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Capturing debriefing and enhancing reflection within simulated clinical learning environmentsThis article presents findings from an evaluation of a new A3-size learner notes sheet designed for use by healthcare students engaging in clinical simulation and clinical skills sessions. The notes sheet consists of an adapted form of the SBAR (situation, background, assessment, response) tool, whilst capturing post-simulation oral debriefing provided by a facilitator. Additionally, the Driscoll (2007) model is used to provide students with an opportunity to reflect on their engagement in clinical simulation. Two cohorts of students, who engaged in separate simulation sessions, completed the A3 sheet. The study featured 33 midwifery and 21 operating department practitioner (ODP) students undertaking a simulation. Documentary analysis was undertaken to identify the depth of reflective writing of both groups of students. Midwifery student participants reflected on their experiences of simulation at a slightly deeper level than their ODP counterparts. All students adhered to the structure of the notes sheet when receiving their briefing from the facilitator and when asked to write their reflective accounts. This study has sought to explore an under-researched area of clinical simulation: the extent to which healthcare students can utilise reflection when engaging with a clinical scenario within a simulated learning environment.
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SOLACE: a psychosocial stigma protection intervention to improve the mental health of parents of autistic children: a feasibility randomised controlled trialThis study presents findings from a feasibility trial, testing an 8-week psychosocial stigma protection intervention (SOLACE) designed to improve the mental health of parents of autistic children. Seventeen parents were stratified then randomly assigned to either SOLACE (n = 9) or control group (n = 8). Retention and adherence rates were excellent with minimal missing data suggesting SOLACE had good acceptability and feasibility. Quantitative analysis revealed that mental health scores had significantly improved for those who took part in SOLACE compared to no significant changes for control group participants. In addition, changes in secondary outcome measures (e.g. stigma, self-esteem and self-compassion) were in favour of SOLACE. Focus group interviews revealed that SOLACE was acceptable to parents. Results suggest that a full randomised controlled trial is warranted.
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British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing careersTo ascertain British South Asian male nurses' views on the barriers and enablers to entering and progressing in nursing education and careers. There is a shortage of men from Black, Asian and Minority Ethnic groups in the National Health Service nursing workforce. There is a dearth of evidence on the views of British south Asian men on this subject. A qualitative interpretative intersectional approach was used to carry out one to one interviews (n=5) with British South Asian male nurses using a semi-structured topic guide. Interviews took place between July 2018 and February 2019, across England. A Framework Analysis approach was used to analyse the interview transcripts. The main themes emerging as barriers were: poor pay and conditions, negative immediate, extended family, community views and a lack of knowledge and awareness of the nursing profession. The main themes emerging as enablers were: personal circumstances (including role models) and ethnicity (including the role of religion and masculinity). Findings suggest that the intersection between ethnicity and gender presents as an important enabler, as well as inhibitor, for British South Asian men. Nursing careers and salient barriers exist at a systemic level and include institutional racism. Review policies and practice on unconscious bias and institutional racism in the recruitment, retention and progression of British South Asian men. Provide continuous professional development including mentoring support to help career progression for these men. Develop culturally specific interventions to reduce the stigma associated with the nursing profession in the British South Asian community. Consider places of worship as venues for delivery of these interventions when promoting nursing. AIM BACKGROUND METHODS RESULTS CONCLUSION IMPLICATIONS FOR NURSING MANAGEMENT
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A comparison of four approaches to evaluate the sit-to-stand movementThe sit-to-stand test (STS) is a simple test of function in older people that can identify people at risk of falls. The aim of this study was to develop two novel methods of evaluating performance in the STS using a low-cost RGB camera and another an instrumented chair containing load cells in the seat of the chair to detect center of pressure movements and ground reaction forces. The two systems were compared to a Kinect and a force plate. Twenty-one younger subjects were tested when performing two 5STS movements at self-selected slow and normal speeds while 16 older fallers were tested when performing one 5STS at a self-selected pace. All methods had acceptable limits of agreement with an expert for total STS time for younger subjects and older fallers, with smaller errors observed for the chair (-0.18 ± 0.17 s) and force plate (-0.19 ± 0.79 s) than for the RGB camera (-0.30 ± 0.51 s) and the Kinect (-0.38 ± 0.50 s) for older fallers. The chair had the smallest limits of agreement compared to the expert for both younger and older participants. The new device was also able to estimate movement velocity, which could be used to estimate muscle power during the STS movement. Subsequent studies will test the device against opto-electronic systems, incorporate additional sensors, and then develop predictive equations for measures of physical function.
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Computer-assisted versus oral-and-written history taking for the prevention of cardiovascular diseaseThis is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of computer- assisted versus oral-and written lifestyle history taking on quality and completeness of collected information; To assess the effects of computer-assisted versus oral-and written lifestyle history taking for the prevention of CVD.
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Ageing carers and intellectual disability: a scoping reviewPurpose: Individuals with intellectual disability(ies) are living longer contributing to an overall increase in the average age of caregivers. The purpose of this paper is to review the literature on the physical, social and psychological needs of ageing carers of individuals with intellectual disability(ies) in the UK. Design/methodology/approach: A scoping review framework was used to identify literature from eleven databases, the grey literature and the references lists of relevant studies. Only primary research studies that discussed the needs of non-professional carers, aged 65+ years old, of individuals with intellectual disability(ies) in the UK were included. No date restrictions were applied. Thematic analysis was used to narratively synthesise findings. Findings: Six studies were included. Five key themes were identified: Living with fear, lack of information, rebuilding trust, proactive professional involvement and being ignored. Housing and support information is not communicated well to carers. Professionals require more training on carer needs and trust must be rebuilt between carers and professionals. Proactive approaches would help identify carer needs, reduce marginalisation, help carers feel heard and reduce the risk of care crisis. Greater recognition of mutual caring relationships is needed. Originality/value: This review highlighted the needs of older caregivers for individuals with intellectual disability(ies) as well as the need for more high-quality research in this field. The information presented in this review may be considered by primary care providers and funding bodies when planning future support for this growing population of carers.
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Telephone consultations for the management of alcohol-related disordersThis is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of telephone consultations for managing patients with alcohol-related disorders across healthcare settings.
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A systematic review of the factors – enablers and barriers – affecting e-learning in health sciences educationBackground: Recently, much attention has been given to e-learning in higher education as it provides better access to learning resources online, utilising technology – regardless of learners’ geographical locations and timescale – to enhance learning. It has now become part of the mainstream in education in the health sciences, including medical, dental, public health, nursing, and other allied health professionals. Despite growing evidence claiming that e-learning is as effective as traditional means of learning, there is very limited evidence available about what works, and when and how e-learning enhances teaching and learning. This systematic review aimed to identify and synthesise the factors – enablers and barriers – affecting e-learning in health sciences education (el-HSE) that have been reported in the medical literature. Methods: A systemic review of articles published on e-learning in health sciences education (el-HSE) was performed in MEDLINE, EMBASE, Allied & Complementary Medicine, DH-DATA, PsycINFO, CINAHL, and Global Health, from 1980 through 2019, using ‘Textword’ and ‘Thesaurus’ search terms. All original articles fulfilling the following criteria were included: (1) e-learning was implemented in health sciences education, and (2) the investigation of the factors – enablers and barriers – about el-HSE related to learning performance or outcomes. Following the PRISMA guidelines, both relevant published and unpublished papers were searched. Data were extracted and quality appraised using QualSyst tools, and synthesised performing thematic analysis. Results: Out of 985 records identified, a total of 162 citations were screened, of which 57 were found to be of relevance to this study. The primary evidence base comprises 24 papers, with two broad categories identified, enablers and barriers, under eight separate themes: facilitate learning; learning in practice; systematic approach to learning; integration of e-learning into curricula; poor motivation and expectation; resource-intensive; not suitable for all disciplines or contents, and lack of IT skills. Conclusions: This study has identified the factors which impact on e-learning: interaction and collaboration between learners and facilitators; considering learners’ motivation and expectations; utilising user-friendly technology; and putting learners at the centre of pedagogy. There is significant scope for better understanding of the issues related to enablers and facilitators associated with e-learning, and developing appropriate policies and initiatives to establish when, how and where they fit best, creating a broader framework for making e-learning effective.
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A pilot study to detect balance impairment in older adults using an instrumented one-leg stance testThe aim of this study was to investigate whether parameters from an instrumented one-leg stance on a force plate test could provide relevant information related to fall risk in older people. Twenty-five community dwelling older people and 25 young subjects performed a one-leg stance while standing on a force plate, with parameters related to transferring weight onto one leg and postural sway in singe-leg stance evaluated. Older participants were classified as being at risk of falling if their performance did not meet one of the previously-established cut-offs for the Five Times Sit-To-Stand and Timed-Up-and-Go tests. Eleven older participants were classified as having a risk of falls. The only significant difference between groups during the weight transfer phase was in the mediolateral displacement, with the fall risk group having less sway than the other groups, signifying a more precautionary approach. With respect to postural sway, both the younger subjects and the no fall risk group stabilised sufficiently to decrease their sway compared to initial values after four and six seconds, respectively. In contrast, the fall risk group was unable to stabilise during the one-leg stance, and continued to sway throughout the 10-sec recording period. These findings suggest that the normal one-leg stance test might not be suitable to detect fall risk. In contrast, an instrumented version of the test could provide valuable additional information that could identify risk of falling in older people.
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Understanding continuous professional development participation and choice of mid-career general dental practitionersParticipating in continuing professional development (CPD) activities is a requirement for dental practitioners to keep their skills and knowledge up to date. Understanding the ways dental practitioners engage with professional development and the impact on practice is not fully known (Eaton et al. 2011, http://www.gdc-uk.org/Aboutus/policy/Documents/Impact Of CPD In Dentistry.pdf). The aim of this study was to gain insights into the ways that dentists reflect on their professional development and what may be influencing their choices. Empirical qualitative data were collected by semi-structured interviewing of five mid-career dentists. Using grounded theory, the data were analysed for themes about CPD choice and participation. Three themes were identified as influences to dentists' choices of CPD with pragmatic considerations of how new learning could benefit their patients and their practices. Dental practitioners were influenced by the requirements of external regulatory bodies which they did not consider to necessarily improve practice. Dentists working in primary care in the UK are undertaking CPD which is influenced by the pragmatic requirements of running a small business and to meet regulatory requirements. In this sample, dentists are not critically reflecting on their education needs when choosing their CPD activity. Protected learning time and organisational feedback and support are recommended as a way to promote more meaningful reflection on learning and to improve professional development. OBJECTIVE METHOD RESULTS CONCLUSION
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The importance of mealtime structure for reducing child food fussinessThe aim of this study was to explore how the structure of mealtimes within the family setting is related to children's fussy eating behaviours. Seventy-five mothers of children aged between 2 and 4 years were observed during a typical mealtime at home. The mealtimes were coded to rate mealtime structure and environment as well as the child's eating behaviours (food refusal, difficulty to feed, eating speed, positive and negative vocalisations). Mealtime structure emerged as an important factor which significantly distinguished children with higher compared with lower levels of food fussiness. Children whose mothers ate with their child and ate the same food as their child were observed to refuse fewer foods and were easier to feed compared with children whose mothers did not. During mealtimes where no distractors were used (e.g. no TV, magazines or toys), or where children were allowed some input into food choice and portioning, children were also observed to demonstrate fewer fussy eating behaviours. Findings of this study suggest that it may be important for parents to strike a balance between structured mealtimes, where the family eats together and distractions are minimal, alongside allowing children some autonomy in terms of food choice and intake.
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Student life - a playful way to learn.Students do not always like speaking in class. The more confident talkers can sometimes overshadow more reserved students, who prefer to let others talk while they think things through.
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Spotlight on equality of employment opportunities: a qualitative study of job seeking experiences of graduating nurses and physiotherapists from black and minority ethnic backgrounds.There is growing attention in the UK and internationally to the representation of black and minority ethnic groups in healthcare education and the workplace. Although the NHS workforce is very diverse, ethnic minorities are unevenly spread across occupations, and considerably underrepresented in senior positions. Previous research has highlighted that this inequality also exists at junior levels with newly qualified nurses from non-White/British ethnic groups being less likely to get a job at graduation than their White/British colleagues. Although there is better national data on the scale of inequalities in the healthcare workforce, there is a gap in our understanding about the experience of job seeking, and the factors that influence disadvantage in nursing and other professions such as physiotherapy. This qualitative study seeks to fill that gap and explores the experience of student nurses (n=12) and physiotherapists (n=6) throughout their education and during the first 6-months post qualification to identify key experiences and milestones relating to successful employment particularly focusing on the perspectives from different ethnic groups. Participants were purposively sampled from one university to ensure diversity in ethnic group, age and gender. Using a phenomenological approach, in-depth semi-structured interviews were conducted at course completion and 6 months later. Two main themes were identified. The 'proactive self' ('It's up to me') theme included perceptions of employment success being due to student proactivity and resilience; qualities valued by employers. The second theme described the need to 'fit in' with organisational culture. Graduates described accommodating strategies where they modified aspects of their identity (clothing, cultural markers) to fit in. At one extreme, rather than fitting in, participants from minority ethnic backgrounds avoided applying to certain hospitals due to perceptions of discriminatory cultures, 'I wouldn't apply there 'cos you know, it's not really an ethnic hospital'. In contrast, some participants recognised that other graduates (usually white) did not need to change and aspects of their identity brought unsolicited rewards 'if your face fits then the barriers are reduced'. The findings indicate that success in getting work is perceived as determined by individual factors, and fitting in is enabled by strategies adopted by the individual rather than the workplace. Demands for change are more acute for graduates from black and minority ethnic backgrounds. This is an issue for healthcare organisations seeking to be inclusive and challenges employers and educators to acknowledge inequalities and take action to address them. BACKGROUND AIM PARTICIPANTS METHODS RESULTS CONCLUSIONS
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Using patient data for patients' benefitEditorial
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Knowledge, attitudes, and behavior of Nigerian students toward organ donationThe Nigerian transplantation program is evolving but is currently over-reliant on living donors. If deceased donation is to be viable in Nigeria, it is important to ascertain the views of the public. The objective of the study was to explore the knowledge, attitudes, and behavior of Nigerian international students toward organ donation. A cross-sectional study was conducted among Nigerian international students of the University of Bedfordshire through the use of a modified self-administered questionnaire. The participants were recruited by means of purposive sampling. Of the 110 questionnaires distributed, 103 were returned fully completed (response rate = 93.6%). A significant majority (93.2%) of the participants are aware of organ donation, and 76.7% have a good knowledge on the subject. Furthermore, more than half (52.8%) of the participants have a positive attitude toward organ donation, and less than half (42.8%) have favorable behavior toward it. Higher knowledge does not correlate to either positive attitude or behavior, but a positive attitude is correlated with favorable behavior toward donation. The attitudes and behavior of the respondents toward organ donation is not commensurate with the level of knowledge they possess. This highlights the urgent need for well-structured educational programs on deceased organ donation. BACKGROUND METHODS RESULTS CONCLUSIONS
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Embedding ethics in the design of culturally competent socially assistive robotsResearch focusing on the development of socially assistive robots (SARs) for the care of older adults has grown in recent years, prompting a great deal of ethical analysis and reflection on the future of SARs in caring roles. Much of this ethical thinking, however, has taken place far from the settings where technological innovation is practiced. Different frameworks have been proposed to bridge this gap and enable researchers to handle the ethical dimension of technology from within the design and development process, including Value Sensitive Design (VSD). VSD has been defined as a 'theoretically grounded approach to the design of technology that accounts for human values in a principled and comprehensive manner throughout the design process'. Inspired in part by VSD, we have developed a process geared towards embedding ethics at the core of CARESSES, an international multidisciplinary project that aims to design the first culturally competent SAR for the care of older adults. Here we describe that process, which included extracting key ethical concepts from relevant ethical guidelines and applying those concepts to scenarios that describe how the CARESSES robot will interact with individuals belonging to different cultures. This approach highlights the ethical implications of the robot's behavior early in the design process, thus enabling researchers to identify and engage with ethical problems proactively.
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Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autismBackground: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. Methodology: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. Discussion: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. Trial registration: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019. Keywords: Autism spectrum disorder, Minimally verbal, Non-verbal, Motor, Language, Communication, iPad, Feasibility, Randomised controlled trial
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Bereaved donor families' experiences of organ and tissue donation, and perceived influences on their decision makingTo elicit bereaved families' experiences of organ and tissue donation. A specific objective was to determine families' perceptions of how their experiences influenced donation decision-making. Retrospective, qualitative interviews were undertaken with 43 participants of 31 donor families to generate rich, informative data. Participant recruitment was via 10 National Health Service Trusts, representative of five regional organ donation services in the UK. Twelve families agreed to DBD, 18 agreed to DCD, 1 unknown. Participants' responses were contextualised using a temporal framework of 'The Past', which represented families' prior knowledge, experience, attitudes, beliefs, and intentions toward organ donation; 'The Present', which incorporated the moment in time when families experienced the potential for donation; and 'The Future', which corresponded to expectations and outcomes arising from the donation decision. Temporally interwoven experiences appeared to influence families' decisions to donate the organs of their deceased relative for transplantation. The influence of temporality on donation-decision making is worthy of consideration in the planning of future education, policy, practice, and research for improved rates of family consent to donation. PURPOSE METHODS RESULTS CONCLUSIONS
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CARESSES: the flower that taught robots about cultureThe video describes the novel concept of 'culturally competent robotics', which is the main focus of the project CARESSES (Culturally-Aware Robots and Environmental Sensor Systems for Elderly Support). CARESSES a multidisciplinary project whose goal is to design the first socially assistive robots that can adapt to the culture of the older people they are taking care of. Socially assistive robots are required to help the users in many ways including reminding them to take their medication, encouraging them to keep active, helping them keep in touch with family and friends. The video describes a new generation of robots that will perform their actions with attention to the older person's customs, cultural practices and individual preferences.
