Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
1.
JMIR Res Protoc ; 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1555867

ABSTRACT

BACKGROUND: Stress, anxiety, distress, and depression are high among healthcare workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources. OBJECTIVE: The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality (VR) and a mobile platform) to understand the causes and ultimately reduce the moral distress of healthcare providers during the COVID-19 pandemic. This project is a proof-of-concept integration of concepts/applications to demonstrate viability over six months and guide future studies to develop these state-of-the-art technologies to help frontline healthcare workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury. METHODS: This will be a prospective, single cohort, pre- and post-test study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during the scenario known to potentially elicit moral distress. To accomplish this, we have developed a VR simulation scenario that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an ICU setting during the COVID-19 pandemic, and participants will be placed in a morally challenging situation. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for a) physiological measures of stress and after each test, data will be collected regarding b) thoughts, feelings and behaviours during a morally challenging situation, and c) perceptual estimates of psychological stress. We aim to create an effective compound intervention composed of the VR-based simulation educational intervention that is examined through the data collected from mental health questionnaires. In addition, participants will continue to be monitored for moral distress and other psychological stresses for eight weeks through our Digital intervention/intelligence Group mobile (DiiG) platform for a longer-term impact. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the VR intervention. RESULTS: Funded in (November, 2020), approved by REB in (March, 2021), the study is ongoing. CONCLUSIONS: This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress. CLINICALTRIAL: Trial registry name: ClinicalTrials.gov, registration/identifier number: NCT05001542, URL: https://clinicaltrials.gov/ct2/show/NCT05001542, Unity Health Toronto protocol record: 21-066.

2.
Nurse Educ Today ; 93: 104516, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1454378

ABSTRACT

OBJECTIVES: The purpose of this review was to identify pedagogical practices that contribute to professional identity formation in undergraduate nursing education and to map the components of professional identity described within these practices. DESIGN: A scoping review using a six-stage methodological framework was used to capture a range of evidence describing how professional identity has been conceptualized and integrated into nursing curriculum. DATA SOURCES: Databases searched included: Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily and Ovid MEDLINE® 1946-Present, EBSCO CINAHL (1981 to present), OVID PsycINFO (1806 to Present), ProQuest ERIC, ASSIA, and Sociological Abstracts. Additional studies were identified by scanning the reference lists of relevant articles. REVIEW METHODS: The study team collaboratively designed the data charting table and two coauthors independently screened the studies using Covidence software. Qualitative content analysis was used to categorize learning outcomes into five components of professional identity that were associated with pedagogical practices identified in the studies. RESULTS: A total of 114 peer-reviewed journal articles were initially charted. Articles were categorized as intervention studies (46, 40%), perspective studies (40, 35%), theoretical papers (17, 15%), or reviews (11, 10%). To ensure feasibility in collating and reporting the results, the review focused on the 46 empirical intervention studies that described associations between pedagogical practices and professional identity formation learning outcomes for students. CONCLUSIONS: This scoping review illustrates the range of contexts in which nursing students learn, the multidimensional nature of identity formation, as well as the breadth of pedagogical practices and learning outcomes that guide course design. The results can be used to inform future curriculum planning and to identify focused research questions to extend our understanding of evidence-based teaching practices supporting professional identity formation.


Subject(s)
Learning , Nurse's Role , Professionalism , Students, Nursing/psychology , Curriculum , Education, Nursing, Baccalaureate , Humans
3.
CMAJ Open ; 9(1): E142-E148, 2021.
Article in English | MEDLINE | ID: covidwho-1115548

ABSTRACT

BACKGROUND: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial to determine if virtual care with remote automated monitoring (RAM) compared with standard care will increase the number of days adult patients remain alive at home after being discharged following nonelective surgery. METHODS: We are conducting a randomized controlled trial in which 900 adults who are being discharged after nonelective surgery from 8 Canadian hospitals are randomly assigned to receive virtual care with RAM or standard care. Outcome adjudicators are masked to group allocations. Patients in the experimental group learn how to use the study's tablet computer and RAM technology, which will measure their vital signs. For 30 days, patients take daily biophysical measurements and complete a recovery survey. Patients interact with nurses via the cellular modem-enabled tablet, who escalate care to preassigned and available physicians if RAM measurements exceed predetermined thresholds, patients report symptoms, a medication error is identified or the nurses have concerns they cannot resolve. The primary outcome is number of days alive at home during the 30 days after randomization. INTERPRETATION: This trial will inform management of patients after discharge following surgery in the COVID-19 pandemic and offer insights for management of patients who undergo nonelective surgery in a nonpandemic setting. Knowledge dissemination will be supported through an online multimedia resource centre, policy briefs, presentations, peer-reviewed journal publications and media engagement. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04344665.


Subject(s)
Aftercare/trends , Monitoring, Ambulatory/methods , Patient Discharge/standards , Remote Consultation/instrumentation , Adult , COVID-19/diagnosis , COVID-19/epidemiology , Canada/epidemiology , Computers, Handheld/supply & distribution , Humans , Middle Aged , Postoperative Period , SARS-CoV-2/genetics , User-Computer Interface
4.
Int J Nurs Stud ; 117: 103887, 2021 May.
Article in English | MEDLINE | ID: covidwho-1068929

ABSTRACT

BACKGROUND: Nurses have been labelled "heroes" by politicians, the mass media, and the general public to describe their commitment to providing front-line care to people with COVID-19, despite the risks of exposure and lack of clinical resources. Few studies have examined the implications of the hero discourse to nurses' professional, social, and political identities. OBJECTIVE: To critically examine the effects of the hero discourse on nurses who are contending with the ongoing COVID-19 crisis and to consider the political, social, cultural, and professional impact of this discourse on nursing work. METHODS: A poststructural discourse analysis, employing the theoretical ideas of truth, power, knowledge, subjectivity, and normalization, was conducted to explore the mass media's constructions of nurse as hero in the contexts of COVID-19. Media electronic databases were searched between March 1, 2020 to August 1, 2020 to locate newspaper and magazine articles, corporate advertisements, videos, social media postings, and institutional/corporate websites. SETTING: Data sources included English language media accounts that originated from Canada, the USA, and the UK. RESULTS: Three main elements of the hero discourse include: 1. Nurses as a "necessary sacrifice" - portraying nurses as selfless, sacrificing, and outstanding moral subjects for practicing on the front-line without adequate protective gear and other clinical resources; 2. Nurses as "model citizens" - positioning nurses as compliant, hardworking, and obedient subjects in contrast to harmful individuals and groups that ignore or resist COVID-19 public health measures. 3. Heroism itself as the reward for nurses - characterizing hero worship as a fitting reward for nurses who were unappreciated pre-pandemic, as opposed to supporting long-term policy change, and highlighting how heroism reconfigures nursing work from the mundane and ordinary to the exciting and impactful. CONCLUSIONS: The hero discourse is not a neutral expression of appreciation and sentimentality, but rather a tool employed to accomplish multiple aims such as the normalization of nurses' exposure to risk, the enforcement of model citizenship, and the preservation of existing power relationships that limit the ability of front-line nurses to determine the conditions of their work. Our study has implications for approaching the collective political response of nursing in the ongoing COVID-19 crisis and formalizing the ongoing emotional, psychological, ethical, and practice supports of nurses as the pandemic continues.


Subject(s)
COVID-19 , Pandemics , Canada , Delivery of Health Care , Humans , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL
...