Sense Of Preparedness Research Articles

Parent Presence during Invasive Procedures and Resuscitation

Parent presence during invasive procedures and/or resuscitation is a relatively underdeveloped and controversial practice. Much of the concern stems from the apprehension of the medical community. To evaluate whether implementation of formal practice guidelines and corresponding interprofessional education would improve clinicians' sense of preparation and comfort in providing parents with options during their children's procedures. Multiphase pre-post survey of (1) clinician perceptions and (2) practice from the perspective of clinicians and parents experiencing the same procedure. Data were collected over 4 years from a cardiovascular and critical care program in one U.S. children's hospital. More than 70% of clinicians participated in the perception surveys (n = 782) and 538 clinicians and 274 parents participated in the practice surveys. After the intervention, clinicians reported that parents were present during more invasive procedures and reported higher levels of comfort with the practice of providing options to parents during resuscitative events. Levels of comfort were higher in clinicians who had practiced skills in a simulated learning environment. During both phases, few clinicians reported that parent presence affected their technical performance (4%), therapeutic decision-making (5%), or ability to teach (9%). During the post phase, clinicians reported more active parent behaviors during procedures. Parents who reported receiving information to help them prepare for their children's procedures reported higher levels of procedural understanding and emotional support. Implementation of practice guidelines and interprofessional education had a positive impact on clinicians' perceptions and practice when providing parents with options and support during their children's invasive procedures and/or resuscitation.

Incorporating Active Learning Into a Psychiatry Clerkship: Does It Make a Difference?

Medical students' satisfaction with the psychiatry clerkship, sense of preparedness for an institutional Objective Structured Clinical Exam (OSCE), expressed likelihood of choosing psychiatry as a specialty, and National Board of Medical Examiners (NBME) psychiatry shelf-examination scores were compared after a curriculum based on Active Learning (AL) techniques was introduced. In consecutive academic years, two groups of students were compared after completing a 1-month psychiatry clerkship. The first group (N=108) received traditional lectures, and the second (N=102) was taught via AL. Participants were surveyed regarding satisfaction, sense of preparedness for an institutional OSCE, and expressed likelihood of choosing psychiatry as a specialty. NBME psychiatry shelf-examination scores were analyzed; independent-samples t-tests were used to evaluate the data. Satisfaction and sense of preparedness for the institutional OSCE increased with AL techniques. NBME scores were not significantly different between groups. Professed likelihood of choosing psychiatry as a specialty did not increase with the interventional curriculum. We confirmed findings from previous studies that student satisfaction improves with active learning (AL). Sense of preparedness for the OSCE examination improved with AL, as well. NBME psychiatry exam scores and professed interest in psychiatry as a specialty were not different from those taught in a traditional format.

Sexuality Content in the BSW Curriculum: A Pilot Study of Student Perceptions

As attitudes about sexuality change, social workers may confront client issues and/or problems related to human sexuality. This article describes a pilot study of student perceptions of human sexuality curriculum content and their views regarding their sense of preparedness and anticipation in dealing with this area of practice. A convenience sample of undergraduate students (n=170) from BSW programs at public and private institutions in the northeastern United States completed a study- specific questionnaire. Preliminary findings suggest study participants were unable to identify sexuality content within their curriculum. Only 42% (n=71) perceived that they were adequately prepared to handle most sexuality issues, although many anticipate working with clients with sexuality issues in practice. Limitations of the study are addressed. Directions for future research are discussed that may contribute to a better understanding of the delivery of human sexuality content to BSW students.

Supporting family caregivers of hospitalised palliative care patients: a psychoeducational group intervention

BackgroundMany family caregivers of palliative care patients experience poor health and have other unmet needs, requiring health professionals' support. However, there are few evidence-based supportive interventions to address these issues.PurposeThe...

Psycho-Educational Group Intervention for Family Caregivers of Hospitalized Palliative Care Patients: Pilot Study

Family caregivers of patients requiring palliative care commonly experience physical, social, and psychological burdens. Although family caregivers are acknowledged as valid service recipients of palliative care, many have unmet needs, and systematic reviews have shown there are limited evidence-based supportive interventions. This study aimed to develop and pilot test a psycho-educational group education program delivered in the inpatient specialist palliative care setting and designed to prepare primary family caregivers for the role of supporting a relative receiving hospital-based palliative care. (1) Development of education session and delivery protocol by the research team and expert panel; (2) pilot the intervention in three clinical sites (five sessions in total); (3) evaluate its accessibility and acceptability; and (4) preliminary testing of outcome measures used to access the intervention's effectiveness. The results revealed that the intervention was appropriate and acceptable to caregivers. The intervention needs to be tested in a larger sample to determine the potential benefits for caregivers' sense of preparedness and competence, and testing needs to ascertain if the intervention is accessible.

Assessment of the effect of Advanced Paediatric Life Support training on level of self‐perceived preparedness among health‐care workers in Cambodia

The objective of this study was to survey the self-perceived preparedness of Cambodia's Advanced Paediatric Life Support (APLS) providers towards their APLS training and accreditation 5 years post-implementation. A cross-sectional survey was administered in December 2009 to APLS providers who had been trained throughout the 5 year period from December 2005 to May 2009. One hundred and two (93%) APLS providers responded. The median rating for their original APLS learning experience was 6 out of 10, and the reported median recall of the APLS teaching content was 7 out of 10. Since their training, 80% had managed a child in cardiac arrest, 85% a child with serious illness and 72% with serious injury. Their subjective preparedness from APLS training for each of the three resuscitation types, on a scale of 1-10, were medians of 7, 7 and 6, respectively. For all groups, perceived preparedness for all three resuscitation types did not differ despite varying lengths of time from their original training. APLS training has increased the self-perceived preparedness of paediatric health-care workers in Cambodia. RESULTS indicate moderate relevance to real patient resuscitations experienced by health workers, and the perceived recall of the teachings and sense of preparation from APLS training does not significantly decline over time. However, our results suggest subsequent further APLS instructor courses might maintain resuscitation preparedness.

Sexuality Content in the BSW Curriculum: A Pilot Study of Student Perceptions

As attitudes about sexuality change, social workers may confront client issues and/or problems related to human sexuality. This article describes a pilot study of student perceptions of human sexuality curriculum content and their views regarding their sense of preparedness and anticipation in dealing with this area of practice. A convenience sample of undergraduate students (n=170) from BSW programs at public and private institutions in the northeastern United States completed a study- specific questionnaire. Preliminary findings suggest study participants were unable to identify sexuality content within their curriculum. Only 42% (n=71) perceived that they were adequately prepared to handle most sexuality issues, although many anticipate working with clients with sexuality issues in practice. Limitations of the study are addressed. Directions for future research are discussed that may contribute to a better understanding of the delivery of human sexuality content to BSW students.

Uncovering and validating clinicians’ experiential knowledge when facing difficult conversations: A cross-cultural perspective

ObjectiveTo explore clinicians’ experiential knowledge when conducting difficult conversations; and to verify if experiential knowledge is culturally based. MethodData were collected in Italy and the United States during the Program to Enhance Relational and Communication Skills (PERCS) workshops. At the beginning of each workshop, during a whiteboard exercise, clinicians shared the strategies they had found helpful in difficult conversations. The strategies were analyzed in each country through content analysis. Upon completion of this primary analysis, the themes identified within each country were synthesized into second-order themes by means of aggregated concept analysis. ResultsWe conducted 14 Italian and 12 American PERCS-workshops enrolling a total of 304 clinicians. The suggestions that were similar across both countries were related to: organizational aspects and setting preparation; communication and relational skillfulness; clinician mindfulness; interpersonal qualities and sensibilities; and teamwork and care coordination. Additionally, US participants identified attention to cultural differences as a helpful strategy. ConclusionClinicians can access relational strategies, tied to their experience, that are typically unrecognized in medical education. The whiteboard exercise is an effective teaching tool to uncover and validate already-existing relational knowledge. Practice implicationsCommunication training programs can foster clinicians’ sense of preparation by building upon their already-existing knowledge.

Preparedness for Alzheimer's disease and its determinants among laypersons in Israel

Despite the increasing prevalence of Alzheimer's disease (AD), very few studies have examined advanced preparation for the possibility of becoming sick with AD, and these few studies indicate a general lack of preparation. This study aimed to expand knowledge regarding preparedness for AD among younger and older Israeli laypersons, and to explore the determinants of such preparedness, in terms of knowledge and beliefs concerning AD. This study was based on a national representative sample of 632 Israeli laypersons. Participants were interviewed by telephone to assess their preparedness for AD, beliefs related to AD in terms of vulnerability, worry, fear, and perceptions about the importance of planning for the future, and their perceived knowledge of AD. Low levels of preparation for AD were reported, especially among younger participants. Multivariate analyses indicated that for both older and younger participants, taking actual steps to prepare oneself for AD was significantly associated with a general sense of preparedness, and that a general sense of preparedness was associated with perceptions regarding the importance of planning for the future. For older participants, a general sense of preparedness was also associated with greater knowledge of AD. Findings indicate that Israeli laypersons are not preparing for AD, and that attitudes and beliefs play an important role in this preparation. Thus, measures should be taken to emphasize the importance of planning for the future contingency of AD in younger and older persons and to expand the knowledge of older persons regarding the disease.

Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare

Background: The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians’ preparedness to engage in difficult conversations.Aim: To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy.Methods: The Italian PERCS program featured 4-h experiential workshops enrolling 10–15 interdisciplinary participants. The workshops were organized around the enactment and debriefing of realistic case scenarios portrayed by actors and volunteer clinicians. Before and after the workshop, participants rated their perceived preparation, communication and relational skills, confidence, and anxiety on 5-point Likert scales. Open-ended questions explored their reflections on the learning. T-tests and content analysis were used to analyze the quantitative and qualitative data, respectively.Results: 146 clinicians attended 13 workshops. Participants reported better preparation, confidence, and communication skills (p < 0.001) after the workshops. The program had a different impact depending on the discipline. Participants valued the emphasis on group feedback, experiential and interdisciplinary learning, and the patient's perspective, and acquired: new communication skills, self-reflective attitude, reframed perspective, and interdisciplinary teamwork.Conclusion: PERCS proved culturally adaptable to the Italian context and effective in improving participants’ sense of preparation, communication skills, and confidence.

Psychiatric Residents' Experience Conducting Disability Evaluations

The increasing frequency and societal cost of psychiatric disability underscore the need for accuracy in evaluating patients who seek disability benefits. The authors investigated senior psychiatric residents' experiences performing disability evaluations, their self-assessment of competence for this task, and whether they perceived a need for more training. Seventy-nine third- and fourth-year psychiatric residents in Massachusetts and Rhode Island training programs were surveyed from May to June in 2008. Participants were asked about the frequency of requests and completion of disability evaluations, the practice patterns followed when performing evaluations, the identification of role and potential conflict of interest in doing evaluations, and their sense of preparedness and need for more training. Residents reported having limited experience performing disability evaluations and followed a variety of practice patterns when performing evaluations. They reported having a limited understanding of what constitutes psychiatric disability and a lack of confidence in their ability to perform evaluations accurately. A significant minority had identified patients as disabled despite believing otherwise. A majority of residents reported receiving no didactics on psychiatric disability and desired more training. Residents may be unprepared to perform disability evaluations. Residency programs may need to provide additional training.

Predicting Preservice Teachers' Self-Efficacy to Resolve a Cultural Conflict Involving an African American Student

This study examined preservice teachers' (1) sense of efficacy to resolve a cultural conflict involving an African American student, (2) sense of preparedness to effectively handle cultural conflicts, and (3) culturally responsive teaching self-efficacy beliefs. After reading a case study describing a teacher working with an African American male student, participants (n = 84) were asked to indicate how efficacious they were in resolving the conflict and how prepared they were to do so. The findings suggest that preservice teachers' sense of preparedness and the strength of their culturally responsive teaching self-efficacy beliefs contribute to the prediction of their sense of efficacy to resolve the conflict presented in the case study. The implications of these findings are discussed.

Becoming a Global Citizen through Nursing Education: Lessons Learned in Developing Evaluation Tools

While global health practica are being increasingly described in nursing education literature, course evaluation of same receives comparatively less attention. In this article, authors report on an evaluation project, undertaken to rigorously examine the existing evaluation methods for an elective global health practicum with placements in India and northern Canada. Sixteen students were interviewed and course evaluation tools were reviewed. Resulting themes include students' sense of preparedness, the centrality of the student-preceptor relationship, the importance of supported self-reflection, and the usefulness of evaluation methods. Participants viewed existing course evaluation methods as generally useful, therefore requiring only minor adjustments. There were also structural revisions to the preparation, placement, and post-placement phases of the course and broader lessons learned. Lessons include the importance of critical social perspectives and the value of past students revisiting their experiences in such a way as make conscious connections between placement experiences and their current professional practice.

Preparing LGBTQ-allies and combating homophobia in a U.S. teacher education program

Interns in a US teacher education program were surveyed regarding their attitudes towards diversity, particularly issues of sexuality, their feelings of “cultural competence” around diversity, and the repertoires of practices and resources they feel prepared to draw on in their work with middle and high schools students (11–18 year olds). Analysis of course materials provided insight into distinctions between anti-homophobia and LGBTQ-ally stances among students. Extensive semi-structured interviews with 7 students explored these issues in more depth, documenting their sense of preparedness and cultural competence, where locate and how they identify “useful experiences in learning how to teach LGBTQ youth, and the concerns they face in their work against heterosexism and homophobia in schools.

Social Work Students' Pre-placement Anxiety: An International Comparison

This paper compares the degree and nature of anxiety experienced by American and Israeli social work students as they anticipate beginning field placement. Despite having greater prior exposure to social work through relevant coursework and experience, American students were significantly more anxious than Israeli ones. Overall, Americans reported a slightly higher sense of preparedness, but this difference was not statistically significant. While there were some shared worries, notably regarding the quantity and quality of field instruction, and their capacity to meet both field and academic obligations, specific concerns regarding field agencies, clients, and social work education differed between the groups, likely reflecting the distinct social, cultural, historical and educational contexts. Implications for social work education and future research are discussed.

Difficult conversations: Improving communication skills and relational abilities in health care*

Communication skills and relational abilities are essential core competencies that are associated with improved health outcomes, better patient adherence, fewer malpractice claims, and enhanced satisfaction with care. Yet, corresponding educational opportunities are sorely underrepresented and undervalued. To evaluate the impact of an interdisciplinary experiential learning paradigm to improve communication skills and relational abilities of pediatric critical care practitioners. Prepost design, including baseline, immediate follow-up, and 5-month self-report questionnaires. Tertiary care pediatric hospital, Children's Hospital Boston. One hundred six interdisciplinary clinicians with a range of experience levels and clinical specialties. Participants rated their sense of preparation, communication and relational skills, confidence, and anxiety. Open-ended questions asked participants about lessons learned, aspects of the training they found most helpful, and suggestions to improve the training. When questions were posed in a yes/no format, participants were nearly unanimous (93% to 98%) that the training had improved their sense of preparation, communication skills, and confidence immediately after and 5 months posttraining. Ninety percent of participants reported improvements in establishing relationships immediately after the training and 84% reported improvements 5 months posttraining. Eighty-two percent reported reduced anxiety immediately after training and 74% experienced reduced anxiety 5 months posttraining. On Likert items, 70% estimated their preparation had improved; 40% to 70% reported improvements in communication skills, confidence and anxiety, and 15% in relationship skills. Four qualitative themes emerged: identifying one's existing competence; integrating new communication skills and relational abilities; appreciating interdisciplinary collaboration; and valuing the learning itself. A 1-day experiential learning paradigm focused on communication skills and relational abilities was highly valued, clinically useful, and logistically feasible. Participants reported better preparation, improved communication and relational skills, greater confidence, and reduced anxiety. Participants deepened their understanding of family perspectives, recognized valuable existing competencies, and strengthened their commitment to interdisciplinary teamwork.

MSW Students' Experience with Termination: Implications and Suggestions for Classroom and Field Instruction

Social work students' experiences with termination are rarely explored. This paper discusses the results of a survey of 54 MSW interns regarding termination and, in particular, premature termination resulting from placement completion. Twenty‐four percent of respondents experienced natural terminations, 35% experienced client‐initiated ones, and 93% experienced forced terminations resulting from internship completion. Students felt termination was well‐covered in practice classes, less so in supervision, and felt moderately prepared for the process. Nevertheless, students found terminations significantly harder than their sense of preparation would indicate, and recommend earlier, more comprehensive training in classroom and field settings to support them and their clients.

Implementation of geographic information system (GIS) in secondary geography curriculum in Hong Kong: current situations and future directions1

Using geographic information system (GIS) in teaching and learning geography is an important direction in the secondary geography curriculum in Hong Kong. In the present study, interviews were conducted individually with 28 geography teachers from different secondary schools in Hong Kong, with a view to finding their views on the inclusion of GIS in the secondary geography curriculum and the current state of GIS implementation in their schools. The study reveals that the level of use of GIS in geography teaching in Hong Kong was low, despite the fact that teachers generally found GIS to be an important geographical skill. In addition, teachers' understanding of how GIS could be used in teaching to enhance student learning in geography was limited. There is evidence that basic conditions, in terms of hardware and software, for using GIS in geography teaching were present in schools, and that teacher commitment was a critical factor determining whether or not GIS would be used. Teacher commitment was found related to teachers' sense of preparedness to implement GIS, the perceived practicality of its use in teaching and whether GIS use was mandated in the curriculum.

A Medical Education Model for Collaborative Chronic Disease Management

Purpose: The purpose of this study was to evaluate the impact of a curriculum enhancement project on physician assistant (PA) students’ abilities, attitudes, and preparedness to provide collaborative disease management. Method: The authors identified competencies needed for collaborative chronic disease management and developed curriculum interventions. The interventions were piloted with a single cohort of PA students at the Jefferson College of Health Sciences. Full implementation and evaluation was conducted with a separate cohort of students. Students self-reported their (1) previous exposure to chronic disease; (2) abilities related to collaborative disease management; (3) attitudes towards chronic disease patients and collaborative disease management; (4) preparedness to provide chronic disease care; (5) perceptions of the benefit of the community medicine rotation and; (6) self-efficacy to support patient self-management. Results: Significant improvements (p < .05) were noted in all 10 ability areas. Few significant changes in attitudes occurred though many attitudes were positively maintained. Significant changes were found for students’ preparedness for chronic disease care. Students also reported a high level of self-efficacy to provide patient self-management support. Conclusions: Findings indicate that curriculum interventions can positively affect PA students’ collaborative disease management abilities and sense of preparedness to manage patients with chronic disease. While curriculum enhancement may not significantly improve attitudes, the study suggests that interventions may be supportive of already favorable attitudes. Further study is needed to determine the most time- and cost-effective methods for facilitating improvement in both ability and attitude. J Physician Assist Educ 2008;19(2):18-29

Terrorism Threats and Preparedness in Canada: The Perspective of the Canadian Public

Although Canada has not experienced a major terrorist attack, an increased global pending threat has put preparedness at the top of the Canadian government's agenda. Given its strong multicultural community and close proximity to the recently targeted United States, the Canadian experience is unique. However, minimal research exists on the public's reactions to terrorism threats and related preparedness strategies. In order for response initiatives to be optimally effective, it is important that the public's opinions regarding terrorism and preparedness be considered. This qualitative study examined perceptions of terrorism threats among Canadians living in Central and Eastern Canada (N = 75) in the fall of 2004. Conceptualizations of terrorism threat, psychosocial impacts, and sense of preparedness were explored in a series of qualitative interviews. Findings revealed that the majority of Canadians did not feel overly threatened by terrorist attacks, due in part to a perception of terrorist threats as related to global sociopolitical events and a positive Canadian identity. In addition, while most respondents did not feel they were individually affected by the threat of terrorism, there was some concern regarding larger societal impacts, such as increased paranoia, discrimination, and threats to civil liberties. Participants' views on preparedness focused largely on the utility of emergency preparedness strategies and the factors that could mitigate or inhibit preparedness at the individual and institutional levels, with a specific focus on education. Finally, the significant relevance of these findings in shaping terrorism preparedness, both in Canada and generally, is discussed.