Can a web-based community of practice be established and operated to lead falls prevention activity in residential care?

The aims of this study were to evaluate establishing and operating a web-based community of practice (CoP) to lead falls prevention in a residential aged care (RAC) setting. A mixed methods evaluation was conducted in two phases using a survey and transcripts from interactive electronic sources. Nurses and allied health staff (n = 20) with an interest in falls prevention representing 13 sites of an RAC organization participated. In Phase 1, the CoP was developed, and the establishment of its structure and composition was evaluated using determinants of success reported in the literature. In Phase 2, all participants interacted using the web, but frequency of engagement by any participant was low. Participatory barriers, including competing demands from other tasks and low levels of knowledge about information communication technology (ICT) applications, were identified by CoP members. A web-based CoP can be established and operated across multiple RAC sites if RAC management support dedicated time for web-based participation and staff are given web-based training

Factors influencing the implementation, adoption, use, sustainability and scalability of mLearning for medical and nursing education: a systematic review protocol

Background: mLearning is increasingly presented as an attractive novel educational strategy for medical and nursing education. Yet, evidence base for its effectiveness or factors which influence use, success, implementation or adoption are not clear. We aim to synthesise findings from qualitative studies to provide insight into the factors (barriers and facilitators) influencing adoption, implementation and use of mobile devices for learning in medical and nursing education. The review also aims to identify factors or actions which are considered to optimise the experience and satisfaction of educators and learners in using mobile technologies for medical and nursing education and to identify strategies for improving mLearning interventions for medical and nursing education. / Methods: A systematic search will be conducted across a range of databases for studies describing or evaluating the experiences, barriers, facilitators and factors pertaining to the use of mLearning for medical and nursing education. The framework synthesis approach will be used to organise and bring different components of the results together. The confidence in the qualitative review findings will be assessed using the CERQual approach. / Discussion: This study will contribute to the planning and design of effective mLearning and the development of mLearning guidelines for medical and nursing education. / Systematic review registration: PROSPERO CRD4201603541

Evaluating the impact of a falls prevention community of practice in a residential aged care organisation

Falls in the residential aged care (RAC) sector are a global concern with humanitarian and economic consequences. Reducing falls using a multifactorial approach involving multidisciplinary staff is recommended, but it is not clear how RAC organisations in Australia can achieve this in a resource constrained environment. One potential solution is to develop a sustainable means of addressing falls prevention from within an organisation, creating a forum for staff to share ideas, expertise and achieve goals in a community of practice (CoP). The purpose of this research was to evaluate the impact of a falls prevention CoP on falls outcomes in a RAC setting. A mixed methods design framed by a realist approach was undertaken, to better understand how CoP interventions were influenced by current conditions (contexts) in triggering (mechanisms) the observed outcomes. Diverse data sources including surveys, electronic CoP discussion transcripts, semi-structured interviews and organisational falls data were used to triangulate findings. The CoP was mapped across three phases. Phase 1 described how the CoP was developed, then evaluated its establishment and operation across 13 geographically diverse RAC sites. In Phase 2 the CoP identified gaps in falls prevention practice using evidence-based audit and feedback, determining the areas for priority intervention. Phase 3 comprehensively evaluated the impact of CoP activity at three levels; member, site and organisation. Overall the CoP had a positive impact; members gained new peer connections and falls prevention knowledge, the proportion of residents supplemented with vitamin D improved significantly and a falls prevention policy and risk assessment tool were developed and implemented across the organisation. Management recognition and support were key mechanisms in achieving successful outcomes. Falls rates pre CoP were 10.1/1000 occupied bed days (OBD) compared with 10.9 /1000 OBD post CoP operation [coefficient 0.7, 95% CI (-33.5, 34.9) p = .967]. This was potentially confounded by an increased use of beds for short stay transition care services and identified differences in defining falls between sites. A downward trend in the rate of injurious falls resulting in fractures was observed (pre CoP 0.2/1000 OBD compared with 0.1/1000 OBD post CoP; [coefficient -0.3, 95% CI (-1.1, 0.4) p = .423]. As the prioritised CoP interventions required design and development, implementation only occurred towards the end of the research period meaning the intervention effect on falls outcomes may require longer term follow up. The CoP remains operational and is ideally positioned to continue to lead evidence-based falls prevention practice change as determined by its membership

Incorporating innovations into practice: Professional learning of genetic counselors

Genetic counselors are healthcare professionals who work with patients and families affected by or at risk for conditions with a genetic cause or component. They act as purveyors of genetic and genomic testing and support the translation of test results into targeted and personalized medical care. Innovations, which arise and are introduced into practice continuously, compel genetic counselors to update their skills, knowledge, and approach quickly to ensure adequate and appropriate care of patients. The purpose of this study was to explore the professional learning strategies utilized by genetic counselors, with particular attention to learning which occurs in response to innovation. Utilizing critical incident questionnaires, interviews, and a database of credits accrued for continuing education, this study sought to contribute to a detailed understanding of genetic counselors’ professional learning and how strategies may vary by specialty or years of experience. Genetic counselors were found to utilize reflection to identify learning needs arising within uncertain, complex, and ambiguous circumstances of practice, and match those needs to appropriate learning strategies. Prized learning strategies included reading to gather information, discussion with colleagues to curate alternative perspectives and past experiences, and experimentation to actively test ongoing apprehension. Through strategies which were permeable, complementary, and active, genetic counselors demonstrated their abilities to synergize learning, practice, and novel, complex, ambiguous, and uncertain environments

Imagen Vascular, una nueva app médica con fines docentes

Antecedentes: Las aplicaciones de alta calidad diseñadas por los clínicos con experiencia vascular están faltando actualmente y representan un área de preocupación en el mercado del m-Health. Objetivos: 1. Principal: Reunir y comunicar el contenido y los hallazgos radiológicos obtenidos en pruebas de imagen de una colección de casos de escasa casuística y complejidad diagnóstica, bajo el formato de una app médica gratuita e interactiva, una herramienta on line y off line que lleva por nombre “IMAGEN VASCULAR”. 2: Secundario: Conocer la opinión de los profesionales sanitarios sobre los contenidos y el propósito de la aplicación, así como el impacto e implicación que esta app de aprendizaje ha tenido en el manejo clínico-radiológico del paciente. Metodología: Fase 1. Estudio observacional descriptivo longitudinal. Serie de casos. Creación de base de datos en formato app. (n>65). Fase 2. Evaluación de la utilidad de la app mediante una encuesta. Estudio observacional descriptivo transversal. Muestreo no probabilístico discrecional. (n>50) [grupo A: médicos adjuntos; grupo B: médicos residentes]. Los datos se analizan con spss 15. Estudio de la consistencia interna del test y comparación entre grupos mediante la X2 de Pearson para variables categóricas. Resultados: Informamos que el hardware no es un problema para el acceso a aplicaciones móviles médicas en la comunidad médica. Al 42,4% de la muestra le da vergüenza utilizar el móvil delante del paciente. El índice Alfa de Cronbach nos indica que el cuestionario es aceptable para lo que se pretendía medir, con un valor muy cercano a bueno de consistencia. Curiosamente, el uso de dispositivos móviles para el estudio fue significativamente mayor en el grupo de adjuntos. Conclusiones: Nuestro estudio indica que el acceso libre y oportuno a la aplicación móvil “IMAGEN VASCULAR” apoya el aprendizaje de médicos adjuntos y residentes. La aplicación se utilizó estratégicamente para complementar otros métodos de aprendizaje. Algunos médicos también usaron la aplicación móvil para consolidar su enfoque diagnóstico. Aún falta investigación en este campo

The impact of midwife moderated social media based communities on pregnant women and new mothers

This PhD study examines the impact of moderated social media based groups for pregnant women on the provision of information and support. During pregnancy and early motherhood, women need information and support from health professionals, other pregnant women and mothers. Whilst women have access to overwhelming amounts of information they may not have contact with, or support from, other pregnant women and new mothers. Such relationships are fundamental for a supported transition to motherhood. This thesis explores the concept of Communities of Practice as a framework for social learning, and seeks to explore if and how Communities of Practice can develop from online groups to improve information provision and support for pregnant women and new mothers. A qualitative methodology, with a modified action research component, was used to explore women’s experiences, the concept of Communities of Practice and the potential for their emergence from an online group. Two midwife moderated online groups were created with 31 pregnant women (n=17, n=14). Data were collected using focus groups (k=8) every 3 months and individual interviews (k=28) in the early postnatal period. A thematic analysis framework, informed by Communities of Practice theory, was used to interrogate the different data at different points in time. This generated process findings on which to act; and new knowledge to understand whether and how a Communities of Practice approach could be adopted as a new model of support within midwifery. The key findings show that women will engage with midwives and other pregnant women through social media and doing so improves their pregnancy experience. Information and support needs can be met through such groups and, furthermore, midwifery relational continuity can be achieved. Communities of Practice can emerge from online groups but they are not essential for information and support needs to be met, or for relational continuity. However, Communities of Practice can provide greater information convergence and the potential for sustained relationships. Mutual engagement is the key Community of Practice dimension which differentiated the groups and signified that one group had evolved into a Community of Practice. Midwife moderated social media based groups may provide a solution for service providers who thus far have struggled to provide relational continuity which is vital for quality, but so often lacking from traditional models of maternity care