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The article shares strategies associated with reengineering the core functionalities of an electronic health record (EHR) system of a Kentucky geriatric-focused primary care (PC) clinic. It notes that the strategy necessitated a shift from traditional roles of geriatrician-led PC to team-based PC. It states that the success of the strategy relied on comprehensive education for team members on age-friendly health care.

Patient harm, patient safety and their governance have been ongoing concerns for policymakers, care providers and the public. In response to high rates of adverse events/medical errors, the World Health Organisation (WHO) advocated the use of surgical safety checklists (SSC) to improve safety in surgical care. Canadian health authorities subsequently made SSC use a mandatory organisational practice, with public reporting of safety indicators for compliance tied to pre‐existing legislation and to reimbursements for surgical procedures. Perceived as the antidote for socio‐technical issues in operating rooms (ORs), much of the SSC‐related research has focused on assessing clinical and economic effectiveness, worker perceptions, attitudes and barriers to implementation. Suboptimal outcomes are attributed to implementations that ignored contexts. Using ethnographic data from a study of SSC at an urban teaching hospital (C&C), a critical lens and the concepts of ritual and ceremony, we examine how it is used, and theorise the nature and implications of that use. Two rituals, one improvised and one scripted, comprised C&C's SSC ceremony. Improvised performances produced dislocations that were ameliorated by scripted verification practices. This ceremony produced causally opaque links to patient safety goals and reproduced OR/medical culture. We discuss the theoretical contributions of the study and the implications for patient safety. [ABSTRACT FROM AUTHOR]

Play is regarded as a child's primary occupation and provides valuable information about the child's abilities. Thus, informative assessment tools of play skills are critical for establishing play-related treatment goals in occupational therapy. The objective of this study is to present a practical method for occupational therapists to develop intervention goals using the Yonsei-Social Play Evaluation Tool (Y-SPET) keyforms. Parent responses (n = 310) for preschool children (three to six years old) who did not have a medical diagnosis were examined. The Rasch measurement model was used to create keyforms for the Y-SPET. All children's raw scores were converted into individual Rasch-calibrated logit scores and standard errors were estimated to establish logically attainable treatment goals. Results showed use of the keyforms could logically identify the intervention goals of the children's social play. This suggests that the Y-SPET keyforms are helpful for assessing the level of children's social play and establishing practical treatment goals. [ABSTRACT FROM AUTHOR]

Background: National nurse shortages, ongoing nurse faculty retirements, and a dearth of clinical sites make it challenging to prepare advanced practice registered nurses (APRNs) who are ready to transition into independent provider roles, especially in acute care settings. One of the most effective ways to address these experiential learning challenges is for academic institutions and healthcare systems to form collaborative academic–practice partnerships. However, many partnerships between schools of nursing and healthcare institutions have found numerous challenges, including time to devote to the partnership, funding of ideas, competing initiatives and needs, and sustainability. Objective: The University of Maryland School of Nursing (UMSON) set out to expand the traditional academic–clinical partnership approach with a new collaborative model. Methods: Rather than both parties coming to the table with their own goals, the partnership focused on intentional relationship building, transparency, measurable outcomes, and sustainability. This model, further called the Sustainable Academic–Clinical Alliance (SACA), assures that both sides of the partnership benefit. The SACA model was used to create an academic–practice partnership with the University of Maryland Upper Chesapeake Health System in order to increase APRN clinical practice sites and readiness of APRN students to provide care across the continuum in the state of Maryland. Results: Since July 2016, the SACA model has enabled over 40 clinical providers in over 20 different clinical areas to offer 329 different clinical and nonclinical experiences to APRN students from UMSON. At the end of the 5-year alliance, 150 unique UMSON APRN students completed 257 different clinical rotations. Conclusion: The SACA model effectively promotes the development and achievement of sustainable academic–practice partnerships by focusing on (a) intentional relationship building, (b) transparency in goal setting and alliance maintenance, (c) development of outcome measures, and (d) sustainability. Implications for Nursing: The components of the SACA model made sustainability more achievable, which has eluded previous academic–clinical partnerships. This model can serve as a blueprint for other academic and healthcare institutions to establish sustainable academic–practice partnerships. [ABSTRACT FROM AUTHOR]

We investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI. [ABSTRACT FROM AUTHOR]

Uncompensated work in academic infectious diseases (ID) may be high value (eg, important for academic promotion or necessary for advancement to leadership roles) or low value (eg, not aligning with or contributing to professional goals and aspirations). "Curbside" consultations, participation in hospital committees outside of professional interests, and other "citizenship" tasks are common examples of threats to our valuable time as ID providers. Herein, we define the scope of the problem of low-value uncompensated work in academic ID and outline a 6-step program to minimize these threats. Collaboration with professional sponsors, such as division chiefs, to align individual and team goals and use of a "value-versus-compensation" matrix to prioritize activities may help us establish our own agendas and reclaim our professional autonomy. [ABSTRACT FROM AUTHOR]

Background: Training in speaking up skills for nursing professionals provides the groundwork for promoting a culture of curiosity and inquiry. At the foundation of speaking up is psychological safety for team members to disagree, offer alternative ideas, and ask questions. Method: A large-scale training session, Finding Your Voice: Speaking Up & Listening Skills, was designed and delivered to 1,306 nurses at an academic medical center. Results: Most participants reported that the session met the training goals (97%). There was an increase in participants' confidence in speaking up (pretraining 69% ± 19%; posttraining 73% ± 15%; p <.0001), and listening (pretraining 68% ± 19%; post-training 74% ± 15%; p <.0001). Leaders showed greater increases in confidence in listening and responding to nurses speaking up (leaders 5.6% vs. nonleaders 4.2%, p <.00001). Conclusion: Nurses benefited from an interactive educational experience by practicing strategies for speaking up and listening. [J Contin Educ Nurs. 2024;55(6):309–316.] [ABSTRACT FROM AUTHOR]

Background. Human capital is the most vital strategic element and the most basic way to improve the performance and efficiency of an organization. Concerning the importance of human resources, it is obvious that in order to achieve the goals of the health system, human resources must have a favorable sense of belonging and commitment in addition to skills and expertise. Based on this, the current study aimed at providing a structural model for predicting professional commitment based on the components of self-leadership among the employees of a medical science university. Methods. The current applied research utilized a descriptive-correlational design. The statistical population of the employees of Tabriz University of Medical Sciences (northwest of Iran) was 976. Of this amount, 276 individuals were estimated as the statistical sample based on Cochran's formula and were randomly selected. Data were collected randomly through a questionnaire. In this study, structural equation modeling based on PLS3 software was used to test the hypotheses. Results. The results indicated that the components of self-leadership-visualization of successful performance, personal goal setting, self-rewarding, evaluation of beliefs and assumptions, personal observation, focusing on natural rewards, and self-guidance had a positive effect on professional commitment among the employees of Tabriz University of Medical Sciences. What is more, the components of self-leadership positively predicted professional commitment. Conclusion. Strengthening the components of self-leadership among employees will lead to the improvement of their morale, job satisfaction, and professional commitment, and in general, a better manifestation of lofty goals and a significant increase in the performance of the organization. [ABSTRACT FROM AUTHOR]

Purpose. Breast cancer is considered a huge health problem among women all over the world due to its increased mortality rate. Breast cancer deaths are decreased by 28–34% due to improvement in treatment and early detection. In order to detect breast cancer early and provide the best possible therapy, knowledge and awareness are essential. So, this study aimed to assess risk of breast cancer among nurses, the knowledge and practices of breast self-examination (BSE) and determine its barriers, and implement an educational program for them. Design. A quasiexperimental research design was used. Methods. This study was conducted at two university hospitals (main university hospital and woman's health hospital). A purposive sample of 280 nurses with age more than thirty-five years were included in the study using three tools, namely, structure interview questionnaire, breast cancer risk assessment tool, and a structured breast cancer knowledge and practice questionnaire. Nurses' knowledge and practices regarding breast cancer and BSE were first assessed and then they were provided with two educational courses covering theoretical and practical information. One month after the program ended, the nurses' knowledge and practices were assessed again. Results. About 3.2% of the participants have five years high risk of developing breast cancer according the risk assessment tool, the main barriers of do not do BSE did not find any symptoms and scared from finding any abnormality. There was a significant increase in knowledge and practice of breast self-examination posteducation compared to pre-education (73.2 and 98.2%, respectively). Also, there was a statistically significant difference between pre- and postprogram with a p value of 0.0001. Conclusion. This study concluded that 3.2% of the nurses with high risk of developing breast cancer needed a follow-up; more than half of them do not perform breast self-examination because they think that do not have any symptoms in the breast and the educational program with a significant effect on knowledge and practices of nurses. So, the researchers recommend the nurses need for an empowerment program and support by providing assistance in places of work as done free clinical examination and mammography by female specialist for privacy. [ABSTRACT FROM AUTHOR]

The adoption of Collaborative Goal Setting (CGS) is limited in most rehabilitation settings in Nigeria despite its recommendations in clinical practice guidelines. To explore the perceptions of physiotherapists and patients about CGS at a tertiary healthcare facility in Ibadan, Nigeria. We conducted focus group discussions among purposively selected physiotherapists (n = 8) and patients (4 stroke survivors, 3 patients with brain injury) to qualitatively explore their perceptions. Audio-taped discussions were transcribed verbatim and thematically analyzed. We identified four themes around CGS which were: 1) paternalistic view of goal setting; 2) physiotherapists as goal setters; 3) perceived benefits of collaborative goal setting; and 4) barriers and facilitators to CGS. The physiotherapists articulated goals as expected outcomes from treatment and believed they were better poised and experienced to determine what patients could achieve during each phase of treatment. Patients' view of goal setting agreed with the physio-therapists', as they also opined that goal setting is the responsibility of physiotherapists. Time constraint, inadequate knowledge and the inability of patients to appropriately articulate their goals and expectations from treatment were barriers to CGS. Concerns about who to collaborate with when dealing with patients with impaired cognition and/or disorders of consciousness were raised by the physiotherapists. Participants in both groups indicated that education on how to set patient-oriented goals could facilitate CGS. Though rarely practiced, participants agreed that collaborative goal setting could be beneficial. Both the physiotherapists and patients require education on how to appropriately collaborate in setting goals of rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Digital texts are progressively becoming the medium of learning for students, but research has indicated that students tend to process information more superficially while reading on screen. It is therefore relevant to examine what strategies can support digital text comprehension. Objectives: This study aimed to investigate the effects of highlighting—both learner generated and experimenter provided—when reading digitally. Methods: University students (N = 170) were randomly assigned to the condition of learner‐generated highlighting, experimenter‐provided highlighting, or control. Reading outcomes were measured as literal and inferential text comprehension, transfer of knowledge, and metacognitive calibration of comprehension performance at immediate and delayed post‐tests. Individual differences in prior knowledge, cognitive reflection, and reading self‐efficacy were taken into account. The quality of the information highlighted by students in the condition of active highlighting was also measured. Results: From linear mixed‐effects models, the main effect of condition did not emerge for any of the outcomes. However, an interactive effect of condition and cognitive reflection emerged for literal text comprehension that favoured readers in the condition of experimenter‐provided highlighting with higher ability to resist automatic thinking. Inferential text comprehension, transfer of knowledge, and calibration of performance were only predicted by cognitive reflection or reading self‐efficacy. Finally, the quality of information highlighted significantly contributed to students' literal text comprehension and transfer of knowledge in the learner‐generated highlighting condition. Takeaways: Active highlighting is not effective per se during digital reading. The "amplification" effect of already highlighted text and higher cognitive reflection suggests that readers who are more able to resist automatic thinking may also invest more effort in the task, taking more advantage of the provided support. Even if active highlighting may not be effective per se compared to other reading conditions, what students highlight contributes to literal text comprehension and their learning from text. Lay Description: What is already known about this topic: Reading on a screen to learn new content for academic assignments is a typical learning activity for todays' students.For digital reading students tend to adopt a more superficial approach compared to traditional reading.Reading strategies can help readers to comprehend complex digital texts.Highlighting is a technically simple strategy to use for digital reading, which can at least support the selection of relevant information for text comprehension. What this paper adds: When considering digital reading neither learner‐generated highlighting nor experimenter‐provided highlighting is effective by itself.Experimenter‐provided highlighting is more effective for literal text comprehension than learner‐generated highlighting when combined with readers' ability to cognitively reflect and resist more automatic responses.The individual differences of cognitive reflection and reading self‐efficacy predicted inferential text comprehension and transfer of knowledge.Reading self‐efficacy also predicted readers' metacognitive calibration of comprehension performance (accuracy of self‐judgements of comprehension performance). The implications of study findings for practitioners: The effective use of highlighting for text comprehension probably requires some explicit instruction and practice in learning devices.The potential benefits of either learner‐generated highlighting or experimenter‐provided highlighting should be considered in relation to cognitive and motivational individual differences.It is important to create or refine readers' awareness that the quality of the information they highlight matters as it is associated with their text literal text comprehension and transfer of knowledge. [ABSTRACT FROM AUTHOR]

Previous findings on media multitasking, sustained attention and inhibitory control have been mixed with some studies linking heavy media multitasking with impaired sustained attention and inhibitory control whereas others have failed to find any relationship. This study examined the relationships between these factors using a three-state attentional disengagement model that focuses on transient aspect of attention. A sample of 238 participants completed a media use questionnaire and a Sustained Attention to Response Task (SART) with mind-wandering probes. They also completed the Barratt Impulsivity Scale and Boredom Proneness Scales. Heavier media multitasking was associated with higher rates of omission and commission errors and greater response variability in the SART. Heavier media multitaskers tended to mind wander more without awareness rather than with awareness, suggesting a more progressed form of attentional disengagement during the SART. They also made more anticipatory responses that suggest automatic responses to task stimuli without fully processing the stimuli. Higher media use scores were associated with greater self-reported attentional impulsivity and boredom proneness. Media multitasking was not linked to perceived difficulty or interestingness of the task. Taken together, these results provide evidence that heavy media multitasking is linked to poorer sustained attention and inhibitory control. [ABSTRACT FROM AUTHOR]

Background/Aims: Depression is a common symptom in schizophrenia and can negatively affect treatment. The aim of this study was to examine the effects of goal‑oriented dance or movement therapy on depressive symptoms in individuals diagnosed with schizophrenia. Methods: The study was designed as a randomised controlled rater‑blinded study, in which 32 individuals diagnosed with schizophrenia were randomly assigned to either the intervention (dance movement therapy) group or control group. The intervention consisted of twice‑weekly goal‑oriented dance movement therapy sessions, with each session lasting approximately 40–50 minutes, for a total of 8 weeks. Depressive symptoms were evaluated using the Calgary Depression Scale for Schizophrenia. Results: The depressive symptoms before and after the intervention were compared. No significant differences between groups were observed at baseline. There was no change in the control group, whereas a significant improvement on depressive symptoms was observed in the total Calgary Depression Scale for Schizophrenia score in the dance movement therapy group after the intervention. Conclusions: Goal‑oriented dance movement therapy is an effective treatment for the depressive symptoms in schizophrenia patients in addition to conventional treatments. Although the results are favourable, further studies are needed to test its effectiveness. Implications for practice: In the traditional treatment of schizophrenia, it is important to evaluate depression and support the treatment with approaches such as dance movement therapy. [ABSTRACT FROM AUTHOR]

Aim: Standardised enteral nutrition protocols are recommended in critical care, however their use and safety are not well described in other inpatient populations. This mixed methods study reports on the use and safety of enteral nutrition protocols for non‐critically ill adults. Methods: A scoping review of published literature was conducted. In addition a retrospective audit of practice at an Australian tertiary teaching hospital with an existing hospital‐wide standardised enteral nutrition protocol was performed. Data on use, safety and adequacy of enteral nutrition prescription were collected from medical records for patients receiving enteral nutrition on acute wards (January–March 2020). Results: Screening of 9298 records yielded six primary research articles. Studies were generally low quality. Published literature suggested that protocols may reduce time to enteral nutrition initiation and goal rate, and improve adequacy of nutrition provision. No adverse outcomes were reported. From the local audit of practice (105 admissions, 98 patients), enteral nutrition commencement was timely (median 0 (IQR 0–1) days from request; goal rate: median 1 (IQR 0–2) days from commencement and adequate (nil underfeeding), without prior dietitian review in 82% of cases. Enteral nutrition was commenced per protocol in 61% of instances. No adverse events, including refeeding syndrome, were observed. Conclusions: Most inpatients requiring enteral nutrition can be safely and adequately managed on enteral nutrition protocols. Evaluation of protocols outside of the critical care setting remains a gap in the literature. Standardised enteral nutrition protocols may improve delivery of nutrition to patients, whilst allowing dietitians to focus on those with specialised nutrition support needs. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of a goal-directed movement intervention in two medical wards, including recommendations for implementation and evaluation. Design: Implementation Research. Setting: Pulmonology and nephrology/gastroenterology wards of the University Medical Centre Utrecht, The Netherlands. Participants: Seven focus groups were executed including 28 nurses, 7 physical therapists and 15 medical specialists. Patients' perceptions were repeatedly assessed during the iterative steps of the intervention development. Intervention: Interventions were targeted to each ward's specific character, following an Intervention Mapping approach using literature and research meetings. Main measures: Intervention components were linked to Behavior Change Techniques and implementation strategies will be selected using the Expert Recommendation Implementing Change tool. Evaluation outcomes like number of patients using the movement intervention will be measured, based on the taxonomy of Proctor. Results: The developed intervention consists of: insight in patients movement behavior (monitoring & feedback), goal setting (goals & planning) and adjustments to the environment (associations & antecedents). The following implementation strategies are recommended: to conduct educational meetings, prepare & identify champions and audit & provide feedback. To measure service and client outcomes, the mean level of physical activity per ward can be evaluated and the Net Promoter Score can be used. Conclusion(s): This study shows the development of a goal-directed movement intervention aligned with the needs of healthcare professionals. This resulted in an intervention consisting of feedback & monitoring of movement behavior, goal setting and adjustments in the environment. Using a step-by-step iterative implementation model to guide development and implementation is recommended. [ABSTRACT FROM AUTHOR]

In the present study, I explore the relationship between purpose, which was measured by the Claremont Purpose Scale, and moral psychological indicators, moral reasoning, moral identity, and empathy. Purpose was quantified in terms of three subcomponents: meaning, goal, and beyond-the-self motivation. Moral reasoning was assessed in terms of utilization of postconventional moral reasoning. Moral identity was examined with two subscales: moral internalization, and symbolization. Among diverse subscales of empathy, I focused on empathic concern and perspective taking, which have been reported to be strongly related to morality. To explore the best prediction models using the data, I employed Bayesian Model Selection and Bayesian regression analysis. In general, purpose was significantly predicted by most surveyed moral psychological indicators but not by moral symbolization. The best prediction model for beyond-the-self motivation included the most moral psychological indicator predictors including moral reasoning, which did not significantly predict other dependent variables. [ABSTRACT FROM AUTHOR]

We conducted a service evaluation of the medical support worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the Coronavirus 2019 (COVID-19) pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the goals of the MSW position, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorised into micro-, meso-, and macro-levels of the health system. At the micro-level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who had a crucial role during the pandemic. At the meso-level, participants emphasised the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarise MSWs with the health system. At the macro-level, the role facilitated MSW integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas. [ABSTRACT FROM AUTHOR]

Background: The competency-based medical education new curriculum stresses on the foundation course at the beginning of the MBBS programme, with an objective to orient the students on new knowledge and skills that will aid them in adapting to the new professional environment, providing the opportunity for faculty and peer interactions and sensitisation towards various teaching–learning methods. Aims: The Aim of the study was to analyse the student’s feedback on the foundation course and to determine the level of satisfaction of the learners towards the course. Patients and Methods: This was a programme evaluation of foundation course for newly joined MBBS students in Mamata Academy of Medical Sciences, Hyderabad, Telangana, India, during December from 12th to 19th for 7 days. Results: On feedback analysis, around 90% of the students were satisfied with all the sessions and the students have expressed a high level of satisfaction towards the sessions of teamwork, leadership skills, interpersonal communication skills, Basic Life Support (BLS), first aid, field visit and Indian Medical Graduate (IMG) goals. A statistically significant difference between the mean scores of pre and post test was found. Conclusions: The overall feedback on the foundation course was satisfactory. Students have gladly received the foundation course and they were well sensitised by the topics covered and activities conducted. There was a significant improvement in their assessment scores. Thus, the impact of the foundation course will definitely help in accomplishing the goals of IMG effectively [ABSTRACT FROM AUTHOR]

Background: Goal-oriented patientcare is a key element in qualityhealthcare. Medical-caregiver's (MC) are expected to generate a shared decision-making process with patients regarding goals and expected health-outcomes. Hip-fracture patients (HFP) are usually older-adults with multiple health-conditions, necessitating that agreed-upon goals regarding the rehabilitation process, take these conditions into consideration. This topic has yet to be investigated by pairing and comparing the perception of expected outcomes and therapeutic goals of multidisciplinary MCs and their HF patient's. Our aim was to assess in a quantitative method whether HFPs and their multidisciplinary MCs agree upon target health-outcomes and their most important goals as they are reflected in the SF12 questionnaire. Methods: This was a cross-sectional, multi-center, study of HFPs and their MCs. Patients and MCs were asked to rate their top three most important goals for rehabilitation from the SF12 eight subscales: physical functioning, physical role limitation, bodily pain, general health, vitality, social functioning, emotional role limitation and mental health, and indicate their expected outcome. Descriptive statistics and mixed effect logistic-regression were used to compare concordance of the ratings. Agreement between patients and MCs was assessed using interclass coefficients (ICCs). Results: A total of 378 ratings were collected from 52 patients, 12 nurses, 12 physicians and 6 paramedical personnel. Each patient had between 3 and 9 raters. Patients considered physical functioning and physical role limitation more important than did MCs. Physicians and nurses emphasized the importance of bodily pain while patients referred to it as relatively less significant. The total ICC was low (2%) indicating poor agreement between MCs and patients. With the exception of physical-functioning, MCs predicted a less optimistic outcome in all of the SF12's subscales in comparison to HFPs. Conclusion: Effective intervention in HFPs requires constructive communication between MCs and patients. The study suggests that caregivers have an insufficient understanding of the expectations of HFPs. More effective communication channels are required in order to better understand HFPs' needs and expectations. [ABSTRACT FROM AUTHOR]

(1) Background: Design thinking, as a human-centered design method, represents a unique framework to support the planning, testing, and evaluation of new clinical spaces for diabetic care throughout all phases of construction. This approach prioritizes the needs and experiences of diabetic patients to create innovative and effective healthcare environments. By applying design-thinking principles, healthcare facilities can optimize the design and functionality of their clinical spaces, ensuring a patient-centered approach to diabetic care. This holistic and personalized approach can ultimately enhance the overall quality of diabetic care provided to patients. (2) Methods: The study used the action research method and progressively explored diabetes patients' needs and preferences for care, subsequently developing creative solutions to achieve the goals. There were six doctors, seven nursing staffs, four case managers and three family members who participated in the design-thinking workshop. (3) Results: The participating trainees in this study developed unique and innovative solutions during the iterative process of "divergent thinking" and "focused thinking", including diabetes dietary guidelines for food ordering and delivery platforms, and the design of accompanying health-education picture books to enable patients to learn the care process and precautions before, during, and after discharge. (4) Conclusions: This continuing education model promoted sharing among participants, improved collaboration and mutual learning, and increased motivation through goal setting. [ABSTRACT FROM AUTHOR]

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Introduction/Objectives: While it is well established that unmet healthrelated social needs (HRSN) adversely affect health outcomes, there has been limited evaluation in adult primary care of patients' perceptions of how these needs impact their health and the role of the primary care provider (PCP). The objective of this study is to identify patients' perceptions of HRSN and how PCPs could help address them. Secondary objectives include exploring the impact of goal setting and a 1-time cash transfer (CT). Methods: This qualitative study used semi-structured baseline and follow-up interviews with patients in internal medicine clinics. Adult primary care patients were included if they screened positive as having 1 of 3 HRSN: financial resource strain, transportation needs, or food insecurity. All participants completed an initial interview about their HRSN and health, and were asked to set a 6-month health goal. At enrollment, participants were randomized to receive a $500 CT or a $50 participation reward. At 6-months, patients were interviewed again to investigate progress toward meeting their health goals, [when applicable] how the CT helped, and their beliefs about the role of PCPs in addressing HRSN. Results: We completed 30 initial and 25 follow-up interviews. Participants identified their HRSN, however most did not readily connect identified needs to health. Although participants were receptive to HRSN screening, they did not feel it was their PCP's responsibility to address these needs. Verbal goal-setting appeared to be a useful tool, and while the CTs were appreciated, patients often found them inadequate to address HRSN. Conclusions: Given the importance of identifying the social conditions that shape patients' health, providers, and health systems have an opportunity to re-evaluate their role in helping patients address these barriers. Future studies could examine the effect of more frequent disbursement of CTs over time. [ABSTRACT FROM AUTHOR]

To evaluate/compare the effects of the Bobath concept and task-oriented training on motor function, muscle thickness, balance, gait, and perception of goal achievement in patients with stroke. Thirty-two patients were randomly divided into Bobath and task-oriented groups. Exercises were applied for one hour a day, three days a week, for eight weeks. Clinical (Trunk Impairment Scale (TIS), Stroke Rehabilitation Assessment of Movement (STREAM), Goal Attainment Scale (GAS), balance, gait)) and trunk muscle thickness assessments (with ultrasound) were performed. Thirty patients completed the study. TIS, STREAM, and GAS scores were increased in both groups (all p < 0.05). Bilateral rectus abdominis thickness was found to have increased in the Bobath group whereby this increase was better when compared with the task-oriented group (p < 0.05). The limits of stability increased in both groups (p < 0.05). Postural sway was decreased in the anteroposterior (normal stability eyes open) in the Bobath group and the anteroposterior (perturbated stability eyes closed) in the task-oriented group. Velocity, step length, and functional ambulation profile scores increased, and double support of the paretic side decreased in the task-oriented group (all p < 0.05). The Bobath concept appears to be superior to task-oriented training in increasing the thickness of rectus abdominis in patients with stroke. Although the task-oriented training provided significant improvement, especially in terms of gait, no superiority was found between the two rehabilitation approaches in terms of functional ability. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe the experiences of a master's‐level critical care nursing program for trainees in postoperative and intensive care units. Design: An exploratory design with a multidimensional approach was chosen. Methods: The study was conducted from 2018 to 2019 at a university hospital in southern Norway in collaboration with a university college of nursing. Data were collected through seven focus group interviews with trainees, preceptors, heads of departments, clinical nurse educators and professors (n = 26). The thematic analysis progressed from description to a deeper understanding, searching for manifest and latent patterns across the data. The COREQ checklist was used for reporting the study. Results: The analysis resulted in one overarching theme: 'To walk the critical care nursing pathway – balancing competency, time, and challenges to become proficient'. The subthemes were 'expectations, obligations, and workload in unknown environments', 'constantly assessing while being assessed', 'continuous precepting and challenges', 'vulnerability and commitment' and 'thriving in the role, mastering new skills'. The study provides valuable insights into a complex learning environment and the importance of caring aspects for trainees during their critical care nursing education. Conclusion: Precepting, continuous competence assessment and clear learning outcomes are necessary to create a safe environment for the trainees during their development. Implications for the profession: The results advocate investing in inexperienced trainees' competency development to become proficient, creating a safe learning environment in a highly complex setting. This may also, as previous studies suggest, increase staff retention. [ABSTRACT FROM AUTHOR]

PURPOSE: Conventional hematology/oncology fellowship training is designed to foster careers in academic practice through intensive exposure to clinical and laboratory research. Even so, a notable proportion of graduating fellows opt to pursue a clinically focused career outside the realm of academic medicine. Given the corresponding shortage of oncologists in nonurban and rural settings, improving the representation of hematologists/oncologists in the community setting is a national priority. METHODS We reviewed current national challenges and changing models of cancer care delivery in the context of the traditional academic training model along with trends in practice patterns for recent hematology/oncology graduates. We defined the Academic-Community hybrid (ACH) and how it supports the evolution in contemporary models of cancer care. We then drew on the authors' experiences to formulate an innovative goalconcordant training paradigm for fellows seeking careers in the ACH model. RESULTS: The ACH hematology/oncology fellowship training pathway emphasizes and optimizes professional development domains including clinical care, patient safety and quality improvement, business and operations, cancer care equity and community access, healthy policy and alignment with professional organizations, and medical education. CONCLUSION: This novel hematology/oncology training model provides a paradigm for optimizing preparedness for practice in an increasingly complex cancer care delivery environment while addressing workforce shortages and health disparities. [ABSTRACT FROM AUTHOR]

Postgraduate medical burn rehabilitation training has been limited, with very few academic physiatrists specializing in burn rehabilitation. As a result, there are no existing models for postgraduate burn rehabilitation education. A 12-mo comprehensive clinical fellowship in burn rehabilitation was offered through a tertiary burn center with formal university accreditation. In this article, the clinical, educational, and skill-based goals developed and implemented for this novel fellowship was outlined to serve as a blueprint for future fellowships in burn rehabilitation, as well as reflections on the experience. [ABSTRACT FROM AUTHOR]

We tested the process of change in Alliance Empowerment Family Therapy (AEFT; Escudero, 2013), a systemic, team-based approach for treating child welfare involved families. Since building and balancing strong personal and within-family therapeutic alliances are crucial for motivating and sustaining change in these multistressed, overburdened families, we assessed alliance perceptions over time in relation to two indices of therapy outcome, youth functioning, and family-specific goal attainment. Specifically, we administered the self-report version of the System for Observing Family Therapy Alliances (Friedlander et al., 2006) following Sessions 3, 6, and 9 to 156 Spanish families seen by 20 therapists in six agencies whose mission is to serve child welfare referred maltreated youth. Results showed that AEFT delivered in M = 11.04 sessions (SD = 3.29) was effective in attaining family-specific goals and improving child functioning, d = 1.16, as rated by the therapist team in coordination with the referring caseworker. A unique aspect of the study was the modeling, at each time point, of the shared therapeutic system alliance, a latent variable consisting of the therapist's rating of the alliance as well as the alliance ratings of the youth and primary caregiver. As we hypothesized, shared alliance perceptions strengthened with time and positively predicted posttreatment outcomes. Moreover, a comparison of linear growth models with and without the therapist's perspective showed that inclusion of the therapist ratings in the shared alliance variables improved the predictability of child and family outcomes. Public Significance Statement: We studied the process and outcomes of Alliance Empowerment Family Therapy (AEFT), a treatment specifically developed for child welfare referred families that emphasizes the therapeutic alliance as the central component of change. As we predicted, the shared alliance perceptions of youth, caregivers and therapists increased in strength over time and positively predicted improved child and family functioning. [ABSTRACT FROM AUTHOR]

Students of medical sciences are under intense mental stress induced by medical training system and are more likely to develop psychological and mental disorders. These psychological disorders may influence their performance in different aspects of life including their study. The aim of the present study is to assess the possible relationships between mental health, achievement motivation, and academic achievement and to study the effect of background factors on mentioned variables. The sample group consists of students of Kurdistan University of medical sciences. 430 students at Kurdistan University of Medical Sciences were selected randomly to participate in the present cross-sectional study in 2016. We used General Health Questionnaire (GHQ) and Achievement motivation test (AMT) as the measures of our study. Our findings indicated that mental health is significantly correlated with achievement motivation (p <.001), but has no correlation with educational success (p =.37). Also, a significant relationship was observed between achievement motivation and academic achievement (p =.025). GHQ was not correlated with demographic factors, while academic achievement and achievement motivation are associated with the field of study and marital status respectively. Conclusively, students who are more motivated to achieve their educational and academic goals, will be more likely to be successful in their education and have stronger academic performance. Also, students with more appropriate mental health status will have higher level of motivation in their education and studies. These findings reflect the importance of maintaining the medical field students' motivation and its role in their academic success. [ABSTRACT FROM AUTHOR]

Effective mentorship is widely believed to be an important factor in career satisfaction and advancement. Adequate mentorship has been linked to perceived institutional support, research productivity, and protects against burnout. Despite these facts, less than half of junior faculty in academic medicine feel as if they have adequate mentorship. Given that the current landscape in academic medicine has a paucity of available mentors, both in rank and representation for true dyadic mentorship, junior faculty clinician educators may need mentorship and paths to sponsorship. The importance of peer networks has become increasingly recognized, and some institutions have begun to use peer mentoring as a means of addressing mentorship and sponsorship needs. This model can potentially circumvent some of the main barriers to mentorship by providing protected time, ameliorating power differentials, creating an environment where members have shared goals, and mitigating the need for senior faculty mentorship. The following are twelve tips to create and maintain a successful peer mentoring group for junior faculty clinician educators in academic medicine which can serve to complement the dyadic mentorship model. [ABSTRACT FROM AUTHOR]

Objectives: The presence of skilled, motivated therapists is critical to meet the rehabilitation needs of children with disability. This study aimed to determine whether on-the-job training on applying goal attainment scaling (GAS) affects pediatric occupational therapists' burnout and job motivation. Methods: This study was quasi-experimental with a pre-test-post-test design. After signing the informed consent, 35 pediatric occupational therapists at a child rehabilitation center attended a course of five 1.5-2 h workshop sessions during 5 consequent weeks on applying GAS in their workplace. Through the workshop, the trainees practiced setting goals and making 5-point scales to measure the degree of reaching those goals. The participant asked to bring some of their client's descriptions (anonymous) to the workshop as samples to talk about them. Afterward, they were asked to fill in the GAS documentation form as part of their rehabilitation records. Participants' job motivation and burnout scores were measured by the Maslach questionnaire and Loudahel Kitchener's Job Motivation Scale, respectively, before the workshop and 30 and 60 days later. The paired t-test and Wilcoxon test were used for comparisons. Results: The Mean±SD job motivation scores, which were 42.37±6.73 before the intervention, rose to 52.82±8.51 and 56±7.59 at the end of the workshop (day 30) and on follow-up measurement (day 60), respectively (P<0.001). The effect size was 0.556. The burnout scores slightly decreased from 58±12.86 before the intervention to 55.37±12.07, with an effect size of 0.117 on day 60 measurements. Discussion: A short on-the-job training workshop on applying GAS in the formal assessment of achievements in different aspects of child life by rehabilitation practices could help in enhancing therapists' job motivation. Positive effects of GAS administration on motivation and burnout in therapists should take into account along with the client benefits for judging the usefulness of the GAS. [ABSTRACT FROM AUTHOR]

Background: Health information technology is a leading cause of clinician burnout and career dissatisfaction, often because it is poorly designed by nonclinicians who have limited knowledge of clinicians' information needs and health care workflow. Objective: Describe how we engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. Design: Descriptive study of the steps followed when involving clinicians and their at-risk patients in the design of the content, layout, and flow of an application for collaborative dietary goal setting. This began with individual clinician and patient interviews to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. Participants: Primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. Main Measures: Descriptions of the content, format, and flow of information from pre-visit dietary history to the display of evidence-based, guideline-driven suggested goals to final display of dietary goals selected, with information on how the patient might reach them and patients' confidence in achieving them. Key Results: Through three iterations of design and review, there was substantial evolution of the program's content, format, and flow of information. This involved "tuning" of the information desired: from too little, to too much, to the right amount displayed that both clinicians and patients believed would facilitate shared dietary goal setting. Conclusions: Clinicians' well-founded criticisms of the design of health information technology can be mitigated by involving them and their patients in the design of such tools that clinicians may find useful, and use, in their everyday medical practice. [ABSTRACT FROM AUTHOR]

Background: The importance of dignity in health care is well described, yet limited interventions exist to improve dignity, particularly patient-driven interventions. Objectives: To test the hypothesis that patient-selected photographs at the bedside would impact patients' sense of dignity and clinicians' sense of meaningful work, stimulate conversation between patients and clinicians, and serve as a visual and patient-driven complement to the Patient Dignity Question (PDQ). Methods: Patients admitted to three units at an academic medical center displayed photographs above their head of bed and were interviewed for this study. We used thematic content analysis to compare themes extracted from patient interviews, the PDQ, and clinician surveys. Results: Eight themes emerged from patient interviews (n = 19): conveying goals, joy, capturing the patient's spirit, faith and spirituality, sense of belonging, physical appearance and health, stimulating conversation and meaningful connections, and humanizing the patient. The same themes emerged from the PDQ, with the exception of physical appearance and health. Notably, analysis of the clinician surveys (n = 40) yielded six similar themes: conveying goals, joy, stimulating conversation and meaningful connections, humanizing the patient, meaningful work, and compassion and empathy. Conclusions: Patient-selected photographs at the bedside impact both patients and clinicians by stimulating conversation and meaningful connections, humanizing patients, and fostering meaning and joy in work. Photographs and the PDQ provide a similar window into personhood, thereby supporting the use of a photograph as a visual and patient-driven complement to the PDQ. [ABSTRACT FROM AUTHOR]

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health. [ABSTRACT FROM AUTHOR]

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an "Indian Medical Graduate" (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers' perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross-sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n=192). The data collection was done using Google forms online survey platform on teachers' perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke's six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum's implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an "Indian Medical Graduate" for the needs of todays' society. [ABSTRACT FROM AUTHOR]

Importance: Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home. Objective: To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement. Design: Single-group feasibility study. Setting: Academic and county hospital inpatient rehabilitation units. Participants: Adult patients with stroke and planned discharge home. Intervention: Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters. Results: Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire–8 M score = 29.3, SD = 4.4; range = 8–32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ–8] score, M = 11.0, SD = 6.1; range = 0–27), mild depression at 3 mo postdischarge (PHQ–8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10–40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2). Conclusions and Relevance: PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving. Problem-Solving Training (PST) during inpatient rehabilitation is feasible and the results of this study suggest that patients with stroke may have the ability to identify problems, set goals, and develop plans to accomplish goals. [ABSTRACT FROM AUTHOR]

Background: Aortic stenosis is the most common valvular disease, and its prevalence is increasing due to the ageing population. Transcatheter aortic valve replacement (TAVR) is the recommended method when treating frail, older patients. Knowledge of what motivates older patients to undergo TAVR is important, in order to meet patients' expectations. Objective: The study aimed to explore the meaning of older patients' motivation to undergo TAVR. Design and Methods: The design was a qualitative study, analysed using a phenomenological hermeneutic approach. In‐depth, semi‐structured interviews with open‐ended questions were conducted. Participants were selected from a specialist cardiology clinic in Sweden. Eighteen patients, six women and twelve men, aged 66–92, were recruited. Results: The analysis showed that patients who had agreed to undergo TAVR were deeply affected by their body's failure. Before the TAVR procedure, the participants were limited in their daily activities and experienced that their life was on hold. They experienced that they were barely existing. They were aware of their life‐threatening condition and were forced to confront death. Yet despite an advanced age, they still had considerable zest for life. It was very important to them to remain independent in everyday life, and fear of becoming dependent had a strong impact on their motivations for undergoing TAVR. Conclusion: Older patients' motivations to undergo TAVR are strongly influenced by their fear of being dependent on others and their zest for life. Health care professionals need to support these patients in setting realistic and personalised goals. Implication for practice: Person‐centered care actions could facilitate patients' involvement in the decision about TAVR and strenghten patients' beliefs in their own capabilities, before and after TAVR. [ABSTRACT FROM AUTHOR]

The article focuses on the evolving landscape of the healthcare industry, emphasizing discussions around innovation, disruption, care delivery, value, quality, workforce, and finances. Topics include the transition from the "Triple Aim" to the "Quadruple Aim" and now the "Quintuple Aim," which incorporates health equity alongside improved patient experience, outcomes, lower costs, and clinician well-being.

The article presents a study which described a student-led telephone-based clinical learning pilot program for medical and nurse practitioner (NP) students in response to the increasing needs of older adults during the COVID-19 pandemic. Topics discussed include effect of the COVID-19 pandemic on social and healthcare inequities for older adults, an overview of program curriculum and workflow, and primary limitations of the program.

Ward rounds are crucial for the exchange of information among healthcare professionals to achieve joint planning and shared decision-making in healthcare to enhance patient safety. The aim of this study was to describe the content and structure of ward rounds focusing on interprofessional collaboration on an internal medicine ward at a university hospital in Western Sweden. An inductive qualitative approach was used to explore 13 participatory observations of ward rounds (sitting/team rounds). Qualitative content analysis was used. The analysis revealed one category, titled interprofessional teamwork, that utilises all available resources, which consisted of three subcategories: usefulness of specialist competencies, collaboration for patient safety, and leading healthcare to achieve goal fulfilment. It was also found that the participating specialists' competencies were not being optimally used before patients were discharged from the hospital. Therefore, communication and leadership skills were revealed as ways to improve interprofessional teamwork to achieve goal fulfilment and patient safety regarding care and treatment issues on the ward. We found that reversing the order of ward rounds to start with the sitting round followed by the team round (i.e. hybrid distance participation methods), with the same ward round leader who has skills in leadership and interprofessional teamwork, could eliminate the need for healthcare providers to repeat questions and tasks (i.e. double work) on their ward rounds. Second, patient involvement is grounded in collaboration, and can be emphasised through person-centred care to facilitate patient safety during hospital stays. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To improve diabetic retinopathy (DR) screening rates through a primary care-based "teleretina" screening program incorporating clinical informatics tools. STUDY DESIGN: Quality improvement study at an academic institution. METHODS: Existing DR screening workflows using in-person eye examinations were analyzed via a needs assessment. We identified gaps, which clarified the need for expanding DR screening to primary care settings. We developed informatics tools and described associated challenges and solutions. We also longitudinally monitored imaging volume and quality. RESULTS: The needs assessment identified several gaps in baseline DR screening workflows. Health information technology (IT) considerations for the new primary care-based teleretina screening program included integrating the new program with existing information systems, facilitating care coordination, and decreasing barriers to adoption by incorporating automation and other features aimed at decreasing end-user burden. We successfully developed several tools fulfilling these goals, including integration with the ophthalmology picture and archiving communication system, a customized aggregated report in the electronic health record to monitor screenings, automation of billing and health maintenance documentation, and automated results notification to primary care physicians. Of 316 primary care patients screened between October 2020 and July 2021, 73 (23%) were found to have ocular pathology, including DR, glaucoma, age-related macular degeneration, and a range of other eye conditions that were previously undiagnosed. CONCLUSIONS: New models of health care delivery, including telemedicine workflows, have become increasingly important for complex diabetic care coordination and require substantial health IT engagement. This program illustrates how clinical informatics tools can make substantial contributions to improving diabetes care. [ABSTRACT FROM AUTHOR]

Purpose: This descriptive study was conducted to investigate the relationship between problematic smartphone use and the life goals. Design and Methods: The study was conducted on 310 nursing students. The data were collected with the "Smartphone Addiction Scale" and "Life Goals Scale." Findings: Increased internal life goals of the students was found to decrease the tendency to be engaged in a virtual relationship while increased external life goals increased the risk of smartphone addiction. Practice Implications: Programs to increase awareness should be developed to minimize smartphone addiction and increase internal goals in nursing students, and similar programs should also be conducted for nurses. [ABSTRACT FROM AUTHOR]

The pursuit of independent living outcomes has been a longstanding emphasis of disability policy, practice, and research. Yet the ways in which the experience of independent living is understood and advanced locally warrants more focused attention. This article describes a collaboration among a regional Center for Independent Living (CIL) and university researchers focused on developing more informed programs and supports to promote independent living for persons with disabilities in their service area. A total of 75 adults with disabilities attended four "community conversations" during which they provided diverse definitions of independent living and shared a wide range of supports they needed and currently accessed to meet their independent living goals. Attendee conversations generated 14 unique dimensions of independent living and 11 categories of independent living supports. Findings align with existing research asserting independent living as a multifaceted construct and extend the literature to include perspectives across a wider range of disability categories. This study suggests that collaborations among Centers for Independent Living and researchers can be a fruitful context for conducting "needs assessments" and soliciting the perspectives of individuals with disabilities on (a) how they conceptualize independent living and (b) the local services and supports they need to attain their independent living goals. Community conversations are an efficient and engaging way of soliciting the perspectives of community members with a variety of disabilities. Establishing a planning team fluent in universal design, accessibility options, and local needs is critical to implementing effective community conversations. For Centers for Independent Living (CILs), community conversations offer a valuable approach for obtaining substantive stakeholder input to inform strategic planning. CILS could play an active role in equipping transition-age students with the skills, knowledge, relationships, and linkages needed to attain their independent living goals in early adulthood. [ABSTRACT FROM AUTHOR]

The article presents a summary of the best available evidence on the experiences of faculty and staff nurses in facilitating learning for nursing students on clinical placement in residential aged care facilities (RACF). Topics include the importance of clinical placement for nursing students, the need for nursing students to receive clinical experience focusing on the care of older adults, and the facilitators and barriers to student learning as experienced by faculty and staff.

Background: Person‐centred care is a growing imperative in healthcare, but the documentation of person‐centred care is challenging. According to the Gothenburg Framework of Person‐centred Care, care should be documented in continuously revised care plans and based on patients' personally formulated goals and resources to secure a continuous partnership. Objectives: This study aimed to examine care plans produced within a randomised controlled trial that tested a person‐centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person‐centred care had written the care plans. Methods: We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person‐centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life‐world and medical/health resources and goals. Results: The analysis illustrates the differences and overlaps between life‐world and medical/health goals and resources. The documented goals and resources change over time: life‐world goals and resources decreased with time as medical/health goals and resources documentation increased. Conclusions: This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person‐centred care recorded fewer life‐world and more medical/health goals over time. Placing life‐world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain. Trial registration: Swedish registry, Researchweb.org, ID NR 65 791. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of a medication assistance program and the addition of pharmacist management on clinical outcomes in patients with hypertension and diabetes through an Advanced Pharmaceutical Care program. Methods: This was a prospective quality improvement study on patients with hypertension and/or diabetes resistant to usual care. The primary outcomes were change in A1C, blood glucose, and blood pressure between 3 phases: usual care, free medications, and free medications plus pharmacist management. Secondary outcomes included achievement of A1C, blood glucose, and blood pressure goals as well as pharmacist interventions. Results: Seven patients were included in the study. The mean A1C decreased from 11.3% to 8.3% with free medications (p = 0.28) and from 8.3% to 6.4% with pharmacist management (p = 0.119). Mean blood pressure during usual care, free medications, and pharmacist intervention was 150/87 mm Hg, 148/85 mm Hg, and 125/78 mm Hg, respectively. After pharmacist management, 75% of patients with type 2 diabetes were able to achieve A1C and blood glucose goals, and 71% of patients with hypertension achieved blood pressure <130/80 mm Hg. Conclusions: The Advanced Pharmaceutical Care program allowed pharmacists to identify and overcome patient-specific barriers to care, provide individualized disease state education, and optimize medication management. Medication assistance led to improvements in A1C and blood pressure, but did not affect achievement of disease state goals. Pharmacist involvement in hypertension and diabetes care led to clinically significant reductions in blood pressure and A1C and enabled patients to reach guideline-recommended blood pressure and glycemic goals. [ABSTRACT FROM AUTHOR]

Background: Trauma patients are at increased risk of developing venous thromboembolism given alterations in the coagulation cascade. Chemoprophylaxis with standard dosing of enoxaparin 30 mg subcutaneously twice daily has evolved to incorporate the use of anti-factor Xa (AFXa) trough level monitoring given concerns for decreased enoxaparin bioavailability in this patient population. Current available evidence suggests low rates of goal AFXa trough level achievement with standard enoxaparin dosing. Our study aims to identify the incidence of critically ill trauma patients that did not achieve goal AFXa trough levels and attempts to identify predictors that may influence the lack of achievement of goal levels. Methods: This was a retrospective, cohort analysis performed at a single academic medical center. Adult patients 18 years or older admitted to the surgical intensive care unit secondary to trauma who were initiated on standard prophylactic enoxaparin and had at least 1 AFXa trough level representative of steady state were included. Patient demographics and clinical data were collected, and descriptive statistics were utilized. All statistical tests were 2-tailed and a P <.05 was considered significant. Variables with a P <.10 on univariable analysis were included in a multivariable logistic regression analysis. Results: A majority of our patient population did not achieve goal AFXa trough levels while receiving standard doses of prophylactic enoxaparin (82.4% [108/131]). Sub-target AFXa levels were associated with higher creatinine clearance values. Positive predictors of obtaining target AFXa levels included automobile versus pedestrian mechanism of injury and requiring an enoxaparin dose escalation to at least 40 mg twice daily. Conclusions: Our study found low rates of achievement of goal AFXa trough levels in critically ill trauma patients receiving standard prophylactic enoxaparin dosing. Certain variables were identified as negative and positive predictors for achievement of goal AFXa trough levels, although the biologic plausibility of these predictors is questionable and requires further investigation. [ABSTRACT FROM AUTHOR]

Background & Aims: Today, the term sustainable is widely used to describe a world where human and natural systems can continue to exist until the distant future. Sustainable development means providing solutions to mortal patterns. It is a physical, social, and economic development that can prevent issues such as the destruction of natural resources, the destruction of biological systems, global pollution, climate change, excessive population growth, injustice, and the lowering of the quality of life of people now and in the future. Therefore, sustainable development is a transformation to meet today's needs without destroying the capabilities of the future generation in meeting their needs. In fact, a transformation is sustainable when it protects the environment and generates opportunities. This evolution requires an unbreakable link between the environment, economy, and social security, and economic developments and social life conditions must be in accordance with the long-term flow of maintaining the foundations and natural resources of the biosphere. Sustainable development includes (economic), (social), and (environmental) aspects. So far, various indicators have been presented by many international organizations for the purpose of comprehensive evaluations of sustainable development. Among them, we can mention the United Nations Environmental Program, the United Nations Development Program, the World Bank, the World Resources Institute in Washington and the Global Monitoring Institute in Washington, and finally the United Nations Commission on Sustainable Development. The aim of all the aforementioned institutions is to provide criteria and indicators to determine the success rate of countries in achieving the multiple goals of sustainable development in social, economic, and environmental aspects. The concept of sustainable development is based on the undeniable fact that ecological considerations can and should be applied to economic activities. These considerations include the idea of creating a rational environment in which the claim of development to advance the quality of all aspects of life is challenged. Organizational development is the application of behavioral science knowledge in the scope of the system for planned development and strengthening of organizational strategies, structures, and processes to improve the effectiveness of the organization. The organization means employees with different attitudes, interests, thoughts, knowledge, and physical conditions without which the organization would never have an external existence. Today, private organizations in an environment that requires green accountability, try to increase their market share and strengthen their accountability with a variety of green methods and techniques, and public organizations also try to benefit from the benefits of trust and satisfaction. Green management for the realization and convergence of green values and a wide range of economic, social, political, and legal motives is possible only by benefiting from green human resources management. Considering the importance of the subject, the purpose of this study was to evaluate the green performance on the sustainable organizational development of the employees of Iran University of Medical Sciences. Methods: The data collection tool includes a researcher-made questionnaire on green human resource management systems and sustainable organizational development. Convergent validity and reliability were calculated through Cronbach's alpha coefficient. The statistical population of this research includes all employees of the Iran University of Medical Sciences. The sample size was selected based on Cochran's formula of 341 people and the sampling method was randomly stratified. The research data analysis method was through structural equation modeling using PLS software. To collect information, library and field methods including questionnaires were used. And the effect of the five dimensions of green human resources management on sustainable organizational development was investigated. Results: The results indicated that the five dimensions of green human resource management have a positive and significant impact on sustainable organizational development. Also, the results showed that performance evaluation analysis 0.478, green choice 0.367, safety management 0.149, green training 0.283, and reward management 0.454 directly explain the changes related to the variable of sustainable organizational development. Conclusion: Tehran state universities are in their highest state in terms of quantitative development and have attracted the largest number of students over the past years, and of course, the energy consumption of these universities has increased accordingly. Lack of work and delay in the implementation of green management in universities will cause waste of energy resources, and water resources and as a result increase the cost of the government, increasing the share of universities in air pollution and environmental damage. The discussion of evaluating the green choice is in line with the goals of green human resources management and it is quite obvious that without an accurate assessment of personnel ability, planning for the establishment of green human resources management and the implementation of its instructions will not be successful. This evaluation can include their awareness of the importance and method of green human resource management and the evaluation of personnel motivations in establishing green management or their contributions and abilities in this direction. If they do not have enough motivation, the management should take measures to create motivation and provide the necessary incentives to accompany the person in the steps of establishing green management, or if there is not enough awareness in this field, by holding explanatory classes on the importance of green management and methods explain their participation. In addition to explanatory and in-service classes, distribution of brochures, and providing necessary guidance according to the position of the personnel, the use of technology potential was used to inform the employees. Currently, universities do not have authority in the field of green education courses and topics, which has made the subject of green education in universities weak and ineffective, and the expectations of the function of green education in universities are not met. Therefore, according to the state of the university, the statistical society is of the opinion that they will not have much effect on the issue of green management in the issue of green education. In terms of its importance and role in sustainable development, health and safety management is among the last row of components. And the reason is that although it is lower in terms of importance than other components, universities have almost no plans and have not done anything in this field. The explanation of the goals, plans, and problems of the establishment of green management shows that there is no objective and practical output from many of the meetings, and for this reason, this component is less important than other components for the statistical society. It shows that in order to advance the programs, it is not possible to establish green management without organizing planning and coordination meetings. [ABSTRACT FROM AUTHOR]

This article summarizes a collaboration between the Illinois Department of Corrections and an academic partner, University of Illinois at Chicago College of Nursing (UIC Nursing), to deliver a quality improvement (QI) and patient safety plan to the state. Included is a description of the need for meaningful data-driven QI as a method to deliver health care to the incarcerated population. An overview of the assessment, gap analysis, and collaboration between partners to develop a mission, vision, and performance dashboard with a beginning set of measures is presented. The dashboard with performance measures was developed to highlight the priorities of the organization and to focus improvement work to meet those goals. Next step recommendations for UIC Nursing to consult on implementation priorities and training are described. [ABSTRACT FROM AUTHOR]

Background: Experts consider goal-concordant care an important healthcare outcome for individuals with serious illness. Despite their relationship to the patient and knowledge about the patient's wishes and values, little is known about bereaved family caregivers' perceptions of how end-of-life care aligns with patient goals and preferences. Aim: To understand caregivers' perceptions about patients' care experiences, the extent to which care was perceived as goal-concordant, and the factors that contextualized the end-of-life care experience. Design: Qualitative interview study employing a semi-structured interview guide based on the National Health and Aging Trends Survey end-of-life planning module. Template analysis was used to identify themes. Setting/participants: Nineteen recently bereaved family caregivers of people with serious illness in two academic medical centers in the Northeastern United States. Results: Most caregivers reported goal-concordant care, though many also recalled experiences of goal discordance. Three themes characterized care perceptions and related to perceived quality: communication, relationships and humanistic care, and care transitions. Within communication, caregivers described the importance of clear communication, inadequate prognostic communication, and information gaps that undermined caregiver confidence in decision making. Patient-clinician relationships enriched care and were considered higher-quality when felt to be humanistic. Finally, care transitions impacted goal discordance when marked by logistical barriers, a need to establish relationships with new providers, inadequate information transfer, and poor care coordination. Conclusions: Bereaved caregivers commonly rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Communication, relationships and humanistic care, and care transitions are modifiable quality improvement targets for patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Healthcare institutions including hospitals and clinics are increasingly using social media platforms, such as Twitter, to raise awareness in the community about health and wellness topics. In line with this trend, this study seeks to understand how three leading medical centers in the USA use Twitter to share educational content about medical conditions, treatments, preventive measures and other health-related topics. A sample of tweets posted by Cleveland Clinic, Johns Hopkins Hospital and Mayo Clinic during a 6-month timeframe was collected and thematically analyzed. The first analysis, which focused on eight popular health topics, showed that diet and cancer were consistently the most and diabetes was the least frequently used topics in the tweets. The second analysis, which drew upon the health belief model to understand the educational themes embedded into the tweets, revealed that the three institutions mainly provided general health advice and information in their tweets and paid less attention to causes and consequences of diseases, preventive strategies and patient success stories. Accordingly, it is recommended that healthcare institutions adjust their tweeting activities and align them with society's health education needs. Such revised content strategies can help medical institutions achieve their health promotion goals more effectively. [ABSTRACT FROM AUTHOR]