Assessing Transgender-Related Content in Radiography Programs in the United States: A Survey of Educators

IntroductionImaging science technologists care for diverse populations of individuals and need to be adequately prepared to provide optimal patient care that reduces any potential disparities among these individuals. In particular, exposure to transgender individuals is increasing in today's society. The purpose of this research study was to examine the extent to which transgender-related content is taught in radiography programs in the United States by surveying educators to assess their knowledge of, experience with, and readiness to teach such content.MethodsA survey was designed to determine radiography educators’ knowledge of, awareness of, and preparedness to teach imaging considerations related to transgender individuals. A total of 325 radiography educators participated in this study.ResultsThe results suggested that transgender-related content is not being consistently taught in radiography programs in the United States. Radiography educators are limited in their preparedness (readiness) to teach the imaging considerations related to transgender patients; however, they believe it is important to incorporate such content in the radiography curriculum. A weak negative correlation was identified between educators’ perceived level of importance of incorporating transgender-related content and their years of teaching experience.DiscussionAlthough most of the participants in this study indicated they would be comfortable teaching transgender-related content in their radiography programs, their knowledge and awareness of the unique imaging considerations related to transgender individuals were limited. There is a need for professional development training programs and continuing education opportunities to assist radiography educators in teaching and delivering transgender-related content in the radiography curriculum in the United States.ConclusionInstruction pertaining to the imaging considerations of transgender individuals is limited in radiography programs in the United States. Future research is warranted to further investigate this topic.     

Identification of Factors Integral to Designing Community-based CPR Interventions for High-risk Neighborhood Residents

Abstract

Background. High-risk neighborhoods can be identified as census tracts in which cardiac arrest incidence is high and bystander cardiopulmonary resuscitation (CPR) prevalence is low. However, little is known about how best to tailor community CPR training to high-risk neighborhood residents. The objective of this study was to identify factors integral to the design and implementation of community-based CPR intervention programs targeted to these areas. Methods. Using qualitative methods, six focus groups with 42 participants were conducted in high-risk neighborhoods in Columbus, Ohio during January and February 2011 to elicit resident views on how best to design community-based CPR educational programs for these neighborhoods. Snowball and purposeful sampling by community liaisons was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Results. Focus group participants identified four principal considerations for the design of community-based CPR interventions: 1) identifying lay people to serve as motivated leaders while targeting both senior citizens and school children to increase reach, 2) finding appropriate community-based locations to hold CPR training, 3) providing incentives to encourage more people to participate, and 4) identifying and addressing barriers to participation. Conclusion. Out-of-hospital cardiac arrest is a particular risk for minority and low-income communities. By working together with the community key factors integral to designing community-based CPR within these high-risk communities can be identified and implemented.     

Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the “Real World”

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the “ideal” rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum. Approach: Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews. Findings: Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.     

Research Informed Teaching Experience in Diagnostic Radiography: The Perspectives of Academic Tutors and Clinical Placement Educators

IntroductionThis small scale, qualitative research study investigated the perceptions by both academic tutors and clinical placement educators of integrating the research-informed teaching experience (RiTe) within an undergraduate radiography curriculum to support the learning and practice of image quality and dose optimization.MethodA purposeful sampling approach was used to recruit participants and two asynchronous online focus groups (OFG) were used for data collection. An inductive thematic approach was taken to analyse both sets of OFG data.Results and discussionFive academic tutors and four clinical placement educators participated in the research. Three overarching themes common to both sets of OFG data were identified. Findings confirmed that both OFGs felt that the RiTe supported student learning of image quality and dose optimization as well as the development of research skills. However, the clinical placement educators did identify that students may find it difficult to transfer and apply this knowledge into practice (theory-practice gap).ConclusionResults from both OFGs support RiTe with regard to the teaching and practice of image quality and dose optimization. However, greater involvement by clinical placement educators may help to overcome issues with the translation of RiTe by students into the clinical environment (theory-practice gap) and support its continued development within the curriculum. It was also identified that RiTe could be developed for qualified staff for continued professional development.     

Needs assessment for development of 6for6: Longitudinal research skills program tailored to rural and remote family physicians

ConclusionThe assessment identified barriers to RRFPs engaging in research, priority considerations for the development of a research FDP for RRFPs, and research areas to be included in the program curriculum. This information was used to inform phases 2 and 3 of program development, which are further discussed in a companion article.     

Introduction of patient electronic medical records (EMR) into undergraduate nursing education: An integrated literature review

BackgroundTo prepare student nurses for clinical practice where patient electronic medical records (EMR) competence is required, nursing undergraduate curricula must provide simulation access to developing this skill set. At this stage, however, the integration of electronic documentation into the Australian undergraduate nursing curriculum has been piecemeal.AimThe aim of this integrated literature review was to identify benefits and challenges for faculty nursing staff and nursing students in relation to the integration, use and evaluation of EMR in an undergraduate nursing program.MethodsA systematic search of relevant peer-reviewed research and project report articles was conducted in the electronic databases. Generic qualitative thematic analysis was then undertaken with themes generated from the data itself.ResultsFifty eight articles were identified, of these 23 were found to meet the inclusion criteria. Three major themes were identified: 1) Advantages of using EMR in academic settings, 2) Identified Challenges and Limitations of EMR programs; and 3) Developing an academic EMR program and implementing EMR education program in stages. All papers acknowledged that EMR will be standard in healthcare and should be viewed as an ‘essential tool’ for inclusion in undergraduate nursing programs.Conclusion and implications for practiceThere is a significant increase of electronic technology in healthcare settings, especially relating to patient documentation. Therefore, teaching the use of EMR in the simulated clinical learning environment for new healthcare providers such as nursing students is essential. The papers reviewed identified an urgent need for higher education nursing programs to support undergraduate nursing students and faculty staff to ensure EMR can be implemented effectively into the undergraduate nursing curriculum.     

Neonatal healthcare providers’ perceptions of the feasibility of home phototherapy in neonatal jaundice

PurposeThis project aims to explore healthcare professionals’ perceptions of providing home phototherapy for neonatal jaundice as part of standard care.Design and MethodsIn-depth, semi-structured interviews were conducted with a purposive sample of nine healthcare professionals from the Neonatal Intensive Care Unit. The data was analyzed according to the Interpretive Phenomenological Analysis using six steps devised by Braun and Clarke for thematic analysis using NVivo Software.ResultsSix major themes were identified that encompassed healthcare professionals’ perceptions of home phototherapy for neonatal jaundice. These themes included: baby factors for home phototherapy, better in own environment, parent factors for home phototherapy, perceived benefits for home phototherapy, perceived risks of home phototherapy, and system factors impacting home phototherapy.ConclusionsHome phototherapy was perceived positively amongst the healthcare professionals. The healthcare professionals expressed many perceived benefits of home phototherapy such as family-centred care, improved bonding, improved establishment of breastfeeding, and decreased healthcare expenditure.Practice implicationsEnables understanding of the barriers to establishing home phototherapy programs and provides a scaffold for the development of these programs.     

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.     

Undergraduate nursing students' use of video technology in developing confidence in clinical skills for practice: A systematic integrative literature review

Aims and objectivesThis review examines the current evidence of the effectiveness of the use of video or video podcast technology produced either commercially or in-house in developing nursing students' confidence in clinical skills for practice.BackgroundThe ability of graduates to provide safe, quality, nursing care is the core of any nursing education curriculum. Developing teaching and learning strategies to enhance skills development and confidence is challenging for educators, particularly with contemporary and diverse student populations requiring student-centred, technology-enhanced learning.DesignAn integrative review framework.Review methodsA systematic search was conducted using the following eight databases: CINAHL, MEDLINE, ProQuest, PubMed, ERIC, Scopus, EMBASE, and Google Scholar. Selection criteria included: published in English, involving undergraduate nursing students, measuring confidence in relation to skills development, and using video or video podcasts.ResultsFour studies met the inclusion criteria, with six themes identified. Four themes emerged: Pedagogy; Skills performance and competency; Student satisfaction and confidence in relation to skills development; Technical constraints. Two additional themes related to the impetus for introducing video podcasts: first, time as an institutional, curricular, and academic/student challenge; and second, meeting the generational needs of students.ConclusionThis review demonstrates that video technology teaching methods and traditional teaching methods used in conjunction with each other create the most positive learning environment. Although video technology methods provide a flexible teaching option for the contemporary student population, developing and delivering videos in a clinical skills program need to be conceptualised within an appropriate pedagogical approach to ensure a purposeful and meaningful learning experience. Whilst student confidence was embedded within other evaluations, it is not clearly reviewed or understood; therefore, further research is required in this area.     

How organisational processes influence assessors’ experiences of marginal students’ performances in clinical assessments

BackgroundCompetence assessment has become the accepted modality of assessing practice based disciplines, such as nursing. However, assessment of clinical competence remains a challenge for assessors.AimThis study sought to describe assessors’ experiences of grading undergraduate students’ performances in clinical courses when that performance is marginal; not a clear pass or fail.MethodsFourteen semi-structured interviews and two focus groups were undertaken with university employed assessors from a pre-registration bachelor of nursing programme at a multi-campus Australian university.FindingsThematic analysis identified two distinct theme themes from the textual data: ‘human influences’ and ‘organisational processes’. The first theme of human influences was reported elsewhere. ‘Organisational processes’, including three emerging themes:time demands and pressures; assessment processes and learning and teaching practices, were identified as key impacts on assessors’ experiences of grading student clinical performances and is addressed in this paper. The impact of organisational policies and processes on the assessor around workload, teaching and learning practices and assessment processes were significant to assessors.DiscussionTertiary assessment processes were found to significantly influence, both in a positive and negative manner, assessors’ experiences of grading student performances in clinical courses. Provision of a holistic approach to clinical assessment that includes robust assessor support measures should be developed and implemented to enhance student success and assist assessors to meet their professional responsibilities.ConclusionTertiary institutions play a key role in supporting effective and meaningful assessment of clinical programme components. Through understanding the significance of the organisations’ role, key stakeholders can start to examine and enact measures to bolster the enabling factors and reduce the barriers to assessing student performances that are not a clear pass or fail.     

Oncology nurses' experiences with prognosis-related communication with patients who have advanced cancer

BackgroundOncology nurses have opportunities to engage in prognosis-related communication with patients who have advanced cancer but encounter barriers that impede the patient's understanding of prognosis, delay transitions to end-of-life care, and contribute to nonbeneficial treatments.PurposeTo describe nurses' experiences with prognosis-related communication with patients who have advanced cancer.MethodThematic analysis of audio-recorded interviews with oncology nurses (n = 27). After data coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used.ResultsSix themes were identified: being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to help patients with prognosis understanding.ConclusionsShortcomings in prognosis-related communication with patients who have advanced cancer may contribute to negative outcomes for patients and nurses. Interventions that empower nurses to engage in prognosis communications are needed. Interprofessional communication skills education also may be beneficial.     

Leukocyte cell population data from the blood cell analyzer as a predictive marker for severity of acute pancreatitis

BackgroundThe prediction for severe acute pancreatitis (SAP) is the key to give timely targeted treatment. Leukocyte cell population data (CPD) have been widely applied in early prediction and diagnosis of many diseases, but their predictive ability for SAP remains unexplored. We aim to testify whether CPD could be an indicator of AP severity in the early stage of the disease.MethodsThe prospective observational study was conducted in the emergency department ward of a territory hospital in Shanghai. The enrolled AP patients should meet 2012 Atlanta guideline.ResultsTotally, 103 AP patients and 62 healthy controls were enrolled and patients were classified into mild AP (n = 30), moderate SAP (n = 42), and SAP (n = 31). Forty‐two CPD parameters were examined in first 3 days of admission. Four CPD parameters were highest in SAP on admission and were constantly different among 3 groups during first 3 days of hospital stay. Eighteen CPD parameters were found correlated with the occurrence of SAP. Stepwise multivariate logistic regression analysis identified a scoring system of 4 parameters (SD_LALS_NE, MN_LALS_LY, SD_LMALS_MO, and SD_AL2_MO) with a sensitivity of 96.8%, specificity of 65.3%, and AUC of 0.87 for diagnostic accuracy on early identification of SAP. AUC of this scoring system was comparable with MCTSI, SOFA, APACHE II, MMS, BISAP, or biomarkers as CRP, PCT, and WBC in prediction of SAP and ICU transfer or death.ConclusionsSeveral leukocyte CPD parameters have been identified different among MAP, MSAP, and SAP. They might be ultimately incorporated into a predictive system marker for severity of AP.     

Delays in Palliative Care Referral Among Surgical Patients: Perspectives of Surgical Residents Across the State of Michigan

ContextPalliative care services (PCS) are underutilized and frequently delayed among surgical patients. Surgical residents often serve at the forefront for patient issues, including conducting conversations regarding prognosis and goals of care.ObjectivesThis qualitative study identifies critical barriers to palliative care referral among seriously ill surgical patients from the perspective of surgical residents.MethodsWe conducted semistructured interviews with surgical residents (n = 18) across the state of Michigan, which focused on experiences with seriously ill surgical patients and PCS. Inductive thematic analysis was used to establish themes based on the research objectives and data collected.ResultsFour dominant themes of resident-perceived barriers to palliative care referral were identified: 1) challenges with prognostication, 2) communication barriers, 3) respect for the surgical hierarchy, and 4) surgeon mentality. Residents consistently expressed challenges in predicting patient outcomes, and verbalizing this to both attendings and families augmented this uncertainty in seeking PCS. Communicative challenges included managing discordant provider opinions and the stigma associated with PCS. Finally, residents perceived that an attending surgeon's decisive authority and mentality negatively influenced the delivery of PCS.ConclusionsAmong resident trainees, unpredictable patient outcomes led to uncertainty in the timing and appropriateness of palliative care referral and further complicated communicating plans of care. Residents perceived and relied on the attending surgeon as the ultimate decision maker, wherein the surgeon's sense of responsibility to the patient was identified as a significant barrier to PCS referral. Further studies are needed to test surgeon-specific interventions to improve access to and delivery of PCS.