What can you expect during your onsite survey?

The world of accreditation is in constant change, and as health information management professionals, we should always embrace change. New standards and survey procedures provide us with new goals, outlooks, ways to increase the quality of patient care, and opportunities to mentor the hospital staff including the medical staff and governing board. I encourage you to evaluate, amend, and build on the information contained within this article. Remember that talking to your peers about their experiences and working as though your survey is tomorrow is your best bet for superior survey results. Who knows, you could receive an unannounced survey.     

Older men’s participation in community‐based men’s sheds programmes

The purpose of this qualitative study was to investigate the lived experience of older men taking part in community‐based shed programmes. Five men, aged 65 and over, who attended two different community sheds participated in semi‐structured in‐depth interviews in 2007. Data were analysed thematically with six main themes emerging as follows: ‘company of fellas’; ‘everybody’s got a story to tell’; ‘still got some kick’; ‘passing on your experiences’; ‘get on your goat’ and; ‘nobody’s boss’. Participation in community‐based men’s sheds positively influences the health and well‐being of older Australian men through provision of a ‘men’s space’ in which meaningful activities occur. Provision of community‐based men’s shed programmes as among a range of activity options in the community may contribute positively to the physical, mental, social and occupational health of older men.     

The Untaught Lesson

My fellow physician and friend died from a rare type of cancer. She was a model for me in many respects. She showed me how to cope with a chronic disease together with a demanding professional life, yet she left me without any comfort or guidelines on how to contend with a terminal disease.This story is a reflection on my frustration and disappointment with my friend’s final choices that prevented us from processing our feelings and sharing our deepest thoughts. The story includes reflections and insights about our ability to understand and accept the preferences of patients and others close to us.I remember the very first time I saw you. I was a young intern in a robe heavily laden with work tools and books; you were a senior intern, petite, energetic, standing at the counter of the ambulatory hematologic department. Your voice was captivating: simultaneously funny, cynical, and confident. It would be the beginning of a long relationship with you as my mentor, my colleague, at times my physician, and my cherished friend.Your family and close friends called you “Tiny.” Having met you as an adult, I could never get used to that. You were larger than life.We both suffered from a chronic disease that we would often discuss. You always knew how to recognize the fact that we had a chronic disease as well as a determination to live with it as best as we were able.We gave birth to our first-born daughters at the same time. A few years later, you accompanied me to the operation room where I gave birth to my last son. Our friendship extended to our families and children, and was graced by several years of shared happiness. We were both living life in the fast lane.When I was 40-something and you were 40-something and a bit more, illness struck you. The tests revealed a strange and rare growth. We read the diagnosis in disbelief: adenocarcinoma of the biliary tract. Neither of us had ever met such a patient. We both voraciously read anything we could get our hands on about the disease and within a few hours summarized: “Pretty lousy, huh?” to which you added: “Only doctors get such exotic diagnoses.”You sought doctors who could treat the disease, requesting second and third opinions. Despite the horrible prognosis, you grasped onto any treatment that offered hope, anywhere in the world. You used your personal and professional connections to obtain experimental treatments and protocols were invented just for you. There was no previous experience in successfully treating your type of cancer. You were willing to suffer any side effect; you forewent every form of quality of life. You held onto life and onto the anger about life slipping out of your control.I secretly lost hope from the first moment. I identified with your denial in one respect only: as a mother of two adolescents, you had to do anything possible to get better. You weren’t allowed to die. It was inconceivable.Yet it was impossible to talk openly about these emotions. I longed to tell you: “Irene, you know how our patients sometimes hold onto life and it is our job to help them accept that death is approaching, and to tell them that maybe they should focus on pain relief and not recovery, and perhaps they should write their advance directives.…? Well, now that patient is you.” But I could not be so blunt. The topic was strictly taboo.I tried to listen to you. Just as you taught me to live with a chronic disease, I thought perhaps you would show me what to do when the battle fails and the disease overtakes unimaginable parts of the body. How does a brave, determined, realistic, and energetic woman like you (and me) deal with a fatal disease?If I had said the word “fatal” you would have kicked me out of your room and out of your life. There was no room for such conversation. You refused to discuss it, to recognize it. You refused to say goodbye. It was heartbreaking to watch you suffer. I supported transferring to palliative care, but you maintained your battle with the disease with all your might and effort.For what would be your last birthday I bought you a comic book about cancer (Cancer Made Me a Shallower Person¹—written and illustrated by Miriam Engelberg, a woman who used humor to work with her breast cancer, from which she eventually died). You always had a cynical sense of humor and you were one of the funniest people I knew, but “This time,” you said, “Ruth, you’ve crossed the limit. It’s like telling a Holocaust joke to a survivor.”I was at a loss of finding a way in, beyond the fortress of denial you imposed on yourself and your surroundings.We never said goodbye. You never told me what you wanted me to do after your death. You never asked me to take care of your husband and the children. You never said any concluding words, no words of farewell. In the past, we often spoke of the fact that as doctors when we accompanied patients to their death, we were in fact also rehearsing for our own death. You stopped training me during those final days when your impending death lingered in the air.On a pain-ridden Saturday, with just your husband at your side, you asked for a terminal sedation until your final rest. When I last saw you, you were already sedated, taking away my final chance for a closure you so adamantly wanted to avoid. You left me: a colleague, a friend, with a huge question mark and without any comfort or guidelines as to how to cope with a serious, fatal, hopeless illness.You could not face the uncontrollable truth, either with yourself or with me, leaving me to contend alone with my own unanswered questions and fears. Perhaps all of my experiences, insights, and resolutions will be of no avail when faced with the threat of losing my own life.Even as an experienced and empathic teacher, well aware of the dynamics between physician and patient, I realize I can never fully comprehend the factors that converge to ultimately determine a patient’s decisions. It is a complex fabric of culture, personality, conditions, community, and family, and there is no formula. I understand that my only remedy is to live life fully with open arms in the hope I will be wise enough to learn how to accept death when it appears.What I did learn from you, Irene, is about the unknown. I learned this: that I cannot assume that just because we were so similar in education, background, vocation, and coping with a chronic disease, that we would cope with death in the same way.You taught me by not teaching me. You taught me by leaving me alone to walk this untrodden path.Your guidance was in reflecting through your example how I would not like to cope with death, yet I fear that I am not immune to such a battle. And you taught me that I simply cannot know how I will cope should I face a similar situation—perhaps I too will fight until the end. Through this, you taught me about humility. There are unknown parts of ourselves that arise when we encounter unknown situations. This is part of what I now try to teach my students—that no matter what knowledge, values, perspectives we hold—to allow for the unknown to surprise us…mold us, shape us, impact us. This is what it truly means to be open to life and death: to agree to not know.Another untaught lesson you gave me was to learn to accept you unconditionally. Despite my deep disappointment and frustration at not being able to communicate openly with you, I accept this as your final lesson for me. Although I wanted to learn something else, perhaps this was exactly what I needed to learn.     

The ATP 30—a scale for measuring medical students' attitudes to psychiatry

The development and validation of a thirty item, Likert-type scale designed to measure medical students' attitudes to psychiatry—the ATP-30 (Attitudes Toward Psychiatry—30 items)—are described. We had hoped to demonstrate that 'attitude to psychiatry' was not a unitary matter but an amalgam of attitudes to a number of things to do with psychiatric practice. This hope was not fulfilled, as a unitary dimension was obtained. A positive change in the attitudes of students toward psychiatry was demonstrated in third and fourth medical year students in relation to exposure to psychiatry. Such a change was not demonstrable in two classes of occupational therapy students exposed to a course in psychiatry. The reasons for this difference between medical students and occupational therapy students are discussed—there possibly being important implications here for psychiatric curriculum planning in medical school. Lastly, we have demonstrated that the positive change in attitudes amongst medical students was transient rather than lasting—a matter which most studies of attitude change do not address. In spite of the apparent impermanence of the positive change in attitudes among medical students, there are a number of possible uses to a scale such as the ATP-30, and these are discussed.     

Writing Manuscripts for Peer Review: Your Guide to Not Annoying Reviewers and Increasing Your Chances of Success

“Publish or perish.” Does this send chills down your spine? For many academicians, it certainly does. Publishing your work is a necessary part of achieving success in an academic and research career. The ability to articulate your ideas and contribute to the body of knowledge in your discipline is an essential skill and, happily, one that can be cultivated and refined. We have drawn on our own experiences in learning to write, being reviewed, successfully publishing and being reviewers ourselves. We also have included some excellent resources in the literature to help you maximize your chance of success.     

Lights] Camera] Action] Sexual decision-making

Responsible adolescent decision making can be enhanced with activities summarized in this article. Most adolescents recommend an older age to begin sexual intercourse than when they first began. Translating attitudes into personal behavior is difficult. Educators can help by devoting 2 50-minute class periods to introducing Sexual Intimacy: Considerations for Responsible Decision-making and directing groups to prepare a skit and resolution, which would be performed in the 2nd class period. Sexual Intimacy Considerations involve 8 points: being comfortable about your level of involvement, confident that humiliation or guilt will not result, sex is not being forced, tender feelings are being expressed rather than attempting to improve a relationship, contraception is agreed upon, sexual disease transmission is discussed, and agreement is reached on resolution of unexpected pregnancy. In addition, you should not be trying to prove your love, increase your self-worth, prove you are mature, show you can attract a sexual partner, get affection or attention or love, reel, or prove your masculinity or femininity. Groups should be small at 5-6 people. The skit should portray a situation involving pressure to have sexual relations. At least 10 verbal exchanges which express conflict should take place between the pressurer and pressuree. The 2nd time through resolution should be added. Discuss and summarize the issues presented. Compare the ways groups evaluate consequences, weigh factors, communicate, and negotiate. Make a list of consistent issues such as: coercion, ambivalence, pregnancy/sexually transmitted disease prevention, sex role stereotypes. Learning becomes more than decision making; it also 1) provides an opportunity to make or defend a rational rather than an emotional decision about sexual intimacy, 22) increases awareness of sexual pressures the opposite sex experiences, and 3) gives an opportunity for group feedback. Discussion guides suggest identifying the important decision in the skit, applying criteria from Sexual Intimacy Considerations, the alternatives available for each of the characters, selecting a resolution and sharing information.     

Experience of women in labor. Nurses' observations

This study emerged from my own experience in Obstetric Nursing and my living in Obstetrics. I searched for comprehending the real meaning of delivery labor experiences as a situated phenomenon. It is a qualitative research with phenomenological approach. The lying-in women were the witnesses through the question: 'What was your daily experience in the pre-delivery room like?' Through analysis and hermeneutics of speeches, I have used the knowledge of Matin Heidegger's philosophical-theoretical referential. Thus, I managed to clarify that the parturient is fearful when left by herself in her experience, showing surprise for the labor of delivery is singular, noting down the pain as a possibility of the existential limit, being open to help and noticing the impersonality of care provided. With this watchful sense, I approached the comprehension of a lying-in woman as a being-in-a-world-with-health-professionals. This discovery indicated the possibility of new ways of caring in Obstetrics.     

Transitioning to a new era: Future directions for staff development during COVID‐19

The COVID‐19 pandemic created an urgent need for staff development. However, COVID‐19 has created many challenges, including the inability to meet in‐person, travel restrictions to conferences, overwhelming clinical demands on already overextended faculty members and the increased need to focus on personal health and safety. Although current challenges were immediately met with solutions borne out of an emergency, questions remain on how to identify and sustain best practices and further evolve staff development beyond the immediate crisis. Reviewing the Medical Adaptations series revealed several lessons. Several authors used cognitive apprenticeship to provide scaffolding upon which learners can build skills, knowledge and attitudes. Additionally, moderators were recommended during live educational sessions in order to manage the chat box and engage the audience. Comprehensive IT support was key. A post‐session debrief helped deepen understanding and provided a space for peer support and community building. Building a repository for educational materials was recommended. Although we made significant gains in the ability to offer staff development, we must consider potential and unintended consequences and explore how we can use transformative learning theory to capitalize on what we have gained. Utilizing technology can potentially increase access to online learning; however, when not implemented carefully, it can magnify inequities. While providing IT support can serve to mitigate some inequities borne by socioeconomic and generational differences, additional strategies should be implemented to account for English as a second‐language learners; those with disabilities who do not have access to adaptive technology; and other marginalized groups who may already feel vulnerable to presenting arguments in oppositions of authority or the majority. Crafting online education experiences to allow for small group, peer‐to‐peer and social interactions is vital to continued professional and identity development. Now that the urgency has lessened, taking time to ensure what is being offered follows best practices in developing and disseminating quality online education is paramount for broad acceptance.     

Optimizing access to and use of formal dementia care: Qualitative findings from the European Actifcare study

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi‐structured in‐depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross‐national analysis. Overall, analysis of the in‐depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease‐related factors and system‐related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care‐giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision‐making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified.     

Sociocultural aspects of menstrual attitudes and premenstrual experiences in India

Menstrual attitudes were studied in a group of 48 Indian women using the Menstrual Attitude Questionnaire, modified and adapted for Indian background. Attitudinal factors of menstruation being a natural, bothersome and debilitating event were studied, as also denial of the event and healthy/unhealthy attitudes. High rating was seen in menstruation being perceived as a natural event and least as a debilitating one. Older women considered menstruation as a natural event. Relating premenstrual experiences to attitudes, it was observed that distressful symptoms correlated significantly with debilitating and unhealthy attitudes. Similarly, premenstrual well-being correlated highly with naturalness attitudes, thereby suggesting that the personal experiences are likely to influence the menstrual attitudes.     

Shortening the Distance Between the “I” and the “It”: A Transformative Approach to Improving Teaching

“It” science focuses on the external and technical dimensions of action. “I” science focuses on the internal experiences and meaning particular actions hold for people. Elevating “It” science over “I” science can deform occupational therapy's body of knowledge and, consequently, stunt its practices. Similarly, elevating the technical or instrumental dimension of teaching over the internal experiences of educators can deform education and even do harm to students. A transformative learning approach to improving teaching foregrounds the inner lives of educators, thus balancing the instrumental with the deeply personal aspects of teaching. Such a balance is vital given the hopes that ride on occupational therapy education.     

Fathers sharing about early parental support in health‐care ‐ virtual discussions on an Internet forum

Becoming a father is a life changing event and this transition is associated with various emotions. Educational activities aimed at new parents are important in healthcare parental support (HCPS). HCPS has been critiqued for its predominant focus on mothers, while the needs of fathers seem to have been downplayed. As a result, fathers often turn to Internet‐based forums for support. As virtual discussions and mutual support among fathers take place in cyberspace, it is important to monitor these forums to observe the ways in which the fathers discuss HCPS. The aim of this study is to explore the ways in which new fathers visiting an Internet‐based forum for fathers communicated their experiences of HCPS. A netnographic method consisting of six steps was used to gather and analyse the data. The findings show that fathers shared with one another their experiences of the attitudes expressed by HCPS workers as well as their own attitudes towards HCPS. The attitudes of HCPS workers that were directed towards the fathers were perceived as highly personal and individual, while fathers described their attitudes towards the HCPS in general terms, towards HCPS as a system. Overall, the fathers described HCPS as a valuable confirmatory support that eased their worries concerning sudden infant death syndrome (SIDS), colic, weight gain, fever and teething. Although the fathers expressed gratitude towards HCPS, they also shared their negative experiences, such as feeling invisible, disregarded and insulted. In fact, the twofold attitudes that exist in the relationship between the fathers and HCPS can act as a barrier rather than being a confirmatory support. We recommend that HCPS adopts a broader approach using more targeted and strategic didactic methods for supporting fathers in the growth of their own personal awareness, as such an approach would offer a competitive and professional alternative to the support offered in informal experience‐based Internet forums.     

Gaining control over breast cancer risk: Transforming vulnerability,uncertainty, and the future through clinical trial participation – a qualitative study

Concepts of disease risk and its management are central to processes of medicalisation and pharmaceuticalisation. Through a narrative perspective, this paper aims to understand how such macro‐level developments may (or may not) be experienced individually, and how an algorithm that is used for recruitment into a clinical trial may structure individual notions of being ‘at risk’ and ‘in need of treatment’. We interviewed 31 women participating in the Study of Tamoxifen and Raloxifene (STAR), a chemoprevention trial conducted in the US between 1999 and 2006. Interviews were thematically analysed. Women in the study had experienced the threat of breast cancer and felt vulnerable to developing the disease prior to STAR participation. The diagnosis of ‘being at risk’ for cancer through an algorithm that determined risk‐eligibility for STAR, opened up the possibility for the women to heal. The trial became a means to recognise and collectivise the women's experiences of vulnerability. Through medication intake, being cared for by study coordinators, and the sense of community with other STAR participants, trial participation worked to transform women's lives. Such transformative experiences may nevertheless have been temporary, enduring only as long as the close links to the medical institution through trial participation lasted.     

Transformational change: Moving toward enterprise risk management through the Power of One™

My oldest daughter, Julia, graduated from high school in June of this year. She leaves for college in the fall. It's not easy letting go; change is hard. Transformational change is harder still. Fortunately, she is being launched into the world with some good principles to help her focus: Be kind to your neighbor. Make the world a better place.     

25 ways your employees can be goodwill ambassadors for your medical practice

Most medical practice employees want their patients' experiences to be very positive. This article suggests 25 specific, easy, and no- or low-cost strategies every staff member can use to roll out the red carpet for patients. It provides several easy-to-implement techniques for remembering and using personal information about patients to demonstrate that you and your staff care about them. This article also suggests a number of finesse strategies that will make every office visitor feel like a VIP. It offers specific do's and don'ts about being courteous to patients. It also offers several tips your staff can use to become goodwill ambassadors for your practice in your community and for going the extra mile for your patients. Finally, this article offers a step-by-step procedure your staff can use to shake hands professionally with every one of your patients.     

Spreading the word about the unique and valuable role of healthcare risk managers

Here I am three‐quarters through my year as president of ASHRM and I am still pinching myself that I am where I am! How has your year been? It has been a tough year for everyone in healthcare. With the Affordable Care Act demands on healthcare and the public, concerns about funding, quality initiatives, and overall potential loss of revenue, it's a wonder we are still in healthcare. But would you be doing anything different? I don't think so. I love that I can help make a difference by assisting staff with a difficult patient or situation or help a patient with a care concern that they are totally frustrated with or explain to a fellow risk manager what I would do in the situation they are dealing with. Although we feel like we are being pulled into new healthcare territories for our insight and recommendations, it is an indication of the value we bring to our organizations. We will get through this and there will be more challenges, but as risk management professionals, we can help solve problems and create value in the upcoming changes in healthcare.     

Prediabetic categorisation: the making of a new person

The increasing global prevalence of type 2 diabetes has given rise to numerous trials designed to preventing diabetes. Most of these trials focus on encouraging individuals, especially ‘high-risk’ individuals to make lifestyle changes to reduce their chance of developing diabetes. Based on group interviews with health care professionals and qualitative in-depth interviews with participants in a diabetes preventive intervention with a biomedical aim to reduce risk of diabetes, in this article I critically explore the transformative potential of the medical classification prediabetes. My analysis of these data was informed by Bourdieu’s theory of practice and his concept of habitus which he defined as ‘systems of durable, transposable dispositions, structured structures predisposed to function as structuring structures, that is, as principles which generate and organise practices and representations’. Health professionals especially doctors saw the categorisation of patients as prediabetic in biomedical terms as a technical exercise that made visible information that already existed. In contrast, I found that patients saw the categorisation as creating a more fundamental change, the making of a new ‘high-risk’ person who had to take action based on a dialectical interplay between freedom and constraint in their everyday life, to manage these risk factors. They defined themselves as having a medical condition, a ‘lifestyle disease’. For these individuals, the precise meaning of and potential course of action depended on context, for example being diagnosed with prediabetes, could lead to personal benefits for those who were able to lower their blood glucose level. However, for some, there were circumstances, such as genetics, age or race, which could be neither influenced nor controlled. In this article, I note that screening-based preventive interventions that fail to consider embodied social knowledge and lived experiences will not achieve their desired outcomes.     

ATTITUDINAL AND NORMATIVE FACTORS ASSOCIATED WITH ADOLESCENT CIGARETTE SMOKING IN AUSTRALIA AND THE UNITED STATES OF AMERICA: A METHODOLOGY TO ASSIST HEALTH EDUCATION PLANNING

This paper describes an empirically based method for defining the role of attitudes in health education planning. An explicit assumption underlying this method is that the professional health educator is an agent for behavior change who works, primarily via other health professionals, to enhance the health of the target population. To effect change, the health educator must be skilled in (a) problem definition, (b) program development or the treatment of the problem, (c) program implementation and (d) program evaluation. To illustrate this approach we present a model for measuring attitudes and social normative factors which seems useful in defining education need, illustrate its use in a cross-culture comparison of a sample of adolescent cigarette smokers in Australia and United States of America and suggest some further steps to aid in planning and evaluating health education activities. While this paper emphasizes the role of attitude, attitudes are but one of a number of factors to be considered in health education program development. Anderson¹ and Green² suggest that attitudes and knowledge contribute to a predisposition to a particular behavior but that the ultimate behavior is also influenced by a set of factors best described as enabling the behavior and a set of factors which reinforce the behavior.     

Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

PurposeInequitable attitudes toward men’s and women’s roles, rights, and responsibilities are associated with poor health–related outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented “cash plus” intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training.MethodsThe study utilizes a cluster randomized design, using data from 1,933 males and females aged 14–19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores).ResultsThe “cash plus” intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females.ConclusionsGender transformative social protection is currently being advocated as a way to address the gendered nature of poverty and its consequences. Initiatives such as the one studied here, which address the multifaceted drivers of gender inequities, could be a promising way forward.     

'It's the system working for the system': carers' experiences of learning disability services in Ireland

The aim of this article is to examine the experiences of families with young adults with learning disabilities trying to access services. The landscape of disability services for this group is made up of day care, special vocational training and respite places. It aims to identify the extent of an implementation gap between government rhetoric and the degree to which services are characterised as being non-supportive interactions on the ground. Using Ireland as a case study, during a time when the economy is booming and government rhetoric claims unparalleled developments in allocating resources and extra respite 'places', this article identifies the main challenges faced by family carers associated with accessing appropriate services for their disabled adult child, in their attempt to achieve greater independence. This article reports the findings of a qualitative study in which individual semistructured interviews were held with family carers ( n  = 25) and representatives from national carer organisations ( n  = 6) in Ireland. These were people caring for an adult (18–30 years) with a learning disability and their experiences were also useful in cross-checking the carer organisation interviews. The findings show that there is limited flexibility, choice and availability in meeting the preferences of the service-users, and throughout the study, services were characterised as being non-supportive interactions. This is not simply symptomatic of a lack of resources. Despite improved funding, supportive attitudes and flexibility are still crucial in meeting user requirements at the level of delivery; thus highlighting that often the system works for the system, not for the user.