Clinical supervision experience of nurses in or transitioning to advanced practice: A systematic review

AIMS

To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice.

DESIGN

A qualitative systematic review using Joanna Briggs Institute meta-aggregation following an a priori protocol published on PROSPERO (CRD42023426658).

DATA SOURCES

Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer-reviewed, published and unpublished studies from inception to July 2023.

REVIEW METHODS

Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews.

RESULTS

Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS.

CONCLUSIONS

This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well-structured supervision offers a safe space to share work-related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work-related burdens and reduce professional isolation and burnout.

IMPLICATIONS FOR THE PROFESSION

Peer-support networks are vital for successful transition to advanced practice.

IMPACT

This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention.

PUBLIC CONTRIBUTION

No direct patient contributions are included as it forms part of a research degree.

Adolescents and Young Adults with Cancer and the Desire for Parenthood-A Legal View from a Swiss Perspective in Consideration of the Relevance of Cancer Support Organizations

This commentary focuses on the challenges and possibilities that adolescents and young adults with cancer (AYA) desiring parenthood face under Swiss law. The regulation of reproductive medicine procedures is stricter in Switzerland than in some other countries. Health insurance is compulsory, but the interventions that are covered are in constant flux. Recent changes pertain to the possibilities of future AYA parenthood and keeping up to date with practical and legal ramifications is taxing even for health professionals. AYA facing treatment decisions are uniquely vulnerable and dependent on comprehensive, clear, current, and country-specific information regarding risks and options pertaining to their fertility. This commentary provides a short overview of the Swiss legal framework related to reproductive medicine, highlighting its access restrictions and prohibitions, as well as recent changes. While the importance of patient, peer, caregiver, and interest groups supporting people affected by health conditions has long been recognized in many countries, an AYA organization was only recently established in Switzerland. Such organizations are vital for providing accurate, country-specific information and support, while individualized medical guidance, informed by the most current legal framework and its consequences, remains essential in addressing AYAs' specific needs in connection with the desire to have children.

Peer-led alcohol intervention for college students: A pilot randomized controlled trial

This study aims to assess the preliminary efficacy and feasibility of a brief, peer-led alcohol intervention to reduce alcohol consumption in binge-drinking Spanish nursing students. A pilot randomized controlled trial was conducted with 50 first-year nursing students who were randomly assigned either a 50-min peer-led motivational intervention with individual feedback or a control condition. Primary outcomes for testing the preliminary efficacy were alcohol use and alcohol-related consequences. Quantitative and content analyses of open-ended survey questions were performed. Participants in the intervention condition significantly reduced binge-drinking episodes, peak blood alcohol content, and consequences compared to the control group. Principal facilitators were completing the questionnaire during the academic schedule and providing tailored feedback through a graphic report. The main barrier was the unreliability of students' initial commitment. The findings suggest that a brief motivational intervention could be effective for reducing alcohol consumption and alcohol-related consequences in Spanish college students. Peer counselors and participants reported high satisfaction, indicating that the intervention is feasible. However, a full trial should be conducted taking into account the identified barriers and facilitators.

An expert patient program to improve the empowerment and quality of life of people with multiple sclerosis: protocol for a multicenter pre-post intervention study

Introduction

Multiple sclerosis (MS) causes a progressive disability, which substantially impacts the quality of life (QoL). Health interventions that meet the needs and demands of people with MS are essential to minimize QoL impairment. Expert patient programs (EPPs) facilitate health-related empowerment through peer learning. Based on a previous focus group study, we designed an EPP for MS coordinated by nursing professionals for implementation in the different MS reference units of Catalonia (Southwestern Europe). This study aims to evaluate the effects on quality of life, disease-related knowledge, and self-management related to the health process of the participants of the Expert Patient Program Catalonia™ for people with multiple sclerosis (EPPC-MS).

Methods

Pre-post intervention multicenter clinical study involving 12 groups of 12 participants: six groups including relapsing and six groups including progressive MS patients, with 144 participants from 7 MS reference units from all over Catalonia, organized in six teams. The intervention will consist of nine telematic learning peer-led sessions (one weekly session). The expert patient (EP) leading the sessions will be an individual with MS with disease-related knowledge, who will be further trained by nurses to lead the sessions. Study variables will be measured before and immediately after the intervention and 6 and 12 months after the end of the sessions and will include: QoL, emotional impact, activation of the person, MS-related knowledge, fatigue, habits and lifestyles, health services use, and program-related experience. Baseline characteristics considered will be sociodemographic data, date of MS diagnosis and type, family history, and treatment characteristics. Variables related to disease follow-up will be new relapses and characteristics and changes in the ongoing treatment. The number of sessions attended will also be collected. Study variables will be analyzed using a pre-post comparison.

Discussion

Peer-led learning programs led by EP help empower people with chronic conditions and offer them tools to improve their autonomy and QoL. This study's intervention will be performed remotely, offering advantages both for people with chronic conditions and the healthcare system regarding the facilitation of family and work conciliation, saving time, simplifying attendance to meetings, lowering costs, and using fewer material resources.

Trial registration

NCT04988880 on September 22, 2021.

Peer Support Activities for Veterans, Serving Members, and Their Families: Results of a Scoping Review

For many, including military veterans and their families, support between individuals with shared lived experiences, or peer support, has long been utilized as a way to support each other through many different challenges. Building on other reviews and guided by the seven domains of well-being in the Canadian veteran well-being framework, the objective of this paper is to describe and catalogue the nature of peer support activities and related outcomes in the veteran, serving member, and family member populations. A scoping review following the five stages outlined by Arksey and O'Malley was conducted; it was guided by the question: What is currently known about peer support activities for veterans, serving members, and their families that has been evaluated in the literature? In total, 101 publications from 6 different countries were included in this review and catalogued based on publication characteristics, participant information, peer support activity information, and peer information. Peer support activities have the potential to positively influence the well-being of veterans, serving members, and their families on a holistic level across multiple domains. This scoping review highlights the existing gaps in the literature and provides an important foundation for future research on peer support for these populations, specifically in the Canadian context.

Evaluating the online delivery of an autistic-led programme to support newly diagnosed or identified autistic adults

Background & aims

Exploring Being Autistic is an autistic-led group-based programme providing psychoeducation and peer support to newly identified/diagnosed autistic adults. In 2020, due to social distancing measures implemented following the coronavirus pandemic, Exploring Being Autistic was adapted for online delivery. Here, we aimed to replicate previous research into the in-person delivery of Exploring Being Autistic, to determine whether similar results were obtained when the programme was delivered online. Further, we aimed to identify the unique opportunities and challenges that online delivery afforded.

Methods

We used a community-based participatory research (CBPR) approach, whereby the autistic developer and facilitator of Exploring Being Autistic worked collaboratively with a team of academic researchers throughout the research process. Together, we evaluated two iterations of the online Exploring Being Autistic programme, involving 16 attendees. Attendees completed questionnaires before, during and after the programme. Attendees were also invited to participate in two post-programme (group or individual) interviews: one following the completion of the programme (time one) and another 6-8 months later (time two). Attendees were included in the research if they completed at least one questionnaire or interview. Data were analysed qualitatively, using reflexive thematic analysis.

Results

Experiences of participating in the programme tended to be positive. Participants appreciated the autistic-led nature of the programme, found unity in the diversity of the group, and developed a positive and practical outlook as a result of the programme. Further analyses of our data revealed mixed views regarding the online delivery of the programme. Opportunities of online delivery were noted, such as this mode of participation reducing cognitive load, enabling the programme to be accessible to more participants, and fostering meaningful social connections among participants. However, technology and practical issues were felt to cause barriers, and some human aspects of participation were felt to be 'lost in translation' (e.g., in breakout groups).

Conclusions

The online delivery of the Exploring Being Autistic programme yielded similar results to previous, in-person evaluations of the programme. While we identified positive aspects of online delivery, this mode did not entirely suit everyone's needs.

Implications

From the current findings, we can make several recommendations to develop online support for autistic people. First, flexibility is key. To make support accessible and inclusive to a broad range of autistic people, the option for attendees to engage in-person, online or in hybrid formats should be considered. Second, if delivering support online, the use of breakout rooms should be carefully considered. While participants appreciated the opportunity to meet different people, some participants found the unpredictability and lack of scaffolding associated with breakout rooms challenging. To mitigate these challenges, groups could be pre-determined and shared with the attendees in advance (although consideration should be given to how the groups 'fit' together, and whether groupings should be changed at set intervals). Gentle warnings should also be given to those in breakout rooms, to alert them of the need to re-join the main group. Finally, support with technological aspects relating to engagement should be prioritised.

Effect of Short Course on the Knowledge and Practice of Housewives Peer Group Activists as Assistance to Lactating Mothers in Providing Exclusive Breastfeeding

Background

Efforts to increase the coverage of exclusive breastfeeding require extraordinary innovation supported by many parties, such as community leaders, including Housewives Peer Group activist living as a neighborhood of lactating mothers. The aim of this study was to analyze the effect of a short course on the knowledge and practice of Housewives Peer Group activists as assistance to lactating mothers in providing exclusive breastfeeding.

Methods

The method of the research was pre and post-test of quasi-experimental. The population was Housewives Peer Group activists in the working area of Tlogosari Wetan Community Health Center, Semarang City. Samples were chosen using purposive random sampling to 37 Housewives Peer Group activists. The intervention given was a short course which should be attended by the group, and the post-test was assessed 1 month after conducting the pre-test.

Results

The results of the Wilcoxson Match Paired test showed differences in knowledge (P < 0.05) and practice (P < 0.05) of the Housewives Peer Group activists before and after attending a short course regarding exclusive breastfeeding and lactation management. At the end of the study, the knowledge and practice of the Housewives Peer Group activists increased by 4.21 points and 3.73 points, respectively.

Conclusions

Short course on exclusive breastfeeding and lactation management significantly influences the increased knowledge and practice of Housewives Peer Group activists that further improve the quality of transferred information, monitor public health, especially to increase the coverage of exclusive breastfeeding and lactation management for breastfeeding mothers.

The Effect of Peer Teaching on the Quality of Report Writing Based on the Nursing Process

Background

Considering the importance of report writing and its problems, different teaching methods can be used to improve nurses' knowledge and performance, among which is peer teaching. This study aimed to determine the effect of peer teaching on the quality of report writing based on the nursing process.

Materials and Methods

This quasi-experimental study examined 60 nurses working in the surgical and cardiac wards of Razavi Hospital in Mashhad during 2019. These wards randomly assigned to intervention (n = 30) and control (n = 30) groups. For 2 weeks, report writing teaching was implemented for the intervention group based on the nursing process through peer teaching. The control group routinely performed report writing. At the beginning and end of the study, we reviewed nursing reports of both groups using a valid and reliable checklist. Data were analyzed using two-way analysis of variance with repeated-measures analysis of variance.

Results

Before the intervention, there was no significant difference between the two groups in terms of scores of report writing quality in structure, content dimensions, and the total scores (p > 0.05). After the intervention, the mean score changes were significantly higher in the structure (Mean Difference (MD) = 4.99, 95%CI: 1. 26-8.72, p < 0.010), content (MD = 8.11, 95%CI: 4.91-11.31, p < 0.001), and the total quality of report writing (MD = 7.54, CI: 4.56-10.53, p < 0.010) in the intervention group than the control group.

Conclusions

Peer teaching improved the nurses' quality of report writing. The teaching planners are recommended to use this method to train nursing staff.

Patient expectations and preferences for community-based hypertension classes with implications for action

BACKGROUND

Uncontrolled hypertension disproportionately affects Black men. Patient engagement with health promotion and health behavior programs for hypertension control is low. We held evidence-based hypertension classes at a Federally Qualified Health Center.

AIMS

The aim of this project was to elicit patient preferences and expectations for community-based hypertension classes.

METHODS

Group hypertension classes were held at a Federally Qualified Health Center. The priority population was Black men with hypertension. Semi-structured interviews were conducted with the group class attendees. Two independent coders performed content analysis using field notes from the interviews.

RESULTS

Seven group class attendees were interviewed. Six interviewees were Black males, one was a Black female, and the mean age was 65.7 years. Content analysis of the interview field notes revealed five content areas: (1) Recommendation of Group Classes to a Friend, (2) Expectations for the Group Classes, (3) Reasons for Continued Attendance, (4) Lifestyle Changes and Adopting the Group Class Lessons, and (5) Feedback and Recommendations to Improve Group Classes. Findings suggest that creating a cultural context in which open, transparent discussion of blood pressure occur can be achieved. Thus, regarding acceptability, classes fulfilled and often exceeded the attendees' expectations and needs.

LINKING EVIDENCE TO ACTION

Our findings suggest that community-based group classes are a viable intervention to contribute toward addressing the disparity of hypertension control among Black men. When designing peer-group interventions, taking patient preferences and expectations into account increases the effectiveness of these interventions. The qualitative narrative provided in this paper contributes to the development of similar community-based group classes for the management of severe hypertension.

Storytelling and training to advance individual recovery skills (STAIRS). A feasibility study of a blended program to support personal recovery among patients with a major depressive disorder in remission

Because major depressive disorder (MDD) has a strong negative impact on patients' lives, well-designed treatment programs are needed that address the lasting effects of MDD. Previous work has shown that such programs should not only focus on symptomatic recovery, but also on the subsequent personal recovery process. Currently, few programs with this specific focus exist. Therefore, this study aimed to assess the feasibility of a newly developed blended program to support the personal recovery process of MDD patients: Storytelling and Training to Advance Individual Recovery Skills (STAIRS). STAIRS is a program using peer support and guidance by experts by experience and clinicians, which can be added to regular depression treatment when symptomatic recovery is almost reached. Topics addressed in this program are: (1) effects of depression and treatment; (2) structure; (3) (self) stigma; (4) self-image; (5) meaning of life; (6) connection to others; (7) physical health; (8) relaxation; and (9) preventing relapse. Experiences with the STAIRS program were collected from five participating patients with questionnaires and a focus-group interview, as well as from four trainers using semi-structured interviews. Participants valued the topics addressed in STAIRS, the used working methods, the presence of an expert by experience and the ability to share experiences with peers. The use of an online platform and the involvement of others is seen as potentially supportive but turned out to be more challenging. Perceived effects of STAIRS include positive changes in participants' daily lives and their contacts with others. Overall, the results indicate that when implemented accessibly, STAIRS is a promising and feasible program to foster personal recovery among patients recovering from MDD.

Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research

Compelling evidence demonstrates that peer influence is a pervasive force during adolescence, one that shapes adaptive and maladaptive attitudes and behaviors. This literature review focuses on factors that make adolescence a period of special vulnerability to peer influence. Herein, we advance the Influence-Compatibility Model, which integrates converging views about early adolescence as a period of increased conformity with evidence that peer influence functions to increase affiliate similarity. Together, these developmental forces smooth the establishment of friendships and integration into the peer group, promote interpersonal and intragroup compatibility, and eliminate differences that might result in social exclusion.

A comparative study of the effect of two educational methods of motivational interviewing and peers on self-efficacy of female high school students in relation to puberty health

BACKGROUND

Adolescents experience many physical and psychological changes during adolescence. Not paying attention to the issue of girls' puberty may have a negative impact on their mental health and self-efficacy in future. The aim of this study was to compare the two methods of motivational interviews and peers on puberty health of female high school students.

MATERIALS AND METHODS

This study was performed semi-experimental intervention on 334 high school students in 2019 through multi-stage randomization. Data using two demographic questionnaires and Scherrer self-efficacy questionnaire in three stages (pre-test, immediately after the test and one month after the test). It was collected that in the motivational interview group, 5 training sessions were presented, and in the peer group, only one training session was taught to the peers and the control group was not trained in any intervention.

RESULTS

Immediately after, and 1 month after the intervention, the two intervention groups had significantly better scores in self-efficacy compared to the control group (P = 0.001). The mean score of self-efficacy in the control group in the three time periods before, immediately, and one month after the intervention, respectively (50.75 ± 5.322, 50.45 ± 5.34, 50.45 ± 5.37), in the motivational interview group (50.56 ± 5.95, 53.63 ± 5.83, 56.03 ± 6.49) and in the peer group (50.10 ± 5.62, 54.40 ± 4.28, 59.19 ± 4.43) was. Moreover, there were significant differences in self-efficacy scores within and between the groups by time (P < 0.001) in intervention groups.

CONCLUSION

This study showed that puberty health education increases students' self-efficacy, that correct information should be conveyed by peers and motivational interview, and motivational interview is more effective.

Frenemy: A New Addition to the Bullying Circle

Greater knowledge on the social complexities of bullying is crucial to reduce actual bullying behavior. Two main approaches have been used to study bullying: the participant role approach and the bullying circle. In this study, we explored bullying through interviewing adults who had been victims of school bullying in the past, investigating how they perceived their experiences, and how they interpreted the bullying context and their surrounding peer relations. We interviewed 20 participants (more than 18 years old), all of whom had experience of being bullied for more than 1 year. The interview data were then analyzed with a thematic analysis. We found that participants had a different definition of bullying compared with the standard definition formulated by researchers. They also confirmed the fluidity of participants' roles and the changes in behavioral patterns toward victims, depending on the peer context. Most importantly, we revealed a new participant in the bullying circle: the frenemy, whose intervention style changes from pro-victim when alone with the victim to neutral or pro-aggressor when surrounded by members of the bullying circle. This new addition adds to our understanding of the bullying process and the relationships within the bullying circle, which may help with more effective prevention.

The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial

BACKGROUND

Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas.

MATERIALS AND METHODS

This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations.

RESULTS

There was no significant difference in mean QOL between the two groups before the intervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group (P < 0.001).

CONCLUSION

Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients.

Evidence of Gender Violence Negative Impact on Health as a Lever to Change Adolescents' Attitudes and Preferences towards Dominant Traditional Masculinities

Women and girls experience gender violence from a young age. Scientific research has presented evidence of the negative impact of toxic relationships and toxic stress on physical and psychological health. However, less is known on how this evidence can have a preventive effect. Knowing these impacts can be important for women and girls to decide the type of affective-sexual relationships they want to have, and even transform their attraction towards different types of masculinity. This study presents results from the MEMO4LOVE project. Researchers use mixed-methods approaches, including a questionnaire (n = 141) to study adolescents' peer groups' interactions that promoted healthy or toxic affective-sexual relationships, and five communicative focus groups with boys and girls to analyze how these interactions can be transformed by sharing scientific knowledge on the effects of violent relationships with adolescents. The results showed the impact of sharing with adolescents the evidence of the adverse effects of toxic relationships with violent masculinities on health. The peer group's transformation occurred: non-violent boys gained self-confidence, and girls redirected or reinforced their attraction to non-violent boys. These results suggest the potential positive effects of knowing the impacts of toxic relationships on girls' health.

The Effect of Peer Support on Foot Care in Patients with Type 2 Diabetes

Background:

Diabetes mellitus is one of the prevalent diseases in the world with several complications including diabetic foot ulcers. The aim of this study was to investigate the effect of peer support on foot care in patients with type 2 diabetes.

Materials and Methods:

This clinical trial study was performed at selected centers of Isfahan University of Medical Sciences in 2017. Fifty patients with type 2 diabetes were randomly assigned into intervention and control groups. Five 30-min. supportive training sessions were held for the intervention group by the peers and during 35 days. Foot Care Confidence/Foot-Care Behavior Scale For Diabetes (FCCS-FCB) was completed by both groups before, immediately after and 1 month after the intervention. Collected data were analyzed using Chi-square, Mann–Whitney, repeated measures ANOVA and t-test.

Results

: Mean (SD) age of subjects was 56.46 (7.36) years old Mean (SD) score of self-efficacy (F_{2, 26} = 54.71, p < 0.001), preventive behaviors (F_{2, 26} = 28.46, p < 0.001), and potentially damaging (F_{2, 26} = 27.89, p < 0.001) had significant differences between the two groups immediately and 1 month after the peer support.

Conclusions:

Peer support can enhance foot care behaviors in diabetic patients. Therefore, using people who are successful in the education and support of patients has a significant role, and nurses can use them as a support in the field of care and follow-up. However, health agencies are responsible for providing the patients with the best guidelines, and these results can be useful as an evidence for them.

Exploring the potential for online peer support mentorship: Perspectives of pediatric solid organ transplant patients

OBJECTIVE

Self-management for patients who have undergone solid organ transplantation is demanding and a challenge for adolescents transitioning into adult-oriented healthcare systems. This study explores whether adolescent and young adult solid organ transplant patients support the use of online peer support programs that encourage peer mentorship as an approach to improve disease self-management.

METHODS

A qualitative descriptive design comprised of semi-structured interviews with adolescent and young adult transplant patients. Individual interviews were audio-recorded, transcribed verbatim, and subject to content analysis. Emergent categories and themes were refined through member checking and team consensus following saturation.

RESULTS

Interviews were conducted across organ groups with 15 participants (60% female) ages 14 to 22 years. Participants expressed unanimous support for an online peer support mentorship program to aid disease self-management in the pediatric transplant patient population. Three themes emerged from the interviews: (a) self-management care can be "taxing"; (b) there would be value in peer mentorship for adolescent transplant patients; and (c) online peer mentorship is the "best" option but still requires relationship building. Logistical preferences of an online peer mentorship program were solicited. The preferred peer "match" was someone of the same organ transplant group and gender who was able to have weekly contact via texting.

CONCLUSIONS

Creating tailored, online peer mentorship programs is gaining evidence to justify further development. Findings from this study will support program modifications for adolescent and young adult solid organ transplant patients. Next steps will involve usability and feasibility testing of an adapted online program for this patient group.

Weighing Risk Factors for Adolescent Victimization in the Context of Romantic Relationship Initiation

Research has paid little attention to the link between the characteristics of the relational context where adolescents are likely to initiate their romantic relationships and teen dating violence (TDV). Hence, the findings are still scattered. This study examined different risks in the female teenagers' relational context (peer group characteristics, participants' risky activities, and pressure to start dating) and their TDV victimization, which had not been previously studied in the Spanish population. The moderating role of parental monitoring strategies was also analyzed. Participants were 1,248 Spanish female teenagers who completed measures of the aforementioned factors. Highly victimized girls reported having more deviant and older male peers, receiving more pressure to start dating, and using more alcohol and drugs than participants with low victimization did. High parental monitoring was only effective to prevent TDV victimization in low-risk relational contexts. The findings extend prior research by providing evidence of the risk of pressure to start dating and low effectiveness of parental monitoring against high-risk peers. They also highlight the need to reduce specific risks of TDV in the adolescent relational context.

Nurses and midwives' experiences with peer-group clinical supervision intervention: A pilot study

AIM

This study aimed to evaluate differences in supervisees' understanding of clinical supervision and their perceptions of organisational functioning before and after engaging in peer-group clinical supervision.

BACKGROUND

Protected reflective time allows discussion of complex issues affecting health care. Peer-group clinical supervision is one model of clinical supervision that could facilitate this, but it is poorly understood.

METHODS

A pre-post intervention pilot study was performed. The intervention was delivered over a 12-month period. Data were collected using surveys on demographic and work-related factors and experience of clinical supervision pre- and post intervention.

RESULTS

Adaptability increased significantly between the pre- and post surveys. The post survey data showed finding time for clinical supervision scoring lowest with open-ended comments reinforcing this. The supervisees found the sessions to offer a safe place despite initial concerns.

CONCLUSION

The peer-group model of clinical supervision allowed supervisees to build a rapport and trust with their colleagues and share experiences.

IMPLICATIONS FOR NURSING MANAGEMENT

The benefits to participating in peer-group clinical supervision traversed the individual and organisation. These data support the implementation of such sessions while addressing workload and time pressures to aid participation.

Near-Peer Tutor: A Solution For Quality Medical Education in Faculty Constraint Setting

Near-peer mentoring is a formal relationship in which more qualified students guide immediate junior students. It is an innovative approach to increase students' engagement from varied backgrounds and cultures in the health profession. This systematic review and meta-analysis aimed to investigate and compare the effectiveness of near-peer tutoring and faculty/expert teaching in health science undergraduates on knowledge and skill outcome. The review question considered was "how effective is near-peer tutor compare to faculty/expert teaching for undergraduate health science students?" A comprehensive systematic search was undertaken in PubMed, Embase, Scopus, and Cochrane and screened initially in Rayyan software (Qatar Computing Research Institute, Qatar). Identified articles were screened independently for eligibility by two reviewers and extracted the data. Data were analyzed using standardized mean difference with Review manager version 5.5 (Cochrane Campbell Collaboration).  Sixteen studies were analyzed. Heterogeneity (I2) among studies was high in knowledge and skill scores. Heterogeneity was reduced by 30-40% after sensitivity analysis. No difference in knowledge and skill score was found among the near-peer and expert teaching groups. Students had a satisfactory learning experience with near-peer tutors except for some issues related to teaching proficiency in near-peers. Near-peer teaching was found to be as effective as faculty/expert teaching. Students were more comfortable with near-peers. As mentioned by students, some challenges were differences in teaching skills and level of knowledge among near-peers.

Early Attachment to Mothers and Fathers: Contributions to Preschoolers' Emotional Regulation

Children acquire and develop emotional regulatory skills in the context of parent-child attachment relationships, nonetheless empirical studies have focused mainly on mother and less information is available regarding the role of both parent-child attachment relationships. Furthermore, despite its importance, there is no information regarding preschool years. This study aims to fill this gap by exploring the potential influences of both mother-child and father-child attachments on preschooler's later emotion regulation observed in the peer group. Fifty-three Portuguese nuclear families (mother, father and focal child) participated in the study; 47% of the children were boys and 53% were girls. Attachment Security was assessed at home using the Attachment Behavior Q-set when children were 3 years of age, and emotion regulation was observed in the preschool classrooms attended by the children at age 5, using the California child Q-sort to derive an Emotion Regulation Q-Scale. Results showed that the combined influence of both parent-child attachment security predicted better emotion regulation results, than did the specific contributions of each parent per se. Findings are consistent with integrative approaches that highlight the value of including both mother- and father-child attachment relationships, as well as their combined effect, when studying emotion regulation.

Consider the Source: Examining Attrition Rates, Response Rates, and Preliminary Effects of eHealth Mindfulness Messages and Delivery Framing in a Randomized Trial with Young Adult Cancer Survivors

Purpose: Young adults with cancer often experience stress, depression, and anxiety. Mindfulness meditation is an effective intervention for these outcomes, and maintenance support may be needed for long-term improvements. eHealth technologies provide a promising delivery strategy for maintenance interventions. Methods: Following an 8-week mindfulness-based stress reduction (MBSR) course, 62 young adult cancer survivors were randomized to 8 weeks of instructor-framed messages, peer-framed messages, or no messages. On average, participants were 33.6 years old. The majority of participants were college-educated Caucasian females. We examined attrition rates between participants who received messages and those who did not, and compared response rates from different perceived sources. In addition, we evaluated the preliminary effects of eHealth support on mindfulness and associated outcomes. Results: No significant differences in attrition or message response rates across groups were observed. Repeated measures models revealed significant group by time interactions on perceived stress, anxiety, and depression. There were no differences between the groups that received eHealth messages and the group that did not. There was a significant difference in anxiety symptoms from post-MBSR to post-messaging between messaging groups. Individuals who received instructor-framed messages reported increased symptoms of anxiety over time. Conclusion: Attrition and response rates did not differ across groups, suggesting that eHealth may be a feasible strategy for providing maintenance support. However, further evaluation of feasibility, acceptability, and optimal content and dose of such an intervention is needed. Additionally, young adult cancer survivors may be more likely to benefit from eHealth interventions that are not delivered by authority figures.

Implementing Peer Tutoring for the Development of Empathy in Nursing Education

OBJECTIVES

This research sets out the effects of a training method based on peer tutoring, aimed at developing empathy among nursing students at the University of Barcelona (Spain).

METHODS

After initial training, students are matched in pairs with similar level of empathy, exchanging the role of tutor and tutee in every session, during 12 sessions. Before the session, the tutor prepares the activities to work with his or her tutee, following this structure: exploration of prior knowledge, explanation, practical activities, feedback, and reflection. Jefferson Scale of Empathy was administered as pre-test and post-test to 76 nursing students, 40 in the intervention group, and 36 in the comparison group. Following a mixed-methods sequential explanatory design, a quantitative study (a quasi-experimental design with a comparison group) was combined with a qualitative study (interaction analysis of the 12 videotaped sessions).

RESULTS

The results revealed statistically significant improvements in empathy in the intervention group. Subsequent analysis of the peer tutoring interaction highlighted the specific actions that had resulted in these improvements and generated a context in which the tutee was able to understand complex concepts, while enabling both students to participate, reflect and discuss.

CONCLUSIONS

Peer tutoring is an effective method for the development of empathy in nursing students.

The effect of peer group on self-care behaviors and glycemic index in elders with type II diabetes

BACKGROUND

Diabetes is one of the most expensive and chronic diseases of elderly age. Knowledge and self-care behaviors play an important role in treating diabetes and preventing its side effects. This study aimed to investigate the effect of peer group on self-care behaviors and glycemic index in the elderly with type II diabetes mellitus in Fasa city, Fars province.

MATERIALS AND METHODS

This quasi-experimental study was conducted on 100 elderly patients with type II diabetes (50 patients in the intervention group and 50 in control group) referred to the diabetes center. Among the elderly, the intervention group was selected as a trainer based on the checklist of the peer group and was trained by the researcher. In addition to the usual care of the diabetes clinic, the patients in the intervention group received training from their peers for 8 weeks during 8-45 min of training sessions. Data were collected using a valid self-reported questionnaire including demographic variables, awareness, and diabetes self-care behaviors (Summary of Diabetes Self-care Activities), as well as free practice (fasting blood sugar [FBS] and hemoglobin A1c [HbA1c]), which was completed by both groups before and 2 months after the intervention. Then, the data were entered into the SPSS statistical software, version 22 and were analyzed using Chi-square test, independent t-test, and descriptive statistical methods. P < 0.05 was considered statistically significant.

RESULTS

The results showed that the two groups of intervention and test were identical in terms of demographic information. In the intervention group, before and after 2 months of educational intervention, there was a significant difference in increasing awareness and self-care behavior in diet, physical activity, blood sugar testing, foot care, and medication (P < 0.001). However, this difference was not significant in the control group (P < 0.05). In the intervention group, the mean FBS and quarterly (HbA1c) index decreased significantly (P < 0.05).

CONCLUSION

This study showed that teaching self-care program, in the same way, has been effective in improving self-care behavior and blood sugar index in the elderly with diabetes and suggested that this educational method be used in other chronic diseases.

The effect of peer group education on anxiety, stress, and depression in older adults living in nursing homes

Background:

The effects of peer education have been addressed in different populations, but this method of education has not been applied in the elderly population of Iran, and its effect has not been studied. The present study investigated the effects of peer group education on anxiety, stress, and depression of the older adults living in nursing homes.

Materials and Methods:

This research is a quasi-experimental study with an intervention and control group and it was conducted on 70 elderly citizens living in Qom nursing homes in July 2017. For the intervention group, a relaxation and stress reduction program was trained through the peer group. The control group received routine care. Data were collected using a Demographic information questionnaire and Depression Anxiety Stress Scale-21 (DASS-21). Data were collected at the beginning, 10 and 30 days after the intervention. Data analysis was performed using SPSS 19, descriptive statistics, and repeated measure analysis of variance.

Results:

The results of the study showed no significant difference between any of the demographic variables at the beginning of the study (p > 0.05). The statistical test showed that the effects of time (p < 0.001) and group (p < 0.011) were significant on anxiety, stress, and depression.

Conclusions:

The results of this study showed that peer education could decrease anxiety, stress, and depression in the elderly. Therefore, this educational method can be used by nurses to promote various health education programs, e.g., to health promotion and prevent disease especially in the elderly community.

Evaluating the effectiveness of the Family Connections program for caregivers of youth with mental health challenges, part I: A quantitative analysis

INTRODUCTION

Caregivers of youth with mental health (MH) challenges are often faced with complex problems in relation to caring for their youth. Family Connections™ (FC) is a 12-week skills training program for families of individuals with MH challenges, developed originally for Borderline Personality Disorder. Research is needed to examine the effectiveness of FC for caregivers of youth with diverse MH challenges.

OBJECTIVE

To examine the effectiveness of FC for caregivers of youth with MH challenges.

METHODS

A total of 94 caregivers of youth with MH challenges participated in FC, across three sites in Ontario, Canada. Assessments occurred at baseline, 6 weeks, 12 weeks and follow-up. Primary outcomes include the Burden Assessment Scale and The Stress Index for Parents of Adolescents. Secondary outcomes included the caregiver's report of child behaviour, affect, mastery, coping and grief. Linear mixed model analyses were conducted, where time and the time × site interaction were defined as the fixed effects.

RESULTS

Statistically significant improvements over time were observed across outcome measures, including caregiver burden, grief, coping, and other measures. The time × site interaction was only significant for burden (P = .005).

CONCLUSION

This study demonstrates the effectiveness of FC for caregivers of youth with MH challenges. Future research should focus on differences across geographical sites and facilitation models.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers were involved in the facilitation of FC. A person with lived experience was involved in analysing the data, reporting the results, and drafting the manuscript.

A comparison between the effects of school-based education programs provided by peer group versus health practitioners on premenstrual syndrome in adolescents: A protocol for a non-masked clinical trial

Aim

To compare the effect of school‐based education programs, by peer group versus health practitioner on Premenstrual Syndrome (PMS) in adolescent girls.

Design

Non‐masked three‐armed clinical trial.

Methods

Ninety 11th‐grade students with moderate to severe PMS will be allocated to Intervention Group 1 (IG1), Intervention Group 2 (IG2) and Comparison Group (CG). Three weeks (six online sessions) of parallel education will be implemented in IG1 by trained peer educators and in IG2 by a health practitioner. The primary outcome will be changes in PMS severity score between three groups over time (measured by Daily Record of Severity of Problems). Secondary outcomes include changes in Premenstrual Dysphoric Disorder and General Health. Data collection will be conducted in two‐time points, at baseline, and at the end of the intervention.

Results

Our study will explore the effect of school‐based education programs, by peer group versus health practitioner on PMS. This will add to the evidence‐based interventions to PMS management and the effectiveness of peer education in health promotion of adolescents girls.

The Effect of Peers Support on Fear of Hypoglycemia in Iranian Patients with Type 1 Diabetes: A Clinical Trial Study

Background

Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes.

Materials and Methods

This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test.

Results

The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t₅₃ = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t₅₃ = -2.13, p = 0.03).

Conclusions

Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Evaluating the effectiveness of the Family Connections program for caregivers of youth with mental health challenges, part II: A qualitative analysis

Background

The Family Connections™ (FC) program is a 12‐week support and skill‐training program for caregivers of youth with mental health challenges. The intervention was originally developed with a focus on borderline personality disorder (BPD). It is important to understand the experiences of caregivers in such interventions, as well as its applicability beyond BPD, for the purposes of evaluation and ongoing program improvement.

Objective

To explore and analyse the experiences of caregivers of youth with diverse mental health challenges and who participated in FC.

Design

Semi‐structured interviews with thirteen FC‐participating caregivers of youth with mental health challenges.

Results

Thematic analysis uncovered three major themes regarding caregivers' experience with FC: (a) FC increased the caregivers' ability to manage their youth's mental health challenges; (b) participating in FC impacted their intra‐ and interpersonal spheres; and (c) improvements to the program were proposed. Following participation in FC, caregivers felt they learned a new approach to understanding themselves, their youth and mental health, and were better able to manage their youth's mental health challenges.

Discussion and conclusion

FC is a promising intervention for caregivers of youth with mental health challenges, beyond the traditional BPD focus. The intervention has the potential to provide broad‐based benefits for caregivers and should be considered for implementation and scale‐up across youth‐ and caregiver‐serving organizations. Potential areas of intervention flexibility and improvement are discussed.

Patient/public contribution

Caregivers were involved in the program development and facilitation of FC. A person with lived experience was involved with the analysis.

Lessons from implementing community-based group classes for severe hypertension

Due to the impact of persistent structural racism, Black men have low rates of hypertension treatment and control despite having high rates of hypertension-related mortality. Peer-based education can improve blood pressure monitoring and lower blood pressure in Black men with hypertension. To address this disparity, we implemented weekly community-based group classes for severe hypertension at a Federally Qualified Health Center. After 9 months, 28 classes were held and 96 individuals were served. Fifty-six percent of the person-hours of attendance have been by Black men. Seven individuals were interviewed about their perspectives and preferences for the classes. They reported that the peer-based model of the group classes was advantageous, and they would recommend the classes to a friend. Successes of implementation included (a) ability to facilitate medication adjustments for participants with blood pressure readings that were over target goal, (b) capacity to give participants take-home blood pressure monitors, (c) and the community-centered approach. Challenges included variability in attendance by participants and retention of individuals with uncontrolled hypertension in primary care. These findings have implications for other Federally Qualified Health Centers seeking to design similar health promotion programs and policy makers evaluating the funding and reimbursement models for community-based disease management programs.

Gender violence among youth: an effective program of preventive socialization to address a public health problem

Gender violence among youth is a worldwide public health problem. Youth is increasingly exposed to violence in sexual-affective relationships, both stable and sporadic, and the age of victimization decreases. This adverse life experience affects many areas of youth's life, such as education, social relationships and, especially, their physical and mental health, with consequences that can be very harmful in the short and long-term. This situation has given rise to many anti-violence programs for adolescents and youth, yet as some worldwide prestigious organizations, like the American Psychological Association, have pointed out, many of those programs do not work. In this article, we present a program of preventive socialization of gender violence addressed to adolescents that has proven effectiveness. The program was composed of seven interventions based on the social impact of the evidence on preventive socialization of gender violence. It was applied at a group level in groups of 15-16 years old teenagers in three high schools in Barcelona. The interventions were conducted over a period of one school year and shared the trait of discussing research evidence on preventive socialization of gender violence with the youth through egalitarian dialogue. These interventions have proved to have a preventive effect of gender violence victimization on the participating teenagers by raising their critical consciousness regarding a coercive dominant discourse in society that associates attractiveness and violence, supporting the transformation of their memories of violent sexual-affective relationships, and providing them tools to better analyze their and their friends' sexual-affective relationships along the lines of identifying gender violence and being more prepared to help others in this regard. The manuscript describes every intervention applied.

Peer teaching under pandemic conditions - options and challenges of online tutorials on practical skills

Background: Within days, the corona crisis has forced the "Lernzentrum", as well as all other places of training and further education, to discontinue classroom teaching at German universities and vocational schools. In order to start teaching online, tutors had to face the challenge to develop new digital learning formats (virtual classrooms) for the peer teaching of practical skills within a short time. This paper aims at outlining the project of developing e-tutorials with regard to the teaching of practical skills. Methodology: After analyzing the classroom lessons (n=30), some of the tutorials were transformed into digital formats. These so-called "e-tutorials" were held via a digital platform. They have been evaluated continuously with a standardized online questionnaire. The results of this evaluation have been analyzed descriptively. Results: From 27/04/2020 to 17/07/2020 eleven different e-tutorial formats were offered on 246 dates. The evaluation revealed a high degree of acceptance with these course offers as well as with the implementation by the tutors. Interpretation: During the pandemic crisis the substitution of peer teaching into forms of e-tutorials was considered valuable; however, these learning formats present challenges, especially with regard to the interaction between teachers and students. They cannot therefore fully replace the peer teaching of practical skills.

"Your Friends Do Matter": Peer Group Talk in Adolescence and Gender Violence Victimization

Research on gender violence has identified as one main component leading to gender violence a dominant socialization process which associates attractiveness to men who show violent behaviors and attitudes, while egalitarian and non-violent men are emptied of attractiveness. This is known as coercive dominant discourse. Starting from the evidence that the peer group is a main context of socialization in adolescence, quantitative data were collected from six classes of secondary education (14–15-year-old adolescents) to explore whether the coercive dominant discourse is displayed in social interactions in the peer group and, if so, how it influences attractiveness patterns and sexual-affective behavior in adolescence. The analyses reveal that the coercive dominant discourse is often reproduced in the peer group interactions, creating group pressure, and pushing some girls to violent relationships. Alternative ways of interaction are also reported, which allow a socialization leading to more freedom, less coercion, and more healthy relationships.

Association between Friends' Use of Nicotine and Cannabis and Intake of both Substances among Adolescents

Nicotine and cannabis use are common among adolescents and may be associated with behavioral problems, poor academic outcomes and use disorders. The goals of this analysis were the following: (1) Describe the influence of friends’ nicotine and cannabis smoking and vaping on self-reported use. (2) Describe the relationship between friends’ nicotine and cannabis use on participants’ urinary biomarkers of nicotine (cotinine) and cannabis (11-nor-9-carboxy-Δ⁹tetrahydrocannabinol=THC-COOH). This is a secondary analysis of survey and biomarker data collected in adolescents aged 12–21 between April 2017 and April 2018, in Long Island, New York. Bivariate and multivariable analyses were conducted using SPSS 26. A cutoff value of ≥10 ng/mL was used to signify recent usage for urinary cotinine and THC-COOH levels. Over one-third of the 517 surveyed adolescents reported using tobacco and one-third reported using cannabis. A significant relationship between friends’ substance use and self-use was found. For both tobacco and cannabis, over 90% (p < 0.01) of participants with urinary biomarker levels above cutoff had friends who used the respective substance. Friends’ nicotine and friends’ cannabis use were each independently associated with urinary biomarker levels for those substances (for nicotine, beta = 88.29, p = 0.03; for cannabis, beta = 163.58, p = 0.03). Friends’ use of nicotine and cannabis is associated with adolescents’ intake, as well as the physiological exposure to those substances. These findings underscore the importance of including peer influence in the discussion with adolescents about tobacco and cannabis use.

A Conceptual Model to Improve Care for Individuals with Alzheimer's Disease and Related Dementias and Their Caregivers: Qualitative Findings in an Online Caregiver Forum

BACKGROUND

As the population rapidly ages, a growing number of families are engaging in care for individuals living with Alzheimer's disease and related dementias (ADRD). The perceived challenges and burdens that face informal caregivers are enormous.

OBJECTIVE

The objective of this study was to 1) explore from the family caregivers' perspective, the daily lives of individuals living with ADRD, and the challenges family caregivers encounter when caring for a family member with ADRD; and 2) to develop a comprehensive model with the endeavor to improve care for individuals with ADRD and their family caregivers.

METHODS

Posts were extracted from the ALZConnected online caregiving forum in May 2019. Guided by a triangular model focused on Caregiver, Individual with ADRD, and Context of Care, two researchers independently analyzed 654 posts with a combination of deductive and inductive thematic analysis approach. Researchers all agreed on finalized codes and themes.

RESULTS

Thematic analysis resulted in four themes: Individual with ADRD, Caregiver, Dynamic between Caregiver and Individual with ADRD, and Context of Care. The most frequently discussed topics among caregivers were informational and emotional support for caregivers, and the capabilities and functioning of individuals with ADRD.

CONCLUSION

Online forums provide a valuable platform for caregivers to support each other informationally and emotionally, share care strategies, and navigate caregiving burdens. An expanded model was derived to support a comprehensive and dynamic approach to improve care for both caregivers and individuals with ADRD. The unique nature of the caregiver forum data is worthy of further data mining using a novel analysis approach.

Analyzing the Relationship Between Child-to-Parent Violence and Perceived Parental Warmth

The relationship between child-to-parent violence (CPV) and the perceived parental warmth dimension has been well established. However, it is necessary to further investigate the nature of this relationship considering the involvement of other variables. The objective of this study was to analyze the role of cognitive (hostile attribution), emotional (anger), and social variables (deviant peer group and drug use) in the relationship between the perceived parental warmth dimension (warmth-communication and criticism-rejection) and CPV motivated by reactive or instrumental reasons. The community sample consisted of 1,599 Spanish adolescents (54.8% girls) between the ages of 12 and 18 years (M_age = 14.6, SD = 1.6 years) from different secondary schools in Jaén (75.3%) and Oviedo (24.7%) (Spain). Each participant completed the Child-to-Parent Violence Questionnaire (CPV-Q), the Warmth Scale (WS), adolescents’ version, the Social Information Processing (SIP) in Child-to-parent Conflicts Questionnaire and Deviant Peers and Drug Use Questionnaires. The results indicate that perceived parental warmth is negatively correlated with hostile attribution, adolescent anger, relationship with a deviant peer group, while perceived parental criticism is positively linked to these variables. Likewise, hostile attribution and adolescent anger are positively linked to reactive CPV. Relationship with a deviant peer group is associated with drug use, which also predicts both reactive and instrumental CPV. In sum, a lack of perceived parental warmth has important repercussions in the form of the psychological and social maladjustment of children, which in turn is differentially correlated with reactive or instrumental CPV. Thus, prevention and intervention programs for CPV should consider, on the one hand, working with parents on parental practices that incorporate parental warmth as a fundamental element and, on the other hand, working with children on cognitive, emotional, and social aspects, taking into account the different motivations for this type of violence.

Can We Use Peer-Assisted Learning to Teach Basic Surgical Skills?

Background

It is reported that medical students do not receive adequate opportunities to learn surgical skill and are at risk of being unable to perform simple surgical procedures safely. The usefulness of peer-assisted learning (PAL) as a tool to assist in delivering surgical skills training is worth exploring.

Methods

This is a randomised single blinded controlled trial. Fourth-year students from the university’s Surgical Society were asked to volunteer as peer tutors and those in 3rd-year were asked to undertake surgical skills training. A cohort of 35 students were selected and randomised to receive basic surgical skills training conducted either by faculty members or peers. The students’ performance of basic suturing skills was assessed using a checklist, through directly observed procedural skills (DOPS) technique. The assessment was conducted by faculty blinded to the training. Students’ perception to surgical skills training was assessed using a questionnaire survey.

Results

The suturing and knotting skills of students learned from their peers was comparable to that acquired from faculty. The students’ perceived that their peers could conduct surgical skills training similar to their faculty.

Conclusion

PAL approach for basic surgical skills training is as effective as faculty-led training. PAL has the potential to optimise the delivery of surgical skills training in undergraduate medical education.

A Community of Practice of primary health care occupational therapists: Advancing practice-based knowledge

INTRODUCTION

New contexts of practice demand that professionals engage in critical reflection to handle new situations and to create new knowledge that is responsive to professional practices situated in unique historical and social contexts. Community of Practice offers a framework for professions to reflect together on practice dilemmas and to generate practical solutions.

METHODS

This paper presents a participatory action research project that traces the trajectory of a Community of Practice made up of seven occupational therapists working in primary health care and a researcher team, in Brazil. This study mapped the Community of Practice's trajectory between 2013 and 2017 through a group timeline analysis, which occurred gradually, in a collaborative mode.

RESULTS

Three distinct phases in the trajectory of the development of the Community of Practice were identified: narrative perspectives were utilised as a means to identify dilemmas and difficulties in practice; the investigation of clients' needs and identification of issues was an ongoing process; and the generation of practice-based knowledge through the development of instruments to sustain clinical reasoning was a creative solution to practical dilemmas.

CONCLUSION

Three main aspects were highlighted: the partnership between researchers and practitioners as a potential avenue for the production of knowledge relevant to professional practice; the negotiation of the dilemma of "putting practice into words" in the context of constantly changing local and global perspectives; and the investigation of situated practice as an important element that can strengthen, strain, resist or even modify hegemonic perspectives of knowledge production in our field.

The journey of sensemaking and identity construction in the aftermath of trauma: Peer support as a vehicle for coconstruction

Sensemaking is rooted in identity construction and it is a particularly interpersonal process. Moreover, traumatic experiences are known to cause people to engage in sensemaking processes and identity construction. However, knowledge of how this works in an interpersonal, community setting, is lacking. The aim of this study is to assess how peer support contributes to the sensemaking processes and identity construction in the aftermath of trauma. Data from an observational study of organised peer support groups for (co)victims of serious crimes and survivors of traumatic loss were analysed using inductive thematic analysis. Results show how participants of peer support groups move through several phases of sensemaking and identity construction in a fluid, dynamic, way. Identity work is collectively done. Through coconstruction of their identities, participants are able to make sense of a traumatic experience and progress towards a more self-aware and self-centred identity.

Challenges and Benefits of an Internet-Based Intervention With a Peer Support Component for Older Adults With Depression: Qualitative Analysis of Textual Data

Background

Technological interventions provide many opportunities for improving the health and quality of life of older adults. However, interaction with new technologies can also cause frustration. Although these themes have been explored in extant research, much remains to be learned with regard to how the challenges of aging and technology use and the experiences of participating in a social and learning environment are interrelated.

Objective

This study aimed to perform a qualitative analysis of data collected from MoodTech, a pilot study of an internet-based intervention with a peer support component for older adults with symptoms of depression, to better understand the participants’ experience of using technological interventions, including the challenges and benefits that they experienced over the course of these interventions.

Methods

We employed an inductive qualitative analysis method based on grounded theory methodology and interpretative phenomenological analysis to analyze participant textual data. These textual data were of 3 main types: (1) assignments in which participants challenged their negative thoughts, (2) status updates, and (3) comments in the peer support component of the intervention.

Results

We have presented the results through 3 main themes: (1) the challenges of aging as seen through the participants’ comments, (2) the difficulties experienced by the participants in using MoodTech, and (3) the benefits they derived from participating.

Conclusions

This paper offers several contributions concerning study participants’ experiences with internet-based cognitive behavioral therapy (iCBT) interventions with a peer support component and design considerations for developing complex technological interventions that support the challenges participants experience due to aging and cognitive difficulties. First, technical issues encountered by older adults within the context of the intervention can interact with and exacerbate the insecurities they experience in life, and it is important to consider how intervention components might be designed to mitigate these issues. Second, peer support can be employed as a mechanism to facilitate communication, support, and collaborative problem solving among participants in an intervention. The insights from this paper can inform the design of iCBT interventions for older adults.

Healthcare professionals' perceptions of the implementation of the transitional discharge model for community integration of psychiatric clients

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes.

An Evaluation of By My Side: Peer Support in Written Form is Acceptable and Useful for Parents Bereaved by Childhood Cancer

CONTEXT

Cancer is the leading cause of nonaccidental death in childhood, with the death of a child representing a devastating loss for families. Peer support offers a valuable way to support parents' adjustment in bereavement. The By My Side book provides written peer support by sharing bereaved parents' stories to normalize grief experiences and reduce parents' isolation. It is available free of charge.

OBJECTIVES

This project evaluated the acceptability, relevance, emotional impact, and usefulness of By My Side.

DESIGN

Bereaved parents and health care professionals (HCPs) provided feedback via a questionnaire. We used descriptive statistics and qualitative analysis of open-ended responses to analyze the data.

SETTING/PARTICIPANTS

We mailed a study invitation and evaluation questionnaire to parents and HCPs who ordered a copy of By My Side.

RESULTS

About 24 bereaved parents and seven HCPs provided feedback. Parents thought the book's length (91.7%) and amount of information (83.3%) was just right. About 75% of parents reported that the book made them feel that their reactions to their child's death were normal and/or appropriate. Parents reported positive and negative emotional reactions to the book (e.g., 87.5% felt comforted, 87.5% felt sadness). All parents and HCPs reported that the book provided useful information about grief. About 83.4% of parents and 85.7% of HCPs would recommend it to others.

CONCLUSION

By My Side was acceptable and useful to bereaved parents and HCPs. Results suggest that peer support in written form may help normalize aspects of grief and comfort parents bereaved by childhood cancer.

Challenges to Introducing Integrated Diabetes Care to an Inner-Regional Area in South Western Sydney, Australia

Introduction

Diabetes care often requires collaboration between general practitioners, allied health professionals, nurses, and/or medical specialists. This study aimed to describe the establishment of an integrated diabetes prevention and care approach in an area with limited access to primary and secondary care, and the challenges faced in its initial development.

Description

A qualitative research approach to identify challenges was taken. Data included meeting minutes, observational data and reports involving local clinical and non-clinical stakeholders from June 2016- December 2018 and were thematically analysed.

Discussion

Key challenges were low patient attendance in general practice, healthcare professional time, low participation at health promotion activities/peer support groups and diabetes education reflecting a low priority among people with and at risk of diabetes. Coordination between services remained a challenge.

Conclusion

This study highlights the need to integrate new diabetes services with existing health activities in the community and the importance of allowing flexibility and regular contact with local healthcare professional and community to encourage their involvement. Regular meetings with the funders, internal and external stakeholders are key for sustainability and to adapt programmes to the local situation. Further work is needed to identify and implement strategies to overcome these challenges.

Patients' Use of Social Media for Diabetes Self-Care: Systematic Review

Background

Patient engagement with diabetes self-care is critical to reducing morbidity and mortality. Social media is one form of digital health that is available for diabetes self-care, although its use for peer-to-peer communication has not been systematically described, and its potential to support patient self-care is unclear.

Objective

The primary aim of this systematic review was to describe the use of social media among patients (peer-to-peer) to manage diabetes and cardiovascular disease (CVD). The secondary aim was to assess patients’ clinical outcomes, behavioral outcomes, quality of life, and self-efficacy resulting from peer-to-peer social media use.

Methods

We conducted a literature search in the following databases: PubMed, EMBASE, Web of Science, CINAHL, and PsycINFO (January 2008 through April 2019). The inclusion criteria were quantitative studies that included peer-to-peer use of social media for self-care of diabetes mellitus (with all subtypes) and CVD, including stroke.

Results

After an initial yield of 3066 citations, we selected 91 articles for a full-text review and identified 7 papers that met our inclusion criteria. Of these, 4 studies focused on type 1 diabetes, 1 study included both type 1 and 2 diabetes, and 2 studies included multiple chronic conditions (eg, CVD, diabetes, depression, etc). Our search did not yield any individual studies on CVD alone. Among the selected papers, 2 studies used commercial platforms (Facebook and I Seek You), 3 studies used discussion forums developed specifically for each study, and 2 surveyed patients through different platforms or blogs. There was significant heterogeneity in the study designs, methodologies, and outcomes applied, but all studies showed favorable results on either primary or secondary outcomes. The quality of studies was highly variable.

Conclusions

The future landscape of social media use for patient self-care is promising. However, current use is nascent. Our extensive search yielded only 7 studies, all of which included diabetes, indicating the most interest and demand for peer-to-peer interaction on diabetes self-care. Future research is needed to establish efficacy and safety in recommending social media use among peers for diabetes self-care and other conditions.

Peer support interventions in type 2 diabetes: Review of components and process outcomes

BACKGROUND

This review seeks to identify (a) the various components and process outcomes of type 2 diabetes peer support (PS) interventions and (b) the measures implemented to monitor intervention fidelity and evaluate outcomes in these studies.

METHODS

The MEDLINE, PubMed, EMBASE (Excerpta Medica Database), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched from inception to May 2019. Two reviewers independently screened and extracted data from eligible articles via the Template for Intervention Description and Replication (TIDieR) checklist (why, what, who provided, how, where, when and how much, tailoring, modifications, and how well).

RESULTS

Twenty-three trials were included. The total number of participants was 7178. Most interventions were in primary care. Although face-to-face was the most common modality of contact, rates of contact were highest for telephone. Potential peer leaders (PLs) were identified primarily through recommendations from health professionals, based on their communication skills, glycosylated hemoglobin (HbA1c), and coaching interest. PLs were mostly female, university educated, and had a long history of diabetes (≥ 10 years). PL training varied significantly in length and content; the two most frequent topics were communication skills and diabetes knowledge. Although several studies implemented methods to evaluate "intervention fidelity," only few rigorously assessed the two key components of fidelity, "adherence" and "competence," through audio- and video-taping or direct observations.

CONCLUSIONS

The impact of PS on participants' health outcomes is well investigated; however, the implementation and evaluation strategies vary significantly across these studies. In the present review, we define the various components of PS interventions and propose suggestions for enhancing the implementation and evaluation of future PS models.

Experiences of sharing, learning and caring: Peer support in a Finnish group of mothers

Mothers' peer groups constitute a form of communal support that affords potential benefits but has received little attention in Finland. At present, only a few studies have investigated the support provided by peer groups of mothers. This article explores mothers' experiences of peer support in a Finnish peer group. First, the data gathered in 2015 comprise data from thematic interviews with 23 mothers participating in peer group activities. Second, the data include written notes gathered during participant observation in the group's 12 meetings, two outings and summer camp. The data were analysed by utilising a phenomenological-hermeneutic approach, and three themes representing mothers' experiences were identified: (a) sharing of experiences, (b) learning from experiences and (c) experiences of mutual caring. By exploring relationships among these themes, this study found that the sharing of experiences is a starting point for learning and caring among mothers. These findings suggest that the sharing of experiences is a crucial part of peer support because it results in learning and caring. Versatile support can be enabled by strengthening the preconditions for sharing.

"Architects of Their Own Brain." Social Impact of an Intervention Study for the Prevention of Gender-Based Violence in Adolescence

Research in psychology has evidenced both the prevalence of gender-based violence among youth worldwide and the negative impacts that such violence has on the victims’ mental and physical health. Neuroscience has proven that violent intimate relationships harm the brain, while very simple social experiences can change the brain architecture in positive directions. Also, interventions that have been demonstrated to be successful in preventing and responding to gender violence in adolescence have been informed by psychology. This article reviews the social impact of psychology in the field of teen gender violence and then reports on the potential social impact achieved by an intervention study consisting of seven interventions framed by the research line on the preventive socialization of gender violence. The program was addressed to 15- and 16-year-old adolescents and focused on supporting free reconstruction of mental and affective models of attractiveness via critical analysis of the dominant coercive discourse, which links attraction to violence. The communicative methodology involved working with an Advisory Committee from the beginning of the study, as well as continuous dialog between the researchers and the participants, which was used to refine subsequent interventions. The results show that the program contributed to raising participants’ critical consciousness regarding the dominant coercive discourse in their life, provided the participant subjects with cognitive tools to better understand their own and others’ sexual-affective thinking, emotions, and behaviors, in favor of rejecting violence, and supported the modification of female adolescents’ sexual preferences for different types of men. Importantly, the findings also indicate that the interventions aided some participants’ use of the knowledge gained in the project to help their friends and communities in reflecting upon coercive patterns of sexual attraction, the quality of their intimate relationships, and the different effects of sexual violence and toxic relationships on health. Some individuals reported leaving toxic relationships after the interventions. This intervention research illustrates Santiago Ramón y Cajal’s metaphor, employed to explain plasticity: that every person, if s/he decides it, can be the architect of her or his own brain. With evidence-based cognitive tools within the reach of every adolescent, and upon individual free choice for transformation, a new sexual-affective socialization free from violence is possible.

Peer education for medical students on health promotion and clinical risk management

CONTEXT

Health promotion (HP) and clinical risk management (CRM) topics are seldom discussed during medical school lessons. Peer-assisted learning (PAL) has long occurred informally in medical education, and interest in this method has recently grown, as it is considered a valuable technique for both tutors and tutees.

AIMS

The aim was to evaluate the impact of HP and CRM PAL intervention on medical students' (tutees) knowledge level.

SETTINGS AND DESIGN

A PAL intervention has been implemented at Udine University medical school during 2017. It was composed of lectures and practical activities conducted by ten near-peer tutors.

METHODS

The effectiveness has been evaluated by giving tutees: (1) a knowledge multiple-choice questionnaire, before and after the intervention; (2) a satisfaction questionnaire; and evaluating (3) tutees' group assignments.

STATISTICAL ANALYSIS USED

We performed descriptive analysis; then McNemar, Wilcoxon signed rank, Wilcoxon Mann-Whitney, and t-tests were applied.

RESULTS

The number of students addressed by PAL intervention was 62. Difference in total correct answers among pre- and post-intervention questionnaires showed a statistically significant improvement (P < 0.0001), both when analyzing it globally and by area (HP/CRM). Students' satisfaction for CRM was greater than for HP area (P = 0.0041).

CONCLUSIONS

This educational intervention based on PAL showed its effectiveness producing a statistically significant improvement in students' knowledge. Our findings confirm that PAL could be a feasible method for HP and CRM topics.

Toxic Nightlife Relationships, Substance Abuse, and Mental Health: Is There a Link? A Qualitative Case Study of Two Patients

Introduction and Aims: This article explores the role of toxic close relationships in night life on substance use disorders and mental health conditions. We also contrast the quality and effects of social relationships when doing drugs with those produced by a mental health program that fosters quality relationships between patients. Design and Methods: This qualitative case study was carried out at a mental health day care center of a hospital in Malaga (Spain). The cases of two patients with severe mental disorders and a history of drug addiction were analyzed. Data were collected through in-depth interviews with every patient, semi-structured interviews about each patient with the psychologist of the medical team of the program, and medical documentation. The analysis involved a combination of inductive and deductive approaches. Results: The analysis of the data revealed, on the one hand, the influence of toxic relationships in nightlife, including violent sporadic sexual relationships, in the initiation and persistence of substance use that took part of the mental health disorder in these patients. On the other hand, the findings show that these participants' current involvement in a mental health program, which fosters quality relationships between patients, has brought emotional benefits to both of them. Discussion and Conclusion: This paper points out the relevance of considering quality of social relationships when examining substance use disorders and related mental health problems. Additionally, the findings indicate the importance of fostering quality peer relationships in mental health rehabilitation programs addressed to patients with histories of drug addiction to improve treatment outcome.

Perceptions On Reciprocal Peer Teaching Among Medical Students As Learners And As Tutors

OBJECTIVES

The College of Medicine at Imam University has incorporated reciprocal peer-teaching into the curriculum in the form of peer-led seminars. The aim was to evaluate this program and ascertain student perceptions.

METHODS

A cross-sectional survey of medical students attached to the Internal Medicine I and II courses was conducted in 2018. The questionnaire evaluated perceptions about the peer-teaching program, tutors' knowledge, skills and attitudes, both from a student and a tutor perspective.

RESULTS

Based on a 63% response rate from a total of 410 students, 34.5% of learners agreed that peer-tutoring was the most effective method of clinical teaching and 30.3% disagreed. More students reported that peer-led seminars did not prepare them for their exams (38.4%) compared to those who reported it did (27.9%). More than 40% of participants reported the tutors were approachable, created a welcoming learning environment and provided targeted information. From a tutor perspective, more than 70% of participants reported that they developed personally and professionally, improved their collaborative, communication, tutoring and presentation skills and confidence. Female students reported they benefited more as tutors compared to male students.

CONCLUSION

Students regard obligatory reciprocal peer-teaching in the form of peer-led seminars as similar to faculty teaching and an overwhelming majority report that they benefit both personally and professionally from leading seminars. As doctors are expected to teach and train younger generations, medical schools should prepare all students for such roles. A system that provides an opportunity for every student to become a peer-teacher can fulfil this need.