Competent Care Research Articles

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

BackgroundAustralia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment.MethodsWe conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software.ResultsThree themes were developed from participants’ responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services.ConclusionGender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

The WHO World Mental Health Report: a call for action.

The World Health Organization's World Mental Health Report is a call for action and reminds all of the huge personal and societal impact of mental illnesses. Significant effort is required to engage, inform and motivate policymakers to act. We must develop more effective, context-sensitive and structurally competent care models.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines.

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

Fostering Practices of Salvation: On Communities of Care and Ecclesial Practices

This article explores how Christian faith communities respond to challenges in health care. These challenges are described, and a broader context is sketched, through an exploration of an ethics of care. Subsequently, two examples of Christian communities who respond intentionally to the need for care are presented and studied by using four sub-elements of care (attentiveness, responsibility, competence, and responsiveness) as a heuristic lens. Next, the relationship between care and salvation is discussed. Concludingly, the article argues that Christian communities of care are well equipped for sustainable caregiving because of their spiritual resources, and because they provide a life-context well-suited for caregiving.

Correction to: Culturally Competent Care in the Breast Imaging Clinic: Hispanic/Latino Patients.

Correction to: Culturally Competent Care in the Breast Imaging Clinic: Hispanic/Latino Patients.

Caregivers’ willingness to pay for digital support services: Comparative survey

BackgroundConsidering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers’ willingness to pay for digital support services is needed. ObjectiveThe aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden. MethodsA sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver’s demographics, caregiver’s socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay. ResultsMore than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers’ willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057). ConclusionsFactors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers’ willingness to pay for digital support services. The digital and social divide may negatively affect caregivers’ willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers’ health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.

Self-assessment of a breast care nursing model within a Breast Unit: learning process and keys to improving breast care.

To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators. Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care. Cohort study. Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study. We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines. The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond completion of primary treatment. This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care. No contribution from the patient or the public because the data collected was entered into the clinical history by the health professionals of the Breast Unit as part of their usual clinical practice.

Psychometric properties of the Korean version of the Palliative Care Nursing Self-Competence scale for infant use

BackgroundDespite the significant advances in neonatal treatment and care over the past 30 years, palliative care in the neonatal intensive care unit has not been fully provided in South Korea. Neonatal nurses are essential professionals in palliative care as they are directly involved in the care, but there is little information on their palliative care competency because no assessment instrument is available in Korea. ObjectivesThe aim of this study was to develop and test the validity and reliability of the Korean version of the Palliative Care Nursing Self-Competence scale for neonatal palliative care. MethodsThis scale for infant care was developed through parallel translation techniques and revised based on cognitive interviews. Survey data were then collected from 220 neonatal nurses who worked in 13 neonatal intensive care units in Korea. Internal consistency reliability, construct validity based on exploratory factor analysis, and criterion-related validity were tested. ResultsThe final version of the scale included 40 items in five domains that explained 53.4% of the variance. Criterion-related validity was confirmed based on a positive correlation with the Korean version of the attitudes towards neonatal palliative care measurement tool. The Cronbach's alpha for the scale was 0.95. ConclusionsThe Korean version of the Palliative Care Nursing Self-Competence scale for infant care has satisfactory construct validity and reliability to measure palliative care self-competence of neonatal nurses in Korea and evaluate an education program in future studies.

Comparisons on factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes: a qualitative study

BackgroundStudies revealed that supporting residents fulfilling self-determination is positively associated with their health, wellbeing and quality of life. Cross-cultural care poses significant challenges for nursing home residents to fulfil their self-determination in control of own care and maintaining meaningful connections with others. The aim of the study was to compare factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes.MethodsA qualitative descriptive approach was applied to the study. Culturally competent care and person-centred care were employed as guiding frameworks. Individual interviews or a focus group with residents and family members were conducted to collect data.ResultsIn total, 29 participants participated in the study. Three main themes were identified: communicating needs and preferences; mastering own care; and maintaining meaningful relationships. Each theme includes sub-themes that detail similarities and differences of factors affecting residents fulfilling self-determination in the two type nursing homes. Findings indicate that residents from both types of nursing homes experienced challenges to communicate their care needs and preferences in daily care activities. Moreover, residents or their representatives from both types of nursing homes demonstrated motivation and competence to master residents’ care based on their individual preferences, but also perceived that their motivation was not always supported by staff or the nursing home environment. Residents’ competence in mastering their care activities in ethno-specific nursing homes was based on the condition that they were given opportunities to use a language of choice in communication and staff and the nursing home demonstrated culturally competent care for them. In addition, ethno-specific nursing homes showed more recourse to support residents to maintain meaningful relationships with peers and others.ConclusionsCulturally competent care created by staff, nursing homes and the aged care system is a basic condition for residents from ethnic minority groups to fulfil self-determination. In addition, person-centred care approach enables residents to optimise self-determination.

Do personal and behavioural characteristics of physiotherapy students predict performance during training and course completion?

BackgroundSpecific personal and behavioural characteristics are required for competent health care practice. Research investigating relationships between these characteristics and course performance of health professions students is expanding, yet little research is conducted within the undergraduate physiotherapy student population. This study aimed to explore the relationships between personality, approaches to learning, and coping strategies of undergraduate physiotherapy students and their performance in academic, clinical and in-course assessment tasks and course progression.MethodsParticipants from six cohorts of undergraduate physiotherapy students (commencing years 2012–2017, 66% response rate) completed questionnaires measuring personality (NEO-FFI-3), approaches to learning (RASI) and coping strategies (Brief COPE). Correlation and multiple regression analysis were conducted to investigate relationships between scores on written examinations, in-course assessment tasks and assessments of clinical performance. Mann–Whitney U test was used to compare subgroups on these measures in those who completed or did not complete the course.ResultsConscientiousness and a strategic approach to learning predicted higher scores in written examinations, and for most clinical and in-course assessments with conscientiousness being a stronger predictor. A lack of purpose (surface) learning approach was predictive of lower clinical placement scores. Non-course completers had higher scores for lack of purpose (surface) approach to learning and lower scores for the coping strategies of support seeking and humour.ConclusionsThis study confirms the importance of conscientiousness and a strategic learning approach on the academic and clinical performance of undergraduate physiotherapy students. Identifying learners with a surface learning approach and low support seeking coping strategies could assist in providing support to students at risk of poor performance and minimising attrition.

Experience of non-ICU nurses and factors influencing the resiliency while working in ICU during the covid-19 pandemic in a tertiary hospital

Background and objective: The coronavirus outbreak in 2019 has created unprecedented pressure on health care staff and material resources such as PPEs, Ventilators, Oxygen supplies, hospital beds etc. Ensuring an adequate supply of nurses to maintain a high standard of care and safe infective care practices in the phase of the increased patient load is a huge challenge for all stakeholders. Utilizing non-ICU nurses for ICU care is an option. However, factors that influence the optimal selection and coping behaviour (resilience) of a non-ICU nurse are not well examined. In this paper, we “adopt a mixed method design” to determine the suitable specialty staff for ICU attachment during a pandemic. I will emphasise the significance of educational training and preparation of critical care on non-ICU nursing staff in relation to their adaption and coping level throughout this study. The objectives of this study were (1) to explore experiences, perceptions and factors influencing resilience of non-ICU nurses during the COVID-19 pandemic and (2) to review the lived experience of non-ICU nurses after the critical care competency training programme.Methods: After obtaining the comments from the Dissertation Review Board, the study adopted a mixed method study design. The authors selected 76 samples (eight males and sixty-eight females) by “non-probability convenient sampling”. The authors used a survey for data collection lasting 8 weeks. The authors used descriptive (frequency, percentage distribution, mean and standard deviation) and inferential statistics to analyse the data collected.Results: The study revealed that most of the staff (75%) met the prepared objectives of the orientation program. Approximately 90% of the staff agreed that they are able to take care of critically ill patients with minimal supervision. Further, 29% of the staff stated that psychological preparation & staff readiness are the first priorities to be considered before ICU attachment. We also evaluated the ability of the staff to bear the ICU workload, and 51% of the staff reported it being bearable. This number is similar to the number of staff who reported suitable health status to physical exertion needs of the ICU. Staff age, marital status, gender, qualification, area of experience, and years of experience did not influence staff coping mechanisms. However, the attachment staff with previous ICU exposure have effective coping mechanisms during their attachment in ICU.Conclusions: In shortage of ICU staff in case of a pandemic, staff with neurology and neurosurgery background showed a higher confidence and coping level to ICU stressful environment. Furthermore, staff with other clinical backgrounds can work effectively during this circumstance with organized training, preparedness plan, effective clinical follow up and psychological support. All these factors facilitate the coping mechanism.

Lesbian, gay, bisexual, transgender and or queer patient experiences in Canadian primary care and emergency departments: a literature review

This literature review synthesises existing evidence and offers a thematic analysis of primary care and emergency department experiences of lesbian, gay, bisexual, transgender, queer and/or any other sexual or gender minority (LGBTQ+) individuals in Canada. Articles detailing first-person primary or emergency care experiences of LGBTQ + patients were included from EMBASE, MEDLINE, PsycINFO and CINHAL. Studies published before 2011, focused on the COVID-19 pandemic, unavailable in English, non-Canadian, specific to other healthcare settings, and/or only discussing healthcare provider experiences were excluded. Critical appraisal was performed following title/abstract screening and full-text review by three reviewers. Of sixteen articles, half were classified as general LGBTQ + experiences and half as trans-specific experiences. Three overarching themes were identified: discomfort/disclosure concerns, lack of positive space signalling, and lack of healthcare provider knowledge. Heteronormative assumptions were a key theme among general LGBTQ + experiences. Trans-specific themes included barriers to accessing care, the need for self-advocacy, care avoidance, and disrespectful communication. Only one study reported positive interactions. LGBTQ + patients continue to have negative experiences within Canadian primary and emergency care – at the provider level and due to system constraints. Increasing culturally competent care, healthcare provider knowledge, positive space signals, and decreasing barriers to care can improve LGBTQ + experiences.

An Assessment of Dementia Knowledge and Its Associated Factors Among Health College Students in Saudi Arabia.

Background Dementia is a public health concern and the main cause of impairment and dependency among the elderly worldwide. It is characterized by a progressive decline in cognition, memory, and all domains of quality of life with preserving the level of consciousness. Accurate measurement of dementia knowledge among future health professionals is required to improve targeted educational initiatives and supportive care of patients. This study aimed to assess knowledge of dementia and its associated factors among health college students in Saudi Arabia. Methods A descriptive, cross-sectional study was conducted among health college students from various regions in Saudi Arabia. Data on sociodemographic characteristics and dementia knowledge were gathered using a standardized study questionnaire Dementia Knowledge Assessment Scale (DKAS) distributed on different social media platforms. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA) statistical software. A P-value of <0.05 was considered significant. Results A total of 1,613 participants were included in the study. The mean age was 20.5 ± 2.5 years (range 18-25years). The majority of them were males (64.9%), and females represented 35.1%. The mean knowledge score of the participants was 13.68 ± 3.18 (out of 25). According to DKAS subscales, we found that the respondents scored the highest in care considerations (4.17 ± 1.30) and the lowest in risks and health promotion (2.89 ± 1.96). Furthermore, we found that the participants with no previous dementia exposure had a significantly higher level of knowledge than those with previous dementia exposure. In addition, we found that both genders, aged 19, 21, 22, 23, 24, and 25 years; the geographic distribution of respondents; and previous dementia exposure significantly affected the DKAS score. Conclusions Our findings showed that health college students in Saudi Arabia had poor knowledge about dementia. Ongoing health education and comprehensive academic training are recommended to improve their knowledge and provide competent care for dementia patients.

“Watchful waiting”: everyday ethical caring practices of general practitioners in cases of intimate partner violence

This article focuses on the ethical caring practices of general practitioners in dealing with intimate partner violence. In-depth interviews were conducted with general practitioners to inquire about their concrete experiences and conflicts, which were then submitted to a thematic analysis based on Tronto’s elements of an ethics of care. The results show the difficulties faced by general practitioners when it comes to clarifying their patients’ caring needs, determining what is meant by competent care and dealing with the conflicting expectations of the caregiver and care receiver particular to the issue of intimate partner violence.

Competency-Based Workforce Development and Education in Global Oncology.

The healthcare workforce plays a pivotal role in cancer care delivery, leadership, policy, education, and research in complex cancer systems. To ensure quality and relevance, health professionals must have the necessary competencies to deliver patient-centered and efficient care, coupled with the ability to work in teams and manage health resources wisely. This paper aims to review the concept of competency-based medical education (CBME) in the context of oncology to provide insights and guidance for those interested in adopting or adapting competency-based education in training programs. The results of a scoping review of CBME in oncology are presented here to describe the current status of CBME in oncology. The literature describing the implementation and evaluation of CBME in oncology training programs for medical professionals internationally is summarized and key themes identified to provide practical guidance for educators. Further, the paper identifies critical competencies for oncology education and training globally and presents recommendations and opportunities for collaboration in competency-based education and training in oncology. The authors argue for increased global collaboration and networking in the realm of CBME to facilitate the establishment of a competent global cancer care workforce.

Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity

Features| February 2023 Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity Dennis M. O'Brien, DNP, MS, CRNA; Dennis M. O'Brien, DNP, MS, CRNA Search for other works by this author on: This Site PubMed Google Scholar Omonele O. Nwokolo, MD, FASA Omonele O. Nwokolo, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2023, Vol. 87, 18–19. https://doi.org/10.1097/01.ASM.0000919532.32287.7e Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Dennis M. O'Brien, Omonele O. Nwokolo; Patient Population Diversity: Culturally Competent Care and the Importance of Adjusting Practice to Promote Inclusivity. ASA Monitor 2023; 87:18–19 doi: https://doi.org/10.1097/01.ASM.0000919532.32287.7e Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: culturally competent care Positive patient outcomes are dependent on the provision of culturally competent care. Providers must consider the diverse beliefs, attitudes, values, and behaviors governing personal health care choices. This article offers an inquiry into challenges to consider with our modern population, conscientious practice adjustments needed to accommodate inclusivity, and the benefits of equitable delivery of care. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Dr. Martin Luther King Jr., at the 2nd National Convention of the Medical Committee for Human Rights, March 25, 1966 The subtleties of language are timeless; however, as the narrative on health care delivery continues to morph, organizations and individual providers find themselves wanting to be more accountable. Systemically, conversations include ongoing assessment and commitment to change when addressing social disparities and the health care needs of marginalized communities. This dialog has provided an opportunity for delivering effective, quality... You do not currently have access to this content.

Cultural competence among nursing students and nurses working in acute care settings: a cross-sectional study

BackgroundThe increasing cultural diversity in healthcare in European countries, including Austria, has highlighted the need to enhance nurses’ cultural competence. Assessing cultural competence and identifying relevant influencing factors can help to improve culturally competent care. The aim of this study was to assess the cultural competence of nurses and nursing students working in Austrian acute care settings and to identify influencing factors using the Cultural Competence Assessment scale.MethodsA cross-sectional design was used. Data collection was carried out in March 2021 with nurses and nursing students in the last year of their studies who were working in Austrian acute care settings. Descriptive analysis was applied to display the general characteristics of the study participants and the levels of their overall cultural competence. A multiple linear regression analysis was conducted to analyze the influencing factors of cultural competence.ResultsThe nurses’ cultural competence level was moderate to high (mean = 3.89; SD = .48). Their age, educational level, cultural diversity training and self-perceived cultural competence significantly influenced the level (F (6, 875) = 18.971, p < .0000, adj. R2 = 1.09).ConclusionsProviding culturally competent healthcare services for culturally diverse patients is essential for all healthcare professionals, and especially for nurses who spend the most time with patients. Effective interventions, such as educational training, need to be implemented in order to deliver culturally competent care and potentially reduce disparities in healthcare and improve patient outcomes.

Nursing Students' Caring Behavior Towards Clinical Learning Readiness

Aims: There was a high rate of psychological issues among students engaging in clinical practice. Students that focus on caring as their pedagogical foundation will be more equipped to provide nursing intervention in clinical situations. Objective: This research aimed to examine nursing students' caring behaviors as they relate to their readiness for clinical practice. Methods: A total of 122 nursing students from nursing schools in Bandung participated in this descriptive and cross-sectional study, with a response rate of 81.3%. Students' caring behavior and clinical readiness are assessed using the Casey-Fink Readiness for Practice Survey and the CBI-24 (Caring Behavior Instrument short form). Pearson correlation and linear regression tests in SPSS 26 were used to establish associations between the variables. Results: Findings demonstrated a statistically significant correlation between students' caring conduct and clinical preparation (sig 0.000; p0.05). The correlation between the two variables was 23.8% strong, which was statistically significant. Student readiness for clinical practice was only strongly related to the connection factor. Nursing students' caring attitudes and clinical readiness were not significantly influenced by students' age, gender, or work situation. Conclusions: The level of empathy and social connection among nursing students influenced how well they were prepared for clinical practice. The development of students' caring behaviors, including self-assurance, competency, and respect, should be a primary goal of nursing education.

Black men in white coats - Barriers black men face in medicine, implications to decreased representation, and potential interventions at the uniformed services university of the health sciences

The number of black male applicants to US medical schools has remained stagnant over the last 30 years. The etiology behind the lack of applicants is multifaceted and involves greater systemic barriers, specifically, educational and social barriers. The lack of representation of black males in medicine also has downstream implications for the health of the African American/black community. African Americans exhibit some of the lowest levels of trust in the healthcare system, have less access to care than their non-minority peers, and have, comparatively, poorer healthcare outcomes than other populations in the US. Research has demonstrated that patient-provider race concordance improves communication, outcomes, culturally competent care, and satisfaction with care. The greater the gap between these two populations, the harder it becomes to improve healthcare outcomes, maintain a medically ready fighting force in the US military, and improve trust in the healthcare system. This article provides an analysis of the multifactorial barriers black male applicants face applying, matriculating, and graduating medical school and how decreased representation may affect healthcare delivery. Furthermore, this review explores next steps and potential implementations at the Uniformed Services University of the Health Sciences to address the above deficiencies.