Comfort Working Research Articles

Correlates of stocking naloxone: a cross-sectional survey of community pharmacists

BackgroundProvision of take-home naloxone (THN) and overdose education reduces opioid-related mortality. In Australia, from July 2022, all Australian community pharmacies were eligible to supply naloxone for free through the national THN Program.AimThis study aimed to identify naloxone stocking rates and correlates of stocking naloxone across Australian pharmacies.MethodData were collected from a representative sample of Australian pharmacists in Victoria, New South Wales, Queensland and Western Australia via an online survey. Data collected included pharmacy and pharmacist characteristics and services offered within the pharmacy, including needle and syringe programs, opioid agonist treatment (OAT) and stocking naloxone. Binary probit regression analysis was used to identify correlates of stocking naloxone after controlling for key covariates.ResultsData from 530 pharmacists were analysed. In total, 321 pharmacies (60.6%) reported stocking naloxone. Chain pharmacies and pharmacies that provided OAT had a greater probability of stocking naloxone (B = 0.307, 95%CI: [0.057, 0.556], and B = 0.543, 95%CI: [0.308, 0.777] respectively). Most (61.7%) pharmacists felt comfortable discussing overdose prevention with patients who use prescription opioids, and this comfort was associated with a higher probability of stocking naloxone (B = 0.392, 95%CI: 0.128, 0.655). Comfort discussing overdose prevention with people who use illicit opioids was lower (49.4%) and was not associated with stocking naloxone.ConclusionThere is scope to increase stocking of naloxone and comfort with overdose prevention, particularly through addressing comfort working with higher risk groups such as people who use illicit opioids.

Effectiveness, acceptability, and potential of lay student vaccinators to improve vaccine delivery

SettingTask sharing can fill health workforce gaps, improve access to care, and enhance health equity by redistributing health services to providers with less training. We report learnings from a demonstration project designed to assess whether lay student vaccinators can support community immunizations.InterventionBetween July 2022 and February 2023, 27 undergraduate and graduate students were recruited from the University of Toronto Emergency First Responders organization and operated 11 immunization clinics under professional supervision. Medical directives, supported with online and in-person training, enabled lay providers to administer and document vaccinations when supervised by nurses, physicians, or pharmacists. Participants were invited to complete a voluntary online survey to comment on their experience.OutcomesLay providers administered 293 influenza and COVID-19 vaccines without adverse events. A total of 141 participants (122 patients, 17 lay vaccinators, 1 nurse, and 1 physician) responded to our survey. More than 80% of patients strongly agreed to feeling safe and comfortable with lay providers administering vaccines under supervision, had no concerns with lay vaccinators, and would attend another lay vaccinator clinic. Content and thematic analysis of open-text responses revealed predominantly positive experiences, with themes about excellent vaccinators, organized and efficient clinics, and the importance of training, communication, and access to regulated professionals. The responding providers expressed comfort working in collaborative immunization teams.ImplicationsLay student providers can deliver vaccines safely under a medical directive while potentially improving patient experiences. Rather than redeploying scarce professionals, task sharing strategies could position trained lay vaccinators to support immunizations, improve access, and foster community engagement.

Perceived Knowledge, Attitude, and Practices of Employees Towards Diversity and Inclusivity in the Workplace

Perceived Knowledge, Attitude, and Practices of Employees Towards Diversity and Inclusivity in the Workplace

Evaluating the impact of a national geriatric mental health ECHO educational program on healthcare providers’ practice

ABSTRACT Project Extension for Community Healthcare Outcomes (ECHO) enables healthcare providers to share knowledge and best practices via telementoring. The ECHO model builds provider capacity and improves care for patients with a variety of health conditions. This study describes a Canada-wide National ECHO pilot project in the area of geriatric mental health and reports on the program’s impact on providers’ care practices. A mixed-methods approach was used to analyze surveys completed by participating healthcare providers. Program evaluation measured satisfaction, achievement of learning objectives, awareness of issues related to geriatric mental health, and comfort and self-efficacy working with older adults. The program led to a statistically significant increase in participants’ awareness of issues related to support for older adults with mental illness and comfort and self-efficacy in managing these patients in their own practice. The National ECHO pilot project was successful in building healthcare providers’ capacity to care for older adults with mental health issues and positively impacting their practice. These findings support using the ECHO model to provide ongoing geriatric mental health education for clinicians from across Canada and beyond.

Use of gender-inclusive language in genetic counseling to optimize patient care.

Providing welcoming, inclusive, and culturally competent care is essential for genetic counselors (GCs) to serve the needs of all patients, including transgender and nonbinary (TGNB) individuals. Inclusive language creates welcoming healthcare spaces and improves health outcomes for TGNB individuals. Training on gender-affirming healthcare can increase knowledge, comfort, and self-efficacy working with TGNB patients. Using a mixed-method survey, this study assessed 65 GCs' gender-inclusive communication practices and elucidated reasons for discomfort using language to determine how language builds trust and fosters patient-provider relationships, ascertain differences between specialties, and identify potential gaps in education and professional development. This study found that approximately one-third of GCs are comfortable using gender-inclusive language and just over half regularly use it with patients. Most GCs do not share their pronouns or ask patients theirs, which was not correlated with comfort levels or frequency of using gender-inclusive language. There were no significant differences based on specialty. Thematic analysis of open responses revealed GCs used gendered language to promote shared language and for clarity, some mentioning sex assigned at birth was relevant for risk assessment. Most felt the impact of gendered language depended on the patient's perspective. Twenty-five percent noted gendered language was familiar for most patients and 40% recognized negative impacts on TGNB individuals. Most GCs desired more gender-inclusivity training even though >95% had some type previously. Those who had gender-inclusivity training in their genetic counseling program were more comfortable using gender-inclusive language and were more likely to share their pronouns with patients. This study adds to the growing body of literature demonstrating GCs' desire for more gender-inclusivity education and highlights the potential importance of having this education integrated into genetic counseling training programs. GCs should continue to incorporate gender-inclusive language into their practice in concordance with the tenants of the Reciprocal Engagement Model.

Undergraduates’ perceptions of the value of service-learning

Service-learning integrates community service with academic study. Students apply skills and knowledge in practical situations and reflect on their experiences. Our 3000-level service-learning college course, Leadership Development in Agricultural Sciences, involved student-led development and execution of a one-day event, “AgCamp,” held on a university campus for high school students. The objective of this study was to evaluate if an intervention (i.e., a service-learning project) changed undergraduate students’ perceptions of their ability to collaborate, ability to lead, and overall perceptions of the usefulness of service-learning. An electronic mixed methods questionnaire-based survey was developed, tested for validity and reliability, and distributed to college students enrolled in Leadership Development in Agricultural Sciences as a pre- and post-test at the beginning and end of two semesters. Data were analyzed in SPSS 26.0 using measures of central tendency and paired sample t-tests. Undergraduate students’ (n = 74) had positive perceptions of service-learning entering the semester, all measures of which improved as a result of their experiences in the course. In comparison with traditional courses, students felt service-learning courses have more societal benefits and should be increasingly offered. Participating in the service-learning project significantly increased students’ comfort working with people from different cultures or backgrounds and empowered them in different ways, including with decision-making. Ultimately, our data indicate that students enjoyed service-learning and received soft skill development through the course. We recommend service-learning be increasingly integrated into post-secondary curriculum.

Brief trauma-informed care training to enhance health care providers' knowledge, comfort, and implementation of trauma-informed care in primary care clinics: A pilot effectiveness study.

Trauma-informed care (TIC) training may be valuable for patient-facing health care providers within primary care in urban health care settings serving patients with high levels of trauma exposure. This study tested the pilot effectiveness of a clinic-wide TIC initiative to enhance providers' knowledge, comfort in caring for trauma-exposed patients, and implementation of TIC within a primary care clinic of an urban safety net hospital using a single-arm longitudinal within-subjects design. Measures were obtained at baseline (T1), posttraining (T2), 1-month (T3), and 6-months (T4). Twenty-nine providers who completed TIC training were included in study analyses. Twenty-one completed T2 and 14 completed T3 and T4. Knowledge was measured with the Providers' Knowledge Regarding Injury-Related Posttraumatic Stress, comfort with a researcher-generated two-item measure, and TIC implementation with an eight-item binary scale from the Trauma Provider Survey. Repeated-measures general linear model examining within-subjects change over time in knowledge was significant (n = 8; F₃ = 4.74, p = .01, ηp² = .40); the model measuring change in comfort was not significant but trending (n = 9; F₃ = 4.56, p = .06). The model examining change in TIC implementation from T1 to T4 was not significant (n = 14; F3 = 4.32, p = .21). This pilot study demonstrated the preliminary effectiveness of a brief TIC training on improving health care provider knowledge and comfort working with trauma-exposed patients that sustained through 6-months posttraining. The findings indicate that additional support is needed to change behaviors in provider implementation of TIC in primary care clinic settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating an intergenerational art and storytelling program with older adults and medical students

Older adults in residential communities face loneliness and isolation, challenges exacerbated by COVID-19, leading to adverse physical and mental health outcomes. Intergenerational arts and humanities programs have been successful in addressing these challenges while also enabling medical learners to better understand aging populations. Draw YOUR Story, a program at a Houston residential senior living community, connects premedical and medical student volunteers with older adults through an art and storytelling activity. To evaluate the program, we conducted a focus group with older adults and pre and post-volunteering student surveys with questions about attitudes towards older adults and an Interpersonal Reactivity Index. Student surveys (n = 18) showed increased comfort working with older adults after volunteering (p = 0.02). Students who spent less time volunteering reported a decline in their perceptions of older adult quality of life, when compared to more frequent volunteers (p = 0.02). Older adults shared that the program encouraged learning new skills, offered time for reflection, connected them to medicine, and furthered desire for community. Draw YOUR Story benefitted students and older adults, increasing student comfort with older adults, providing aging adults opportunities to learn new skills and reflect, and building intergenerational connections.

Self-Assessment of General Education and Resource Teachers to Work in The Paradigm of Inclusive Education

The article analyzes the qualitative results obtained from a study of pedagogical specialists' self-assessment of their professional comfort working in an inclusive environment – 151 teachers and 150 resource teachers. The work of pedagogical specialists today is in the process of implementation and development of a new normative system, and tracking their evaluation and self-assessment is informative not only for their satisfaction, but also for the quality of normative provision of the process of education of children and students with different abilities. On the basis of the analysis, a system of conclusions based on the subjective selfassessments is made in the direction of: the need for targeted support of both general education and resource teachers in three directions: 1) logistical through the development of ready-to-use methods for identification and orientation of the necessary actions for the first group and unified validated diagnostic methods for the second group; 2) taking into account the specificities of educational institutions, where there are different but essential needs for effective work, some of which can be addressed locally; 3) receiving regular feedback for the purpose of improving the regulatory framework.

Building a dementia-capable nursing workforce.

Undergraduate nursing students will play a pivotal role in caring for the rising numbers of older adults and people living with dementia (PLWD). However, many do not receive training in geriatrics or dementia and do not enter this field post-graduation, contributing to the workforce shortage. We aimed to capture students' interest and intention to work with PLWD, their suggestions about training, and to evaluate interest in a new elective long-term care (LTC) externship. We developed and administered a survey to Bachelor of Science in Nursing students consisting of questions modified from the Dementia Attitude Scale and related to respondents' health care experience, attitudes about caring for older adults, comfort working with PLWD, and willingness to develop geriatric and dementia care skills. We then conducted focus groups about desired curricular and clinical content. Seventy-six students completed the survey. The majority reported low interest in working with and low knowledge of caring for older adults and PLWD. Six focus group participants expressed interest in participating in hands-on learning opportunities. Participants identified specific training components to attract students to geriatrics education. Our findings informed the development, piloting, and evaluation of a new LTC externship at the University of Washington Schoool of Nursing.

Evidence-Based vs Informal Suicide Training: Nurse Confidence and Comfort With Suicidal Patient Care

IntroductionEmergency nurses are on the front line of patient care for suicidal persons, yet many nurses report feeling unprepared to effectively manage suicidal patients owing to a lack of suicide-specific training. The purpose of this study was to examine the suicide-specific training experiences of emergency nurses and evaluate how training relates to burnout, confidence, and comfort working with suicidal patients. MethodsEmergency nurses at critical access and community hospitals completed an anonymous online survey during work hours. The survey included questions about training experiences, burnout, confidence, and comfort working with suicidal patients, perceptions of the quality and interactive nature of training, and desires for future suicide-specific intervention training. ResultsGroup comparisons among the 117 emergency nurses revealed that those who received evidence-based/expert-delivered training reported greater confidence, comfort, and perceived ability to treat suicidal patients and lower burnout than those who received informal or no training. Those with informal training reported greater confidence and ability to treat suicidal patients, but similar levels of comfort and burnout as those with no training. Mediation analyses showed that training was associated with greater comfort working with suicidal patients through its effect on increased confidence. A majority desired additional suicide-specific training. DiscussionEvidence-based/expert-delivered professional training in suicide intervention is associated with improved confidence, comfort, and perceived ability to care for suicidal patients and lower burnout. Providing evidence-based suicide intervention training may improve quality of care for suicidal patients by improving emergency nurse confidence and comfort for treating these high-risk patients.

Preparing a Workforce of Care Coordinators to Address Patient Mental Health Needs in the Digital Age: Training and Needs Identification.

Care coordinators (CCs) are specialized healthcare providers and often the primary point of contact for patients with multiple medical and mental health comorbidities in integrated healthcare settings. Prior work shows CCs have lower comfort addressing mental health than physical health concerns. Digital mental health interventions can support CCs' management of patient mental health needs, but training gaps must be addressed prior to a digital mental health intervention's implementation. As part of a quality improvement initiative, a 1-hour training focused on the assessment and management of depression and suicide-related thoughts and behaviors was delivered to CCs within a large midwestern healthcare system's Division of Ambulatory Care Coordination. CCs completed online surveys prior to and following the training. Training resulted in increased comfort working with clinical populations, including patients who experience suicide-related thoughts and behaviors. Gains around screening for suicide risk were modest. Brief trainings for CCs can address training gaps, however, ongoing training and case consultation may also be indicated.

Building a Dementia-Capable Nursing Workforce.

Today's undergraduate nursing students will play a pivotal role in caring for the rising numbers of older adults and people living with dementia (PLWD). Because current nursing training does not require dementia care competencies, new graduates may not be adequately prepared to care for this population. This study aimed to capture students' interest and intention to work with older adults and PLWD as a career path, and elicit their feedback on how best to structure educational and clinical training offerings that would attract them to this field. Long-Term care (LTC) settings blend clinical and residential features in a comprehensive setting uniquely suited for teaching nursing students about dementia. Hence, we evaluated students' interest in enrolling in a new elective rotation, the LTC Externship. We designed and administered a survey and conducted a focus group. The survey consisted of 20 questions modified from the Dementia Attitude Scale and eight questions related to respondents' health care experience and attitudes about nursing care for older adults, comfort working with PLWD, and willingness to further develop geriatric and dementia care skills. Focus group enrollment was limited to the first 8 participants who expressed interest and completed preliminary questionnaires. First and second-year Bachelor of Science in Nursing students at the University of Washington School of Nursing (SoN). Seventy Six of 223 (34%) students responded to the survey. The majority expressed low interest in working with older adults, as evidenced by the low survey response rate, low self-reported knowledge of nursing care for PLWD, and a lack of desire to work with older adults after graduation. Among the eight focus group participants, six expressed interest in acquiring additional knowledge and hands-on learning opportunities. Participants identified three specific training components that could attract students to geriatrics and LTC education: weekly structured seminars that reflect the depth of relevant scholarship; access to interactive, relevant pre-study materials developed by clinicians; and 4-6 hours per week of supervised paid, clinical training in hands-on skills. The findings informed the development of a LTC Externship at the UW SoN that is currently being piloted and evaluated.

Sexual prejudice as an institutional barrier to the social justice agenda in early childhood settings

ABSTRACT This exploratory cross-sectional study aimed to identify whether specific sociodemographic and attitudinal characteristics could predict educators’ comfort working with sexuality minority people and willingness to take action in their own school or classrooms to help children and sexuality and gender minority parents feel accepted and welcome. The study included 122 early childhood educators working in the northern part of Greece. The School Professionals’ Attitudes Towards Homosexuality (SPATH) measure was used to examine comfort and action orientation to work with sexuality and gender minority parents and their children. The study’s find ings show that educators’ sexual prejudice affects the promotion and endorsement of sexuality and gender minority families’ rights in school settings. Findings emphasise the need to implement training to contribute to reducing prejudice about specific minorities and facilitate inclusion in school settings.

3.109 Therapeutic Groups for LGBTQ+ Adolescents to Advance Community Needs and Psychiatry Trainees’ Learning

LGBTQ+ youth have disproportionate mental health needs and feelings of isolation, as explained by the minority stress model. However, most psychiatry trainees report that they do not have adequate exposure to LGBTQ+ youth mental health topics. The aims of this project are to: 1) address LGBTQ+ youth mental health needs through creating a therapeutic group environment; and 2) train psychiatrists to serve the needs of LGBTQ+ youth through case-based learning modules and supervised real-world experiences while measuring their knowledge, comfort, and competency working with this population.

Impact of a stroke interprofessional simulation on health professional students

IntroductionThe objective was to describe the interprofessional stroke simulation delivered across three campuses with seven types of health professions students and the impact the activity had on the students. MethodsAn interprofessional stroke simulation event was completed with pharmacy, medical, nursing, physician assistant, occupational therapy, physical therapy, and speech pathology students across a multi-site campus. Pre-activity, demographic information was requested including age, gender, discipline, year in respective program, number of experiences in prior interprofessional events, and comfort working with other health care professionals. The survey was repeated after the session and gathered free-text responses on whether learners gained information on working together, if they learned about the roles of other health care workers, and if they found the session useful. ResultsA total of 1820 health care professional students completed the simulation activity over four years. Of those students, 1035 (57%) completed the pre-survey, and 884 (49%) completed the post-survey. From the post-survey results, 91.5% of participants felt that they learned how health care disciplines can work together. Also, 87% of participants felt more comfortable working with learners from other professions. Most participants agreed the session was useful (77.1%) and rated it as moderately to extremely effective (81.8%). ConclusionsInterprofessional sessions with health care professional students are beneficial for learning new information about other professions and enhancing comfort levels in working with interprofessional groups. The interprofessional simulation improved the comfort level of students working with other health care professional students and should be considered in professional student curricula.

The DAS-6: A Short Form of the Dementia Attitudes Scale.

Attitudes toward persons with dementia (PWD) are important predictors of emotional and behavioral outcomes for PWD and their caregivers. It is often desirable to have short, psychometrically-sound measures of such attitudes for inclusion in large community-based surveillance surveys and quick training assessments. The Dementia Attitudes Scale (DAS) is a 20-item scale that examines person-centered knowledge and perceptions of comfort working with PWD. Shorter versions of this scale have been used in various settings, although the psychometric properties of this abbreviated scale are unknown. This study used a principal components analysis to examine the properties associated with scales using a reduced number of items. Our final scale, the DAS-6 includes three items in each of the comfort and person-centered knowledge subscales.

Suicide-Specific Training Experiences and Needs Among Military Mental Health Providers

Background Military suicide rates have risen over the past two decades, with a notable spike in recent years. To address this issue, military mental health providers must be equipped with the skills required to provide timely and effective care; yet little is known about the suicide-specific training experiences or needs of these professionals. Methods Thirty-five mental health care providers who treat active duty personnel at military treatment facilities participated in this mixed-methods study. All participants completed a survey assessing training and clinical experiences, comfort and proficiency in working with patients at risk for suicide, and perceived barriers to obtaining suicide-specific training. A sub-set of participants (n = 8) completed a telephone interview to further describe previous experiences and perceived challenges to obtaining training. Results The majority of participants (79.4%) had 6+ years of clinical experience, had a patient who had attempted suicide (85.3%), and completed at least one suicide-related training since finishing their education (82.4%). Survey results showed the leading barrier to enrolling in suicide-specific trainings was perceived lack of training opportunities (40.7% reported it was a barrier “quite often” or more), followed by lack of time (25%). Interview results revealed lack of time, location and logistical issues, and low perceived need for additional training among providers could impede enrollment. Conclusions Study results identified several modifiable barriers to receiving suicide-specific continuing education among military mental health providers. Future efforts should develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide. HIGHLIGHTS Military mental health providers report significant experience and relatively high degrees of comfort and proficiency working with patients at high risk for suicide. Most providers reported receiving training in suicide assessment and screening; few reported prior training in management of suicidality. Study results identified several modifiable barriers to receiving suicide-prevention continuing education among military mental health care providers; future efforts should seek to develop accessible training programs that can be easily integrated into routine clinical operations to mount the best defense against suicide.

Improving gender-affirming care in genetic counseling: Using educational tools that amplify transgender and/or gender non-binary community voices.

Transgender and/or gender non-binary (TGNB) individuals face significant health care disparities, including deficiencies in provider knowledge. To address this knowledge gap for genetic counselors, we developed, implemented, and analyzed an educational intervention on gender-affirming genetic counseling (GC) and care for TGNB patients. In partnership with the TGNB community, we designed a 5-module (length=146min±94min) genetic counseling-targeted online learning program focused on gender-affirming care (Amplify). Content included elements of gender-affirming care, core components of gender-inclusive GC sessions, and cancer risk assessment/management. Video testimonials featuring TGNB individuals complemented learning within each module. Educational outcomes measured included comfort working with TGNB patients (n=2 multiple choice questions (MCQs)), impact of education on knowledge (n=25 MCQs), and clinical self-efficacy based on the Accreditation Council for Genetic Counselingcompetencies (n=35 skills). Participants (n=40), recruited through state and national GC organizations, completed all modules, and pre- and post-education/self-efficacy assessments. Pre-Amplify, 65% (n=26/40) of participants endorsed feeling 'somewhat comfortable' working with TGNB patients. The average knowledge score was 77.6% (SD=11.2%) with the lowest scores related to the gender affirmation process. After Amplify, overall knowledge improvement was statistically significant with an average 16.9% (p<0.001) increase in score. Pre-Amplify, the average self-efficacy score was 78.4% (SD=15.8%) with lowest scores seen in statements surrounding information gathering of family and medical histories. Post-Amplify, overall self-efficacy improvement was statistically significant with an average 13.8% (p<0.001) increase in score. Linear regression did not identify an impact of practice specialty on participants' knowledge gains or self-efficacy. This study shows online modules are an effective form of gender-affirming care education for GCs. This intervention can positively improve the care practicing genetic counselors provide to patients and inform future decision-making about the development of gender-affirming care education for genetic counselors.

Clinicians as a critical link: Understanding health professionals’ beliefs and attitudes toward anorexia nervosa, bulimia nervosa, and binge eating disorder

Understanding the perspectives of health professionals remains an understudied issue, yet may help bridge research-practice gaps and pinpoint important areas for education, training, and research. This study investigated attitudes toward anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) among Nordic health professionals specialized within the eating disorder (ED) field. Participants (n = 144) completed a modified ED-version of the Illness Perception Questionnaire which assessed attitudes and beliefs toward perceived symptom controllability, severity, treatment effectiveness, and views on the prognosis of AN, BN, and BED. Personal enjoyment and level of comfort working with AN, BN, and BED were also assessed. The majority agreed or strongly agreed that patients with AN, BN, and BED were not responsible for their illness, and viewed the illnesses as psychological rather than medical in etiology. AN was viewed as the most severe and enduring, followed by BN, then BED. Treatment for BN was viewed as being more highly effective than treatments for either AN or BED. Professionals rated significantly less enjoyment and less confidence working with BED. To conclude, both commonalities and differences in attitudes toward AN, BN and BED were found in terms of perceived symptom controllability, views on severity, treatment effectiveness, and anticipated prognosis. In particular, findings emphasized the need for additional training in the management of BED among Nordic healthcare professionals.