Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology

BACKGROUND

Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling.

OBJECTIVE

This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments.

DESIGN

A mixed method approach using the Q Methodology was employed.

SETTING(S)

Three public and private hospitals in Japan.

PARTICIPANTS

Eighteen nurses participated in the study.

METHODS

Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies.

RESULTS

Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population.

CONCLUSIONS

Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand.

STUDY REGISTRATION

Not registered.

Meaningful clinical outcomes for young people and parents when treated for chronic musculoskeletal pain in the UK: Q set development

Previous studies have established a core outcome set for paediatric chronic pain clinical trials. The aim of this research was to establish which outcomes young people and parents considered important to measure during treatment for chronic musculoskeletal pain. To the best of our knowledge, this is the first study to explore which outcomes could be used to tailor interventions within a clinical setting. Twenty-one young people (age 11-18 years) and twenty-one parents were recruited from two UK hospital sites and took part in semi-structured interviews that incorporated drawing a timeline of their treatment. They identified positive and negative outcomes showing the perceived effectiveness of treatment. Informed by Q methodology, the words and phases of young people and parents were developed into 101 statements that were mapped onto the core outcome set and represented wide-ranging opinions regarding the outcomes they considered important (Q set). This approach helped identify additional statements related to 'parent and family functioning' not routinely considered. Outcomes related to the treatment experience and adverse effects were highlighted as important, yet are not routinely prioritised in clinical research. Parents prioritised outcomes related to the treatment experience, whereas young people prioritised their overall wellbeing. Over the course of treatment, outcome focus changed, with some outcomes only deemed relevant at a specific time point. Overall, the research highlighted the need for clinical guidance on which outcome domains to measure during the treatment course to gauge treatment effectiveness and optimally tailor interventions. PERSPECTIVE: This study established the range of outcomes that were important to young people and their parents during treatment for chronic musculoskeletal pain. The findings show how young people and parents have different outcome preferences and how their outcome focus changes during the treatment course.

Identifying Perspectives on Physical Therapist Residency Program Goals: Hallmarks of Success and Excellence

OBJECTIVE

The purpose of this study was to describe common perspectives important to achieving excellence and success in physical therapist residency education programs.

METHODS

Individuals with direct responsibility for creating and revising physical therapist residency program goals participated in a mixed-methods study using Q-methodology. They sorted 31 goal topics based on the level of importance for achieving excellence and success in physical therapist residency education. By-participant factor analysis identified dominant perspectives, which were interpreted based on emergent themes from the topics identified as the most important. Participants' rationale for selecting goal topics as the most important were extracted from the post-survey.

RESULTS

Seventy-three individuals responded, representing 9 of the 11 clinical residency areas of practice. Three main perspectives emerged: resident behaviors, resident achievements, and program attributes. One shared perspective emerged across all 3 factors that emphasized the residents' ability to become self-regulated, lifelong learners who integrate learning into practice: preparation for future learning.

CONCLUSIONS

Variability in weighting the importance of program goals associated with each perspective may include a program's organization and mission, individual beliefs and experiences related to program leadership, and resource availability. Although respondent emphasis placed importance of some items over others, the findings do not suggest that items ranked lower were unnecessary or unimportant in achieving program excellence. The relative importance of items was weighted differently based on the perspective of program leadership and the individual completing the sorting activity.

IMPACT

The results of this study suggest that physical therapist residency programs should have at least 1 or 2 goals in each of the 3 distinct perspectives, as well as the 1 shared perspective identified in our findings. Some consistency in program goals based on the perspectives identified here may enable further research exploring excellence, value, and outcomes in physical therapist residency education.

[Evaluation of motivational factors of adolescent patients for orthodontic treatment using the Q methodology]

The management of adolescents in the orthodontic practice remains a challenge in terms of motivation and adherence to treatment. Some factors seem to be of paramount importance in the success of treatment. The objective of the present study was to evaluate the motivational factors of adolescent patients seeking orthodontic treatment using the Q methodology. After interviews with adolescent patients, 32 reasons for seeking orthodontic treatment were identified and ranked in order of importance on a Q methodology grid by 40 patients aged 10 to 16 years. Factor analysis was used to classify the patients' views into groups of shared opinions. Four motivating factors were identified in adolescent patients. However, the factor « the advice of general Dentist and the aesthetic need » was the most important. An effective treatment strategy can be chosen for each patient according to their motivational profile; this could therefore improve their cooperation and guarantee a more satisfactory therapeutic outcome.

Neither Knowledge Deficit nor NIMBY: Understanding Opposition to Hydraulic Fracturing as a Nuanced Coalition in Westmoreland County, Pennsylvania (USA)

The expansion of unconventional sources of natural gas across the world has generated public controversy surrounding fracking drilling methods. Public debates continue to reverberate through policy domains despite very inconclusive biophysical evidence of net harm. As a consequence, there is a need to test the hypothesis that resistance to fracking is due to the way it redistributes economic and environmental risks. As in many other communities, opposition to fracking is common in central Westmoreland County, Pennsylvania, (USA) but the rationale underpinning opposition is poorly understood. We test the prevailing assumption in the environmental management literature that fracking opposition is motivated by knowledge deficits and/or not-in-my-backyard (NIMBY) politics. This study uses Q methodology to examine emergent perspectives and sub-discourses within the fracking opposition debate in central Westmoreland County, PA. Q methodology offers a systematic and iterative use of both quantitative and qualitative research techniques to explore frequently overlooked marginal viewpoints that are critical to understanding the fracking problem. The analysis reveals four different narratives of factors amongst people actively involved in locally opposing fracking, labeled (1) Future Fears; (2) NIMBY (3) Community Concerns; and (4) Distrust Stakeholders. The conflicts that emerge across these four factors are indicative of deeper discourse within the fracking debate that signifies diversity in motivations, values, and convictions, and suggests the inadequacy of relying on knowledge deficit and/or NIMBY explanations to fracking politics.