Experiences of Frontline Managers during the COVID-19 Pandemic: Recommendations for Organizational Resilience.

The COVID-19 pandemic caused a global health crisis directly impacting the healthcare system. Healthcare leaders influence and shape the ability of an organization to cope with and recover from a crisis such as the COVID-19 pandemic. Their actions serve to guide and support nurses' actions through unpredictable health service demands. The purpose of this paper was to examine frontline managers' experiences and organizational leadership responses that activated organizational resilience during the COVID-19 pandemic, and to learn for ongoing and future responses to healthcare crises. Fourteen managers participated in semi-structured interviews. We found that: (1) leadership challenges (physical resources and emotional burden), (2) the influence of senior leader decision-making on managers (constant change, shortage of human resources, adapting care delivery, and cooperation and collaboration), and (3) lessons learned (managerial caring behaviours and role modelling, adaptive leadership, education and training, culture of care for self, and others) were evidence of managers' responses to the crisis. Overall, the study provides evidence of managers experiences during the early waves of the pandemic in supporting nurses and fostering organizational resilience. Knowing manager's experiences can facilitate planning, preparing, and strengthening their leadership strategies to improve work conditions is a high priority to manage and sustain nurses' mental health and wellbeing.

How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review.

AIM: To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older. DATA SOURCES: Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature. METHODS: A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles. RESULTS: Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment. CONCLUSION: The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions. IMPACT: The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care. PATIENT OR PUBLIC CONTRIBUTION: During the development phase, the study was presented to a consumer group from the researcher's workplace. PROSPERO REGISTRATION: CRD42022299336.

Embracing relational competencies in applying the LEADS framework for health-care leaders in transformational change and the COVID-19 pandemic.

PURPOSE: The purpose of this paper is to assess the extent to which the LEADS Framework guided health-care leaders through organizational change and the COVID-19 pandemic in a western Canadian province. DESIGN/METHODOLOGY/APPROACH: A qualitative exploratory inquiry assessed the extent to which health leaders applied competencies that aligned with the LEADS Framework. A purposeful sample of 22 health-care leaders participated in the study representing senior, mid-level and front-line health-care leaders in various health-care organizations to ensure diverse representation of leader competencies. The authors conducted semi-structured interviews to collect the data and used Braun and Clarke's (2006) six-phase approach to guide data analysis. FINDINGS: The analysis suggests that health-care leaders found Engaging with Others and Developing Coalitions were the most critical themes of the LEADS Framework for change management and for navigating the COVID-19 pandemic. Findings reveal that during transformational change and a crisis context, leaders embrace relational approaches to adapt and improve performance in dynamic organizations. PRACTICAL IMPLICATIONS: These findings have implications for a relational approach to improve teamwork and decrease emotional strain; a focus on mobilizing and sharing power with nurses; and educational programs to advance relational and self-management skills, shared leadership, communication, change management, human resource and talent development as critical learning components for current and future health-care leaders. ORIGINALITY/VALUE: The LEADS Framework is used to examine how health-care leaders responded to transformational change in the organization while situated in a pandemic context.

Mental health and well-being of unpaid caregivers: a cross-sectional survey protocol.

INTRODUCTION: Unpaid caregiving, care provided by family/friends, is a public health issue of increasing importance. COVID-19 worsened the mental health conditions of unpaid caregivers, increasing substance/drug use and early development of chronic disease. The impact of the intersections of race and ethnicity, sex, age and gender along with unpaid care work and caregivers' health and well-being is unknown. The aim of this study is to describe the inequities of caregiver well-being across the intersections of race and ethnicity, sex, age and gender using a cross-sectional survey design. METHODS AND ANALYSIS: We are collaborating with unpaid caregivers and community organisations to recruit a non-probability sample of unpaid caregivers over 18 years of age (n=525). Recruitment will focus on a target sample of 305 South Asian, Chinese and Black people living in Canada, who represent 60% of the Canadian racial and ethnic populations. The following surveys will be combined into one survey: Participant Demographic Form, Caregiver Well-Being Index, interRAI Self-report of Carer Needs and the GENESIS (GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond-Premature Acute Coronary Syndrome) PRAXY Questionnaire. Sample characteristics will be summarised using descriptive statistics. The scores from the Caregiver Well-Being Index will be dichotomised into fair/poor and good/excellent. A two-stage analytical strategy will be undertaken using logistic regression to model fair/poor well-being and good/excellent well-being according to the following axes of difference set a priori: sex, race and ethnicity, gender identity, age, gender relations, gender roles and institutionalised gender. The first stage of analysis will model the main effects of each factor and in the second stage of analysis, interaction terms will be added to each model. ETHICS AND DISSEMINATION: The University of Toronto's Health Sciences Research Ethics Board granted approval on 9 August 2022 (protocol number: 42609). Knowledge will be disseminated in pamphlets/infographics/email listservs/newsletters and journal articles, conference presentation and public forums, social media and through the study website. TRIAL REGISTRATION NUMBER: This is registered in the Open Sciences Framework with a Registration DOI as follows: https://doi.org/10.17605/OSF.IO/PB9TD.

Building a new life: a qualitative study of how family carers deal with significant changes.

BACKGROUND: Family carers of persons living with dementia who are residing in long term care (LTC), often experience significant changes in their roles and relationships which affects mental and physical health. Research has focused on describing the carers' experience, but not on how they deal with these changes or their perceptions of support needs. The purpose of this study was to explore how family carers of persons living with dementia residing in LTC deal with significant changes and to understand how best to support these carers. METHODS: Eight face-to-face audio-recorded focus group interviews were conducted with 45 participants from September 2019 to January 2020, as part of a larger study aimed at guiding the adaptation of an online toolkit to support family carers of persons living with dementia residing in LTC. Applied thematic analysis was used to analyze the focus group data. FINDINGS/RESULTS: Carers dealt with the significant changes they experienced through the process of "building a new life" consisting of two sub-processes: a) building new relationships (with their family member, LTC staff and others outside of LTC), and b) finding space for themselves (sharing of care and finding balance). Understanding dementia, support from others (staff, family and friends), connecting with resources, and being included in care decisions helped carers build a new life. CONCLUSION: The process of building a new life describes the ways that family carers deal with the life-altering changes they experienced when a family member is admitted to LTC. Carers may be supported in building their new life, by providing them with information about dementia and how to relate to staff and their family member living with dementia. The quality of care being provided and the LTC environment may also play an important role in how carers deal with the significant changes they experience.

Implementing the Synergy Model: A Qualitative Descriptive Study.

Hospitals across our nation are seeking to implement models of care that meet the primary goals of Quadruple Aim: Improved population health, cost-effective care delivery, and patient and provider satisfaction. In an effort to address the Quadruple Aim and our patients' care needs, Hamilton Health Sciences (HHS) embarked on a model of care delivery redesign, beginning with nursing care delivery. From 2013 to 2018, 12 clinical programs at HHS implemented the Synergy Model with its accompanying synergy patient needs assessment tool for nurses to objectively assess patients' acuity and dependency needs. Data on patients' priority care needs were used to inform a nursing model of care redesign at HHS, including skill mix and staffing levels. This five-year project was an organization-wide quality improvement initiative. As part of the evaluation, HHS leaders partnered with health services nurse researchers to conduct a mixed methods study. This paper describes the evaluation outcomes from the qualitative component of the study, which included interviews with clinical nurse leaders and direct care nurses. Data were analyzed using descriptive thematic analysis. Some key findings were increased nurse awareness of patients' holistic care needs and leaders' capacity to plan staffing assignments based on patients' priority care needs. Themes helped inform recommendations for key stakeholders, including nurse leaders and direct care nurses.

Rethinking Resilience: Nurses and Nurse Leaders Emerging From the Post-COVID-19 Environment.

Nurses and nurse leaders are working in unprecedented intense and demanding environments, and the COVID-19 pandemic continues to place strain on their mental well-being. If stressful work conditions remain at extraordinary high levels, nurses and leaders may ultimately leave their positions, creating even more uncertainty in the workforce. Enhancing individual resilience has become a superficial response in retaining nurses during a global nursing shortage. We argue that resilience is not solely an individual responsibility. Rather, resilience it is a mutual responsibility between the individual and the organization. In this article, we discuss how nurse leaders can foster organizational resilience while also enhancing their own individual resilience within the current pandemic environment, and as we transition to a post-COVID environment.

Study protocol: pragmatic randomized control trial of my tools 4 care- in care (MT4C-in care) a web-based tool for family Carers of persons with dementia residing in long term care.

BACKGROUND: When a family member resides in long term care facility (LTC), family carers continue caregiving and have been found to have decreases in mental health. The aim of My Tools 4 Care - In Care (an online intervention) is to support carers of persons living with dementia residing in LTC through transitions and increase their self-efficacy, hope, social support and mental health. This article comprises the protocol for a study to evaluate My Tools 4 Care-In Care (MT4C-In Care) by asking the following research questions: 1) Is there a 2 month (immediately post-intervention) and 4 month (2 months post-intervention) increase in mental health, general self-efficacy, social support and hope, and decrease in grief and loneliness, in carers of a person living with dementia residing in LTC using MT4C-In CARE compared to an educational control group? 2) Do carers of persons living with dementia residing in LTC perceive My Tools 4 Care- In Care helps them with the transitions they experience? METHODS: This study is a single blinded pragmatic mixed methods randomized controlled trial. Approximately 280 family carers of older persons (65 years of age and older) with dementia residing in LTC will be recruited for this study. Data will be collected at three time points: baseline, 2 month, and 4 months. Based on the feasibility study, we hypothesize that participants using MT4C-In Care will report significant increases in hope, general self-efficacy, social support and mental health quality of life, and significant decreases in grief and loneliness from baseline, as compared to an educational control group. To determine differences between groups and over time, generalized estimating equations analysis will be used. Qualitative descriptive analysis will be used to further evaluate MT4C-In Care and if it supports carers through transitions. DISCUSSION: Data collection will begin in four Canadian provinces (Alberta, Manitoba, Ontario and Saskatchewan) in February 2020 and is expected to be completed in June 2021. The results will inform policy and practice as MT4C-In Care can be revised for local contexts and posted on websites such as those hosted by the Alzheimer Society of Canada. TRIAL REGISTRATION: NCT04226872 ClinicalTrials.gov Registered 09 January 2020 Protocol Version #2 Feb 19, 2020.

The Similarities and Differences in Transition to Practice Experiences for New-Graduate RNs and Practical Nurses in Long-term Care.

OBJECTIVE: The aim of this study was to describe the transition-to-practice experience of new-graduate nurses (NGNs) in long-term-care (LTC) settings. BACKGROUND: Transitioning to professional practice is a challenging time for an NGN. This experience is scarcely described for RNs outside of acute care settings and not described for the LPN. METHODS: A qualitative case study was used to explore the described transition-to-practice experience of new-graduate RNs and LPNs in LTC. RESULTS: This study revealed that the transition-to-practice experience of new-graduate LPNs was similar to the experience described by RNs. Differences in experience were related to leadership roles in the setting. CONCLUSIONS: Findings contribute to new understanding of the experience of the NGN in LTC settings. This study reinforces the need for greater support for nursing graduates in this setting.

Transitioning to practice in long-term care: New graduate nurses' experience of an accelerated transition to nurse leader.

AIM: To describe the transition to practice experience of new graduate nurses in long-term care. BACKGROUND: Nursing is facing increasing pressures related to outpaced demands and a greater acuity of patients accessing services. Hiring new graduate nurses into long-term care (LTC) is a strategy to counteract these pressures, however, little is known about the transition experience of new graduate Registered and Licensed Practical Nurses in this setting. DESIGN: A qualitative, explanatory case-study design explored the transition to practice experience of seven new graduate nurses and the observations of two LTC directors from two homes. The study focused on the self-described transition to practice experience and those contextual factors present in LTC that influenced this experience. METHODS: Thematic analysis of semi-structured interview transcripts and key document review were completed in 2017. RESULTS: Results of this study introduced contextual factors that must be considered in LTC as each influences the transition to practice experienced by new graduate nurses. These factors included five processes that resulted in an accelerated transition to practice experience: (a) struggling to meet expectations; (b) practicing in isolation; (c) relying on others; (d) developing skill and confidence despite challenges; and (e) recognizing complexity and value in LTC practice. CONCLUSION: The findings from this study refute universally applied transition to practice theory and contribute new understanding of the experience of the new graduate nurses in LTC settings. This study reinforces the need for greater support for nursing graduates in LTC settings.

Daily versus weekly evidence reports for orthopaedic surgeons in India: A mixed-methods study.

BACKGROUND: There is a dearth of research regarding the impact of evidence-based medicine (EBM) tools, such as evidence summaries, in developing countries. The goals of this study were to: investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery in India; explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports; and identify and explain the barriers and benefits of an online EBM resource in the Indian context. METHODS: Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized into 2 groups-1 group received daily targeted evidence summaries while the other received general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated 2 questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons' usage, perceptions, and impact of OE. RESULTS: There were no observable differences in OE usage between groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups' perceptions of the OE tool. semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature and limited incentive to keep up with current evidence. CONCLUSIONS: Neither frequency of delivery (daily versus weekly) nor targeted versus general content affected the use of evidence summaries. Facilitating uptake of current evidence into clinical practice among Indian orthopedic surgeons may require additional components beyond dissemination of evidence summaries.

Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge.

BACKGROUND: Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. METHODS: We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon's approach to meta-synthesis. RESULTS: Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers' use of research on staff or patient outcomes. Meta-synthesis yielded four contextual factors influencing the perceived effectiveness of interventions to enhance research use by HCMs: organizational culture, competing priorities, time as a resource and capacity building. Included studies differed in how they defined research and demonstrated varying understandings of research among HCMs, limiting the generalizability of work in this field. CONCLUSIONS: Healthcare managers are increasingly called upon to make evidence-based decisions in practice, but the small number of studies and diverse strategies employed hinder our ability to identify any intervention to increase use of evidence as superior. Future studies in this area should clearly articulate the definition of research evidence they base their decisions on. Registration: PROSPERO (CRD42014006256).

What's the fuss? Gender and academic leadership.

PURPOSE: Women continue to be disproportionately represented in top leadership positions. Leadership development programs typically focus on skills attainment. The purpose of this paper is to explore the perceptions and experiences of academic leaders in order to inform how leadership development programs may more effectively address the gender gap in leadership. DESIGN/METHODOLOGY/APPROACH: A sequential mixed methods study design was used. Participants completed the Leadership Practice Inventory ®(LPI) survey followed by individual interviews of a subset of participants. The survey results were analyzed and compared by gender using the t-test. Thematic analysis was used to compare themes across and between genders. Quantitative and qualitative findings were integrated in the final analysis. FINDINGS: In total, 65 leaders (38 women; 27 men) (37.7 percent response rate) participated in the survey. There were no significant demographic or statistical differences between women and men on any of the LPI® components. Five women and five men were interviewed. Thematic analysis revealed common leadership aspirations and values. Gender differences were noted in leadership attainment, mentorship and the influence of gender on leadership. While the male narratives reflected cognitive awareness of gender inequities, the female narratives also included lived experiences. Male participants focused on the importance of meritocracy whereas the female participants emphasized the gendered social and structural influences on leadership attainment. PRACTICAL IMPLICATIONS: Leadership development programs need go beyond generic "skills-building" in order to conceptualize leadership within a gendered social context. This framework will enable critical awareness and tools for developing both women and men's fullest leadership potential. ORIGINALITY/VALUE: This study was conducted in order to better understand how academic health leaders experience the intersection of gender and leadership. The findings contribute to the current literature by providing insight into perceptual gaps that exist at the level of practice between women and men leaders. In doing so, the authors discuss how leadership development programs may play a more effective role in addressing gender equity in leadership.

Protocol for a Case Study to Explore the Transition to Practice of New Graduate Nurses in Long-Term Care.

A qualitative case study protocol for an exploration of the transition to practice of new graduate nurses in long-term care is presented. For the new graduated nurse, the transition to professional practice is neither simple nor easy. This time of transition has been examined within the hospital setting, but little work has been done from the perspective and context of long-term care. As the global population continues to age and the acuity of persons accessing services outside of hospital continues to increase, there is a need to better understand the transition experience of new graduate nurses in alternative, tertiary settings such as long-term care. Therefore, the purpose of this report is to situate a study and describe a protocol that explored the transition to practice experience of seven new graduate nurses in long-term care using Yin's case study methodology. The case or phenomenon being explored is new graduate nurse transition to practice. This report presents an overview of the literature in order to situate and describe the case under study, a thorough description of the binding of the case as well as the data sources utilized, and ultimately reflects upon the lessons learned using this methodology. The lessons learned include challenges related to precise case binding, the role and importance of context in conducting case study research, and difficulties in disseminating study findings. Overall, this report provides a detailed example of the application of the case study design through description of a study protocol in order to facilitate learning about this complex and often improperly utilized study design.

Models of partnership within family-centred care in the acute paediatric setting: a discussion paper.

AIMS: A discussion of partnership in the context of family-centred care in the acute paediatric setting, through a critical analysis of partnership models. BACKGROUND: Paediatric healthcare practitioners understand the importance of family-centred care, but struggle with how to translate the core tenets into action and are confused by several rival terms. Partnering relationships are included in definitions of family-centred care, yet less is known about strategies to fully engage or support parents in these partnerships. A rigorous examination of concepts embedded in family-centred care such as partnership may provide a better understanding of how to implement the broader concept and support exemplary care in today's clinical practice environment. DESIGN: Discussion paper. DATA SOURCES: Electronic search (January 2000 - December 2014) performed on CINAHL, Medline, EMBASE, Sociological Abstracts and PsychINFO using keywords partnership, family-centred care and conceptual framework. Eligible references were drawn from the databases, reference lists and expert sources. Eight models met inclusion criteria and had currency and relevance to the acute paediatric setting. IMPLICATIONS FOR NURSING: Nurses should continue exploring partnership in various paediatric contexts given the wide-ranging definitions, lack of operational indicators and need for stronger relational statements in current models. An examination of key strategies, barriers and facilitators of partnership is recommended. CONCLUSION: One partnership model had both high overall maturity and best fit with family-centred care principles. All models originate from Western and developed countries, indicating that future partnership models should be more geographically, culturally and economically diverse.

Sociotechnical Human Factors Involved in Remote Online Usability Testing of Two eHealth Interventions.

BACKGROUND: Research in the fields of human performance technology and human computer interaction are challenging the traditional macro focus of usability testing arguing for methods that help test moderators assess "use in context" (ie, cognitive skills, usability understood over time) and in authentic "real world" settings. Human factors in these complex test scenarios may impact on the quality of usability results being derived yet there is a lack of research detailing moderator experiences in these test environments. Most comparative research has focused on the impact of the physical environment on results, and rarely on how the sociotechnical elements of the test environment affect moderator and test user performance. Improving our understanding of moderator roles and experiences with conducting "real world" usability testing can lead to improved techniques and strategies OBJECTIVE: To understand moderator experiences of using Web-conferencing software to conduct remote usability testing of 2 eHealth interventions. METHODS: An exploratory case study approach was used to study 4 moderators' experiences using Blackboard Collaborate for remote testing sessions of 2 different eHealth interventions. Data collection involved audio-recording iterative cycles of test sessions, collecting summary notes taken by moderators, and conducting 2 90-minute focus groups via teleconference. A direct content analysis with an inductive coding approach was used to explore personal accounts, assess the credibility of data interpretation, and generate consensus on the thematic structure of the results. RESULTS: Following the convergence of data from the various sources, 3 major themes were identified: (1) moderators experienced and adapted to unpredictable changes in cognitive load during testing; (2) moderators experienced challenges in creating and sustaining social presence and untangling dialogue; and (3) moderators experienced diverse technical demands, but were able to collaboratively troubleshoot with test users. CONCLUSIONS: Results highlight important human-computer interactions and human factor qualities that impact usability testing processes. Moderators need an advanced skill and knowledge set to address the social interaction aspects of Web-based usability testing and technical aspects of conferencing software during test sessions. Findings from moderator-focused studies can inform the design of remote testing platforms and real-time usability evaluation processes that place less cognitive burden on moderators and test users.

Quality-based procedures in Ontario: exploring health-care leaders' responses.

AIM: To examine health-care leaders' initial response to the implementation of orthopaedic quality based procedures (QBPs) in hospitals across Ontario, Canada. BACKGROUND: In 2012, Ontario, Canada shifted 91 hospitals to a patient-based funding (PBF) approach. This approach funds health-care organisations based on the number of patients treated with select procedures known as QBPs. METHODS: An exploratory descriptive design was employed to better understand health-care leaders' early implementation experiences. Seventy organisational leaders from 20 hospitals participated in six focus groups and four interviews to discuss their initial responses to the implementation of two QBPs (primary unilateral hip replacement and primary unilateral knee replacement). Qualitative data underwent content analysis. FINDINGS: Three key major themes emerged; (1) responding to change, (2) leading the change and (3) managing the change. Within each of these themes, barriers and benefits were identified. CONCLUSION: Leaders are accepting of PBF and QBPs. However, challenges exist that require further exploration including the need for a strong infrastructure, accurate and timely clinical and financial data, and policies to prevent unintended consequences. IMPLICATIONS FOR NURSING MANAGEMENT: Implementing QBPs requires careful planning, adequate and appropriate resources, vertical and horizontal communication strategies, and policies to ensure that unintended consequences are avoided and positive outcomes achieved.

Usability evaluation with mental health professionals and young people to develop an Internet-based cognitive-behaviour therapy program for adolescents with anxiety disorders.

BACKGROUND: Use of the Internet to deliver cognitive behavioural therapy, a frontline treatment for anxiety disorders, is emerging as an option to increase access to treatment among adolescents with anxiety disorders. This study examined the usability of the Internet-based component of Breathe, a CBT program designed for adolescents with mild to moderate anxiety and impairments. METHODS: A mixed-method usability testing design with semi-structured interviews, task completion, and survey by trained usability moderators was undertaken with two interactive cycles to determine the usability (ease of use, efficiency, errors, and user satisfaction) of the user interface and content areas of the program. Purposeful sampling was used to recruit mental health clinicians with expertise in treating adolescent anxiety disorders and young people aged 15 to 24 years involved. Testing involved using Web-conferencing software that allowed remote participation through personal computers. Two testing cycles involved participants completing structured 'think aloud' and 'cognitive walkthrough' tasks within the program. At the end of each cycle participants completed a 15-item global usability evaluation survey and were asked a series of open-ended questions. Descriptive and simple content analyses were used to identify and score usability issues for frequency and severity. RESULTS: Five clinicians and four young people (all < 20 years of age) participated. Most participants described their computer skills as 'good' (60% clinicians, 50% young people), and attitudes toward Internet-based health care ranged from negative (75% young people) to positive (60% clinicians, 25% young people). Scores from the global usability evaluation after both testing cycles ranged from 3.5 to 5 out of 5 in strong agreement/support of the program in terms of user performance indicators (i.e., learnability, efficiency and number of errors) and user satisfaction. Participants were able to complete all critical tasks with minimal errors. Errors and issues identified during testing were predominantly around enhancements to the visual design and navigational support. Opinions across usability elements did not differ between young people and clinician participants. CONCLUSIONS: A multi-method remote usability approach provided the opportunity to improve the technical interface, therapeutic messaging and user experience of an Internet-based treatment program for adolescent anxiety disorders.

Exploring Student and Faculty Perceptions of Clinical Simulation: A Q-Sort Study.

BACKGROUND: Simulation learning has become a widely accepted and valuable methodology within nursing education. This study assessed whether student and faculty perceptions regarding simulation learning have changed since curricular integration of simulation activities within an undergraduate nursing program. METHOD: Q-methodology was used to identify unique and similar perspectives of 12 faculty and 21 students. Participants completed a brief demographic questionnaire and sorted statements related to beliefs about simulation-based learning. RESULTS: Faculty perceptions were captured within one viewpoint-positive enthusiasts. Three student viewpoints were identified: challenge seekers, realistic embracers, and support seekers. Both students and faculty believed that simulation improved critical thinking. CONCLUSION: The findings suggest that faculty should be aware of the range of student perceptions and tailor their teaching approaches accordingly to maximize student learning.

Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

INTRODUCTION: Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. PURPOSE: The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. METHODS: We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. RESULTS: Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. CONCLUSIONS: Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care.