Practical Tips for using a Human Library approach In medical education.

A Human Library is a structured event that brings people from different groups together. It simulates the format of a customary library, with 'Readers' borrowing 'Books', who are human volunteers sharing their lived experiences and perspectives. Rooted in principles of social psychology, Human Libraries provide opportunities for Books and Readers to interact in meaningful dialogue. The goal of each interaction is to give the Reader new understanding of the Book's life. The Human Library was originally developed as a strategy to challenge prejudice through conversation and personal connection, but the approach is remarkably versatile. We repurposed it for a medical education context in order to provide learners in medical school with information and inspiration, particularly about rural life and rural medicine. We organized and held two Human Library events where pre-medical and undergraduate medical students (Readers) engaged in dialogue with rural physicians (Books). However, the strategy could be used to address a wide variety of challenging subjects where the potential Readers are biased or lack experience. This article draws upon research literature and our own experiences of running Human Library events to give practical advice for other organizations who might want to use this novel approach in medical education.

How do intensive work environments affect nurses' absenteeism and turnover intent?

BACKGROUND: Intensive hospital work environments can affect staff, patient, and organizational outcomes. PURPOSE: (1) To assess quantitatively the relationship between critical care registered nurses' perceptions of their workplace, their absenteeism, and their turnover intent; and (2) to analyze nurses' recommendations for improvements for critical patient care. METHODS: Following STROBE guidelines, a cross-sectional survey sampled registered nurses (n = 302), across the Canadian province of Alberta, in October 2018. We assessed nurses' perceptions of their work environment relative to their absenteeism and turnover intent utilizing regression modelling and the Practice Environment Scale of the Nursing Work Index. FINDINGS: A negative binomial analysis indicated that RNs' positive perceptions about their workplace had significant associations with lower rates of absenteeism. Additionally, participants who scored their work environment higher were found to have decreased intentions of leaving the workplace. RNs ranked their "participation in hospital affairs" lowest when comparing practice environment domains and recommended optimizing staffing as the most important improvement for their work environment and patient care. DISCUSSION: Considering the demands associated with critical care patient settings, stakeholders can consider these findings that significant associations exist between nursing staffs' perceptions of the workplace relative to their absenteeism and their turnover intent. IMPLICATIONS FOR POLICY: Value-based solutions are needed in optimizing these key factors, and staffs' participation in hospital affairs appears vital for organizational success.

A cross-sectional study evaluating cardiovascular risk and statin prescribing in the Canadian Primary Care Sentinel Surveillance Network database.

BACKGROUND: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Canada. Assessment and management of CVD risk is essential in reducing disease burden. This includes both clinical risk factors and socioeconomic factors, though few studies report on socioeconomic status in relation to CVD risk and treatment. The primary objective of this study was to estimate the cardiovascular risk of patients attending primary care practices across Canada; secondly, to evaluate concordance with care indicators suggested by current clinical practice guidelines for statin prescribing according to patients' cardiovascular risk and socioeconomic status. METHODS: This cross-sectional observational study used the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database, which is comprised of clinical data from primary care electronic medical records. Patients aged 35-75y with at least one visit to their primary care provider between 2012 and 2016 were included. Patients were assigned to a CVD risk category (high, medium, low) and a deprivation quintile was calculated for those with full postal code available. Descriptive analyses were used to determine the proportion of patients in each risk category. Logistic regression was used to evaluate the consistency of statin prescribing according to national clinical guidelines by risk category and deprivation quintile. RESULTS: A total of 324,526 patients were included. Of those, 116,947 (36%) of patients were assigned to a high CVD risk category, primarily older adults, males, and those with co-morbidities. There were statistically significant differences between least (quintile 1) and most (quintile 5) deprived socioeconomic quintiles, with those at high CVD risk disproportionately in Q5 (odds ratio 1.4). Overall, 48% of high-risk patients had at least one statin prescription in their record. Patients in the lower socioeconomic groups had a higher risk of statin treatment which deviated from clinical guidelines. CONCLUSIONS: Primary care patients who are at high CVD risk are more often male, older, have more co-morbidities and be assigned to more deprived SES quintiles, compared to those at low CVD risk. Additionally, patients who experience more challenging socioeconomic situations may be less likely to receive CVD treatment that is consistent with care guidelines.

The impact of virtual simulation on the recognition and response to the rapidly deteriorating patient among undergraduate nursing students.

A major patient safety challenge is recognition and response to deteriorating patients since early warning signs are often not detected in a timely manner. Nursing students typically learn the skills for early identification through clinical placement, but clinical placements are not guaranteed to provide exposure to deteriorating patients. Nursing students require practice with emergency scenarios to develop their competency and confidence to act in this area. This study aimed to explore the impact of a virtual simulation intervention on the recognition and response to the rapidly deteriorating patient among undergraduate nursing students. A mixed methods study involving a quasi-experimental pre/post design and focus groups. The participants were third or final year undergraduate nursing students from five university sites across four countries (Canada, England, Scotland and Australia, n = 88). Students were randomly assigned to a treatment or control group. The treatment group received a virtual simulation intervention and participated in a focus group. The virtual simulation intervention had a significant effect on improving nursing student knowledge and clinical self-efficacy in the recognition and response to the rapidly deteriorating patient. Students reported that the virtual simulations decreased anxiety, helped them prioritize, filled gaps in their learning, and encouraged autonomous learning within a safe 'low risk' environment. Virtual simulation is an effective strategy for improving knowledge and confidence in recognizing and responding to the rapidly deteriorating patient among undergraduate nursing students.

Convergent Validity of Three Measures of Reflective Function: Parent Development Interview, Parental Reflective Function Questionnaire, and Reflective Function Questionnaire.

Reflective function (RF) is defined as an individual's ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child's mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children's mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale (RFS) applied to the Parent Development Interview (PDI) or Adult Attachment Interview (AAI), which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire (RFQ) and Parental Reflective Function Questionnaire (PRFQ). We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers (n = 150) was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort when their children were 42-60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen's kappas measures of agreement. Two subscales of the PRFQ correlated significantly (p < 0.05) with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health.

Description of Continuous Palliative Sedation Practices in a Large Health Region and Comparison with Clinical Practice Guidelines.

Background: Published reports of continuous palliative sedation therapy (CPST) suggest heterogeneity in practice. There is a paucity of reports that compare practice with clinical guidelines. Objectives: To assess adherence of continuous palliative sedation practices with criteria set forth in local clinical guidelines, and to describe other features including prevalence, medication dosing, duration, multidisciplinary team involvement, and concurrent therapies. Design: Retrospective chart review. Settings/Subjects: We included cases in which a midazolam infusion was ordered at the end of life. Study sites included four adult hospitals in the Calgary health region, two hospices, and a tertiary palliative care unit. Measurements: Descriptive data, including proportion of deaths involving palliative sedation therapy, number of criteria documented, midazolam dose/duration, concurrent symptom management therapies, and referrals to spiritual care, psychology, or social work. Results: CPST occurred in 602 out of 14,360 deaths (4.2%). Full adherence to criteria occurred in 7% of cases. The most commonly missed criteria were: a "C2" goals-of-care designation order (comfort care focus in the imminently dying) (84%) and documentation of imminent death in the chart (55%). Concurrent medical therapies included opioids in 98% of cases and intravenous hydration in 85% of cases. Few referrals were made to multidisciplinary care teams. Conclusions: We found low adherence to palliative sedation guidelines. This may reflect the perception that some criteria are redundant or clinically unimportant. Future work could include a study of barriers to guideline uptake, and guideline modification to provide direction on concurrent therapies and multidisciplinary team involvement.

EXPERIENCIAS Y PROCESO DE DUELO ENTRE PROFESIONALES DE ENFERMERÍA ONCOLÓGICA PEDIÁTRICA: EXPERIENCES AND GRIEVING PROCESS AMONG PEDIATRIC CANCER NURSES.

Explore how nursing professionals handle the death of a pediatric patient with cancer under their care and identify needs that they face in the workplace. An exploratory qualitative design was used, under the phenomenological framework and the Model of Information, Motivation and Behavioral Skills (IMHB). The data was obtained through semi-structured interviews with a sample of ten pediatric oncology nursing professionals. Each interview was transcribed and analyzed to identify thematic axes in the narrative of the participants. The findings revealed four categories that alluded to professional experiences in the face of the death of a patient and their handling of the grieving process. These were: Perception of nursing professionals about cancer; management of the pediatric patient in the terminal phase, coping strategies and areas of professional need. According to the findings, limitations were identified in knowledge about the subject of death and the grieving process of these health professionals. These limitations reflect being an obstacle in their clinical skills and in their capacity for assertive management. It is essential to educate these professionals about Thanatology and its benefits; as well as, to enable them access to psychological interventions for emotional management.

Explorar cómo los profesionales de enfermería manejan el fallecimiento de un paciente pediátrico con cáncer bajo su cuidado e identificar necesidades que enfrentan en el área laboral. Se utilizó un diseño exploratorio de corte cualitativo, bajo el marco fenomenológico y el Modelo de Información, Motivación y Habilidades Conductuales (IMHB). Los datos se obtuvieron a través de entrevistas semi-estructuradas a una muestra de diez profesionales de enfermería de oncología pediátrica. Cada entrevista fue transcrita y analizada para identificar ejes temáticos en la narrativa de las personas participantes. Los hallazgos revelaron cuatro categorías que aludían a las experiencias profesionales ante la muerte de un paciente y su manejo ante el proceso de duelo. Estas fueron: Percepción de los profesionales de enfermería sobre el cáncer; manejo del paciente pediátrico en fase terminal, estrategias de afrontamiento y, áreas de necesidad profesional. Según los hallazgos, se identificó limitaciones en conocimiento sobre el tema de la muerte y el proceso de duelo de estos profesionales de la salud. Estas limitaciones reflejan ser un obstáculo en sus destrezas clínicas y en su capacidad de manejo asertivo. Resulta fundamental educar a estos profesionales sobre la tanatología y sus beneficios; como también así, posibilitarles el acceso a intervenciones psicológicas para el manejo emocional.

Procedural Knowledge and Skills of Residents Entering Canadian Family Medicine Programs in Alberta.

BACKGROUND AND OBJECTIVES: Incoming family medicine (FM) residents start residency with different levels of procedural training. Understanding their baseline skill level is necessary to plan the educational experiences and teaching methods that will provide the desired knowledge, skills, and attitudes related to performing medical procedures. METHODS: A survey of 69 procedures based on the core list issued by the College of Family Physicians of Canada was administered to incoming residents in Alberta (Calgary and Edmonton FM programs). The survey intended to identify the levels of training and confidence acquired for each listed procedure before residency, and plans to perform each of the procedures in future independent practice. RESULTS: A total of 146 residents from both programs responded to the survey (82% response rate). Of the 69 procedures evaluated, 15 (21.7%) had been previously performed at least five times by 50% or more residents. Only five procedures were rated by 80% or more of the residents as being able to perform independently or to teach to others: simple suture, infiltration of local anesthetic, intramuscular injection, cryotherapy of skin lesions and Pap smear. More male residents than female residents felt confident in performing 10 procedures, while female residents were more confident in performing Pap smears. Rural residents felt more confident to perform 22 procedures than their urban colleagues. CONCLUSIONS: This information demonstrates limited prior training in procedures among entering residents, and provides guidance to FM programs to develop teaching interventions to achieve competence in those procedural skills seen as necessary for family physicians.

Hospice care in Calgary: Survey of family physicians on their knowledge, experience, and attitudes.

OBJECTIVE: To explore Calgary family physicians' knowledge about hospices, their attitudes toward the referral process, and their understanding of barriers to referral for hospice care. DESIGN: Surveys were mailed to 400 randomly selected participants. The survey contained 18 questions related to hospice care, physician experience, attitudes, and perceived barriers to making a hospice referral. SETTING: Calgary, Alta. PARTICIPANTS: Family physicians. MAIN OUTCOME MEASURES: Survey responses were analyzed quantitatively using the (2) goodness-of-fit test, Kruskal-Wallis tests, and logistic regression analyses to examine univariate associations. Qualitative analysis of open-ended questions was done by content analysis and thematic coding. RESULTS: In total, 104 surveys were mailed back. Family physicians agreed that palliative care in a hospice setting can greatly improve quality of life for patients, but only 2 of 6 knowledge questions about hospice care were answered correctly by most. Family physicians with special areas of interest or subspecialties were more likely to feel well-informed about hospice referrals (P = .017), indicated a higher comfort level discussing hospice and palliative care (P = .030), and were less likely to defer discussing it with patients (P = .023). Physicians with a special interest in palliative medicine were more likely to correctly answer the knowledge questions (P < .034) and to be familiar with the referral process (P < .001), patient eligibility (P < .001), and the palliative home care program (P = .003). Qualitative analysis revealed support for palliative home care and consultation services but concerns about caregiver coping and family issues. Concerns about disengagement of family physicians and uncertainty about the referral process are obstacles to referral. CONCLUSION: While Calgary family physicians are appreciative of hospice care, there are knowledge gaps. It is important to engage family physicians in the referral process.

[STIGMA AND HIV / AIDS AMONG PUERTO RICAN PARENTS / MOTHERS AND ADOLESCENTS]. / ESTIGMA Y VIH/SIDA ENTRE PADRES/MADRES Y ADOLESCENTES PUERTORRIQUEÑOS/AS.

Communication between parents and adolescents about sexuality is important for the healthy development of young people. Stigmatizing attitudes towards HIV/AIDS may adversely impact this communication. The aim of this study was to identify stigmatizing attitudes towards HIV/AIDS among Puerto Rican parents and adolescents. This effort is part of the Cuídalos Project which aimed to test a web-based intervention to increase communication about sexuality and health among parents and adolescents through an experimental design with 458 parent/adolescent (13-17 years of age) dyads. For the purposes of this article we report descriptive statistics on HIV/AIDS stigma attitudes gathered as part of our baseline measurement. Both parents and adolescents manifested stigmatizing attitudes towards HIV/AIDS. In light of these results it is necessary to continue developing interventions to reduce stigma among this population. Parents can be an invaluable asset to reduce stigma among adolescents and to help prevent sexual risk behaviors and new infection.