptions, leading to Seeing older people as individuals.

CONCLUSIONS

These findings highlight how visual and narrative methodologies can be used as an effective reflective learning tool to challenge medical students' assumptions around ageing and how these may influence their care of older adults.

[Olfaction in depressive disorders: Issues and perspectives]

Research on sensorial interactions with psychiatric diseases and particularly with the depressive syndrome has mainly focused on visual or auditory processes and much less on olfaction. The depressive illness is one of the most frequent psychiatric diagnoses in the community, with approximately one in five women and one in eight men experiencing a major depressive episode during their lifetime. Although genetic, epigenetic, neuroanatomical, neurochemical, neuroendocrinological and neuroimmunological changes can be detected during depression, the etiology of depression remains partly unclear. The current explanatory models are based on two main factors, i.e. pharmacological dysfunctions and stress effects. In this way and because of strong connections between olfactory pathways and cerebral areas implied in mood regulation and emotions (i.e. the limbic system and prefrontal areas), the interactions between olfaction and depression could constitute a relevant way of research at three different levels. First, olfactory dysfunction observed in depression could serve the diagnosis and contribute to a better understanding of mechanisms implied in thymic pathologies. Published papers show a decrease of olfactory sensitivity in major depression which does not occur in bipolar or saisonal depression. Second, it has been shown that olfactory deficits could induce depressive symptoms. In this context, an animal model (olfactory bulbectomized rat) reinforces the hypothesis of the important role of olfaction in depression based on neuroanatomical and neurochemical observations. Third, several publications have demonstrated that odors can positively impact the depressive mood. Thus, a remediation by odors in depression appears to be a promising way. From several decades, the olfaction/depression interactions have been covered by a broad literature. Thus, the present review will not propose an exhaustive examination but aims to point out the most recently published papers and highlight their contributions to the understanding of olfactory processes implied in depression.

Expanding the Caring Lens: Nursing and Medical Students Reflecting on Images of Older People

In changing higher education environments, health profession's educators have been increasingly challenged to prepare future health professionals to care for aging populations. This article reports on an exploratory, mixed-method research study that used an innovative photo-elicitation technique and interprofessional small-group work in the classroom to enhance the reflective learning experience of medical and nursing students. Data were collected from pre- and postquestionnaires and focus groups to explore shifts in perceptions toward older persons following the reflective learning session. The qualitative data revealed how using visual images of older persons provides a valuable learning space for reflection. Students found meaning in their own learning by creating shared storylines that challenged their perceptions of older people and themselves as future health professionals. These data support the use of visual methodologies to enhance engagement, reflection, and challenge students to explore and deepen their understanding in gerontology.

"Helping someone with a skill sharpens it in your own mind": a mixed method study exploring health professions students experiences of Peer Assisted Learning (PAL)

BACKGROUND

Peer assisted learning (PAL) has been described as "the development of knowledge and skill through active help and support among status equals or matched companions". To enhance the learning experience of health professions students and improve collaborative and collegial learning, six pilot Peer Assisted Learning (PAL) projects were conducted across a health science faculty.

METHODS

A responsive mixed method evaluation design was applied to explore the adequacy of the preparation for PAL, the impact PAL had on student attainment of examination, consultation, communication and feedback skills and to explore students' learning experiences through PAL.

RESULTS

The 149 participants agreed the training programme was well organised, offered a safe learning environment and prepared the participant for the PAL activity. The impact of PAL included improvements in students' confidence and ability to give feedback and developed students' teaching, clinical and communication skills. Qualitative analysis revealed participants experienced deeper learning through teaching and learning from their peers, became more open to giving and receiving feedback and valued the comfortable/safe learning environment offered through PAL.

CONCLUSION

Providing appropriate training in peer teaching and feedback and the schools engagement and openness to peer learning in the classroom and clinical setting enhances students' peer assisted learning experience.

“You don’t know half the story”: deepening the dialogue with young mothers in Australia

Pregnant and young mothers’ stories often go untold or are poorly represented within dominant health and social care discourses. Consequently, narratives of young mothers are largely absent from social and health care literature, especially in relation to how young women make sense, understand, and experience young motherhood. Drawing on 7 months of participant observation fieldwork at a community service, and 11 in-depth interviews, we discuss six metaphorical themes which capture the experiences of young mothers using a narrative approach. These include: Picking up the Pieces; Walking a Narrow and Familiar Path; Jumping over Puddles; Riding the Rapids to Motherhood; Living with Dirty Looks; and Asking for Directions. Contrary to the wider community’s deficit view and stereotypes of young mothers, what emerged from the narratives was quite a different story. Becoming a young mother meant taking a stand against stigma from the wider community; recognising motherhood as a significant and transformational turning point in their lives, one that opened doors to alternative storylines of hope, autonomy and agency, especially given a supportive context. These findings enhance our understandings by widening the lens to diverse realities that exist in young mothers’ lives and present a strong case for using a narrative approach to research and practice when working with young mothers.

Scaffolding young Australian women's journey to motherhood: a narrative understanding

Pregnant and young mothers' stories often go untold within community social and health service policy, planning and practice. Consequently, there is a significant gap between young women's experiences of motherhood and current service provision. This study was undertaken in response to a paucity of observational and contextually rich research that explores young women's experiences of pregnancy and motherhood, including the role a community service played in scaffolding their motherhood journeys. Fundamental to this study's purpose was the premise that to improve planning and delivery of more appropriate services for this group, we need to listen, consult and consider what life is like for young mothers. The purpose of this paper is to describe the role a community service played in scaffolding young women's experiences as they transitioned to motherhood. Using a narrative approach, this study draws on data collected from contextual observations of 31 informants and 11 in-depth interviews over 7 months of fieldwork in 2010 at a community service in the Peel region of Western Australia. The integral role a community service played in the young women's transition to motherhood was analysed thematically and captured in three metaphorical themes, finding a circle of friends, weaving a tapestry and turning the page. The young women's storied experiences of motherhood present a strong argument for radical re-visioning of community and social health policy, practice and service delivery for young mothers. The findings revealed that judgement-free services that foster social and supportive relationships were integral in developing positive motherhood identities. The power of narrative and social learning when working with young mothers suggests that social models of health that foster a relational, narrative approach to practice are fundamental to young mothers finding their own voices and solutions and becoming active agents in re-authoring future narratives of hope, autonomy and agency.

Expanding Worldview: Australian Nursing Students' Experience of Cultural Immersion in India

Abstract Increasing cultural diversity and a sense of global community has necessitated the introduction of cultural competence in the education of health care providers. Some institutions have utilized cultural immersion programs to address this need of cultural competence. Studies have not yet described what this experience is for Australian nursing students. The purpose of this study is to describe the immersion experience of a group of senior Australian nursing students who participated in a five week cultural immersion program in India.