An exploration of how domains of quality of care relate to overall care experience

Purpose: To determine the relative influence of the different domains of healthcare quality from the Care Experience Feedback Improvement Tool and identify key predictors of healthcare quality from the patients’ perspective. Measurement is necessary to determine whether quality of healthcare is improving. The Care Experience Feedback Improvement Tool was developed as a brief measure of patient experience. It is important to determine the relative influence of the different domains of healthcare quality to further clarify how the Care Experience Feedback Improvement Tool can be used and identify key predictors of healthcare quality from the patients’ perspective. Methods: 802 people with a healthcare experience during the previous 12 months were telephoned to complete the Care Experience Feedback Improvement Tool questions and an additional eleven-point global rating of patient experience. To estimate the influence of different domains of healthcare quality on patient overall ratings of quality of healthcare experience, we regressed the overall rating of patient experience with each component of quality (safety, effectiveness, timely, caring, enables system navigation and person-centred). Findings: We found that all of the domains of the Care Experience Feedback Improvement Tool, influenced patient experience ratings of healthcare quality. Specifically, results show the degree of influence, the impact of demographics and how high scores for overall rating of patient experience can be predicted. Originality: Our findings suggest that all of the Care Experience Feedback Improvement Tool domains are important in terms of capturing the wholeness of the patient experience of healthcare quality to direct local quality improvement

True Theatricality: What Separates Live Theatre from All Other Entertainment

In order to better understand the art of live theatre in comparison to its many counterparts, an in-depth study of the elements of live theatre that separate it must be accomplished. Through Aristotle’s The Poetics, to many contemporary studies of theatricality, to recent scripts incorporating those elements and effectively using them, the analysis of theatricality can be applied to an original script of its own kind. Some elements that have been discovered are double casting, expression through song, and even a break in the classic two act structure. The application of these elements of theatricality present a lot more issues to be examined. Do these elements even bring in the audiences, or is there something else that drives them in

Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a systematic review utilising Bradford Hill criteria and meta-analysis of prospective cohort studies

BACKGROUND: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. AIM: The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. METHODS: Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. RESULTS: The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings. CONCLUSIONS: This original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive. Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012003143

Exploring barriers to care home research recruitment during the COVID-19 pandemic:The influence of social media recruitment posts and public sentiment

IntroductionRecruitment of care home staff to research studies is recognised as challenging. This was further exacerbated by the COVID-19 pandemic and the associated negative media portrayal of care home workers. Social media use has surged since the onset of COVID-19 lockdowns, offering a plausible approach to understanding the barriers to care home research recruitment and gaining insight into public perceptions of care home workers.AimTo utilise comments from two Facebook recruitment posts to: 1) gain an understanding of potential barriers to recruitment of healthcare workers (HCWs) in UK care homes, and 2) explore public sentiment towards care home research and care homes in the context of the COVID-19 pandemic.MethodsThis cross-sectional study analysed comments from two Facebook posts (available June-October 2021) advertising a separate study on psychological support for care staff during the pandemic. This study was situated within a larger investigation into the mental health and wellbeing of care home staff and employed both qualitative analysis and quantitative methods (word count and correlations between words used and between posts).ResultsThree themes were identified from the qualitative analysis: support, mistrust and blame. There was a greater use of words associated with support and negative emotive words in post 2. Post 2 comments featured significantly more choice words and first-person singular pronouns than post 1 which indicated a resentful sentiment from those who advocate freedom of choice and control. Discussion of mistrust towards researchers was most prominent in post 1 indicating the importance of relationship building between researchers and HCWs in UK care homes. With attribution to blame, there was a larger range of negative emotion words than positive emotion words.Discussion and conclusionTaken together our findings offer novel insights into why recruitment to care home research during the pandemic including the use of social media might be problematic. Social media is a useful tool for recruitment but should not be considered as a one-time input. Researchers should pro-actively engage with the study population from the start using co-design with resident and public groups to support recruitment and ensure these populations are accurately represented within research

Time, fear and transformation: Student nurses' experiences of doing a practicum (quality improvement project) in practice

Background  Improving and sustaining quality in healthcare continues to be a global challenge, resulting in the necessity of developing quality improvement (QI) skills and knowledge to use in practice. This paper reports student nurses' experiences of conducting a quality improvement project (Practicum) as a compulsory assessment whilst on clinical placement areas across Scotland.  Methods  Telephone and face-to-face interviews (n=18) were conducted using a semi-structured interview schedule. Discussions were transcribed verbatim and data were analysed thematically. Data were extracted from Practicum assignments (n=50).  Results  Three key themes emerged from the analysis: 1) Time; students highlighted the necessity of time in practice areas to acclimatise, socialise and conduct the Practicum. Timing of the Practicum within the curriculum was also important. 2) Fear; was experienced by many students at the perceived enormity of the assignment, the bravery needed to attempt to change practice and the adjustment to a unique type of assignment. 3) Transformation; students shared their shifted perceptions on completing a Practicum, including a sense of achievement and acknowledgement of key improvement skills for the future.  Conclusions   Student nurses need to be stretched beyond their comfort zones to rise to the challenge of the Practicum, whilst ensuring adequate support mechanisms are in place from a range of sources

Knockdown of the survival motor neuron (Smn) protein in zebrafish causes defects in motor axon outgrowth and pathfinding

Spinal muscular atrophy (SMA) is an autosomal recessive disorder characterized by a loss of α motoneurons in the spinal cord. SMA is caused by low levels of the ubiquitously expressed survival motor neuron (Smn) protein. As it is unclear how low levels of Smn specifically affect motoneurons, we have modeled SMA in zebrafish, a vertebrate model organism with well-characterized motoneuron development. Using antisense morpholinos to reduce Smn levels throughout the entire embryo, we found motor axon–specific pathfinding defects. Reduction of Smn in individual motoneurons revealed that smn is acting cell autonomously. These results show for the first time, in vivo, that Smn functions in motor axon development and suggest that these early developmental defects may lead to subsequent motoneuron loss

“I know exactly what I'm going into”: recommendations for pre-nursing experience from an evaluation of a pre-nursing scholarship in rural Scotland.

AimTo develop a model of pre-nursing experience from evaluation of a pre-nursingscholarship for school pupils in Scotland.DesignAction research study.MethodsSchool pupils (n = 42) completed questionnaire surveys and participated inanecdote circles. Student nurses acting as pupil ‘buddies’ (n = 33) participatedin focus groups. Descriptive quantitative data and thematic analyses of qualitativedata were integrated across cohorts and campuses.ResultsTen recommended components of a model of pre-nursing experience wereidentified: educational experience of: (1) face-to-face on-campus teaching; (2)hands-on clinical skills sessions; and (3) andragogy, practice exposure to (4)nursing language; (5) nurses’ emotional labour; (6) patients’ stories; (7) pupilssocializing with buddies; (8) buddies planning placement activities; and (9) supportingpupils during placements. Academic attainment was not a central componentof the model due to pupils’ need to (10) prioritize examined work forfurther/higher education entry

Transition into remote and rural nurse education and careers: a qualitative study of student nurses

Background: Global nurse shortages present a threat to the sustainability of remote and rural healthcare. Interventions have been developed to support recruitment and retention of nurses that focus on providing pre-nursing experience for school pupils who intend to pursue nursing careers. However, there is a lack of evidence around how pre-nursing experience supports transition into nurse education.Aims: To explore the impact of a pre-nursing scholarship for school pupils in remote and rural areas of Scotland on experiences of transition into nurse education.Methods: Qualitative study involving semi-structured telephone and face-to-face interviews with pre-nursing scholarship participants.Results: An authentic pre-nursing experience supported school pupils’ transition to nurse education. First, it increased students’ self-efficacy, both in their decision to choosing nursing as a career and their ability to nurse. Second, it helped students to realise that the opportunity to study closer to home was available to them. Third, it supported students’ educational and social integration, helping them feel prepared for university teaching and learning approaches and the social experience of being a student.Conclusions: Pre-nursing experience can support transition into nurse education and contribute to career pathways that support recruitment and retention of nurses in remote and rural areas