Development and evaluation of shared decision-making tools in rheumatology: A scoping review.

INTRODUCTION: Shared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology. OBJECTIVE: To describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology. METHODS: Bibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language. RESULTS: Of the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53 %). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16 %), Informed Medical Decision Foundation elements (3/36, 8 %), edutainment principles (2/36, 5.5 %), and others (e.g. DISCERN and MARKOV Model) (9/31,29 %). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39 %), acceptability and knowledge (7/46, 15 %), and the preparation for decision-making scale (5/46,11 %). CONCLUSION: For better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.

Older people's perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study / Percepções e experiências de idosos com a atividade Sit-to-stand: Um estudo etnográfico de pré-viabilidade / Percepciones y experiencias de los adultos mayores con respecto a la actividad Sit-to-stand: Un estudio etnográfico de viabilidad previa

Abstract Objective: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. Method: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. Results: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. Conclusion: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.

Resumo Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.

Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.

Perceptions of Cannabis Use: A Qualitative Descriptive Study of Rheumatology Patients.

INTRODUCTION/OBJECTIVES: Some rheumatology patients use or contemplate using cannabis, however, may not be transparent about use with their providers. The objective of this qualitative descriptive study was to describe beliefs, perceptions, and learning needs of adults with rheumatic conditions regarding the use of cannabis products. METHODS: Purposive sampling was conducted through a rheumatology clinic and sought participants who were using or thinking about using cannabis. Two online focus groups based on cannabis use patterns (non-users and users) were conducted separately. Interviews were audio recorded and transcribed. Three research team members read the transcripts independently to identify initial codes and themes. Data saturation was reached with the interviews. RESULTS: We recruited 12 participants between 52 and 85 years old. The first theme was pain and desperation. Stigma was the second theme with a perception of physician opposition to cannabis, and the reluctance of many participants to discuss cannabis use with physicians. The final theme was a need for information and a general lack of trustworthy and credible sources. Users were willing to try cannabis even if they still had questions. CONCLUSION: Rheumatology patients are open to using cannabis due to the burden and suffering associated with pain. They remain silent on the topic, however, because of stigma and lack of engagement from health care professionals, particularly physicians. Patients voiced a strong need for information regarding cannabis and want healthcare providers to initiate discussion. These findings are clinically relevant to the management of rheumatic conditions and the promotion of therapeutic relationships.

Experiences of new tenure-track PhD-prepared faculty: a scoping review.

The purpose of this scoping review was to assess the state of the literature concerning the experiences of new PhD-prepared tenure-track faculty, with a keen interest in nursing faculty. Effective recruitment and retention strategies for new nursing academic faculty need to be found and implemented. A literature review based on Arksey and O'Malley's five-stage framework for scoping reviews was undertaken. Using the PRISMA protocol, a systematic literature search was conducted in seven databases of studies published in English. Based upon inclusion criteria and relevance, 13 studies out of 90 papers were included in this study. Themes identified from the studies were transitioning to academia, developing a research program, balancing work and life, and perceived inequity. The research was predominately American and Canadian based. Several gaps in the literature were identified. Further research is critical to make recommendations to key stakeholders for recruitment and retention strategies.

Older people's perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study.

OBJECTIVE: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. METHOD: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. RESULTS: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. CONCLUSION: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.

Eco-anxiety in youth: An integrative literature review.

Climate change-related eco-anxiety in young people has made headlines around the world, but most study of this phenomenon has been limited to adults. Eco-anxiety is still not well defined in the literature, but generally refers to distress, worry, or concern related to the climate change crisis. Young people will be chronologically more exposed to climate change-related harms and problems, and this may be causing increased eco-anxiety in this population. This literature review aimed to summarize the relevant works on eco-anxiety in young people, provide a critique of the literature, identify gaps, and discuss the relevance to nursing practice. A literature search using multiple databases and other sources was completed, using applicable key terms and resulted in 23 sources to inform the review. Key themes of eco-anxiety definition variation, hopelessness and burden in young people, and responses to eco-anxiety are discussed, and critical analysis is undertaken. The main conclusions include a broad working definition of eco-anxiety that does not pathologize the eco-anxiety experience but recognizes that it can cause suffering. Also discussed is the role of nurses in reducing the potential or actual suffering of youth through hope promotion, challenging binary thinking patterns, building emotional resilience, encouraging action or involvement in climate change spheres, and promoting climate justice and advocacy. Recommendations for further research are offered.

Developing nursing students' informatics competencies - A Canadian faculty perspective.

OBJECTIVES: The aim of this study was to explore nursing faculty experiences in integrating digital tools to support undergraduate students' learning and development of nursing informatics competencies. METHODS: This focused ethnography study used a combination of semi-structured interviews, document reviews, and field visits. Convenience and snowball sampling were applied to recruit participants. Data were analyzed concurrently with data collection, using thematic analysis. RESULTS: Twenty-one faculty members from nine undergraduate nursing programs in Western Canada participated. Themes discussed include: 1) meaning of the term nursing informatics, 2) faculty perceived nursing informatics competence, 3) developing students' nursing informatics competencies, 4) facilitators, and 5) challenges. CONCLUSIONS: Nursing faculty are relatively engaged in developing students' informatics competencies. However, challenges must be addressed and faculty need more support to improve their own informatics capacity. Implications for Practice and Research: This study has implications for faculty, nursing program administrators, and nursing organizations.

Negative nursing stereotypes: past or present? / Estereotipos negativos en Enfermería: ¿Pasado o presente? / Estereótipos negativos na Enfermagem: passado ou presente?

Introduction: nursing has been moving towards the formation of its own body of knowledge through increased research and technological advances. However, the social image of the profession identified in society seems to reflect an invisible professional with an outdated professional image associated with negative stereotypes. Aim: to analyze the presence of negative stereotypes associated with nurses' social image in the literature. Method: integrative literature review study that included scientific articles published from 2007 to 2013, in the databases: BVS, CINAHL / EBSCO, MEDLINE, Scopus and Web of Science. Results and Discussion: fourteen studies dealing with the image of nursing met inclusion criteria, 57.1% showed low incidence of negative stereotypes, 35.7% showed high incidence of negative stereotypes and 7.2% did not find negative stereotypes. Negative stereotypes such as low status and subordination to the medical field were evidenced. However positive stereotypes such as careerist were also identified. Closing Remarks: the results indicate the possibility of improvement in the social image of nursing. These stereotypes about the profession remain in the social imagination, causing anachronism, making difficult the recognition and appreciation of this profession.

Introdução: a Enfermagem tem avançado para a conformação de sua própria base de conhecimentos, através de crescentes progressos na pesquisa e tecnologia. Porém, o imaginário social da profissão, identificado na sociedade, parece refletir um profissional invisível, com uma imagem profissional desatualizada e associada a estereótipos negativos. Objetivo: analisar a presença de estereótipos negativos associados com a imagem social de enfermeiros na literatura. Método: revisão integrativa da literatura incluindo artigos científicos publicados entre 2007 e 2013 nas seguintes bases de dados: BVS, CINAHL / EBSCO, MEDLINE, Scopus e Web of Science. Resultados e discussão: quatorze estudos que investigaram a imagem da Enfermagem atenderam aos critérios de inclusão: 57,1% indicaram baixa incidência de estereótipos negativos, 35,7% apresentaram alta incidência de estereótipos negativos e 7,2% não encontraram estereótipos negativos. Estereótipos negativos como baixo status e subordinação ao campo da Medicina tornaram-se evidentes. No entanto, estereótipos positivos, como ser carreirista, também foram identificados. Considerações finais: os resultados indicam a possibilidade de melhoria da imagem social da Enfermagem. Esses estereótipos sobre a profissão permanecem no imaginário do coletivo social, gerando anacronismo e dificultando o reconhecimento e a valorização dessa profissão.

Introducción: la Enfermería ha venido avanzando hacia la conformación de su propio bagaje de conocimientos a través de mayores progresos en investigación y tecnología. Sin embargo, la imagen social de la profesión que se identifica en la sociedad parece reflejar a un profesional invisible con una anticuado imagen profesional y asociada a estereotipos negativos. Objetivo: analizar la presencia de estereotipos negativos asociados con la imagen social de los enfermeros en la literatura. Método: revisión integradora de la literatura que incluyó artículos científicos publicados entre 2007 y 2013 en las siguientes bases de datos: BVS, CINAHL / EBSCO, MEDLINE, Scopus y Web of Science. Resultados y discusión: catorce estudios que investigaron la imagen de la Enfermería cumplieron con los criterios de inclusión: el 57,1% indicó baja incidencia de estereotipos negativos, el 35,7% presentó gran incidencia de estereotipos negativos y el 7,2% no encontró estereotipos negativos. Se hicieron evidentes estereotipos negativos como bajo estatus y subordinación al campo de la Medicina. Sin embargo, también se identificaron estereotipos positivos como ser ambicioso en la carrera. Consideraciones finales: los resultados indican la posibilidad de mejora de la imagen social de la Enfermería. Estos estereotipos sobre la profesión permanecen en la imaginación del colectivo social, generando anacronismo y dificultando el reconocimiento y la valoración de esta profesión.

Perceptions and experiences of functional mobility for community-dwelling older people: A focused ethnography.

BACKGROUND: Mobility challenges may indicate functional decline and are a relevant problem faced by older people. An individual's perception of mobility is affected and moderated by several factors and varies significantly from one community to another. Providing an improved understanding of how older people perceive and experience mobility is a step towards better preparing nurses for roles they are increasingly expected to play. PURPOSE: The purpose of the study was to investigate perceptions and experiences of mobility in a group of Brazilian community-dwelling older people living with mobility challenges. METHOD: Data were generated between June and October 2018 through in-depth interviews, socio-demographic surveys and field notes. Purposive sampling strategies were used to recruit 23 Brazilian older people to participate in this focused ethnographic study. Data were analysed using qualitative content analysis. FINDINGS: Perceptions of Brazilian community-dwelling older people living with mobility challenges were culturally learned and influenced by the social, physical and health environments. Participants' previous experiences with mobility had significant implications on values they attributed to mobility challenges. In addition, older people's experiences with mobility challenges were an integral part of sense of self and strongly related to contextual factors. CONCLUSIONS: This study contributes new information to the field of inquiry on mobility of older people as it focuses on the perceptions of a specific age group and culture and attends to the interrelationships between health conditions and contextual factors affecting the mobility of older people. IMPLICATIONS FOR PRACTICE: This study's particular contributions to the nursing discipline are related to improving care by revealing the significance of the context of mobility in which nursing actions are applied.

Are Future Nurses Ready for Digital Health?: Informatics Competency Baseline Assessment.

BACKGROUND: Research continues to show significant gaps in nursing graduates' preparedness in digital health. PURPOSE: The aim of this study was to explore nursing students' self-perceived nursing informatics competency and preparedness in digital health, describe learning opportunities available, and identify perceived learning barriers and facilitators to developing informatics competency. METHODS: A sequential mixed-methods design, using a cross-sectional survey and interviews, was used. Senior undergraduate students (n = 221) in BScN programs in a Western Canadian Province participated. RESULTS: Participants self-reported being somewhat competent in nursing informatics. Three themes were identified: struggling to make sense of informatics nursing practice; learning experiences; and preparedness for future practice. CONCLUSION: Addressing inconsistencies in informatics education is an urgent priority so that nursing graduates are competent upon joining the workforce. Implications for nursing education, practice, and policy are discussed.

Compassionate nursing care and the use of digital health technologies: A scoping review.

BACKGROUND: Compassion is an essential component of quality patient-centered care and a core value in nursing practice. Although much work has been done to enhance nurses' informatics competency, there is limited understanding of how nurses can use, express, and preserve compassion when they use digital health technologies in the provision of patient care. PURPOSE: This study aimed to explore the nursing literature on how nurses provide compassionate care when they use digital health technologies. A secondary aim was to identify best practices that could be used to guide nursing education and practice toward enhancing compassionate care in digital environment. METHOD: A scoping review was conducted to address the following research question: What is known about compassionate care in relation to the use of digital health technologies within the nursing literature? A comprehensive search strategy was applied to CINAHL Plus with full text, Ovid Medline, Ovid HealthStar, Embase, APAPsychINFO, Scopus, and ProQuest Dissertations and Theses. In addition, a search of selected organizational websites and a hand search of reference lists of included studies were conducted. The eligibility of articles was determined by two reviewers independently. Descriptive and content analyses were applied. Findings were presented narratively and in a tabular format. RESULTS: Twenty-eight articles were included in this review. Most of this research was published between 2004 and 2020, using mostly qualitative methods. Narrative results were organized into three themes: 1) evolving understanding of compassionate nursing care in relation to use of digital health technology, 2) compassionate nursing care in relation to the type of digital health technology, and 3) strategies and interventions to improve education and competence relevant to digital health and compassionate nursing care. CONCLUSION: The use of technology influences how nurses do their work and interact with patients. As advances in digital health continue to evolve, future research should aim to expand understanding of compassion relevant to digital health by articulating its characteristics and associated competencies for nurses to further enhance their ability to provide compassionate care when digital health technologies and services are used to support care delivery. TWEETABLE ABSTRACT: A scoping review that identified how nurses can provide compassionate nursing care in technologically rich practice environments.

Becoming scholars in an online cohort of a PhD in nursing program.

The goal of this descriptive qualitative study was to examine the views of students about their experience and development as scholars during the first two years of an online cohort nursing doctoral program. A secondary goal was to seek the views of faculty members very involved in the program. Semi-structured interviews were conducted with 10 of the 13 students of the first two online cohorts and five faculty members. Four themes emerged from the data: adjusting to the program; the group as emotional and academic support; reflections on teaching and learning; and becoming a scholar. The findings suggest that the students were developing as scholars, and that the cohort model was a source of support for them. Similar to other PhD students, transition into doctoral education necessitated finding a new balance between other commitments and doctoral studies. Providing opportunities to engage with faculty outside of courses is important.

A Century of Political Influence: The Evolution of the Canadian Nurses Association's Policy Advocacy Agenda.

The Canadian Nurses Association has a long-standing history of strengthening the nursing profession and the health system, supporting professional practice, and advocating for healthy public policy at the local, national, and global level. Historical writings have typically focused on the significant milestones achieved throughout the past century, and the various social, political, and economic contexts that have shaped the evolution of the association. While historical sources illustrate an organization with a strong track record of policy advocacy leadership and presence, there is little literature that has examined how the association's policy advocacy agenda has evolved overtime. Using Shamian's emerging "Bubble" Theory and Spheres of Policy Influence Model as an analytical framework, the authors use historical archives and documents to examine the internal and external drivers that have shaped the association's policy advocacy agenda over the past century and conclude that the Canadian Nurses Association has established itself as a credible leader in shaping not only nursing but also health-care and public policy at the local, national, and global level.

Sit-to-stand activity to improve mobility in older people: A scoping review.

AIMS AND OBJECTIVES: To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research. BACKGROUND: Many older people experience mobility challenges which can negatively affect their well-being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit-to-stand intervention, there is a need to systematically examine the state of knowledge about this intervention. DESIGN: Scoping review using Arksey and O'Malley's methodological framework. METHODS: A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. RESULTS: Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit-to-stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15-45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit-to-stand activity as an intervention; (b) generalisability of findings; and (c) sustainability. CONCLUSIONS: Most of the studies reviewed indicated improvements in performance of the sit-to-stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention. IMPLICATIONS FOR PRACTICE: Healthcare providers are expected to offer evidence-based patient care. This review details current knowledge about the sit-to-stand intervention with older people.

Tracing the Decisions That Shaped the Development of MyChart, an Electronic Patient Portal in Alberta, Canada: Historical Research Study.

BACKGROUND: Understanding how health organizations decide on information technology (IT) investments is imperative to ensure successful implementation and adoption. There is a high rate of failure and a tendency to downplay the complexity of implementation progression. Alberta Health Services introduced a patient portal called MyChart. Although MyChart allows patients to view appointments and selected laboratory results and to communicate with their providers, its uptake varies. OBJECTIVE: The study aimed to examine the institutional decision-making processes that shaped the development and implementation of MyChart. METHODS: A historical study was conducted based on the 7-step framework, where one engages in a rigorous archival critical analysis (including internal and external criticism) of documents and analysis of interviews. We reviewed and analyzed 423 primary and secondary sources and interviewed 10 key decision makers. RESULTS: Supportive leadership, project management, focused scope, appropriate technology and vendor selection, and quick decision making were some of the facilitators that allowed for the growth of proof of concept. The planning and implementation stages did not depend much on the technology itself but on the various actors who influenced the implementation by exerting power. The main barriers were lack of awareness about the technology, proper training, buy-in from diverse system leaders, and centralized government decision making. CONCLUSIONS: Organizational priorities and decision-making tactics influence IT investments, implementation, adoption, and outcomes. Future research could focus on improving the applicability of needs assessments and funding decisions to health care scenarios.

The State of Knowledge Regarding the Use of Simulation in Pre-Licensure Nursing Education: A Mixed Methods Systematic Review.

This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.

Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery.

Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.

Co-supervision of doctoral students: enhancing the learning experience.

Abstract The purpose of this paper is to examine the advantages and challenges of co-supervision of doctoral students, as found in the literature and from our experiences. We define co-supervision and then discuss the process in detail. Examples are based on experiences of co-supervision from faculty perspectives as well as from the point of view of a former doctoral student. We propose that the advantages of co-supervision far outweigh the challenges and should be regularly considered by seasoned academics to enhance student learning. In addition, we suggest that co-supervision is intellectually stimulating for academics.

The influence of gender, ethnicity, class, race, the women's and labour movements on the development of nursing in Sri Lanka.

The paper reveals that historically various socio-political factors, including gender, class, ethnicity, race, waves of colonization, decolonization, the civil and ethnic wars, the women's and labour movements, have influenced the development of nursing in Sri Lanka. However, literature presenting the development of nursing in Sri Lanka is sparse. All relevant journals and books published in the English and Sinhalese languages on nursing in Sri Lanka between the years 1878-2011 were examined. Because there are no nursing journals currently produced in Sri Lanka, CINAHL and Medline databases were accessed and relevant literature published in the English language on Sri Lanka was examined. Government, nurses' union and association reports, other unpublished reports and websites such as Google were also searched to access information related to the influence of gender, race, class, ethnicity, women's and labour movements in Sri Lanka. Poor pay, shortages of resources, failure in recruitment and retention and limited opportunity for career progression have acted as deterrents to persons entering and remaining in the nursing profession. Being non-British was a key issue in terms of race. Further, the shift from a colonized state to a welfare state resulted in a class shift from upper middle class to middle and lower class persons entering into nursing. Although there is a paucity of information available in the nursing literature, this analysis offers an intriguing insight into an angle that may be used to examine the influence of gender, ethnicity, class, race and the women's and labour movements in other contextual situations.

Instructor comfort level in high-fidelity simulation.

BACKGROUND: The literature in the use of simulation in nursing education has expanded significantly over the past 5-10 years. What it is like as an instructor who facilitates this experience is largely unexplored. This paper is part of a larger ethnographic study, and represents findings related to the comfort level of instructors facilitating in high-fidelity simulation (HFS). OBJECTIVES: The question of what is it like to engage in simulated clinical experiences as an instructor is presented in this paper. DESIGN AND PARTICIPANTS: Twenty instructors participated in two separate focus groups and two instructors participated in individual interviews. The average years of nursing experience for this group was over 20 years, whereas the number of years of experience as a clinical instructor was less than five years. METHODS: Ethical approval was obtained from two academic institutions. A focused ethnography was conducted and included two terms of participant observations, recorded field notes, individual interviews and focus groups. Data was coded and then sorted for themes related to the instructor experience. RESULTS: The primary results focus on the comfort level of instructors in HFS, and what instructors believe this meant to student learning in HFS. CONCLUSIONS: What the instructor does during HFS and how they feel about their ability to facilitate HFS has a perceived effect on student learning.