A Peer-Support and Mindfulness Program to Improve the Mental Health of Medical Students

Problem: There is evidence that peer-support programs can improve mental health indices and help-seeking behavior among students in some secondary school and university settings and that mindfulness can improve mental health in medical students. Peer-led programs have not been formally assessed in a medical student population, where psychological issues exist and where it has been shown that students approach peers for help in preference to staff members or professional services. Intervention: Medical students elected peer leaders who underwent training and then provided the intervention. The peer leaders provided support to students in the intervention group, as well as offering teaching in mindfulness meditation. Context: An exploratory study was conducted with 2nd- and 3rd-year medical students at 1 medical school in New Zealand randomized into 2 groups. In addition to existing mental health resources, intervention participants received a program including peer support and peer-taught mindfulness practice. Study participants not offered the intervention participants could use existing mental health resources. Primary measures included depression (PHQ-9) and anxiety (GAD-7) scores. Secondary measures were quality of life, resilience (15-item resilience scale), academic self-concept, and motivation to learn, assessed at baseline and 6 months. Outcome: Of the 402 students eligible, 275 (68%) participated and 232 (58%) completed the study. At baseline, 53% were female and mean age was 21 years (SD = 3)—PHQ-9 score (M = 5.2, SD = 3.7) and GAD-7 score (M = 4.5, SD = 3.4). Twelve peer leaders were elected. There was good participation in the intervention. One fourth of intervention students used the face-to-face peer support and more than 50% attended a peer social event and/or participated in the mindfulness program. Although improvements in mental health were seen in the intervention group, the difference between the intervention and nonintervention groups did not reach statistical significance. Lessons Learned: Although evidence exists for effectiveness of peer support and mindfulness in other contexts, this exploratory study was not able to show a statistically significant effect. Future studies could consider using a longer training period for the peer leaders, as well as targeting the study population to those most likely to benefit such as those with poorer mental health, or using a more intensive intervention or larger sample size. A cluster randomized study design would also reduce the risk of contamination.     

Impact of a concept map teaching approach on nursing students’ critical thinking skills

Nurses confront complex problems and decisions that require critical thinking in order to identify patient needs and implement best practices. An active strategy for teaching students the skills to think critically is the concept map. This study explores the development of critical thinking among nursing students in a required pathophysiology and pharmacology course during the first year of a Bachelor of Science in Nursing in response to concept mapping as an interventional strategy, using the Health Education Systems, Incorporated critical thinking test. A two‐group experimental study with a pretest and posttest design was used. Participants were randomly divided into a control group (n = 42) taught by traditional didactic lecturing alone, and an intervention group (n = 41), taught by traditional didactic lecturing with concept mapping. Students in the concept mapping group performed much better on the Health Education Systems, Incorporated than students in the control group. It is recommended that deans, program directors, and nursing faculties evaluate their curricula to integrate concept map teaching strategies in courses in order to develop critical thinking abilities in their students.     

Debunking myths about “allergy” to radiocontrast media in an academic institution

Purpose: Patients with “allergy” to iodine and shellfish often do not obtain necessary radiologic procedures due to anxiety about potential radiocontrast media reactions. This study assesses the impact of an educational intervention to dispel these myths. Methods: The authors surveyed 252 internal medicine, emergency medicine, pediatrics, radiology, obstetrics/gynecology, and surgery health professionals before and after an educational intervention. Pre- and posttest responses were analyzed to assess the impact of the intervention on beliefs about radiocontrast media reactions and their perceived relationship to shellfish allergy and iodine “allergy.” Results: The mean pre- and posttest correct response scores were 41% and 91%, respectively. The intervention had a greater impact on respondents’ knowledge about iodine allergy than shellfish allergy, most likely due to the difference in baseline knowledge (P < 0.005). Emergency medicine garnered the highest pretest correct response score (54%). Internal medicine earned the lowest pretest score (30%). There was a significant difference between the highest and lowest scoring specialties on the pretest (P = 0.037). There was no statistically significant correlation with training levels. There was a considerable decrease in the percentage of respondents who would withhold radiologic studies from patients suspected of shellfish or iodine allergy. The percentage of respondents who would premedicate patients with antihistamines or steroids also decreased significantly. Conclusion: An educational intervention helps rectify misconceptions among health care professionals about radiocontrast media reactions and their perceived relationship to shellfish or iodine allergy.     

A New Leadership Development Model for Nursing Education

Background

Leadership competency is required throughout nursing. Students have difficulty understanding leadership as integral to education and practice. A consistent framework for nursing leadership education, strong scholarship and an evidence base are limited.

A spiritual education course to enhance nursing students’ spiritual competencies

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students’ spiritual competencies, individual spiritual growth, and the ability to care for patients.     

The evaluation of a multifaceted intervention to promote “speaking up” and strengthen interprofessional teamwork climate perceptions

ABSTRACT

Communication failure is a leading cause of error and is often due to inhibition of individuals to speak up in interprofessional healthcare environments. The present study sought to evaluate the impact of a multifaceted intervention designed to promote speaking up on teamwork climate in one clinical department of a large community hospital based in Canada. The multifaceted intervention included a role-playing simulation workshop, teamwork climate data feedback and facilitated discussion with the interprofessional team (discussion briefings), and other department-led initiatives to promote trust, teamwork, and speaking up among interprofessional team members. A quasi-experiment (pretest–posttest control group design, using two posttests several months apart) was used to evaluate the impact of the complete intervention on individual teamwork climate perceptions. The intervention was implemented with an intact interprofessional team (the Emergency Department—ED) in 2014. The intensive care unit (ICU) was used as the control unit. Survey response rates were the highest at time 1 (83/102 = 81% for the ED and 29/31 = 94% for the ICU) and the lowest at time 3 (38/105 = 36% for the ED and 14/30 = 47% for the ICU). The results obtained from paired and unpaired analyses suggest that this type of multifaceted approach can improve staff perceptions of teamwork climate. The teamwork climate score in the ED was significantly higher at follow-up (Mt2 = 3.42, SD = 0.66) compared to baseline (Mt1 = 3.13, SD = 0.72), (F(1, 34) = 12.2, p = .001, eta²p = .263), while baseline and follow-up scores were not significantly different between baseline and follow-up for the ICU group (Mt1 = 4.12, SD = 0.60; Mt2 = 4.15, SD = 0.56; F(1, 34) = 0.06, p = .806, eta²p = .002). Sustaining high levels of participation in interprofessional initiatives and engaging physicians remain challenging when interventions are used in context. Improving team communication is a broad and challenging area that continues to require attention.     

Challenges in Translation: Lessons from Using Business Pedagogy to Teach Leadership in Undergraduate Medicine

Problem: Leadership is increasingly recognized as a core physician competency required for quality patient care, continual system improvement, and optimal healthcare team performance. Consequently, integration of leadership into medical school curriculum is becoming a priority. This raises the question of the appropriate context, timing, and pedagogy for conveying this competency to medical students. Intervention: Our program introduced a 1-week leadership course grounded in business pedagogy to Year 1 medical students. The curriculum centred on four themes: (a) Understanding Change, (b) Effective Teamwork, (c) Leading in Patient Safety, and (d) Leadership in Action. Post-curriculum qualitative student feedback was analyzed for insight into student satisfaction and attitude towards the leadership course content. Context: The Undergraduate Medical Education program of the Schulich School of Medicine & Dentistry, Western University, is delivered over 4 years across 2 campuses in London and Windsor, Ontario, Canada. Course structure moved from traditional passive lectures to established business pedagogy, which involves active engagement in modules, case-based discussions, insights from guest speakers, and personal reflection. Outcome: A student-led survey evaluated student opinion regarding the leadership course content. Students valued career development reading materials and insights from guest speakers working in healthcare teams. Students did not relate to messages from speakers in senior healthcare leadership positions. Course scheduling late in the second semester was viewed negatively. Overall student opinion suggested that the 1-week course was suboptimal for establishing leadership principles and translated business pedagogy was ineffective in this context. Lessons Learned: Leadership curriculum in Undergraduate Medical Education should be grounded in a healthcare context relevant to the student's stage of training. Student engagement may be better supported if leadership is framed as a competency throughout their career. Schools considering such innovations could draw lessons from other professional schools and utilize material and faculty that resonate with students.     

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BackgroundCritical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.ObjectivesThe purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).DesignA quantitative causal-comparative methodology with a pretest/posttest design.SettingA private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.ParticipantsBaccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).MethodsThis research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.ResultsA repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).ConclusionsThe use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.     

MEMORY IMPROVEMENT IN ASSISTED LIVING ELDERS

Part of the Cognitive Behavioral Model of Everyday Memory (CBMEM), an eight session cognitive enhancement program, entitled "Memories, Memories, Can We Improve Ours?" was tested with older adults living in an assisted living facility in the midwest. The aims of this quasi-experimental study were: to improve everyday memory, memory self-efficacy, and metamemory. A total of 19 older adults (14 female, 5 male) with an average age of 83 years participated. For the pretest there were 16 individuals in the experimental group. The experimental group was posttested one week after completing the intervention. At posttest memory self-efficacy scores significantly increased in the experimental group (M₁ = 52.13, M ₂ = 68.50, where M ₁ represents pretest and M₂ represents posttest). Total memory performance scores were not significantly different at posttest; however the prospective memory items of asking for an appointment (M₁ =. 56, M₂ = 1.25), asking for a belonging (M₁ =. 62, M₂ =. 88), and delivering a message (M₁ = 1.00, M₂ = 1.19) significantly improved.     

The effect of flipped learning on blood pressure knowledge and self-directed learning skills of first-year nursing students: A randomized controlled trial

AimThis study investigated the effect of flipped learning on first-year nursing students’ blood pressure knowledge levels and self-directed learning skills.BackgroundFlipped learning is an innovative approach that helps nursing students learn about blood pressure and how to measure how to measure blood pressure accurately. Flipped learning also promotes active and student-centered learning settings and encourages nursing students to develop self-directed skills.DesignThis study adopted a pretest-posttest open-label randomized controlled trial.MethodThe sample consisted of 94 first-year nursing students randomized into experimental (n = 48) and control groups (n = 46). The experimental group participants were trained using the flipped learning model. Data were collected using a personal information form, the Blood Pressure Knowledge Test (BPKT) and the Self-Directed Learning Skills Scale (SDLSS).ResultsThere was no significant difference in pretest BPKT scores between the experimental and control groups. However, there was a significant difference in posttest BPKT scores between the experimental and control groups (p = 0.011). Moreover, there was a significant difference between the experimental group's mean pretest, posttest and follow-up SDLSS scores (p = 0.009).ConclusionThe experimental group had a significantly higher mean posttest BPKT score than the pretest score. They had significantly higher mean posttest SDLSS total and “self-monitoring,” “motivation,” and “self-confidence” subscale scores than the pretest score.     

Role of Self-efficacy in the Predictive Relationship of Motor Ability to Functional Performance After Task-Related Training in Stroke: A Secondary Analysis of Longitudinal Data

ObjectiveTo determine whether self-efficacy (SE) mediates or moderates the relationship between motor ability at pretest and functional use of the affected arm at posttest in task-related training for stroke.DesignRetrospective, observational cohort study.SettingOutpatient rehabilitation settings.ParticipantsEighty patients with chronic stroke (N=80).InterventionsThe training was delivered to the participants for 60-90 min/session, 3-5 sessions/wk for 4-6 weeks. The training involved specific robot-assisted, mirror, or combined therapy, followed by functional task practice for approximately 30 minutes in each session.Main Outcome MeasuresThe outcome measure was the perceived amount of functional arm use and quality of movement evaluated by the Motor Activity Log (MAL) at posttest. The predictor was scores on the Fugl-Meyer Assessment (FMA)–Upper Extremity subscale at pretest. The tested mediator and moderator were scores on the Stroke Self-Efficacy Questionnaire (SSEQ) at pretest and posttest.ResultsThe SSEQ scores at pretest and posttest moderated the predictive relationship of pretest FMA to posttest MAL. The interaction between pretest FMA and SSEQ accounted for an additional 3.14%-5.37% of the variance in the posttest MAL. The predictive relationship between FMA and MAL was its greatest when the SSEQ was high, with a less amplified positive relationship at low levels of SSEQ.ConclusionsThe results suggest the evaluation of SE at pretest for a better prediction of an individual patient's functional arm use after an intervention and recommend aiming at SE during training to make the most of motor ability transferred to functional use. Future research may compare the effectiveness of task-related training with and without SE building to verify the findings of this study.     

Leadership and leadership development within the profession of physiotherapy in Ireland

Background: Health service reform, physiotherapy graduate unemployment, and the impending introduction of state regulation mean that physiotherapists in Ireland today are facing many challenges. Leadership is needed to ensure that the profession will be able to adapt to the demands and inevitable changes ahead. Objective: To investigate the perceptions of physiotherapists in Ireland of leadership and leadership characteristics, and to explore their participation in leadership development training. Methods: In this cross-sectional nationwide study, an Internet-based survey was administered via e-mail to members of the Irish Society of Chartered Physiotherapists (n = 2,787). Results: There were 615 responses to the survey. A high proportion of respondents (74.0%) perceived themselves to be a leader. Factors associated with self-declaration as a leader were time since graduation, highest qualification attained, and leadership training. Leadership training was also associated with placing greater importance on achieving a leadership position. Some form of leadership training had been completed by 41.5% of respondents. Communication and professionalism were the most highly rated leadership characteristics in all three settings. Conclusion: Physiotherapists who have had leadership training were more likely to perceive themselves to be leaders. Leadership training may support physiotherapists to assume leadership roles both clinically and nonclinically.     

The impact of service–learning on students' cultural competence

The purpose of this study was to enhance students' cultural competence through a service–learning project in a community clinic. This quasi-experimental study used a pretest–posttest control group design. Twenty-six nursing students volunteered either in the comparison or in the experimental group. The students in the experimental group significantly increased their cultural knowledge (Z = ?2.51, p = .01) and the total score of cultural competence (Z = ?2.07, p = .04).     

The effects of light therapy on depression and sleep disruption in older adults in a long‐term care facility

This study aims to evaluate the effect of light therapy on depression and sleep disruption in older adults residing in a long‐term care facility. Psychological morbidity is a problem commonly seen in older adults residing in long‐term care facilities. Limited research has addressed the effect of light therapy on depression in this population. A quasi‐experimental pretest and posttest design was used. Thirty‐four participants in the experimental group received light therapy by sitting in front of a 10000‐lux light box 30 min in the morning, three times a week for 4 weeks. Thirty‐one participants in the control group received routine care without light therapy. Depression was measured by Geriatric Depression Scale‐Short Form at baseline and week 4. After receiving 4 weeks of light therapy, the mean depression score in the experimental group decreased from 7.24 (SD3.42) at pretest to 5.91 (SD 3.40) at posttest, and had a significant reduction (t = 2.22, P = 0.03). However, there was no significant difference in depression score and sleep disruption between the experimental group and control group. Light therapy might have the potential to reduce depressive symptoms and sleep disruption and may be a viable intervention to improve mental health of older adults in the long‐term care facilities.     

Effects of a community‐based intervention on cardio‐metabolic risk and self‐care behaviour in older adults with metabolic syndrome

This pilot study was performed to investigate the effects of a community‐based intervention (CBI) on cardio‐metabolic risk and self‐care behaviour in 92 older adults with metabolic syndrome at public health centres in Suwon, Korea. A prospective, pretest and posttest, controlled, quasi‐experimental design was used. The older adults in the intervention group participated in an 8‐week intensive lifestyle counselling, whereas those in the control group received usual care. The mean (standard deviation) age of the participants was 71.4 (4.43) years ranging from 60 to 84, and 75.0% of the participants were female. The intervention group at 8 weeks showed significant reduction in waist circumference by ?1.35 cm (P < 0.001) and improved self‐care behaviour (+ 5.17 score, P < 0.05) and self‐efficacy (+ 4.84 score, P < 0.001) when compared with the control group. The percentages of those who successfully completed the targeted behavioural modification were 71.7% for exercise and 52.2% for dietary control in the intervention group at 8 weeks. This pilot study provided evidence of the beneficial impact of the CBI for Korean older adults with metabolic syndrome.     

Evaluation of a Tobacco Prevention Program for Children: ToPIC

This intervention study focused on evaluating the effectiveness of teaching tobacco prevention in children using ToPIC, an interactive program. The program was presented in 2 or 3 class sessions to increase awareness of health risks related to tobacco use. Participants consisted of 201 students from the Boys and Girls Clubs in 5 rural counties of a southeastern state. A significant increase in knowledge from pretest to posttest was found; t(200) = ?13.65, p < .0001. Children's responses to the effects of smoking correlated to the content material incorporated in ToPIC. Recommendations for program improvement are discussed.     

Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: A quasi-experimental study

This study evaluated the effect of a community-based participatory health literacy program aimed at improving the health behaviors and health empowerment for older adults. A two-group pretest and posttest quasi-experimental design with surveys conducted at baseline (T₁), immediately after the intervention (T₂), and 6 months after the intervention (T₃). The intervention group (n = 94) attended a 12-week health literacy program; while the comparison group (n = 78) did not. The results demonstrated that intervention group had significantly better health behavior practices for weight control (OR = 3.71, 95% CI = 1.59–8.64), regular exercise (OR = 15.26, 95% CI = 1.92–121.13), and health information navigation (OR = 2.61, 95% CI = 1.16–5.84). Health empowerment was significantly higher in the intervention group than the comparison group (p < 0.01).This study suggests that integrating community-based participatory design is effective in improving some health behaviors and health empowerment in older adults over a short period.     

Implementation of standard sedation management in paediatric intensive care: effective and feasible?

Objective. To study the effects of the introduction of a sedation treatment protocol for children in intensive care, including nurses’ compliance. Background. While several sedation guidelines for adults and children have been developed and implemented, there is little evidence on use of sedation protocols in critically ill infants. Design. Pretest–posttest intervention study. Methods. Administered sedatives and analgesics over the first seven days of admission were documented for convenience samples, before (n = 27) and after (n = 29) implementation of standard sedation assessments and a sedation protocol. Sedation was assessed with the COMFORT behaviour scale, Nurse Interpretation of Sedation Score and the Visual Analogue Scale for three‐month periods, both pretest and posttest. Starting 21 months after the posttest, nurses’ compliance with the sedation protocol, as well as administered sedatives and analgesics were evaluated for 12 months. Results. Infants in the posttest period received significantly more midazolam and morphine. The proportion of patients adequately sedated on the grounds of COMFORT scores had increased from 63% pretest to 72% posttest and to 75% in the long run. Adequate sedation as judged from the sedation protocol cutoffs was found in 71% of the assessments. In 45% of assessments indicating undersedation, the infusion rate had been increased on the guidance of the protocol. A survey among staff revealed that most considered the sedation protocol comprehensible and useful. Conclusion. This study showed that regular sedation assessment in critically ill children was feasible and had become standard practice two years after the first posttest. There is insufficient evidence to conclude whether implementation of a sedation treatment protocol indeed improves sedation treatment. Relevance to clinical practice. This sedation protocol provides decision trees for increasing or weaning of sedatives in both haemodynamically stable and unstable patients. It standardises sedation management and allows nurses to adapt medication themselves.     

A social skills development training programme to improve adolescents' psychological resilience and emotional intelligence level

Study objectivesThis experimental study was designed using pretest, posttest, follow-up, and control group models to explore the effect of a structured education program on adolescents' psychological resilience and emotional intelligence level.MethodThis study was conducted on 70 students at a high school in Turkey. A total of 36 students were assigned to the intervention group and 34 students to the control group. Data were collected using the Adolescent Information Form, Resilience Scale (RS), and Emotional Intelligence Evaluation Scale (EIES). The scales were administered in the intervention group before initializing the education program, who later received a 7-week education program. One month after the administration of the education program, the scales were again administered during follow-up.FindingsIt was found that the education program improved and increased adolescents' psychological resilience and total emotional intelligence level despite not being significant (p > 0.05). During the follow-up, adolescents in the intervention group demonstrated an important difference in follow-up scores in the optimism and communication subdimensions of the RS compared to that in the posttest scores, and the intervention group had a higher average total score in the EIES compared to that in students in the control group (p < 0.05).ConclusionOur results suggest that the training program has positive effects on improving adolescents' psychological resilience and emotional intelligence levels, especially in the long run, which needs to be developed and applied in different samples.