Sequential Mixed Methods Study Research Articles

Effective English teachers in online EFL learning: A post-pandemic reflection on students’ perspectives

In the framework of conventional academic settings, there have been a large number of studies on the qualities of effective teachers; however, studies in the context of online environments seem to be scarcely documented in the literature. This explanatory sequential mixed-method study of 224 secondary school students, 21 of whom were interviewed in detail, examined their perspectives on effective teacher characteristics in online EFL instruction. This study differed from earlier investigations of the qualities of effective teachers in terms of its research site and inquiry emphasis. The results of the surveys and interviews provided students’ judgments of effective teacher traits in terms of roles, professional abilities, personal qualities, and pedagogical expertise. According to the results of the polls, the most significant criteria for effective online learning management were instructors’ classroom management roles and their professional skills. The interviews stressed the importance of teachers’ qualities in managing classrooms and their pedagogical knowledge. In an online EFL instruction, students needed their teachers to scaffold them and explain what they should do with the lesson and the procedures they should follow for activities and assignments. In addition, the interviews validated teachers’ capacity to establish a favorable rapport with the students to facilitate their meaningful learning. As this study identified teachers’ professional abilities in managing online learning as a requirement, an online-learning-based professional development program for teachers is highly recommended as the most plausible alternative for the post-pandemic reflection of this current study.

Development and psychometric evaluation of nurse’s intention to care for patients with infectious disease scale: an exploratory sequential mixed method study

AimsNurses who care for patients with infectious disease may experince significant stress and negative psychological reactions. The intention of nurses to care is a complex and multifaceted concept that is influenced by a range of factors. Therefore, this study was conducted to explain the concept of nurses’ intention to care for patients with infectious disease and then develop a reliable and valid scale to measure this concept accurately in Iranian nurses.DesignThis study is a cross-sectional study with a sequential-exploratory mixed-method approach from May 2022 to July 2023. The concept of nurses’ intent to care for patients with infectious disease was explain using deductive content analysis, and item pools were generated. In the sconed step the samples were 455 nurses. Data was collected by an online form questionnaire using a convenience sampling technique. In this step to determine the psychometric properties of nurse’s intention to care for patients with infectious disease scale (NICPS), face and content validity performed. Then construct validity was determined and confirmed using exploratory and confirmatory factor analysis followed by convergent and divergent validity respectively. Finally, scale reliability including stability and internal consistency were evaluated.ResultsThe finding showed that NICPS with seventeen items were classified into three factors namely “Social support” with seven items, “Spiritual motivation” with six items and “Job satisfaction” with four items. These three factors explained 56.14% of the total variance. The fit indices showed that the model has a fit and acceptable (TLI, CFI, IFI > 0.9; PNFI, PCFI > 0.5, REMSEA > 0.049, CMIN/DF = 2.477). Reliability revealed acceptable internal consistency and stability (> 0.7).ConclusionThe finding showed that NICPS has three factors in Iranian nurses. Nursing managers can use these results to provide training and support intervention for nurses in order to increase their intention to care for this patient. Also, the NICPS is a reliable and valid for evaluating this concept in future studies.

What can we learn from general practitioners who left Spain? A mixed methods international study

BackgroundInternational mobility of health workforce affects the performance of health systems and has major relevance in human resources for health policy and planning. To date, there has been little research exploring the reasons why general practitioners (GPs) migrate. This mixed methods study aimed to investigate the reasons why Spain-trained GPs migrate and develop GP retention and recruitment health policy recommendations relevant to Spanish primary care.MethodsThe study followed an explanatory sequential mixed methods study design combining surveys with semi-structured interviews and focus groups with GPs who qualified in Spain and were living overseas at the time of the study. The survey data examined the reasons why GPs left Spain and their intention to return and were analysed using quantitative methods. The transcripts from interviews and focus groups centred on GPs’ insights to enhance retention and recruitment in Spain and were analysed thematically.ResultsThe survey had 158 respondents with an estimated 25.4% response rate. Insufficient salary (75.3%), job insecurity and temporality (67.7%), excessive workload (67.7%), poor primary care governance (55.7%), lack of flexibility in the workplace (43.7%) and personal circumstances (43.7%) were the main reasons for leaving Spain. Almost half of the respondents (48.7%) would consider returning to Spanish general practice if their working conditions improved. Interviews and focus groups with respondents (n = 24) pointed towards the need to improve the quality of employment contracts, working conditions, opportunities for professional development, and governance in primary care for effective retention and recruitment.ConclusionEfforts to improve GP retention and recruitment in Spain should focus on salary, job security, flexibility, protected workload, professional development, and governance. We draw ten GP retention and recruitment recommendations expected to inform urgent policy action to tackle existing and predicted GP shortages in Spanish primary care.

Theory-based development of a tailored implementation strategy tool to promote Early Essential Newborn Care practice: A protocol

ObjectivesWe aimed to develop an implementation tool that could help healthcare professionals identify modifiable factors and develop tailored implementation strategies to promote the implementation of Early Essential Newborn Care (EENC) under the guidance of the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change (CFIR-ERIC). Methods and analysisThis theory-informed implementation study consists two phases. In Phase 1, an exploratory sequential design mixed-methods study will be used to explore the barriers and facilitators to implementing EENC. The qualitative results will be analyzed using NVivo 12.0, underpinned by the Consolidated Framework for Implementation Research (CFIR), whereas the quantitative results being achieved through questionnaires and analyzed using SPSS26.0. In Phase 2, based on the findings of Phase 1, a tailored EENC implementation strategies tool will be developed through iterative expert consultations utilizing the CFIR-ERIC tool and the Implementation Research Logic Model (IRLM).

Deprescribing – a way to reduce inappropriate use of drugs for overactive bladder in primary care (DROP): protocol for a cluster-randomized controlled trial with an embedded explanatory sequential mixed-method study. (Preprint)

Deprescribing – a way to reduce inappropriate use of drugs for overactive bladder in primary care (DROP): protocol for a cluster-randomized controlled trial with an embedded explanatory sequential mixed-method study. (Preprint)

Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability.

To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.

Epidemiology and perceptions of non-fatal burns among select youth (15–24 years old) from Peshawar Pakistan; a sequential explanatory mixed methods study

PurposeBurns are among the top five cause of unintentional injuries among youth. We aimed to determine the incidence and risk factors of burns in select youth from Pakistan and also explored their perceptions about burns. MethodsA sequential explanatory mixed methods study was conducted which comprised of two phases. Phase 1 consisted of a cross-sectional quantitative survey (QUAN) in which 550 vocational school youth (15 to 24 years-olds) filled out the WHO community survey tool for injuries and violence and provided data on burns in previous 12 months (2021–22). Phase 2 consisted of qualitative (QUAL), in-depth interviews (IDIs) with participants selected from Phase 1 based on the occurrence of burns. STATA™ version 15.1 was used for Phase 1 data analysis and Zero-Inflated Negative Binomial regression was used for determining the Incidence Rate Ratio (IRR) of burns. Thematic analysis was performed for in-depth interviews from Phase 2. ResultsOut of 547 participants, 356 (65%) were males while 191 (35%) were females. Burns were reported by 85 participants (15%). A total of 137 counts of burns were reported showing multiple burns by some participants. The IRR for burns among young females was 2.89 (1.78–4.69) compared to males in the previous 12 months (2021–22). Age, sex, father’s education, and combined family income were significant risk factors for burns in youth. Six IDIs were conducted with burn victims, two were males while six were females. Four cooking-related burns, and two occupational burns during vocational training were reported. Themes that emerged from IDIs were internal and external factors, personal carelessness and lack of knowledge and safety about burns. Two sub-themes that were significant for recovery from burns were family support and access to healthcare. ConclusionYoung females are at a higher risk of burn injuries in Pakistan. Various social, demographic, and behavioral risk factors are associated with burns. Pre-burn and post-burn interventions are needed for prevention from burns in youth.

“If the food is finished after my brother eats then we (girls) sleep hungry.” Food insecurity and dietary diversity among slum-dwelling adolescent girls and boys in Pakistan: A mixed methods study

To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed methods study that included a survey of 391 girls and boys of 10–19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.

Parent Perceptions of Telemedicine for Acute Pediatric Respiratory Tract Infections: Sequential Mixed Methods Study.

Since 2020, parents have had increasing opportunities to use telemedicine for their children, but how parents decide whether to use telemedicine for acute pediatric care relative to alternative sites of care is not clear. One of the most common reasons parents seek acute care for their children is for acute respiratory tract infections (ARTIs). This study aims to examine parental expectations of care via telemedicine for pediatric ARTIs, contrasting expectations of care delivered via primary care telemedicine and direct-to-consumer (DTC) telemedicine. We performed a sequential mixed methods analysis to examine how parents assess telemedicine for their children's acute care. We used ARTIs as a case study for examining parent perceptions of telemedicine. First, we analyzed semistructured interviews focused on parent responses about the use of telemedicine. Each factor discussed by parents was coded to reflect whether parents indicated it incentivized or disincentivized their preferences for telemedicine versus in-person care. Results were organized by a 7-dimension framework of parental health care seeking that was generated previously, which included dimensions related to care sites (expected access, affordability, clinical quality, and site quality) and dimensions related to child or family factors (perceived illness severity, perceived child susceptibility, and parent self-efficacy). Second, we analyzed responses to a national survey, which inquired about parental expectations of primary care telemedicine, commercial DTC telemedicine, and 3 in-person sites of care (primary care, urgent care, and emergency department) across 21 factors identified through prior qualitative work. To assess whether parents had different expectations of different telemedicine models, we compared survey responses for primary care telemedicine and commercial DTC telemedicine using weighted logistic regression. Interview participants (n=40) described factors affecting their perceptions of telemedicine as a care modality for pediatric ARTIs. Generally, factors aligned with access and affordability (eg, decreased wait time and lower out-of-pocket cost) were discussed as potential incentives for telemedicine use, while factors aligned with perceived illness severity, child susceptibility, and clinician quality (eg, trustworthiness) were discussed as potential disincentives for telemedicine use. In survey responses (n=1206), primary care and commercial DTC telemedicine were rated similarly on items related to expected accessibility and affordability. In contrast, on items related to expected quality of care, primary care telemedicine was viewed similarly to in-person primary care, while commercial DTC telemedicine was rated lower. For example, 69.7% (weighted; 842/1197) of respondents anticipated their children would be comfortable and cooperative with primary care telemedicine versus 49.7% (weighted; 584/1193) with commercial DTC telemedicine (P<.001). In a mixed methods analysis focused on telemedicine for ARTIs, parents expressed more concerns about telemedicine quality in commercial DTC models compared with primary care-based telemedicine. These results could help health systems better design telemedicine initiatives to support family-centered care.

Development and psychometric evaluation of the questionnaire on the contributing factors of tendency towards voluntary single-childedness and childlessness: a mixed method study

Couples’ tendency towards voluntary single-childedness and childlessness (VSCC) has turned into a major challenge in all societies and led to different problems such as population aging. A key step to VSCC management is to determine its contributing factors through valid and reliable instruments. This exploratory sequential mixed method study (qualitative-quantitative) was conducted in 2020–2021. Phases of qualitative consists of all couples aged 15–49 in Babol, Iran, who were single or childless. Sampling is based on the purpose, and the number of samples is 20 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants. Sampling continued until data saturation. The data were analyzed by the conventional content analysis method and quantitative phase. Initially, a qualitative study was conducted on twenty couples, and were analyzed through conventional content analysis. Findings were used to develop QFT-VSCC and then, the face, content, and construct validity as well as reliability were assessed. Construct validity was assessed through exploratory and confirmatory factor analyses and reliability was assessed through internal consistency and stability assessments. The results of the qualitative part analysis consist of 140 codes, 30 primary categories, and nine main categories and two themes (individual limitations and social limitations). The primary QFT-VSCC had 78 items. Fifty-eight items were omitted during validity assessment and the remaining twenty-two items were loaded on five factors during factor analysis. These factors were threatened priorities, inappropriate familial context for childbearing, sense of occupational and social insecurity for the child, social modeling of childlessness, and tendency towards change or stability in marital life. The five factors explained 52.56% of the total variance. All model fit indices in confirmatory factor analysis were acceptable and the Cronbach’s alpha values of QFT-VSCC and all its factors were more than 0.70. The results of convergent validity analysis revealed that all factors had an AVE value greater than 0.5, and the HTMT index for all factors was less than 0.85. This indicated that discriminant validity had been achieved. QFT-VSCC is a simple valid and reliable instrument for VSCC assessment among both men and women.

Between now and later: a mixed methods study of HPV vaccination delay among Chinese caregivers in urban Chengdu, China

BackgroundAdolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls.MethodsQuantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen’s Behavioural Model for Health Services Use.ResultsA total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active.ConclusionIn urban areas, Chinese caregivers’ intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents.

The expectations and acceptability of a smart nursing home model among Chinese older adults: a mixed methods study

BackgroundSmart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China.MethodsThis was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi’an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs.ResultsThe newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p < 0.01), and good test-retest reliability for expectation (0.90) and acceptability (0.81). The highest tertile of expectations (X2=28.89, p < 0.001) and acceptability (X2=25.64, p < 0.001) towards SNHs were significantly associated with the willingness to relocate to such facilities. Older adults with self-efficacy in applying smart technologies (OR: 28.0) and those expressing a willingness to move to a nursing home (OR: 3.0) were more likely to have the highest tertile of expectations compared to those in the lowest tertile. Similarly, older adults with self-efficacy in applying smart technologies were more likely to be in the highest tertile of acceptability of SNHs (OR: 13.8).ConclusionsEASNH-Q demonstrated commendable validity, reliability, and stability. The majority of Chinese older adults have high expectations for and accept SNHs. Self-efficacy in applying smart technologies and willingness to relocate to a nursing home associated with high expectations and acceptability of SNHs.

Empowerment-based cognitive behavioural therapy for insomnia in persons with mild cognitive impairment: A sequential explanatory mixed-method pilot study.

Insomnia is an emerging risk factor for the onset of mild cognitive impairment (MCI) and its progression to dementia. Impaired cognition and neuropsychiatric symptoms create challenges for persons with MCI to participate actively in non-pharmacological interventions. This study examined the feasibility and preliminary effects of empowerment-based cognitive-behavioural therapy for insomnia (CBT-I) on sleep, cognitive function, and health-related quality of life (HRQoL) in persons with MCI and sleep problems. Sixty participants were randomly allocated to the intervention or control group to receive empowerment-based CBT-I or usual care, respectively. The 12 week intervention comprised all core CBT-I techniques delivered through a group and individualised face-to-face approach. An empowerment approach with interactive teaching methods, goal setting, and action planning was used to deliver the intervention. Outcome measures included subjective and objective sleep quality and pattern, and a battery of neuropsychological tests and the 12-item Short Form Survey were administered 3 months (T1) and 6 months post-randomisation (T2). This intervention is feasible and highly acceptable for persons with MCI. The intervention group showed significant improvements in subjective and objective sleep-related outcomes compared with the control group. Moreover, the intervention group showed greater improvements in global cognition, processing speed, attention, and mental flexibility than the control group at T1 and/or T2. No significant between-group differences were observed in memory or HRQoL scores. The qualitative data converged with the quantitative data. In conclusion, empowerment-based CBT-I was well received by persons with MCI and had potential positive effects on improving sleep and cognition in this cohort.

Barriers and facilitators to improving the cascade of HIV care in Ontario: a mixed method study

BackgroundEngagement in care is important for people living with HIV (PLH) to achieve optimal outcomes. Several strategies have been developed to improve client flow through the HIV care cascade, specifically targeting initiation of treatment, adherence to antiretroviral therapy (ART), retention in care, and engagement in care. We have previously identified effective care cascade strategies in a systematic review. Initiation of ART could be improved by mobile health interventions, and changes in healthcare delivery. Adherence to ART could be improved by mobile health interventions, incentives, counselling, and psychotherapy. Retention in care could be improved by mobile health interventions, incentives, education, and electronic interventions. The aim of this study was to investigate barriers and facilitators to implementing these effective interventions in HIV clinics in Ontario, Canada.MethodsWe conducted a sequential explanatory mixed methods study. In the quantitative strand, we administered a survey to health workers who provide care to PLH to identify barriers and facilitators. In the qualitative strand, we conducted in-depth interviews informed by the theoretical domains framework (TDF) with health workers and with PLH to explain our quantitative findings. Qualitative and quantitative data were merged to create meta-inferences.ResultsTwenty health workers from 8 clinics in 9 cities in Ontario took the survey. Nine PLH and 10 health workers participated in the qualitative interviews. Clinics in Ontario implemented all the effective interventions identified from the literature for initiation of treatment, adherence to ART, and retention in care despite concerns about resources. Barriers to physical and financial access to care, the workload for tailored care, and expertise were identified by both health workers and PLH. Key facilitators were virtual care and client preparedness through education and peer support.ConclusionClinics in Ontario appear to implement several evidence-based strategies to improve PLH engagement. There is a need for more health workers with skills to address unique PLH needs. Virtual care is beneficial to both health workers and PLH.

COVID-19, Online Learning, and Absenteeism in Detroit

How much school students attend is a powerful indicator of their well-being and a strong predictor of their future success in school. Prior research has documented the myriad in-school and out-of-school factors that contribute to high levels of student absenteeism, many emerging from the root causes of poverty and disengagement. The shift to online learning during the COVID-19 pandemic likely disrupted prior barriers to attendance and may have created new ones. This sequential explanatory mixed-methods study examined student absenteeism during the 2020–2021 school year in Detroit. We used administrative data to show whether and how attendance patterns changed, and we linked family survey and interview data to explain those patterns. We found that 70% of students were chronically absent, with 40% of parents reporting that computer problems contributed to absenteeism. While measures of socioeconomic disadvantage and computer/internet issues were associated with lower attendance and higher probability of chronic absenteeism, reported levels of hardship during the pandemic were not. Despite significant investment in technology, the district’s strategies for engaging students were not sufficient in overcoming economic hardships and the new challenges of online learning.

Development and psychometric testing of a questionnaire for assessment of medical science educators’ adherence to ethical principles in virtual education: exploratory sequential mixed methods study

BackgroundPrinciples of ethics are among the pillars of the teaching-learning system. Evaluation of educators’ adherence to principles of ethics in virtual education requires the use of reliable instruments. This study was carried out to develop and test the psychometric properties of a questionnaire for assessment of medical science educators’ adherence to principles of ethics in virtual education.MethodsThis is an exploratory sequential mixed methods study conducted in two parts. In the first stage (the qualitative phase), we used conventional content analysis to establish the concept of ethical principles in virtual education. Thus, 21 semi-structured, in-depth interviews were conducted with 21 medical science professors on a face-to-face basis from March 2022 to November 2022. Subsequently, we developed the items of the questionnaire based on a review of literature and semi-structured in-depth interviews. In the second stage (the quantitative phase), psychometric features of the questionnaire were evaluated using COSMIN criteria (face validity, content validity, construct validity and internal consistency).ResultsConstruct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 300 medical science professors, who were selected using convenience sampling. The results of exploratory factor analysis yielded a factor loading of the 20 items of the questionnaire to range between 0.79 and 0.98, all the values being significant. The three factors of adherence to the principles of copyright, adherence to educational principles, and justice in evaluation, which were addressed by the instrument, were verified by satisfactory values. The confirmatory factor analysis (CFA) fitted the data well (χ2/df = 13), RMSEA = 0.01, CFI = 0.96, NFI = 0.97, and TLI = 0.99. The total interclass correlation (ICC) of the questionnaire was estimated to be 0.90. Moreover, the reliability of the instrument measured in terms of internal consistency was estimated 0.98.ConclusionThe findings of the study indicated that the questionnaire we developed for evaluation of adherence to ethical principles of in virtual education was valid and reliable enough. Therefore, the managers in the education system can employ this instrument to assess medical science educators’ adherence to principles of ethics in virtual education.

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BackgroundVirtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students’ clinical judgment ability and understanding of nursing students’ experiences of the combined simulation.MethodsA sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.ResultsStudents in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students’ clinical judgment ability.ConclusionsThe integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students’ self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Use of the urine Determine LAM test in the context of tuberculosis diagnosis among inpatients with HIV in Ghana: a mixed methods study.

The urine Determine LAM test has the potential to identify tuberculosis (TB) and reduce early mortality among people living with HIV. However, implementation of the test in practice has been slow. We aimed to understand how a Determine LAM intervention was received and worked in a Ghanaian in-hospital context. Nested in a Determine LAM intervention study, we conducted a two-phase explanatory sequential mixed methods study at three hospitals in Ghana between January 2021 and January 2022. We performed a quantitative survey with 81 healthcare workers (HCWs), four qualitative focus-group discussions with 18 HCWs, and 15 in-depth HCW interviews. Integration was performed at the methods and analysis level. Descriptive analysis, qualitative directed content analysis, and mixed methods joint display were used. The gap in access to TB testing when relying on sputum GeneXpert MTB/Rif alone was explained by difficulties in obtaining sputum samples and an in-hospital system that relies on relatives. The Determine LAM test procedure was experienced as easy, and most eligible patients received a test. HCWs expressed that immediate access to Determine LAM tests empowered them in rapid diagnosis. The HCW survey confirmed that bedside was the most common place for Determine LAM testing, but qualitative interviews with nurses revealed concerns about patient confidentiality when performing and disclosing the test results at the bedside. Less than half of Determine LAM-positive patients were initiated on TB treatment, and qualitative data identified a weak link in the communication of the Determine LAM results. Moreover, HCWs were reluctant to initiate Determine LAM-positive patients on TB treatment due to test specificity concerns. The Determine LAM intervention did not have an impact on the time to TB treatment as expected, but patients were, in general, initiated on TB treatment rapidly. We further identified a barrier to accessing TB treatment during weekends and that treatment by tradition is administrated early in the morning. The Determine LAM testing was feasible and empowered HCWs in the management of HIV-associated TB. Important gaps in routine care and Determine LAM-enhanced TB care were often explained by the context. These findings may inform in-hospital quality improvement work and scale-up of Determine LAM in similar settings.

Library space design to promote student engagement: A comparison of graduate and undergraduate students

This article explores the library space needs and wants of graduate and undergraduate students at a medium-size state University in Southwest Florida. The researcher conducted a sequential explanatory mixed methods study in which they administered a survey to all currently enrolled graduate and undergraduate students at the university and followed up with semi-structured interviews to better understand students library space needs/wants and how those elements contribute to student success through a lens of academic and social engagement. The researcher identified several library space needs that were common to both graduate and undergraduate students including: comfortable and functional furniture, a variety of study spaces including a mix of individual and group spaces, conducive noise levels, technology, whiteboards, windows to let in natural light, seclusion food and drink options nearby, safety and security, adequate lighting and electrical outlets, and effective wayfinding. An additional need of separate graduate student space was also identified. Findings from this study can help inform the design of library spaces to better support student success through engagement.

Factors intervening in the childbirth experience: a mixed-methods study

ObjectiveTo analyze the childbirth experience focusing on the intervening factors and on the delivery method.MethodA sequential and explanatory mixed-methods study guided by the World Health Organization document for positive childbirth experiences. The participants were puerperal women in a maternity teaching hospital from inland São Paulo (Brazil). The first quantitative stage involved descriptive analysis with Poisson regression of 265 answers to the “Termômetro da Iniciativa Hospital Amigo da Mulher e da Criança” (“Women- and Baby-Friendly Hospital Initiative Thermometer”) questionnaire. The second stage, qualitative, thematically analyzed the interviews conducted with 44 puerperal women who took part in the first stage. Data integration was by connection.The results and discussionThe analysis by connection showed that among the factors that restricted the positive experience, C-section was predominant (61.9%), understood as an option due to fear of pain, the treatment modality and previous traumas. Restrictions referring to the presence of a companion (99.6%), not having privacy (83%), disrespectful situations (69.5%), too many touches (56.9%) and the absence of skin-to-skin contact (55%), among others, potentiated fear, loneliness, concern, shame, the perception of disrespect and insecurity with the assistance provided. The promoting factors were as follows: choosing the companion (95.4%) for collaborating in the safety perception, not having infections (83.9%), having continuous team monitoring (82.2%) and pain relief methods (78.9%), which were valued by the women.ConclusionThe intervening factors that promoted positive experiences were related to clinical and protocol-related issues and to service availability. The restrictive factors were associated with excess interventions, deprivation of rights and of choice, absence of privacy and restriction referring to the presence of a companion. Women with a normal postpartum period felt more insecure and disrespected when compared to those subjected to C-sections, whose choices were considered, although they had lower prevalence of skin-to-skin contact. There is an urgent need to apprehend women's experiences and turn them into actions that guarantee their lives in a safe and respectful way.