Engineering Students as Co-creators in an Ethics of Technology Course.

Research on the effectiveness of case studies in teaching engineering ethics in higher education is underdeveloped. To add to our knowledge, we have systematically compared the outcomes of two case approaches to an undergraduate course on the ethics of technology: a detached approach using real-life cases and a challenge-based learning (CBL) approach with students and stakeholders acting as co-creators (CC). We first developed a practical typology of case-study approaches and subsequently tested an evaluation method to assess the students' learning experiences (basic needs and motivation) and outcomes (competence development) and staff interpretations and operationalizations, seeking to answer three questions: (1) Do students in the CBL approach report higher basic needs, motivation and competence development compared to their peers in the detached approach? (2) What is the relationship between student-perceived co-creation and their basic needs, motivation and competence development? And (3) what are the implications of CBL/CC for engineering-ethics teaching and learning? Our mixed methods analysis favored CBL as it best supported teaching and research goals while satisfying the students' basic needs and promoting intrinsic motivation and communication competences. Competence progress in other areas did not differ between approaches, and motivation in terms of identified regulation was lower for CBL, with staff perceiving a higher workload. We propose that our case typology model is useful and that as a method to engage students as co-creators, CBL certainly merits further development and evaluation, as does our effectiveness analysis for engineering ethics instruction in general and for case-study approaches in particular.

Do critical incidents lead to critical reflection among medical students?

CONTEXT: Medical students are exposed during their training to a wide range of experiences and behaviors that can affect their learning regarding professionalism and their behavior and attitudes towards patient-centered care. The aim of the study is to explore learning associated with critical incidents and levels of critical reflection among medical students. APPROACH: Medical students' were invited to narrate a critical incident and reflect on the learning associated with it. All students' narratives were audio-recorded and analyzed thematically. Mezirow's theory of transformative learning was used to analyze the level of reflection reached in students' narratives. FINDINGS: For the present analysis critical incidents narrated by 70 clinical students (4th-6th year) were included. Fifty-two of them were females. Students' experiences are derived from three types of interactions: observed interactions between doctors and patients, personal interactions between students and patients, and interactions between doctors and students. Reflections deriving from the experiences included: behaving to patients as humans not as cases, emotional aspects of care, doctors as role models, skills needed when working under pressure, 'tasting' the real profession, emotional management, the importance of communication skills, teaching qualities of doctors, becoming a doctor, and reflections of future practice. Analyzing the actual level of reflection indicated that only 32 (45.7%) students were categorized as reflectors. CONCLUSIONS: Student interactions with doctors and patients provide insights about; the daily experience of being a doctor, the most common challenges, what qualities are necessary for being a doctor and what do they need to develop their professional identity. However, it is noteworthy that while the majority of students shared a critical incident crucial to their professional development, there is little evidence of critical reflection.

Psychological stress reduces the immunological benefits of breast milk.

Our study aimed to assess the impact of maternal psychological stress on the immunological components of breast milk. Eighty-nine women participated in the study. We assessed general stress, postpartum-specific stress, negative affectivity, salivary cortisol of mother, and secretory immunoglobulin A (sIgA) levels of breast milk 4-6 weeks after delivery. Controlling for the effects of women's age, weight, number, and duration of feedings, postpartum-specific stress was related to reduced sIgA concentration (R2 = .206, beta = -.275, p = .020). This study suggests that the established link between psychological stress and immunity may also extend to the immunity of the newborn by reducing the immunological benefits of breast milk. It also suggests that breastfeeding might be a potential mechanism of the relationship between maternal stress and the health of the offspring. Findings highlight the need for interventions addressing women during the postpartum period, in order to ensure the mother's well-being and the infant's optimal development.

A Phenomenological Investigation of the Interplay Among Professional Worth Appraisal, Self-Esteem and Self-Perception in Nurses: The Revelation of an Internal and External Criteria System.

Nurses' professional self-concept is strongly associated with professional worth appraisal, which encompasses their feelings and perceptions regarding their task efficacy and value of input to clinical outcomes. Professional self-concept and professional worth appraisal are incorporated in one's overall professional role perception. Data show that the way nurses think and feel about themselves personally and professionally, is associated with their well-being, the quality of provided patient care, their job satisfaction and retention. Although researchers indicate that professional self-concept is a different entity from personal self-concept, however, a clear differentiation and possible interaction between these constructs has not been yet adequately described in nursing literature. Personal self-concept mirrors the way people interpret them-selves, incorporating their self-awareness and personal effectiveness. Following purposeful sampling and informed consent, a phenomenological approach based on Munhall's methodology was employed to explore the living experience of professional role perception in 16 critical and emergency nurses, with special focus on their perceptions and feelings about personal and professional-role worth appraisal. Data and theoretical saturation criteria were implemented, along with all nine Munhall's criteria for the rigor and trustworthiness of phenomenological studies. The participants' narratives suggested a possible interaction between professional attitude and personality traits, illuminating as the core theme an interplay among self-perception, personal and professional worth appraisal process. Additionally, the present study emphasized the way self-evaluation criteria system may be associated with the personal and professional self-concept in nurses. In particular, it was highlighted that the way nurses think and feel about themselves is associated with the way they experience their professional role and vice versa, and that professional role-based self-concept and professional worth perception can be linked with their well-being. Furthermore, positive feelings about the self and personal competencies seemed to enhance the perception of effectiveness in clinical settings and adequacy of professional skills, resulting in empowered professional identity and vice versa. Overall, the present findings are discussed in relation to nurses' experience of work-related stressors and relevant interventions. Further exploration of the effectiveness of interventions for facilitating adaptive personal and professional self-appraisal are suggested.

Perceptions of professional role in community mental health nurses: The interplay of power relations between nurses and mentally ill individuals.

Nurses' professional role perception is related to the quality and safety of care. Limited data exist regarding professional role perception in community mental health nurses (CMHNs). The aim of the present study was to investigate the living experience of Greek-Cypriot CMHNs of their professional role. A phenomenological approach based on Munhall's methodology was applied. According to purposive sampling, five Greek-Cypriot CMHNs participated, following informed consent. The interplay of power relations between participants and mentally ill individuals during CMHNs' house calls was revealed as the core theme contributing to the perception of their status within their professional role. Participants' perception of their status as visitors in patients' homes rather than authoritative figures, an image held within hospital mental health services, was deemed as the greatest challenge of their professional role. Moreover, the necessity for autonomous and rapid decision-making during home visits was described as an absolute prerequisite for professional effectiveness. Overall, the main themes were grouped as follows: professional role perceptions, perception of self within professional role, feelings and expectations about professional role. Non-power relations between participants and patients, along with efficacy, control and adequate clinical autonomy for effective professional practice were highlighted as major prerequisites during house calls. Interventions towards nurses' psychosocial and organizational empowerment, as well as strengthening patients' self-determination are proposed.

'You put up a certain attitude': a 6-year qualitative study of emotional socialisation.

CONTEXT: Emotions play a central role in the professional development of doctors; however, research into how students are socialised to deal with emotions throughout medical school is still lacking. OBJECTIVES: This study aimed to gain a better understanding of the emotional socialisation of medical students (e.g. how they learn to express and respond to emotions evoked in clinical practice in the process of becoming a doctor). METHODS: In this longitudinal study, 12 medical students participated in annual, individual, semi-structured interviews, capturing the full 6-year medical school period. We carried out a thematic analysis, which was iterative and inductive. RESULTS: The socialisation of emotion in the process of becoming a doctor happens in a complex interplay between student and context. We identified two modes of emotional socialisation (e.g. explicit and implicit teaching about emotions), the latter including how the people observed by students express their emotions and how they respond to the emotions expressed by students. Although the main message conveyed to students still seemed one about hiding or suppressing emotion, we found that students were able to identify and build upon the emotional expression and responses they observed in positive role models and managed to create their own opportunities to express their emotions. We found large differences between students in how they perceived, presented and developed themselves. CONCLUSIONS: Students differ in how they respond to and what they need from their environment and thus may benefit from tailored supervision in learning how to experience, express and respond to emotion. Providing students with real and authentic responsibility for patients and allowing them time and opportunity to talk about emotion might help them to create an emotional space.

Development and Validation of a Cross-Country Hospital Patient Quality of Care Assessment Tool in Europe.

BACKGROUND: Patient perceptions of quality of care (QoC) are directly linked with patient safety and clinical effectiveness. We need patient-designed QoC instruments that work across languages and countries to optimise studies across systems in this area. Few QoC measurement tools exist that assess all aspects of QoC from the patient perspective. This paper describes the development and validation of a comprehensive measure to assess patient perceptions of QoC that incorporates technical and interpersonal aspects of care and is grounded in the established Institute of Medicine (IOM) QoC framework. DESIGN: We conducted a multi-country cross-sectional study. METHODS: Following a literature review and patient focus groups, an expert panel generated questionnaire items. Following a pilot study, item numbers were reduced. The final questionnaire consisted of three sections: demographics, perceived QoC and one open-ended question. Data was collected from patients (n = 531) discharged from hospitals across seven countries in South East Europe (languages: Turkish, Greek, Portuguese, Romanian, Croatian, Macedonian and Bulgarian). Reliability and validity of the measure were assessed. RESULTS: Confirmatory factor analysis was used to compare various factor models of patient-perceived QoC. Good model fit was demonstrated for a two-factor model: communication and interpersonal care, and hospital facilities. CONCLUSIONS: The ORCAB (Improving quality and safety in the hospital: The link between organisational culture, burnout and quality of care) Patient QoC questionnaire has been collaboratively and exhaustively developed between healthcare professionals and patients. It enables patient QoC data to be assessed in the context of the IOM pillars of quality, considering both technical and interpersonal dimensions of care. It represents an important first step in including the patient perspective.

(How) do medical students regulate their emotions?

BACKGROUND: Medical training can be a challenging and emotionally intense period for medical students. However the emotions experienced by medical students in the face of challenging situations and the emotion regulation strategies they use remains relatively unexplored. The aim of the present study was to explore the emotions elicited by memorable incidents reported by medical students and the associated emotion regulation strategies. METHODS: Peer interviewing was used to collect medical students' memorable incidents. Medical students at both preclinical and clinical stage of medical school were eligible to participate. In total 104 medical students provided memorable incidents. Only 54 narratives included references to emotions and emotion regulation and thus were further analyzed. RESULTS: The narratives of 47 clinical and 7 preclinical students were further analyzed for their references to emotions and emotion regulation strategies. Forty seven out of 54 incidents described a negative incident associated with negative emotions. The most frequently mentioned emotion was shock and surprise followed by feelings of embarrassment, sadness, anger and tension or anxiety. The most frequent reaction was inaction often associated with emotion regulation strategies such as distraction, focusing on a task, suppression of emotions and reappraisal. When students witnessed mistreatment or disrespect exhibited towards patients, the regulation strategy used involved focusing and comforting the patient. CONCLUSIONS: The present study sheds light on the strategies medical students use to deal with intense negative emotions. The vast majority reported inaction in the face of a challenging situation and the use of more subtle strategies to deal with the emotional impact of the incident.

Implementing action research in hospital settings: a systematic review.

PURPOSE: Health care organizations and hospitals in particular are highly resistant to change. The reasons for this are rooted in professional role behaviors, hierarchical structures and the influence of hidden curricula that inform organizational culture. Action research (AR) has been identified as a promising bottom-up approach that has the potential to address the significant barriers to change. However, to date no systematic review of the field in health care exists. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: A systematic review of the literature was conducted. Studies were reviewed with regard to the four stages of AR; problem identification, planning, implementation and evaluation. FINDINGS: Only 19 studies were identified that fit the inclusion criteria. Results revealed significant heterogeneity with regard to theoretical background, methodology employed and evaluation methods used. RESEARCH LIMITATIONS/IMPLICATIONS: Only studies published and written in the English language were included. PRACTICAL IMPLICATIONS: The field of AR interventions would benefit from a theoretical framework that has the ability to guide the methodology and evaluation processes. ORIGINALITY/VALUE: This is the first systematic review of AR in hospitals.