Recognizing pain as an early warning symptom of ischemic cardiovascular disease: A qualitative artistic representation of the journey.

Background: Understanding the experience of prodromal ischemic cardiac pain and associated symptoms through use of literary and visual art evokes heightened a wareness of the emotional journey. AIMS: The aim of this study was to describe the initial early prodromal pain-related symptoms and feelings associated with adjusting to this new cardiac health concern and explore the subjective experience of coming to the realization and awareness of developing heart disease. MATERIALS AND METHODS: This study is a secondary supplemental qualitative analysis, using an arts-based embodied layered exploration assisted to translate the experiences of 23 individuals' journeys through symptom recognition. The analytic process involved three iterative layers: qualitative descriptive analysis of participant pain narratives, interpretation with thematic poetry, and representation via visual art to evoke an aesthetic, heightened level of understanding of the data. RESULTS: Denial and disbelief, encroaching pain and symptoms of heart disease, and self-recrimination were three themes that emerged from the data. Pain described by participants brought forward the emotional dimensions of the experience. Participants described their process of realization as a tumultuous time, fraught with feelings of vulnerability and uncertainty, where anger and self-effacing ridicule permeated their thoughts that were tempered with profound gratitude at survival. CONCLUSION: Bridging the connection between science and art to disseminate awareness of the nature of living with cardiac-related prodromal pain and disease is novel. Providing invitation and entrance into an individual's pain experience through qualitative inquiry with use of arts-based approaches makes visible the emotional meaning of pain.

Contexte: La compréhension de l'expérience de la douleur cardiaque ischémique avant-coureuse et des symptômes qui lui sont associés par l'utilisation de la littérature et des arts visuels permet de mieux prendre conscience du cheminement émotionnel.Objectifs: Cette étude avait pour but de décrire les premiers symptômes avant-coureurs liés à la douleur et les sentiments suscités par l'adaptation à ce nouveau problème de santé cardiaque, ainsi que d'étudier l'expérience subjective de la prise de conscience d'être en train de déveloper une maladie cardiaque.Matériel et méthodes: Cette étude constitue une analyse qualitative supplémentaire secondaire utilisant une méthode d'exploration par les arts à plusieurs niveaux pour traduire le cheminement de 23 personnes en ce qui concerne la reconnaissance des symptômes. Le processus d'analyse comportait trois niveaux itératifs : une analyse descriptive qualitative des récits sur la douleur des participants, l'interprétation par la poésie thématique et la représentation par l'art visuel, afin de susciter un niveau de compréhension esthétique et plus élevé des données.Résultats: Le déni, l'incrédulité, la douleur envahissante et les symptômes de maladie cardiaque, de même que l'autorécrimination, sont trois des thèmes qui sont ressortis des données. La description que les participants ont faite de la douleur a révélé les dimensions émotionnelles de l'expérience. Les participants ont décrit leur processus de prise de conscience comme une période tumultueuse, marquée par la vulnérabilité et l'incertitude, où la colère et une dérision discrète imprégnaient leurs pensées, lesquelles étaient tempérées par une profonde gratitude pour avoir survécu.Conclusion: L'établissement d'un lien entre la science et l'art pour faire connaître la vie avec la douleur avant-coureuse et la maladie cardiaque consistue une approche novatrice. Le fait d'être invité à pénétrer à l'intérieur de l'expérience de la douleur vécue par un individu par le truchement d'une enquête qualitative ayant recours à des approches axées sur les arts rend visible la signification émotionnelle de la douleur.

Dissecting through Barriers: A Follow-up Study on the Long-Term Effects of Interprofessional Education in a Dissection Course with Healthcare Professional Students.

Several studies have shown significant improvements in the attitudes and perceptions of healthcare professional students toward interprofessional education (IPE) immediately following intervention with IPE courses. However, there remains little evidence on the lasting effects of IPE courses and the long-term influences of these IPE experiences are poorly documented. The purpose of this study is to assess the long-term effects of an intensive, ten-week interprofessional gross anatomy dissection course at McMaster University. Attitudes and perceptions of past participants towards interprofessional learning were evaluated, now that they have started working with other healthcare professionals outside of the IPE course setting. Thirty-four past participants who have clinical experience working in interprofessional settings or are currently working in the healthcare field completed a follow-up questionnaire consisting of a modified Readiness for Interprofessional Learning Scale (RIPLS) and open-ended questions. Quantitative analysis revealed a significant decrease in their attitude towards teamwork and collaboration and respect for other health professions, but a significant improvement in their understanding of roles and responsibilities compared to their results immediately after the IPE intervention. Qualitative analysis of open-ended questions revealed several themes such as developing interprofessional competencies, developing relationships, and remembering the strengths of the IPE dissection course. The results of this study indicate that the IPE experience in anatomy was highly valued by the students and that past participants maintain a clear understanding of their scope of practice, but the reality of clinical practice may have eroded gains made in the program. Anat Sci Educ. © 2018 American Association of Anatomists.

Informed Strangers: Witnessing and Responding to Unethical Care as Student Nurses.

Nursing students occupy a unique perspective in clinical settings because they are informed, through education, about how patient care ought to happen. Given the brevity of placements and their "visiting status" in clinical sites, students are less invested in the ethos of specific sites. Subsequently, their perspectives of quality care are informed by what should happen, which might differ from that of nurses and patients. The purpose of this study was to identify predominant themes in patient care, as experienced by students, and the influence that these observations have on the development of their ethical reasoning. Using a qualitative descriptive approach in which 27 nursing student papers and three follow-up in-depth interviews were analyzed, three main themes emerged: Good employee, poor nurse; damaged care; and negotiating the gap. The analysis of the ethical situations in these papers suggests that students sometimes observe care that lacks concern for the dignity, autonomy, and safety of patients. For these student nurses, this tension led to uncertainty about patient care and their eventual profession.

The Applicability of the NCLEX-RN to the Canadian Testing Population: A Review of Regulatory Body Evidence.

The NCLEX-RN® was adopted by Canadian regulators in 2011 as the test which entry-level nurses must pass in order to be certified to practice. As part of their justification for adopting the exam, the Canadian regulators pointed to two studies conducted by the National Council of State Boards of Nursing (NCSBN). These studies aimed to determine the applicability of the NCLEX-RN® test plan to the Canadian testing population (NCSBN, 2014),with the NCLEX-RN® providing "a fair, valid, and psychometrically sound measurement" of nursing competencies of entry-level RNs in Ontario, Canada (NCSBN, 2012 , p. 8). The purpose of this article is to report the findings from a review of the above two NCSBN studies in order to assess whether they provide sufficient evidence to conclude that the NCLEX-RN® is applicable to the Canadian testing population. While some evidence was found of the use of best practice principles in survey and research design, both authors call into question the evidence provided by the NCSBN, and deny the claims that the NCLEX-RN®, as currently designed, is an appropriate assessment tool for Canadian entry-level nurses.

Dissecting through barriers: A mixed-methods study on the effect of interprofessional education in a dissection course with healthcare professional students.

Healthcare delivery is reliant on a team-based approach, and interprofessional education (IPE) provides a means by which such collaboration skills can be fostered prior to entering the workplace. IPE within healthcare programs has been associated with improved collaborative behavior, patient care and satisfaction, reduced clinical error, and diminished negative professional stereotypes. An intensive interprofessional gross anatomy dissection course was created in 2009 to facilitate IPE at McMaster University. Data were collected from five cohorts over five years to determine the influence of this IPE format on the attitudes and perceptions of students towards other health professions. Each year, 28 students from the medicine, midwifery, nursing, physician's assistant, physiotherapy, and occupational therapy programs were randomly assigned into interprofessional teams for 10 weeks. Sessions involved an anatomy and scope-of-practice presentation, a small-group case-based session, and a dissection. A before/after design measured changes in attitudes and perceptions, while focus group data elaborated on the student experience with the course. Pre- and postmatched data revealed significant improvements in positive professional identity, competency and autonomy, role clarity and attitudes toward other health professions. Qualitative analysis of intraprofessional focus group interviews revealed meaningful improvements in a number of areas including learning anatomy, role clarity, and attitudes towards other health professions.

Reality Check: Are We Truly Preparing Our Students for Interprofessional Collaborative Practice?

Many academic settings offer interprofessional education (IPE) experiences that are of short duration and situated in safe, controlled environments such as classrooms or simulation labs. The purpose of this study was to examine the effects of a 10-week IPE strategy that was incorporated into the final clinical practicum of a BScN program. A mixed methods design was chosen, in the belief that qualitative data would help explain quantitative data from pre-test/post-test design (n = 268). Quantitative results revealed that participants disagreed more with statements on interprofessional collaboration (IPC) after completion of the strategy (p = 0.00). Qualitative findings reinforced these results, revealing a theme of common sense is not so common when it comes to IPC in the health-care setting. When student nurses are being prepared for IPC, IPE strategies should be as "real" as possible, with exposure to some of the realities of interprofessional team functioning.

De nombreux milieux universitaires proposent des expériences de formation interprofessionnelle (EPC) de courte durée qui se déroulent dans un cadre sûr et contrôlé comme une salle de classe ou un laboratoire de simulation. Notre étude avait pour but d'analyser les effets d'une stratégie de 10 semaines intégrée au stage clinique final d'un programme de baccalauréat en sciences infirmières. Nous avons eu recours à des méthodes mixtes, estimant que les données qualitatives nous aideraient à expliquer les données quantitatives recueillies pendant l'étude prétest/post-test (n = 268). Les résultats quantitatifs révèlent un désaccord plus grand des participantes avec les énoncés sur la formation interprofessionnelle une fois la stratégie terminée (p =0.00). Les résultats qualitatifs appuient ce constat, ce qui laisse entrevoir que le sens commun n'est pas aussi commun qu'on le croit quand on parle d'EPC dans un milieu de soins. Il importe donc de faire en sorte que les stratégies s'adressant aux élèves-infirmières en matière d'EPC collent le plus possible avec la « réalité ¼ et les exposent notamment à certains aspects du fonctionnement des équipes interprofessionnelles.

Overcoming all obstacles: a framework for embedding interprofessional education into a large, multisite Bachelor of Science Nursing program.

As the delivery of health care becomes more complex and challenging, the need for all health care professionals to collaborate as a team has been identified. Nurses are an integral part of the health care team, so it is critical that their education prepare them for interprofessional collaborative practice. Although many academic settings are currently offering interprofessional education (IPE) in the form of compulsory and elective activities and courses, it may not be enough nor an option for programs with large volumes of students who are distributed across a variety of sites and locations. This article outlines a framework that has been successfully adopted by one large school of nursing that chose to integrate interprofessional competencies throughout its curriculum. This IPE agenda is cost-effective, sustainable, and accessible, and it can be adapted to meet the needs of other prelicensure programs that face similar obstacles or challenges with offering IPE.

Seeking to understand telephone support for dementia caregivers.

Caregivers of persons with dementia encounter particular challenges in their roles and often experience unmet needs for information and emotional support. This article describes a qualitative descriptive study designed to explore the intervention of telephone support for such caregivers. Data were collected from both caregivers and telephone support providers. Results revealed that telephone support met four specific needs of dementia caregivers: the need for (a) information and education, (b) referral and/or assistance required to navigate through the system, (c) emotional support, and (d) caregiver support that is convenient and hassle free. Caregivers' main experience with the intervention was the sense of companionship, whereas service providers experienced mixed feelings of helplessness and an opportunity to empower caregivers.

A critical analysis of the broker and strengths models of case management: identifying a potential framework for community case managers.

In Canada, case management has been applied to a variety of health care settings including the community care system, where case managers have become an integral component in the delivery of government-funded, in-home services. Specifically in Ontario, home care is accessed through 43 Community Care Access Centres (CCACs), and the model currently driving case management practices most closely resembles the Broker model. Not only does this create moral distress among the case managers, but it also hinders their ability to meet the health care needs of the community as current cost containment strategies can lead to suffering and emotional distress for a significant portion of the people who are cut from care. This article will identify a potential framework for case managers in CCACs. The Strengths model offers a framework that is consistent with the goals of Ontario case managers and is committed to client autonomy, empowerment, and client-driven care. Given the multitude of health care challenges facing CCAC case managers today, the Strengths model of practice has the potential to contain and maintain costs without compromising the psychological wellbeing and health care needs of the community.