Learning person-centredness interprofessionally: an uneasy student journey

Elements of a care pathway for human trafficking victims in emergency departments: A mapping review

BACKGROUND

Human trafficking, a form of modern slavery, is a global health problem. Human trafficking victims may need health care while they are being exploited, and traffickers often take victims to emergency departments (EDs) if their injuries and illness prevent them from working. Healthcare professionals in EDs could help combat human trafficking; however, 85% of human trafficking victims in EDs remain unidentified. Implementing a standardized care pathway to improve the identification and care of human trafficking victims may improve the identification of these victims and allow victims to become survivors.

AIMS

This mapping review aimed to identify the elements that should be included in a care pathway facilitating the recognition of and response to human trafficking victims in EDs.

METHODS

Five electronic databases generated 159 articles and 628 gray literature records, of which 23 primary research reports and five reports from gray literature were included. The following electronic databases were searched: EBSCOhost, Scopus, Web of Science, ProQuest, and PubMed. ProQuest Central and gray literature were records OR Magazines OR Newspapers OR Blogs, Podcasts, AND Websites OR Working Papers OR Conference Papers & Proceedings. The inclusion criteria for the population were adults (≥18 years), human trafficking victims, and sex trafficking victims. The concept, pathway and algorithm, and context of the ED were used. Records were blinded when assessing eligibility. The demographics of the included records were descriptively analyzed. The reports and gray literature were deductively coded and charted. The data extraction tool was based on the emergency nursing framework and was developed before data extraction. Inductive analysis was used to create subthemes, namely, approach to victims, characteristics, red flags, identifying questions, opportunities to be recognized, strategies, approach upon recognition, potential danger, and resources.

RESULTS

A holistic care pathway embedded in a person-centered trauma-informed approach was conceptualized. The strategies are based on The Blue Heart and The Blue Campaign 4Ps, including prevention, protection, prosecuting, and partnerships. An evidence-informed approach that is culturally congruent and gender sensitive should be adopted. Healthcare professionals will be able to identify and assess victims, avoid retraumatization, and initiate interprofessional partnerships to provide coordinated care.

LINKING EVIDENCE TO ACTION

Human trafficking victims may escape detection in EDs. This mapping review identified elements to be included in a care pathway for recognizing and responding to victims of human trafficking. The care pathway should be built on person-centered and trauma-informed care and include prevention, protection, prosecution, and partnership-building strategies. Moreover, an interprofessional team approach is needed to identify, assess, and care for such victims. Future studies should develop a standardized care pathway for healthcare professionals to recognize and respond to human trafficking victims in emergency departments.

Person-centred care in the context of higher education - a discourse analysis based on interviews with programme directors

BACKGROUND

As person centred care (PCC) is being implemented globally, higher educational institutions (HEI) have begun to play a crucial part in enabling this transition. In Sweden, however, the delivery of PCC is inconsistently implemented in medicine, nursing, occupational therapy, and physiotherapy study programmes. This inconsistency is partly the result of a lack of a national strategy across HEI. Program directors are responsible for the PCC content of their programs, so their views influence how PCC is taught. Using interviews with programme directors in higher education, we aim to deepen the understanding of the preconditions needed to implement PCC by exploring discourses and identifying subject positions of how PCC is taught and learned.

METHODS

We performed a discourse analysis based on interviews with program directors in the above-mentioned national study programmes. A discourse can be seen as a struggle over identity. The subject position - i.e., discourses designate positions for persons to occupy as subjects - guided our analysis and identification of the subject positions of the teacher and the student in teaching and learning PCC.

RESULTS

This study unfolded in two main antagonistic aspects with respect to teaching and learning PCC, resulting in four subject positions for the teacher and four corresponding subject positions for the students. First, the teacher and student were given a subject position as change agents towards a more egalitarian healthcare and were assigned a subject position to cope with a practical reality they could not change. Second, the teacher and student were assigned a subject position that embodied profession-specific identities, navigating and valuing these boundaries. Simultaneously, both teachers and students assumed a subject position that required interprofessional interaction and co-creation for teaching and learning PCC.

CONCLUSION

This study demonstrates the discursive tension surrounding the implementation of PCC in HEI, and the findings can serve as a basis for creating future relevant and high-quality learning activities. The process of negotiating diverse and co-existing perspectives as well as building interprofessional trust when incorporating PCC into higher education is essential and requires further exploration.

Lived experiences of healthcare. Putting the person in person centred care in the medical radiation sciences

INTRODUCTION

Contemporary healthcare models recognise person-centred care (PCC) as a fundamental principle of quality, safe care. While substantial literature exists on PCC in healthcare generally, there is less evidence on how this relates to medical imaging and radiation therapy. Embedding patient-lived experiences of healthcare into healthcare education has promise in enhancing students' confidence in delivering PCC. Digital storytelling (DST) of patient-lived experiences can help improve reflection, understanding, critical thinking and empathy.

METHODS

Authentic patient-lived experiences were extracted from students' clinical workbooks, transformed into first person vignettes and integrated into the curriculum. Students were invited to attend focus groups to explore the impact the activity had on the student.

RESULTS

Thematic analysis identified three themes. (1) Enhancing PCC; (2) Mode of Delivery (Scaffolded Learning); and (3) Collaborative Learning. PCC was the strongest theme with students stating this is the first time they engaged in an activity focused on the psychosocial aspect of patient care. The majority of students indicated the mode of delivery was engaging and unique, whereby the vignettes were presented incrementally. Collaborative learning was identified by over half of the students where learning took place in a safe and supportive environment.

CONCLUSION

This project explored students' perspectives of integrating patient-lived experiences into the curriculum via DST. Students who engaged with the activities felt better prepared to deliver quality safe PCC.

IMPLICATIONS FOR PRACTICE

Providing healthcare students with opportunities to develop skills to deliver PCC before they enter the workforce can enhance their confidence in delivering effective PCC.

Social and healthcare students' competence in patient-oriented care enhanced during interprofessional practice: A scoping review

AIM

This scoping review aimed to synthesise the findings of previous literature related to social and healthcare students' competence in patient-oriented care in interprofessional practice by attending multidisciplinary student teams.

BACKGROUND

Learning about patient-oriented care requires the comprehensive consideration of patients' physical, emotional, social and economic aspects to offer the best need-based care. Multidisciplinary student teams in the clinical practice may support learning patient-oriented care; however, the current knowledge is fragmented.

DESIGN

Scoping review METHODS: Data (N = 1548) were gathered from four databases, PubMed, MEDLINE, SocIndex and CINAHL, without start-date limitation until the end of December 2022. One article was found on the publisher's webpage recommendations. The selected studies (N = 15) answered the research questions and met the inclusion criteria. Quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) Quality Assessment Checklist. A thematic analysis process was used for data extraction and synthesis of results.

RESULTS

Perspectives on patient-oriented care competencies were analysed for both students and patients cared for by a multidisciplinary student team. The themes described students' profound understanding of professional roles and responsibilities in patient-oriented care, collaborative patient-oriented care skills, improved interprofessional communication and reported patient experiences.

CONCLUSIONS

Interprofessional practice versatility develops students' competence in patient-oriented care. Guaranteeing patient-oriented care requires a broad understanding of patients' comprehensive care needs, which can be addressed through multidisciplinary collaboration. Patients' experiences toward interprofessional student practice are mainly positive. Further research is needed to assess the impact of different interprofessional education methods on students' patient-oriented care competence using valid instruments and the long-term effects of students' competence in patient-oriented care.

Person-centred care on the move - an interview study with programme directors in Swedish higher education

BACKGROUND

There is an increasing trend towards person-centred care (PCC) worldwide, suggesting that PCC should be mastered by future health care professionals. This study aims to explore programme directors' views on facilitators and barriers to implementing PCC in four of the largest national study programmes in Sweden training future health care professionals.

METHODS

A qualitative design was applied and interviews were conducted with 19 programme directors of Swedish national study programmes in medicine, nursing, occupational therapy and physiotherapy. The interviews were analysed using qualitative content analysis. Themes were sorted according to the Consolidated Framework for Implementation Research (CFIR) in an abductive approach. COREQ guidelines were applied.

RESULTS

The overarching theme, as interpreted from the programme directors' experiences, was 'Person-centred care is on the move at different paces.' The theme relates to the domains identified by the CFIR as outer setting, innovation, inner setting and process. PCC was understood as something familiar but yet new, and the higher education institutions were in a state of understanding and adapting PCC to their own contexts. The movement in the outer setting consists of numerous stakeholders advocating for increased patient influence, which has stirred a movement in the inner setting where the higher educational institutions are trying to accommodate these new demands. Different meanings and values are ascribed to PCC, and the concept is thus also 'on the move', being adapted to traditions at each educational setting.

CONCLUSION

Implementation of PCC in Swedish higher education is ongoing but fragmented and driven by individuals with a specific interest. There is uncertainty and ambiguity around the meaning and value of PCC and how to implement it. More knowledge is needed about the core of PCC as a subject for teaching and learning and also didactic strategies suitable to support students in becoming person-centred practitioners.