The perceived experience of supervision within the PACE trial

This study was set within the UK inter-professional multi-centre randomized controlled PACE trial of manual based therapy (White et al 2007). The aim of supervision within ���the trial��� was to maintain specificity, sustain retention, manage quality control and assurance, monitor competence in delivering therapy and enhance professional development. The rationale for the ancillary study was that the approach to supervision within the trial appeared to be different from the previous experience of supervision for many of the therapists (Clouder & Sellars 2004, Sellars 2004, Sweeney et al 2001). A review of the literature on supervision and reflective practice highlighted that there are many models, methods, approaches and factors that influence the effectiveness of supervision (Edwards et al 2005, van Ooijen 2000).

Interprofessional Collaboration: The Experience of Nursing and Medical Students��� Interprofessional Education

In this hermeneutic phenomenological study, we examined the experience of interprofessional collaboration from the perspective of nursing and medical students. Seventeen medical and nursing students from two different universities participated in the study. We used guiding questions in face-to-face, conversational interviews to explore students��� experience and expectations of interprofessional collaboration within learning situations. Three themes emerged from the data: the great divide, learning means content, and breaking the ice. The findings suggest that the experience of interprofessional collaboration within learning events is influenced by the natural clustering of shared interests among students. Furthermore, the carry-forward of impressions about physician���nurse relationships prior to the educational programs and during clinical placements dominate the formation of new relationships and acquisition of new knowledge about roles, which might have implications for future practice.

Graphic medicine from library to classroom

Introduction. Graphic medicine is defined as the use of comics in health sciences education and patient care. Graphic stories about personal experiences of illness from patients and their families can be used to illustrate distress, empathy and collaboration between family members and health professionals and thus give students a broader experience of disease. We present a collection of graphic novels and outline collaboration with professors from various faculties in order to use comics as teaching material in health sciences. Method. The university has health sciences faculties of Nursing, Medicine, Pharmacy, Dentistry, Veterinary Medicine and schools of Public Health, Optometry and Kinesiology. The Health Library is offering its patrons a collection of 40 comics mainly on the theme of patient and family illness experience. An ongoing survey gathers feedback from users; results will help us promote the collection. A librarian is working with professors from the facultiesof Nursing, Medicine and Pharmacy in order to integrate comics��� excerpts into e-learning modules for three health and social services interprofessional courses reaching more than 1000 students annually. Other courses teaching empathy and partnership with patients will be identified and professors will be approached to raise awareness of the collection���s potential as teaching material. Results. The collection has been available to patrons since October 2012. Survey responses collected so far are very positive and titles are regularly borrowed. The collection has been added as suggested reading in a physiotherapy course outline. Discussion. The comics��� collection is already widely used by our patrons. Steps are being taken to integrate the collection into more health sciences courses and thus define graphic medicine as teaching material in health sciences education at the university.

Utilizaci��n de los apuntes de clase en las carreras de Enfermer��a y Medicina de la Universidad de Barcelona

Objetivo: Analizar aspectos relacionados con los apuntes que toman los alumnos de Enfermer��a y Medicina en el transcurso de las respectivas clases. Se comparan cuestiones relacionadas con la revisi��n, conservaci��n, consulta, pr��stamo, etc. de los apuntes. Adem��s, se identifican los recursos bibliogr��ficos empleados (art��culos, libros, Internet, etc.) como complemento de los apuntes y el uso que se les prev�� dar en el futuro. Dise��o: Descriptivo y transversal. Emplazamiento: Facultad de Medicina y Escuela de Enfermer��a de la Universidad de Barcelona. Per��odo de estudio: desde noviembre de 2000 a febrero de 2001. Participantes: Estudiantes del ��ltimo curso de Medicina y de Enfermer��a que asist��an a una asignatura troncal. Se trata de una muestra no probabil��stica de conveniencia. Mediciones: Para la obtenci��n de los datos se emple�� una encuesta autoadministrada compuesta de 27 preguntas de respuesta m��ltiple que fue sometida una prueba piloto. Las variables estudiadas fueron: frecuencia en la toma de apuntes, material utilizado, revisi��n, pr��stamo, recursos documentales complementarios y su posible uso en el futuro profesional. Resultados principales: Se estudi�� a 299 sujetos: 168 (56, 19%) pertenecen a la carrera de Enfermer��a y 131 (43,81%) a la de Medicina. En la muestra, 254 (84,95%) son mujeres y 45 (15,05%) varones. Las medias de edad son de 22,69 (desviaci��n est��ndar [DE]: 2,84) y 23,47 (DE: 2,56), respectivamente. Se aprecian diferencias estad��sticamente significativas en la frecuencia en que se toman apuntes (x2 15,21; df 3; p = 0,002) y en el pasarlos a limpio (x2 66,71; df 3; p < 0,001) a favor de Enfermer��a; en cambio, se revisan con mayor frecuencia en Medicina (x2 23,04; df 3; p < 0,001). No se observan diferencias en la frecuencia, razones y actitud relacionada con el pr��stamo de apuntes. En Medicina se complementan los apuntes con mayor frecuencia que en Enfermer��a (x2 23,16; df 4; p < 0,001). Se tiene intenci��n de guardar y consultar los apuntes sobre todo en Enfermer��a (x2 144,83; df 1; p < 0,001 ). Conclusiones: los apuntes son considerados como el principal recurso para la preparaci��n de los ex��menes en ambas carreras. En Enfermer��a se les asigna un mayor valor para la realizaci��n de la carrera y como material de consulta en el futuro; en tanto que en Medicina es m��s habitual complementarlos con otros materiales bibliogr��ficos.

Utilizaci��n de los apuntes de clase en las carreras de Enfermer��a y Medicina de la Universidad de Barcelona

Objetivo: Analizar aspectos relacionados con los apuntes que toman los alumnos de Enfermer��a y Medicina en el transcurso de las respectivas clases. Se comparan cuestiones relacionadas con la revisi��n, conservaci��n, consulta, pr��stamo, etc. de los apuntes. Adem��s, se identifican los recursos bibliogr��ficos empleados (art��culos, libros, Internet, etc.) como complemento de los apuntes y el uso que se les prev�� dar en el futuro. Dise��o: Descriptivo y transversal. Emplazamiento: Facultad de Medicina y Escuela de Enfermer��a de la Universidad de Barcelona. Per��odo de estudio: desde noviembre de 2000 a febrero de 2001. Participantes: Estudiantes del ��ltimo curso de Medicina y de Enfermer��a que asist��an a una asignatura troncal. Se trata de una muestra no probabil��stica de conveniencia. Mediciones: Para la obtenci��n de los datos se emple�� una encuesta autoadministrada compuesta de 27 preguntas de respuesta m��ltiple que fue sometida una prueba piloto. Las variables estudiadas fueron: frecuencia en la toma de apuntes, material utilizado, revisi��n, pr��stamo, recursos documentales complementarios y su posible uso en el futuro profesional. Resultados principales: Se estudi�� a 299 sujetos: 168 (56, 19%) pertenecen a la carrera de Enfermer��a y 131 (43,81%) a la de Medicina. En la muestra, 254 (84,95%) son mujeres y 45 (15,05%) varones. Las medias de edad son de 22,69 (desviaci��n est��ndar [DE]: 2,84) y 23,47 (DE: 2,56), respectivamente. Se aprecian diferencias estad��sticamente significativas en la frecuencia en que se toman apuntes (x2 15,21; df 3; p = 0,002) y en el pasarlos a limpio (x2 66,71; df 3; p < 0,001) a favor de Enfermer��a; en cambio, se revisan con mayor frecuencia en Medicina (x2 23,04; df 3; p < 0,001). No se observan diferencias en la frecuencia, razones y actitud relacionada con el pr��stamo de apuntes. En Medicina se complementan los apuntes con mayor frecuencia que en Enfermer��a (x2 23,16; df 4; p < 0,001). Se tiene intenci��n de guardar y consultar los apuntes sobre todo en Enfermer��a (x2 144,83; df 1; p < 0,001 ). Conclusiones: los apuntes son considerados como el principal recurso para la preparaci��n de los ex��menes en ambas carreras. En Enfermer��a se les asigna un mayor valor para la realizaci��n de la carrera y como material de consulta en el futuro; en tanto que en Medicina es m��s habitual complementarlos con otros materiales bibliogr��ficos.

Interview with Dorothy Otto

Interview with Dorothy Otto, Associate Professor at the School of Nursing, University of Texas Houston Health Science Center.

UNDERSTANDING NURSE CREATED COGNITIVE ARTIFACTS: PERSONALLY-CREATED-COGNITIVE-ARTIFACTS AS EXTERNAL REPRESENTATIONS OF DISTRIBUTED COGNITION

Manuscript 1: ���Conceptual Analysis: Externalizing Nursing Knowledge��� We use concept analysis to establish that the report tool nurses prepare, carry, reference, amend, and use as a temporary data repository are examples of cognitive artifacts. This tool, integrally woven throughout the work and practice of nurses, is important to cognition and clinical decision-making. Establishing the tool as a cognitive artifact will support new dimensions of study. Such studies can characterize how this report tool supports cognition, internal representation of knowledge and skills, and external representation of knowledge of the nurse. Manuscript 2: ���Research Methods: Exploring Cognitive Work��� The purpose of this paper is to describe a complex, cross-sectional, multi-method approach to study of personal cognitive artifacts in the clinical environment. The complex data arrays present in these cognitive artifacts warrant the use of multiple methods of data collection. Use of a less robust research design may result in an incomplete understanding of the meaning, value, content, and relationships between personal cognitive artifacts in the clinical environment and the cognitive work of the user. Manuscript 3: ���Making the Cognitive Work of Registered Nurses Visible��� Purpose: Knowledge representations and structures are created and used by registered nurses to guide patient care. Understanding is limited regarding how these knowledge representations, or cognitive artifacts, contribute to working memory, prioritization, organization, cognition, and decision-making. The purpose of this study was to identify and characterize the role a specific cognitive artifact knowledge representation and structure as it contributed to the cognitive work of the registered nurse. Methods: Data collection was completed, using qualitative research methods, by shadowing and interviewing 25 registered nurses. Data analysis employed triangulation and iterative analytic processes. Results: Nurse cognitive artifacts support recall, data evaluation, decision-making, organization, and prioritization. These cognitive artifacts demonstrated spatial, longitudinal, chronologic, visual, and personal cues to support the cognitive work of nurses. Conclusions: Nurse cognitive artifacts are an important adjunct to the cognitive work of nurses, and directly support patient care. Nurses need to be able to configure their cognitive artifact in ways that are meaningful and support their internal knowledge representations.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

<p>Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. </p><p>Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes. </p><p>Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance. </p><p>Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.</p>

Learning collaboration in General Internal Medicine: a pilot project for undergraduate students in nursing, physiotherapy and medicine

Background: A form of education called Interprofessional Education (IPE) occurs when two or more professions learn with, from and about each other. The purpose of IPE is to improve collaboration and the quality of care. Today, IPE is considered as a key educational approach for students in the health professions. IPE is highly effective when delivered in active patient care, such as in clinical placements. General internal medicine (GIM) is a core discipline where hospital-based clinical placements are mandatory for students in many health professions. However, few interprofessional (IP) clinical placements in GIM have been implemented. We designed such a placement. Placement design: The placement took place in the Department of Internal Medicine at the CHUV. It involved students from nursing, physiotherapy and medicine. The students were in their last year before graduation. Students formed teams consisting of one student from each profession. Each team worked in the same unit and had to take care of the same patient. The placement lasted three weeks. It included formal IP sessions, the most important being facilitated discussions or "briefings" (3x/w) during which the students discussed patient care and management. Four teams of students eventually took part in this project. Method: We performed a type of evaluation research called formative evaluation. This aimed at (1) understanding the educational experience and (2) assessing the impact of the placement on student learning. We collected quantitative data with pre-post clerkship questionnaires. We also collected qualitative data with two Focus Groups (FG) discussions at the end of the placement. The FG were audiotaped and transcribed. A thematic analysis was then performed. Results: We focused on the qualitative data, since the quantitative data lacked of statistical power due to the small numbers of students (N = 11). Five themes emerged from the FG analysis: (1) Learning of others' roles, (2) Learning collaborative competences, (3) Striking a balance between acquiring one's own professional competences and interprofessional competences, (4) Barriers to apply learnt IP competences in the future and (5) Advantages and disadvantages of IP briefings. Conclusions: Our IP clinical placement in GIM appeared to help students learn other professionals' roles and collaborative skills. Some challenges (e.g. finding the same patient for each team) were identified and will require adjustments.

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Meanings and perceptions of patient-centeredness in social work, nursing and medicine: A comparative study.

Answering patients' evolving, more complex needs has been recognized as a main incentive for the development of interprofessional care. Thus, it is not surprising that patient-centered practice (PCP) has been adopted as a major outcome for interprofessional education. Nevertheless, little research has focused on how PCP is perceived across the professions. This study aimed to address this issue by adopting a phenomenological approach and interviewing three groups of professionals: social workers (n��=��10), nurses (n��=��10) and physicians (n��=��8). All the participants worked in the same department (the General Internal Medicine department of a university affiliated hospital). Although the participants agreed on a core meaning of PCP as identifying, understanding and answering patients' needs, they used many dimensions to define PCP. Overall, the participants expressed value for PCP as a philosophy of care, but there was the sense of a hierarchy of patient-centeredness across the professions, in which both social work and nursing regarded themselves as more patient-centered than others. On their side, physicians seemed inclined to accept their lower position in this hierarchy. Gieryn's concept of boundary work is employed to help illuminate the nature of PCP within an interprofessional context.

[Nursing unit: nurses co-ordinating hospital care--an answer to new challenges in acute medicine]

Some patients at university hospital no longer need frequent medical treatment but complex professional nursing care. At University Hospital (Inselspital) Bern a Nursing Unit with six beds was run as a pilot project based on experiences in British Nursing Development Units. The care concept was specifically developed and based on a definition of professional nursing, an evidence-based practice approach, resource oriented self management, and caring. Primary nursing was used, and the primary nurse was responsible for the coordination and steering of patient care. The project was evaluated prospectively. During the pilot phase, 37 patients were cared for on the NU. On average, 85% of the beds were occupied, patients were hospitalized for 21.5 days and had a mean age of 68.9 years. They were older than the University Hospital's average patient, and cases were more complex than the University Hospital's average case. The nurses' experiences were mainly positive. Their enhanced responsibility and the structured care process were seen as a challenge allowing them to enlarge their abilities. With this project, the University Hospital built up innovative services for patients with complex nursing problems. The project showed that well trained nurses can take on more responsibility for this patient group than in the context of conventional care models.

Psychometric properties of the Swiss version of the Nursing Home Survey on Patient Safety Culture

The Nursing Home Survey on Patient Safety Culture (NHSPSC) was speci���cally developed for nursing homes to assess a facility���s safety climate and it consists of 12 dimensions. After its pilot testing, however, no fur- ther psychometric analyses were performed on the instrument. For this study of safety climate in Swiss nursing home units, the NHSPSC was linguistically adapted to the Swiss context and to address the unit as well as facility level, with the aim of testing aspects of the validity and reliability of the Swiss version before its use in Swiss nursing home units. Psychometric analyses were performed on data from 367 nurs- ing personnel from nine nursing homes in the German-speaking part of Switzerland (response rate = 66%), and content validity (CVI) examined. The statistical in���uence of unit membership on respondents��� answers, and on their agreement concerning their units��� safety climate, was tested using intraclass corre- lation coef���cients (ICCs) and the rWG(J) interrater agreement index. A multilevel exploratory factor analysis (MEFA) with oblimin rotation was applied to examine the questionnaire���s dimensionality. Cronbach���s alpha and Raykov���s rho were calculated to assess factor reliability. The relationship of safety climate dimensions with clinical outcomes was explored. Expert feedback con���rmed the relevance of the instru- ment���s items (CVI = 0.93). Personnel showed strong agreement in their perceptions in three dimensions of the questionnaire. ICCs supported a multilevel analysis. MEFA produced nine factors at the within-level (in comparison to 12 in the original version) and two factors at the between-level with satisfactory ���t statis- tics. Raykov���s Rho for the single level factors ranged between 0.67 and 0.86. Some safety climate dimen- sions show moderate, but non-signi���cant correlations with the use of bedrails, physical restraint use, and fall-related injuries. The Swiss version of the NHSPSC needs further re���nement and testing before its use can be recommended in Swiss nursing homes: its dimensionality needs further clari���cation, particularly to distinguish items addressing the unit-level safety climate from those at the facility level.

A longitudinal study on delirium in nursing homes

OBJECTIVE To investigate the evolution of delirium of nursing home (NH) residents and their possible predictors. DESIGN Post-hoc analysis of a prospective cohort assessment. SETTING Ninety NHs in Switzerland. PARTICIPANTS Included 14,771 NH residents. MEASUREMENTS The Resident Assessment Instrument Minimum Data Set and the Nursing Home Confusion Assessment Method were used to determine follow-up of subsyndromal or full delirium in NH residents using discrete Markov chain modeling to describe long-term trajectories and multiple logistic regression analyses to determine predictors of the trajectories. RESULTS We identified four major types of delirium time courses in NH. Increasing severity of cognitive impairment and of depressive symptoms at the initial assessment predicted the different delirium time courses. CONCLUSION More pronounced cognitive impairment and depressive symptoms at the initial assessment are associated with different subsequent evolutions of delirium. The presence and evolution of delirium in the first year after NH admission predicted the subsequent course of delirium until death.