Reflective practice in health care and how to reflect effectively

Reflect to interact - fostering medical students' communication through reflection-focused e-learning

BACKGROUND

Previous research indicates that reflection can foster medical communication competence. However, best practices for embedding reflection in online medical education are missing. This study examined how reflection processes can be promoted and embedded in an e-learning course on physician-patient communication to foster learning.

METHODS

We investigated three differently designed e-learning conditions featuring different proportions of reflection triggers and compared their effects on students' reflections. We had 114 medical students in their first clinical year complete one of the variants: video modelling (VM, n = 39), video reflection (VR, n = 39), or a variant merging both approaches (VMR, n = 36). Each student wrote a total of nine reflections based on the same guiding questions at three time points embedded in the course. The students' levels of reflection were measured using an adapted version of the REFLECT rubric (scale 0-18).

RESULTS

Students of all course variants achieved good levels of reflection beyond the descriptive level at all three time points, with no significant differences between the variants. The mean reflection scores at the end of the course were M = 14.22 for VM (SD = 2.23), M = 13.56 for VR (SD = 2.48), and M = 13.24 for VMR (SD = 2.21). Students who completed VM showed significantly improved levels of reflection over the course, whereas we found no statistically significant development for those in VR or VMR. The reflection scores correlated significantly positively with each other, as did the text lengths of the written reflections. Reflection scores also correlated significantly positively with text length.

CONCLUSIONS

Our study offers a teaching strategy that can foster good levels of reflection, as demonstrated in the three e-learning variants. The developed reflection prompts can be easily embedded in various e-learning environments and enable reflections of good quality, even in settings with limited available teaching time.

The effect of different patient-based learning models on student perceptions of empathy, engagement, knowledge, and learning experience

BACKGROUND

Problem-based learning is used widely in pharmacy and medical programmes, incorporating realistic patient scenarios into regular teaching as a way of linking theory to practice. Routine case-based learning lessons ranges from real patient involvement, scripted patient scenarios, digital simulations (avatars) as well as through media such as Zoom. The existing literature has explored the extensive benefits of using patients in clinical education, but fewer studies have directly compared the efficacy of each model as learning tools.

AIM

To compare student perceptions of patient-based learning models to elicit student empathy, increase engagement, improve knowledge, and enrich learning experience.

METHODS

A questionnaire was distributed to second-year pharmacy students in Swansea University to gather their perceptions on the nine different patient-based learning models in their routine teaching (SUMS RESC 2023-0011). Students were asked to rank their experience of the models explicitly against each other, based on the four pillars of (1) eliciting student empathy, (2) increasing engagement, (3) improving knowledge and (4) enriching the learning experience. Students were also asked to rate the significance of realism (i.e. knowing the patient demographics/having a visual representation of the patient) to their experience.

RESULTS

Altogether, 31 student rankings of the nine learning models were weighted (9 = highest rank; 1 = lowest ranked). The data showed clear preferences for real-patient involvement over fictional cases, especially for eliciting empathy. Interestingly, scripted scenarios were rated highly for both engagement and learning experience only when avatars were involved, which suggests a role of animated visual representation of the patient in facilitating these outcomes.

CONCLUSION

Whilst it is useful to have multiple patient-based learning models, this study serves as a guide for educators in preparing case-based learning sessions for achieving the desired outcomes of any of the four pillars above.

A systematic scoping review of group reflection in medical education

BACKGROUND

Reviewing experiences and recognizing the impact of personal and professional views and emotions upon conduct shapes a physician's professional and personal development, molding their professional identity formation (PIF). Poor appreciation on the role of reflection, shortages in trained tutors and inadequate 'protected time' for reflections in packed medical curricula has hindered its integration into medical education. Group reflection could be a viable alternative to individual reflections; however, this nascent practice requires further study.

METHODS

A Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure a review of group reflections in medical education. Independent searches of articles published between 1st January 2000 and 30th June 2022 in bibliographic and grey literature databases were carried out. Included articles were analysed separately using thematic and content analysis, and combined into categories and themes. The themes/categories created were compared with the tabulated summaries of included articles to create domains that framed the synthesis of the discussion.

RESULTS

1141 abstracts were reviewed, 193 full-text articles were appraised and 66 articles were included and the domains identified were theories; indications; types; structure; and benefits and challenges of group reflections.

CONCLUSIONS

Scaffolded by current approaches to individual reflections and theories and inculcated with nuanced adaptations from other medical practices, this SSR in SEBA suggests that structured group reflections may fill current gaps in training. However, design and assessment of the evidence-based structuring of group reflections proposed here must be the focus of future study.

Twelve tips for developing and implementing an effective critical care simulation programme

Simulation training in healthcare settings has become a valuable training tool. It provides an ideal formative assessment for interdisciplinary teaching. It provides a high fidelity and highly immersive environment where healthcare staff and students can practice developing their skills in a safe and controlled manner. Simulation training allows staff to practice skills that better prepare them for clinical emergencies, therefore possibly optimising clinical care. While the benefits of simulation education are well understood, establishing a programme for use by critical care staff is complex. Complexities include the highly specialised scenarios that are not typically encountered in non-critical care areas, as well as the need for advanced monitoring equipment, ventilation equipment etc. These 12 tips are intended to assist healthcare educators in navigating the complexities in the establishment of a critical care simulation programme, providing advice on selecting target audiences, learning outcomes, creating a critical care simulation environment and recommendations on evaluation and development of the programme.

A hospital-wide group approach to promote open dialogues of workplace issues and staff wellbeing with Schwartz Rounds

OBJECTIVES

This study aims to explore the feasibility and impact of Schwartz Rounds® led by psychiatrists/mental health professionals in an urban Australian public hospital setting and to develop strategies for optimising participants' experiences.

METHODS

Being a mixed-methods study collecting qualitative and quantitative data through post-Rounds evaluation surveys, this study thematically analysed responses from 105 participants attending four consecutive monthly Rounds between February and May 2023 to assess the perceived benefits and challenges of Schwartz Rounds.

RESULTS

Respondents highly valued the Rounds and felt cared for by the healthcare organisation. Themes related to perceived benefits included (i) Connectedness and shared experience; (ii) Understanding other professionals; (iii) Normalisation of emotional distress, validation and a safe space for vulnerability; and (iv) Fostering authenticity and humanitarian aspects of healthcare. Challenges included (i) Fear of exposure and judgment; (ii) Emotional discomfort; (iii) Unfamiliarity with reflection; and (iv) Safety concerns.

CONCLUSIONS

This study suggests acceptability and feasibility of implementing Schwartz Rounds within an Australian public health setting, particularly when facilitated by skilled mental health professionals. The outcomes provide preliminary support for the use of group interventions to enhance staff collegiality and culture in healthcare settings, thereby addressing critical needs for health professional wellbeing.

Twelve tips for maximizing the potential of reflective writing in medical education

Reflective writing (RW) is a popular tool in medical education, but it is being used in ways that fail to maximize its potential. Literature in the field focuses on why RW is used - that is to develop, assess, and remediate learner competencies - but less so on how to use it effectively. The emerging literature on how to integrate RW in medical education is haphazard, scattered and, at times, reductionist. We need a synthesis to translate this literature into cohesive strategies for medical educators using RW in a variety of contexts. These 12 tips offer guidelines for the principles and practices of using RW in medical education. This synthesis aims to support more strategic and meaningful integration of RW in medical education.

Improving Interprofessional Collaboration Between Social Work and Pharmacy Through Hybrid and Virtual Learning Experiences

The professions of pharmacy and social work are not generally assumed to directly collaborate in patient care; however, these professions are complementary. Health and wellbeing outcomes are significantly improved when care is managed by an interprofessional team that communicates and collaborates to ensure all aspects of care are effectively managed. The creation of educational opportunities for students to practice working together provides enhanced educational experiences and leads to their success as professionals. Pharmacy and social work faculty developed an interprofessional education activity specifically aimed at integrative student learning. Faculty and students based on various islands throughout the state of Hawai'i and the US territory of Guam participated in the experience. The case study encouraged interprofessional teamwork and collaboration. The case study also challenged students to share profession-specific knowledge with each other. Mean evaluation scores were compared between hybrid and fully online platforms. Evaluation scores were high and at least as good or higher in the fully online exercise compared to the hybrid exercises. Using the 20-item pre-post format, Interprofessional Collaborative Competencies Attainment Survey, results indicated statistically significant improvements in scores for all questions and domains (all P<.001). When hybrid training and fully online training were compared, there were no significant differences in pre scores, but post domain scores were significantly higher in students who experienced fully online training. This interprofessional case-based activity successfully promoted interprofessional learning and collaboration. Introducing learners to this type of collaborative practice while in school is critical for future collaboration in the workforce.

[ACACIAS 3: Learning about announcement consultations in the second cycle of medical studies]

INTRODUCTION

The second cycle of medical studies is a key time for developing interpersonal skills and the doctor-patient relationship. High-fidelity simulation is an initial learning option that enables learners to confront situations involving empathy.

METHODS

This is a feedback report from May 2023 on the implementation of simulation as a training tool for 2nd cycle medical students in the announcement consultation. The training consists of two parts: theoretical teaching via a digital platform with an assessment of theoretical knowledge and a practical part with a simulation session with an actress playing a standardized patient. The acquisition of skills and the reflexivity of learners are assessed by means of a pre- and post-test.

RESULTS

Twenty-nine externs took part in this project. Student satisfaction was 96 %. The feedback was very positive, both in terms of the quality of the sessions and the briefings/debriefings. Almost all the students wanted to repeat the experience. The simulation exercise was beneficial for the students in terms of the development (before vs. after) of their skills (verbal, emotional and relational) (1.05±0.25 vs. 1.22±0.19, P=0.047) and appeared to be relevant to the development of reflexivity (3.29±0.72 vs. 3.48±0.9, P=0.134).

CONCLUSION

This first published French study demonstrates the feasibility and value of training in announcing a diagnosis, combining teaching via a digital platform and high-fidelity simulation for second cycle medical students.

Rehabilitation professions' core competencies for entry-level professionals: a thematic analysis

Rehabilitation services are essential interventions designed to optimize functioning and reduce disability in individuals with health conditions. Eight core professions offer rehabilitation services: audiology, occupational therapy, physical and rehabilitation medicine, physiotherapy, psychology, prosthetics and orthotics, rehabilitation nursing, and speech-language pathology. These professions often work together to provide patient-centered care. Each rehabilitation profession has developed its own international or national document to describe entry-level competencies. However, it is not evident in the literature whether rehabilitation professions share the same core competencies. Therefore, we explored the international standards for rehabilitation professions to identify commonalities and differences in entry-level professionals' required core competencies. A thematic analysis of current, published, international, or national entry-level competencies documents was conducted to determine commonalities and differences in the core competence requirements for the eight rehabilitation professions. The following four themes were evident across all professions: (a) evidence-based clinical practice knowledge and skills; (b) culturally competent communication and collaboration; (c) professional reasoning and behaviors; and (d) interprofessional collaboration. This thematic analysis highlighted the commonalities among rehabilitation professionals and may be used to provide a greater understanding of how rehabilitation professionals can support and work together on interprofessional teams.

Novel teaching-learning and assessment tools to complement competency-based medical education in postgraduate training

Medical and educational techniques and approaches have evolved globally over the past few decades. The modern approach is more learner-centred, with a focus on the acquisition of skills. The recently implemented competency-based medical education (CBME) for the National Medical Commission (NMC) undergraduate course curriculum is also competency-based rather than an outcome-based traditional curriculum. It is vital to embrace innovative teaching-learning and educational strategies to achieve the aspiration of CBME. This article provides a list of some of the newer tools and their perceived advantages and challenges and serves as a guide for using these methods effectively to meet the objectives of CBME as proposed by the NMC. Virtual teaching, learning from digital resources, objective-structured practical and clinical examination, flipped classroom, case-based learning, serious gaming, simulation-based learning and learning from role-plays and portfolios emerged as novel instructional strategies.

Should All Nurses Be Required to Complete Implicit Bias Training?

Bias mitigation requires a systematic approach.

Improving patient's intensive care admission through multidisciplinary simulation-based crisis resource management: A qualitative study

AIM

To explore nurses' and physicians' experiences of simulation-based training in a crisis resource management quality improvement intervention on intensive care admission.

BACKGROUND

Quantitative studies have documented that staffs' non-technical skills are improved after simulation-based training in crisis resource management interventions. Experienced-based consensus led to development of a quality improvement intervention based on principles of crisis resource management and tested in simulation-based training to enhance staffs' non-technical skills. However, the impact on staff is unexplored, leaving little understanding of the relationship between simulation-based training in crisis resource management interventions and changes in non-technical skills.

DESIGN

A qualitative study with a hermeneutical approach.

METHODS

Data consisted of semi-structured interviews with physicians (n = 5) and nurses (n = 15) with maximum variation in work experience. Data were collected 3 months after implementation and analysed using thematic analysis. The COREQ guideline was applied.

RESULTS

The analysis revealed three themes: prioritising core clinical activities and patient centredness; transition into practice; and reflection on patient safety. These themes reflected staff's experiences of the intervention and implementation process, which evolved through prioritising core clinical activities that facilitated the transition into clinical practice and staff's reflection on patient safety.

CONCLUSIONS

Prioritising core clinical activities were facilitated by clear communication, predefined roles and better teamwork. Transition into practice stimulated professional growth through feedback. Reflection on patient safety created a new understanding on how a new structure of intensive care admission could be implemented. Collectively, this indicated a joint understanding of admissions.

IMPLICATIONS FOR PRACTICE

Findings enables health care professionals to understand how the intervention can contribute to improve quality of care in management of intensive care admission. Improving non-technical skills are vital in high-quality admissions, which supported a structured process and a collaborative professional standard of admissions.

PATIENT AND PUBLIC CONTRIBUTION

None.

Sustaining Resilience of Healthcare Workers and Leaders during a Pandemic: A Protocol to Support Coping during the COVID-19 Pandemic

Objective: One way healthcare organisations can support their staff is through supervision. Supervision is typically defined as a process in which professionals receive support and guidance from more experienced colleagues. In this brief review we propose a tailored protocol for supporting support workers during a pandemic. Method: We collected narrative data from difference sources including a systematic meta ethnography and used expert advise in order to tailor the protocol. Results: This protocol can be used by management teams (e.g., senior support workers, team leaders, registered managers, and operation managers) without any prior experience of supervision. The protocol suggested includes a template with easy-to-follow instructions. Conclusions: It provides an easy step-by-step guide that simplifies the process whilst maintaining the depth needed to ensure effective supervision.

NASA resilience and leadership: examining the phenomenon of awe

This study examines how a phenomenon, awe, along with related resilience practices, is perceived by a NASA medical and mental health professional, who also serves in a leadership role, and how awe has impacted their work and personal life. Considering both their leadership role and how their work involves supporting the wellbeing of astronauts pre-mission, during missions, and post-mission, the potential impact of awe on the NASA expert has individual implications along with many others, especially in stressful environments. The results indicate that reflecting on awe experiences can support a person finding meaning and purpose in their life, evoke gratitude, increase social connectedness, promote optimism and other resilience skills in the moment, and generally have a sustainable positive effect.

Nurse Residents' Legacy Letters: A Qualitative Analysis

It is important for graduate nurses to reflect on their time in residency programs. Legacy letters, written by oncology nurse residents to future residents, reflect on "what I wish I knew" and "what I learned." A retrospective, qualitative thematic analysis of 30 letters at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States was conducted. Four themes arose. Understanding these experiences can provide insight to nurse residents and guide improvements for the residency program.

Opportunities to develop leadership skills in the undergraduate diagnostic radiography program: Insights from students at an Australian university

INTRODUCTION/BACKGROUND

Leadership is defined as the ability to influence others to work towards common visions and goals. A key principle of the Australian Health Leadership Framework is that it applies to all leaders and potential leaders, who are at any place in the system. Hence, leadership is everyone's responsibility, including health profession students. In this short communication, we discuss the concept of leadership development in the undergraduate diagnostic radiography (DR) program through experiential learning. Examples from students' and academics' perspectives are presented, with the intention of providing a broad context to the range of opportunities that support development of leadership skills in DR students.

DISCUSSION

Experience and experiential learning are fundamental and natural means of learning. Experiential learning has a positive effect on leadership because of its impact on personal, attitudinal, moral, social, and cognitive outcomes. Undergraduate DR students value opportunities to develop leadership skills during their university education. Four opportunities to develop and reflect on leadership skills are discussed. Two of the opportunities, clinical placements and honours programs, form part of the curricula, whilst others, such as mentoring and profession-specific social groups, are not. Through experience-based learning, students may benefit from transformational effects in their individual skills, which may ultimately benefit the organisation or community in which the individual participates.

CONCLUSION

Commitment from clinical and academic educators to enable leadership development in DR students is essential. Through implementation of obligatory and optional experiential learning opportunities, it is anticipated that leadership skills will be cultivated in DR students, enabling students to exercise effective leadership in their current student roles and establish essential skills for their future professional roles.

Professionalism, Resilience and Reflective Thinking: How Do These Influence Occupational Therapy Student Fieldwork Outcomes?

The relationship between entry-level, undergraduate occupational therapy students' fieldwork performance and measures of professionalism, reflective thinking and resilience was examined. A group of 135 undergraduates (86% female) completed a self-report questionnaire containing the standardized instruments measuring professionalism, resilience and reflective thinking. The Australian Student Practice Evaluation Form-Revised (SPEF-R) measured fieldwork performance. Linear regression analyses identified Staying Healthy and Relationships with Others as significant predictors of students' fieldwork performance in Professional Behaviors, Self-Management and Information Gathering. The findings highlight the importance of interpersonal skills and engagement in healthy lifestyles in key fieldwork performance areas.

Twelve tips for medical students to enhance clinical skills learning during disrupted placements

Disruption to healthcare settings can present a significant challenge to traditional, face-to-face models of learning in medical education. Reductions in undergraduate medical students' clinical exposure, whether due to periods of increased healthcare demand, localised service changes or infectious disease outbreaks, are likely to result in fewer opportunities to develop key clinical and practical skills. Proficiency in these skills is often essential to progression and future practice, creating a broad incentive for students to develop techniques to maintain and refine their clinical skills during disrupted placements. These tips, based on our experiences as senior medical students, are intended to help students on disrupted placements to engage in reflective practice, discover ways to facilitate further opportunities for clinical skills learning, and to make the most of clinical skills learning opportunities that they do receive.

Attitudes and Perceptions of Health Leaders for the Quality Enhancement of Workforce in Saudi Arabia

BACKGROUND AND AIM

Besides the unique exposure and experience of health leaders in facing challenges and overcoming them, and the relatively fewer articles relating to the perception of health leaders in workforce quality enhancement, health leadership plays a crucial role in redirecting the workforce, increasing job satisfaction, professional development, and burnout prevention. Thus, this study aimed to understand the current healthcare workforce quality and future expectations from the attitudes and perceptions of health leaders.

METHODS

A qualitative research was carried out using semi-structured interviews consisting of 24 different questions. Participants of the study were healthcare leaders from different backgrounds and governmental institutions. All interviews were recorded, transcribed, and then analyzed using thematic analysis via the N-Vivo program.

RESULTS

Eleven participants were involved in the study, with one female and ten males. A thematic analysis and N-Vivo program yielded 5 main themes: (1) workforce competency, (2) health transformation, (3) leadership, (4) workforce planning, and (5) healthcare quality, with 22 emerging sub-themes. Moreover, participants responded with different attitudes and perceptions.

CONCLUSION

Health leaders are satisfied with the current direction of workforce competency and planning, yet fragmentation of the system and poor accessibility may need further enhancement. Furthermore, misutilization of services and the uncertainty of the future and talent pool are potential barriers for capability building. Moreover, with the existing gap in the workforce, health leaders believe that privatization and corporatization may have a positive effect. Aside from that, Saudization with the current plan of having a minimum standard of accepting non-Saudis in certain areas might benefit in maintaining competition and enriching experience. However, catching up with further research in healthcare quality in Saudi Arabia is needed because of the ongoing health transformation.

Impact of Intercalated Degree on Post-graduate Career Progression and Academic Development in the UK: A Rapid Review of the Literature

An intercalated degree offers medical students an avenue to explore their interests and become competent in scientific literacy. Although intercalating can pose a financial burden and time commitment, they do provide competitive academic and speciality training applications. The aim of this review was to explore academic development and subsequent outcomes of career progression. Medline and EMBASE were systematically searched using keywords. After the removal of duplicates, the studies were screened against the inclusion criteria. For the five studies included in this review, a narrative synthesis was performed. The two main themes were academic development and career progression. All studies showed a plethora of academic achievements during and after intercalation. Two studies showed that students are more likely to enter a career in academic medicine. A further two studies have shown that the transferable skills of academia have allowed alumni to make more competitive applications for foundation year and speciality training. The results have shown a correlation between academic achievements and an increase in competitiveness in foundation programmes and speciality applications. There are clear discrepancies in the success of academic careers depending on the institution and type of intercalated degree. Current literature suggests a master’s degree results in more academic success compared to a bachelor’s degree. Due to the sheer diversity of intercalated degrees offered to medical students in the UK, there is limited literature on post-graduate career progression. More research should be undertaken to look at the implications of intercalation on post-graduate career progression.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study

BACKGROUND

A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention.

OBJECTIVE

To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses.

DESIGN

A prospective two-armed quasi-experimental study.

METHODS

188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings.

RESULTS

Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase =1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase =1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control.

CONCLUSION

Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice.

IMPACT STATEMENT

Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis

INTRODUCTION

Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development.

MATERIALS AND METHODS

Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes.

RESULTS

Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate.

CONCLUSIONS

The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

There is no health without cultural safety: Why cultural safety matters

The authors would like to pay respect to Aboriginal and Torres Strait Islander Peoples by acknowledging the traditional owners of the lands on which this paper was written, the Wadjuk people of the Nyungar Nation and the Darkinjung people. One author (XX) would like to acknowledge her Wiradjuri ancestry and express respect to her Elders past and present and to Culture and Country.

How To Hospital: barriers to developing a patient 'Hospital Survival Guide' to support information transfer during ward-rounds on the patient journey from admission to hospital to discharge

Clinicians can enable patients to actively participate in their care but communication with patients is often poor and highly variable. The aim of this study was to explore patients’ understanding of their current illness while in hospital and using a codesign process to create prototype tools to facilitate better communication during ward rounds.

A mixed-methods, multistep design with step 1: Application of a questionnaire addressing domains of care in the acute medical unit; step 2: Development of communication aids that were codesigned with active help of patients, students and a specialist in user centric design to address patient needs and step 3: Evaluation of tools with patients in four Plan–Do–Study–Act cycles.

In the initial survey of 30 patients 12 (40%) patients did not know what their diagnosis was and 5 (17%) did not know the results of recent key tests. 20 (67%) patients felt that staff communication and coordination could be improved.

An intervention was prototyped with four variations: (1) An A6 ward-round summary sheet completed by doctors during ward rounds. The system worked well but was highly person dependent. (2) An A4 patient-owned diary (‘How to Hospital’) that contained information about key processes in hospital and space to document conversations from rounds and prompts for questions. 10 patients read the diary and commented favourably but did not complete any pages. (3) ‘Diary-cards’: a basic set of information cards was given to patients on admission to hospital. (4) Patient specific ‘diary-cards’ were completed by clinicians—10 forms were piloted during rounds and improved subsequent day information retention of diagnosis to 80%.

Our study identified interventions that were feasible but remained person-dependent. The patients’ ownership of information in relation to their care might facilitate retention and satisfaction but the optimal format for these interventions for enhancing communication remains unclear.

Continuing professional development and mentoring

This professional development paper aims to give you some pointers that will help you get the most from your mentorship experience as a mentor or a mentee. We look at how mentoring can support your professional development. A simple definition is that a mentor may share with a mentee (or protege) information about his or her own career path, as well as provide guidance, motivation, emotional support, and role modelling. A mentor may help with exploring careers, setting goals, developing contacts, and identifying resources.

Development and psychometric evaluation of a reflection on clinical practice questionnaire for nursing students

BACKGROUND

Reflection on clinical practice is the core of education for nursing students. Evaluating reflection on clinical experiences requires a tool which accurately measures reflection skills. The present study aims to develop and test the psychometric properties of a tool for measuring nursing students' reflection on clinical practice.

METHODS

Based on a mix-method exploratory approach, the study was carried out in two stages: in the first stage (the qualitative phase), the concept of reflection on clinical practice was established. In the second stage (the quantitative phase), the psychometric properties of the developed scale were evaluated.

RESULTS

Based on the results of the exploratory factor analysis and the verification process, the final version of the scale came to consist of 36 items and 6 dimensions. The dimensions were: professional competence, internal sources of motivation, challenging situational clinical setting, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. Overall, 6 factors accounted for 62.79% of the variances. The factor loadings of the items ranged between 0.62 and 0.94, all of which were significant. The total intraclass correlation (ICC) of the scale was found to be 0.94. Also, evaluation of the reliability of the scale as measured through internal homogeneity yielded a total Cronbach's alpha of 0.90.

CONCLUSION

The findings show that the developed scale for evaluation of nursing students' reflection on clinical practice possesses satisfactory validity and reliability, and nursing professors can use this instrument to assess students' reflection skills.

A Review on Strategies for Data Collection, Reflection, and Communication in Eating Disorder Apps

Eating disorders (EDs) constitute a mental illness with the highest mortality. Today, mobile health apps provide promising means to ED patients for managing their condition. Apps enable users to monitor their eating habits, thoughts, and feelings, and offer analytic insights for behavior change. However, not only have scholars critiqued the clinical validity of these apps, their underlying design principles are not well understood. Through a review of 34 ED apps, we uncovered 11 different data types ED apps collect, and 9 strategies they employ to support collection and reflection. Drawing upon personal health informatics and visualization frameworks, we found that most apps did not adhere to best practices on what and how data should be collected from and reflected to users, or how data-driven insights should be communicated. Our review offers suggestions for improving the design of ED apps such that they can be useful and meaningful in ED recovery.

RE: learning medical professionalism - the application of appreciative inquiry and social media

A letter to the editor in response to the article by Hsieh et al. published in this journal, discussing the application of appreciative inquiry and social media on medical professionalism education.

Health Professional Digital Capabilities Frameworks: A Scoping Review

Introduction

The term “digital healthcare professional” alludes to a health professional with the additional digital capabilities such as information and technology. The assumption that attaining technical knowledge and skills to meet the available professional standards in digital healthcare, will engage and empower healthcare users, thus deliver person-centered digital healthcare (PCDHc), is flawed. Identifying where digital healthcare and technologies can genuinely support person-centered care may lead to future discourse and practical suggestions to build person-centered integrated digital healthcare environments. This review examines current digital health and informatics capability frameworks and identifies the opportunity to include additional or alternative principles.

Methods

A scoping review was conducted. Literature valuing person-centered digital healthcare requirements, digital health capabilities, and competencies were identified between 2000 and 2019 inclusive, then collated and considered. Using a PRISMA approach for eligibility screening, thirteen articles met the study inclusion criteria. Analysis used a thematic framework approach, which assisted in the data management, abstraction and description, and finally the explanations.

Results

Analysis indexed fifty-nine (59) capabilities, charted thirteen (n13) categories, mapped four (n4) themes, which were then interpreted as findings.

Findings

The four themes identified were Change Management; User Application; Data, Information, and Knowledge; and Innovation. The themes recognize the opportunity to align the application of technical skills towards the capabilities required to deliver authentic PCDHc.

Discussion

Holistic mindsets are imperative in maintaining the objective of PCDHc. The authors propose that debates regarding professional digital capability persist in being “siloed” and “paternalistic” in nature. They also recommend that the transition to authentic PCDHc requires refocusing (rather than rewriting) current capabilities. The realignment of capabilities towards individual healthcare outcomes, rather than professional obligation, can steer the perspective towards a genuine PCDHc system.

Conclusion

This scoping review confirms the assumption that digital skills will empower all healthcare stakeholders is incorrect. This review also draws attention to the need for more research to enable digital healthcare systems and services to be designed to realize complex human behaviors and multiple person-centered care requirements. Now more than ever, it is imperative to align healthcare capabilities with technologies to ensure that the practice of PCDHc is the empowering journey for the healthcare user that theory implies.

Describing healthcare providers' perceptions of relational practice with families in the emergency department: A qualitative study

Background

Emergency departments are regarded as stressful working environments, associated with staff shortages, increased patient numbers and long waiting times. Increased organisational demands for performance can compromise genuine interactions between families and healthcare providers working in emergency departments. A relational practice approach in caring for families can enhance the capability of healthcare providers to simultaneously overcome these difficulties and provide emergency healthcare of high quality.

Objectives

The purpose of the study was to describe healthcare providers’ perceptions of relational practice with families in three emergency departments in KwaZulu-Natal, South Africa.

Method

Using a qualitative descriptive approach data were collected through semi-structured interviews with healthcare providers working in emergency departments. The data were analysed and categorised using qualitative content analysis.

Results

Four categories emerged from data analysis: (1) families and healthcare providers connecting; (2) recognising the uniqueness of families; (3) caring interactions; and (4) taking charge when necessary.

Conclusion

The study elicited that healthcare providers working in emergency departments perceived that despite high patient volumes and resource constraints, collaborative relationships with families were important. However, these collaborative relationships cannot be willed into practice, instead training workshops are needed to develop relational skills of healthcare providers which can facilitate family and healthcare professional collaboration.

Realist evaluation of public engagement and involvement in data-intensive health research

BACKGROUND

High quality public engagement and involvement (PEI) in data-intensive health research is seen as one way of ensuring that social legitimacy, i.e. a social license, is conferred through public acceptance of the need for research use of their data. This is a complex research area, and portfolios of involvement have been suggested, but not yet evaluated, to support the role of public contributors. The study aim was to evaluate if and how membership of a data-intensive research public forum can act as a mechanism for enhancing members' personal development. Our objective was to understand the circumstances and mechanisms that help to explain how, why and for whom involvement with a public forum enhanced those members' personal development.

METHOD

Qualitative data were collected from 15 current and previous members, via semi-structured interviews, notes from meetings, and consultations with and feedback from members. Data were critically compared, contrasted and reviewed until no new themes could be discerned and then condensed into context-mechanism-outcome (CMO) configurations. Realist evaluation was used to generate a theoretical and empirical appreciation of the contextual circumstances and mechanisms which help to explain the extent to which involvement with a public forum would enhance members' personal development and, if so, how, why, and for whom.

RESULTS

Three CMO configurations were identified. All of them showed that using the portfolio facilitated growth in forum members' personal development, but only where the members valued using the portfolio. This was particularly so for female members. Members valued the portfolio in one or more of three ways: as a tool to record and evidence activities, to facilitate reflective practice or as a guiding framework.

CONCLUSIONS

Data analysis and consideration of the three CMO configurations suggests a refined middle range theory that 'The use of a portfolio as a framework for learning in a public forum will facilitate members' personal development if they value its use as a framework for learning'. Further work is needed to confirm these findings both elsewhere in data-intensive health research and in other complex research areas using public forums for PEI.

PLAIN ENGLISH SUMMARY

Public engagement and involvement in health research is now well established and makes a valuable contribution to the research process. However, little is known about its impact on participants. This article investigates how involvement in a data-intensive health research public forum impacts on public forum members, rather than the research process. Personal involvement portfolios were used to support their involvement work and help evaluate if and how involvement in research activities enhanced members' personal development. Taking a realist evaluation approach, 'Context-Mechanism-Outcome' configurations were used to explore how membership of a public forum might enhance public forum members' personal development. The Context-Mechanism-Outcome configuration refers to an exploration of what influences the extent to which an intervention is successful or unsuccessful in producing positive outcomes and tries to identify the reasons why it is successful for some and unsuccessful for others. However, evidence from this realist evaluation recommends that engagement and involvement should always be underpinned by procedures which ensure that public contributors receive ongoing and tailored guidance and support throughout the process.

A Dedicated Education Unit and a Novel Resident Nurse Transition-to-Practice Program in an Ambulatory Oncology Setting

OBJECTIVE

To summarize an innovative initiative in oncology nurse workforce development that addresses critical current and future gaps and encompasses use of dedicated education units for student nurse rotation and a transition-to-practice residency program.

DATA SOURCES

Review of institutional data including original pilot analysis and ongoing programmatic metrics (N=8 years), consensus, professional guidelines, and published literature.

CONCLUSION

The dedicated education unit serves as a conduit for recruitment into institutional oncology nurse residency positions, and retention rates in the residency program continue to exceed national averages. Subsequent mentoring of these nurses in transition to practice has manifested high rates of promotion into nurse leadership roles year over year.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurse practice incorporates state-of-the-science approved therapies, early phase clinical trial implementation, and evidence-based complex oncology patient care management. A new model of student clinical nurse rotations in ambulatory settings, nurse resident transition to practice, and ongoing leadership mentoring is essential in creating a sustainable, highly skilled, and robust oncology nurse work force.

Implementation and evaluation of a training programme to promote the development of professional competences in nursing: A pilot study

BACKGROUND

Clinical narratives may be used as a means to improve the acquisition of clinical competences. Even though there are studies that recognize the potential value of clinical narratives to promote nursing professional development, there is no evidence that shows their value as a tool to improve nurses' competences to provide person-centred nursing care.

PURPOSE

To evaluate the preliminary efficacy of narratives for the development of three nursing professional competences -respect, intentional presence and knowing the person- for providing person-centred care.

METHOD

Using a pre-post quasi-experimental design, a pilot study with a total of 34 nurses enrolled in a training course of nursing specialization was conducted between September 2016 and June 2017. All the nurses received a multi-component intervention based on the Critical Reflective Inquiry model. The strategies of this programme consisted of writing three narratives, attending two masterclasses, participating in a discussion group, and participating in a face-to-face interview. The NarratUN Evaluation tool was used to assess the outcomes. Changes among nurses were analysed using the Wilcoxon signed Rank test.

RESULTS

The difference in the means between the pre- and post-intervention scores were statistically significant for respect [0.59 (95% CI 0.23-0.95; p = 0.001)], intentional presence [0.75 (95% CI 0.32-1.17; p < 0.0001)] and knowing the person [0.62 (95% CI 0.25-0.99; p = 0.001)]. The difference in the mean score for use of the narrative and reflection also increased significantly [0.65 (95% CI 0.32-0.98, p < 0.001)].

CONCLUSIONS

The use of narratives combined with other reflective strategies (masterclass sessions and discussion groups) proved to be effective for the development of professional competences of nurses.

Stimulated by insight: Exploration of critical care nurses' experience of research participation in a recovery programme for intensive care survivors

AIMS AND OBJECTIVES

To explore critical care nurses' experiences of research participation during a one-year recovery programme for intensive care survivors.

BACKGROUND

Nurse-led postintensive care follow-up consultations have emerged to help patients to recover and overcome problems related to critical illness and admission at the intensive care unit (ICU). Previous research exploring post-ICU follow-up programmes have shown inconclusive evidence of their effectiveness on patient-reported outcome measurements, and provider evaluation is scarce. The context of this study is the Recovery and Aftercare in Postintensive care Therapy (RAPIT) trial.

DESIGN

A qualitative descriptive telephone interview study.

METHODS

Data were collected after completion of the RAPIT trial. Participants (n = 14) were trained intensive care nurses, who delivered the post-ICU recovery programme, representing nine out of ten sites from the RAPIT trial. Two focus group discussions were used to construct a semistructured interview guide. A thematic data analysis was performed using Braun and Clark's six-step method. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies.

RESULTS

Our study indicated that nurses considered participation in research as a positive experience. The main finding "Stimulated by insight" described how nurses' engagement and professional growth was gained by reflection, patient feedback and research competencies acquired in the clinical setting. The research programmes stimulated to new knowledge, broaden their perspectives and enhanced critical reflection of ICU nursing practice.

CONCLUSIONS

The study indicates that nurses developed research competencies and enhanced their job satisfaction by using critical reflection and patient feedback. However, there is still a substantial need for support to strengthen nurses' competencies in collaboration with colleagues, managers and researchers.

RELEVANCE TO CLINICAL PRACTICE

This study can contribute to the development of recommendations supporting nurses doing research and to optimise implementation of clinical research.

Applications of the reflective practice questionnaire in medical education

BACKGROUND

We sought to determine whether the Reflective Practice Questionnaire (RPQ) is a reliable measure of reflective capacity and related characteristics in medical students. We also planned to learn how the RPQ could be used in medical education.

METHODS

The RPQ is a 40 item self-report questionnaire that includes a multi-faceted approach to measuring reflective capacity. It also includes sub-scales on several other theoretically relevant constructs such as desire for improvement, confidence, stress, and job satisfaction. The reliabilities of reflective capacity and other sub-scales were determined by calculating their Cronbach alpha reliability values. In the present study, the RPQ was answered by 98 graduating fourth-year medical students from an American University, and these RPQ scores were compared with general public and mental health practitioner samples from a prior study using ANOVA and Bonferroni adjusted comparisons.

RESULTS

Medical students reported a higher reflective capacity than the general public sample, but students were statistically indistinguishable from the mental health practitioner sample. For medical students, reflective capacity was associated with features of confidence, stress, and desire for improvement. Job satisfaction was positively associated with confidence in communication with patients, and negatively associated with stress when interacting with patients. A cluster analysis revealed that around 19% of the medical students exhibited a relatively high level of anxiety interacting with patients, 23% were less engaged, 5% were dissatisfied, and 7% expressed a level of over-confidence in their knowledge and skills that was concerning.

CONCLUSIONS

The RPQ is a reliable measure of reflective capacity (Chronbach's alpha value = 0.84) and related characteristics (Cronbach's alpha values from 0.75 to 0.83) in medical students. The RPQ can be used as part of pre-post evaluations of medical education initiatives, to complement student self-reflection activities in the curriculum, and to identify students who might benefit from targeted intervention.

Personal Commitment Statements: Encouraging the Clinical Application of Continuing Professional Development Events for Health Practitioners in Low- and Middle-Income Countries

INTRODUCTION

Statements of commitment to change are commonly used to evaluate continuing medical education. However, this approach is new to evaluating the continuing professional development (CPD) of other health care practitioners such as audiology, speech-language therapy, occupational therapy, and physiotherapy in low- and middle-income countries. This study explored the use of Personal Commitment (to change) Statements (PCSs) as an evaluation tool of continuing education for health professionals in low- and middle-income countries, and its impact on the integration of new knowledge and skills with previous knowledge and clinical practice.

METHODS

PCSs were used in a case study conducted at a 1-day interprofessional CPD event held for health practitioners in South Africa. A qualitative thematic analysis was made of these PCSs, and results were synthesized into main themes.

RESULTS

Thirty-two participants turned in a PCS at the end of the CPD event with a total of 71 text statements. Three main domains were identified: (1) applying new knowledge in practice (61.97%); (2) increasing training-related content knowledge (21.12%); and (3) sharing information, skill, and resources (16.9%).

DISCUSSION

This study demonstrated that personal commitment statements can be used to describe the outcomes of CPD events for audiologists, speech-language, occupational, and physiotherapists. Participants engaged in reflection generated by the personal commitment statement, which contained no guiding statements, yet elicited responses showing that participants were more aware of the assessment tools and how they could use them in practice. Further study is warranted into the process and the role of follow-up regarding health practitioners' commitment to change in clinical practice.