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Contains fulltext : 306373.pdf (Publisher’s version ) (Open Access), OBJECTIVES: Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN: Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING: We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION(5). PARTICIPANTS: Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS: We included 20 audio-recordings. The mean Observer OPTION(5) score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS: The operationalisation o

Introduction: In 2019 the Australian Government announced funding for 30 new metastatic breast cancer (MBC) nurse roles across Australia. These nurses require specialised training for their new roles to ensure they have the requisite knowledge, skills and confidence to provide complex supportive care to those with MBC. As there were no existing tools to measure the nurses' baseline learning needs in relation to MBC, or their response to training, a tool was specifically developed for this purpose. Aim(s): 1. To develop a self-administered tool to assess knowledge, skills and confidence in relation to 20 key elements of MBC nursing; 2. To test the content validity of the tool with expert Australian and international MBC nurses and nursing educators; 3. To test the reliability of the tool among Australian breast care nurses (BCNs). 4. To determine the level of knowledge, skills and confidence in relation to MBC among a cohort of Australian BCNs. Methodology: An expert working group was formed to identify the key elements of practice in MBC nursing and to design and develop the Cancer Nurse Self-Assessment Tool for Metastatic Breast Cancer (CaN-SAT-MBC), incorporating the five levels of expertise of Benner's Model: novice, advanced beginner, competent, proficient and expert. The Content Validation Index (CVI) was used to assess the relevance and clarity of each item on the tool with n=6 MBC nurse experts and n=6 nursing educators. Nurse experts reviewed the clinical content and nursing educators reviewed the language used in each item. Consensus of >0.83 across both expert groups was required for an item to be included in the tool. The tool was then tested with n=69 BCNs for internal consistency. Where Cronbach's alpha scores were 0.700 or above, the item was considered reliable and remained in the final tool. Result(s): The first version of the CaN-SAT-MBC included 192 items across 20 elements of practice. Content validation led to the revision of five items and remov

Uncertainty tolerance, individuals' perceptions/responses to uncertain stimuli, is increasingly recognized as critical to effective healthcare practice. While the Covid-19 pandemic generated collective uncertainty, healthcare-related uncertainty is omnipresent. Relatedly, there is increasing focus on uncertainty tolerance as a health professional graduate 'competency', and a concomitant interest in identifying pedagogy fostering learners' uncertainty tolerance. Despite these calls, practical guidelines for educators are lacking. There is some initial evidence that anatomy education can foster medical students' uncertainty tolerance (e.g., anatomical variation and dissection novelty), however, there remains a knowledge gap regarding robust curriculum-wide uncertainty tolerance teaching strategies. Drawing upon humanities, arts and social sciences (HASS) educators' established uncertainty tolerance pedagogies, this study sought to learn from HASS academics' experiences with, and teaching practices related to, uncertainty pedagogy using a qualitative, exploratory study design. Framework analysis was undertaken using an abductive approach, wherein researchers oscillate between inductive and deductive coding (comparing to the uncertainty tolerance conceptual model). During this analysis, the authors analyzed ~386 minutes of data from purposively sampled HASS academics' (n = 14) discussions to address the following research questions: (1) What teaching practices do HASS academics' perceive as impacting learners' uncertainty tolerance, and (2) How do HASS academics execute these teaching practices? The results extend current understanding of the moderating effects of education on uncertainty tolerance and supports prior findings that the anatomy learning environment is ripe for supporting learner uncertainty tolerance development. This study adds to growing literature on the powerful moderating effect education has on uncertainty tolerance and proposes translation of HASS

Objective To explore the experiences of newly qualified registered graduate nurses’ clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU). Method Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses’ accounts via semi-structured interviews, conducted between January 2018 – January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit. Setting In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited. Findings Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout. Conclusion In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.

AIM: To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing. BACKGROUND: Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings. METHODS: Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process. FINDINGS: Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system. CONCLUSIONS: Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare. RELEVANCE TO CLINICAL PRACTICE: Those who govern healthcare systems have an obligation to recognise and address the unique needs of men

Background Nursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement. Aim To examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities. Methods Mixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical. Findings Groups were similar at baseline. There were statistically significant changes following the intervention (p ≤ .05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person. Discussion The DOF vignette provided opportunity for students to preflect on ageing

Background: Nursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement. Aim: To examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities. Methods: Mixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical. Findings: Groups were similar at baseline. There were statistically significant changes following the intervention (p ≤. 05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person. Discussion: The DOF vignette provided opportunity for students to preflect on a