The effects of concept care maps on critical thinking in baccaalureate nursing students

The purpose of this study with first year Baccalaureate nursing students was to test the effects of care mapping strategies on critical thinking skills. In a constantly evolving field of nursing, it is important that new graduates are able to assimilate assessment data and use critical thinking to derive sound clinical judgement. Concept mapping is believed to support this endeavor

Making a SPLASH for WASH in schools in Zambia

Zambia has a burgeoning primary school population, but its schools do not provide safe drinking water or adequate sanitation facilities that address the special needs of disabled children and girls entering puberty. USAID/Zambia has a long commitment to Zambia’s education sector. In 2011, it invested in a five-year program called SPLASH (Schools Promoting Learning Achievement through Sanitation and Hygiene) to address the critical WASH needs in schools in four districts of Eastern Province. The comprehensive approach includes construction or rehabilitation of water points and toilets; hygiene education for pupils and training for teachers; sustainability through Ministry of Education (MOE) systems strengthening including EMIS and budget line items; and steady advocacy for institutionalizing WASH within the MOE. In spite of challenges related to geography and bureaucracy, SPLASH has advanced the visibility of school WASH through installations, advocacy, and partnering events that enlist everyone’s contribution to making WASH in schools a reality

Heteronormativity and prostate cancer: a discursive paper

Aims and objectives To discuss the risks that heteronormative assumptions play in prostate cancer care and how these may be addressed. Background There is international evidence to support the case that LGBT cancer patients are less likely to report poor health or self-disclose sexual orientation. Gender-specific cancers, such as prostate cancer, require particular interventions in terms of supportive care. These may include advice about side-effect management (such as incontinence or erectile dysfunction), treatment choices and social and emotional issues. In this paper we discuss and analyse the heteronormative assumptions and culture that exist around this cancer. We argue that this situation may act as a barrier to effective supportive care for all LGBT patients, in this case MSM (men who have sex with men). Design Theoretical exploration of heteronormativity considered against the clinical context of prostate cancer. Methods Identification and inclusion of relevant international evidence combined with clinical discussion. Results This paper posits a number of questions around heteronormativity in relation to prostate cancer information provision, supportive care and male sexuality. Whilst assumptions regarding sexual orientation should be avoided in clinical encounters, this may be difficult when heteronormative assumptions dominate. Existing research supports the assertion that patient experience, including the needs of LGBT patients, should be central to service developments. Conclusion Assumptions about sexual orientation should be avoided and recorded accurately and sensitively, and relational models of care should be promoted at the start of cancer treatment in an appropriate manner. These may assist in reducing the risks of embarrassment or offence to non-heterosexual patients, or to professionals who may adopt heteronormative assumptions. Relevance to clinical practice Having an awareness of the risks of making heteronormative assumptions in clinical practice will be useful for all health professionals engaged in prostate cancer care. This awareness can prevent embarrassment or upset for patients and ensure a more equitable provision of service; including men with prostate cancer who do not identify as heterosexual

Linking child travel routes and routine health data

ABSTRACT Objectives Linking routinely collected health and environment data can allow for large scale evaluations of how our environment impacts our health. Our data linkage approach advances previous research where residence-based environmental exposures were anonymously linked in the SAIL databank using Residential Anonymous Linking Fields (RALFs). The dose-response relationship between exposure to food and dietary intake has not been widely investigated. Previous research found conflicting views on whether increased environmental exposure to unhealthy food contributes to higher BMIs. This may have been due to different methodological approaches, including imprecise exposures, small numbers, and the use of self-reported BMIs. Approach This investigation calculated food exposure environments for routes from all homes to and from school. A Geographic Information System was used to calculate the environmental exposures along all potential routes up to a maximum age-appropriate walking distance from each school. Once within the SAIL databank we selected relevant routes using linked demographic and pupil datasets. To maintain privacy, the primary (doctoral) researcher generating the environmental exposures, did not have access to the final household-level exposure data in their identifiable form. The researcher automated their method so a second researcher could run the GIS analysis. Accuracy of modelled exposures will be compared with actual routes collected from GPS traces of children walking to school. Results Removing access to the final identifiable household-level route exposures enabled the primary researcher to complete analysis on the combined household and individual-level data within the secure environment. The environmental exposures were linked with routine health data from the SAIL databank; including BMI as an indicator of obesity. BMI data for 4-5 year olds, and a sample of 1300 13-14 year olds were linked to associated environmental exposures. Conclusion Depending on modelled accuracy, a GIS and data linkage approach may allow the investigation of natural experiments and intervention evaluation at the scale of the total population. This is the first step towards anonymously modelling part of the daily exposure environment using routine data. A limitation is the lack of routinely collected BMI data for older children and teenagers an age when they are more likely to have the option to choose to buy food on the school route. This work will have many potential applications, including the delivery and evaluation of multiple school and workplace commuting interventions

Clarifying workforce flexibility from a division of labor perspective: A mixed methods study of an emergency department team

Background: The need for greater flexibility is often used to justify reforms that redistribute tasks through the workforce. However, flexibility is never defined or empirically examined. This study explores the nature of flexibility in a team of emergency doctors, nurse practitioners (NPs), and registered nurses (RNs), with the aim of clarifying the concept of workforce flexibility. Taking a holistic perspective on the team\u27s division of labor, it measures task distribution to establish the extent of multiskilling and role overlap, and explores the behaviors and organizational conditions that drive flexibly. Methods: The explanatory sequential mixed methods study was set in the Fast Track area of a metropolitan emergency department (ED) in Sydney, Australia. In phase 1, an observational time study measured the tasks undertaken by each role (151 h), compared as a proportion of time (Kruskal Wallis, Mann-Whitney U), and frequency (Pearson chi-square). The time study was augmented with qualitative field notes. In phase 2, 19 semi-structured interviews sought to explain the phase 1 observations and were analyzed thematically. Results: The roles were occupationally specialized: Assessment and Diagnosis tasks consumed the largest proportion of doctors\u27 (51.1%) and NPs\u27 (38.1%) time, and Organization of Care tasks for RNs (27.6%). However, all three roles were also multiskilled, which created an overlap in the tasks they performed. The team used this role overlap to work flexibly in response to patients\u27 needs and adapt to changing demands. Flexibility was driven by the urgent and unpredictable workload in the ED and enabled by the stability provided by a core group of experienced doctors and nurses. Conclusion: Not every healthcare team requires the type of flexibility found in this study since that was shaped by patient needs and the specific organizational conditions of the ED. The roles, tasks, and teamwork that a team requires to be flexible (i.e., responsive and adaptable) are highly context dependent. Workforce flexibility therefore cannot be defined as a particular type of reform or role; rather, it should be understood as the capacity of a team to respond and adapt to patients\u27 needs within its organizational context. The study\u27s findings suggest that solutions for a more flexible workforce may lay in the organization of healthcare work. © 2020 The Author(s)

Perceptions of prostate cancer risk in white working class, African-Caribbean and Somali men living in south east Wales: a constructionist grounded theory

Abstract Background: Men of African and African-Caribbean origin (black men) have twice the risk of prostate cancer compared to that of white men (UK National Screening Committee 2014), and are more likely to be diagnosed with an aggressive form of prostate cancer (Benarif and Eeles 2016). Despite this, black men are underrepresented in prostate cancer clinics when compared to other men. The reasons for this appear complex and may be related to the high number of black minority ethnic populations living in areas of deprivation, and to the cultural understandings of prostate cancer risk. Aims: This research aimed to understand the differences in perceptions of prostate cancer risk between black and white men without a diagnosis of cancer, living in areas of deprivation in South East Wales. Methods: This research used a constructivist grounded theory methodology to examine the men’s understanding of prostate cancer risk through their everyday lives. A total of 17 men took part in semi-structured interviews and a further 17 men took part in three focus groups during 2015. Data analysis followed the fluidity of constructivist grounded theory methodology and this allowed for changes to the data collection method during theory generation. Discussion: This research has generated theory relating to masculinity, embodiment and Bourdieu’s field and habitus theory. The social construction of the body is seen as important in understanding the ways in which men are socialised to understand and accept their risk for prostate cancer. Conclusion: This research has added to our understanding of social differences in constructions of the body. This work has influenced thinking of how men might differently understand their risk for prostate cancer as related to their expectations and social experiences. The clinician is encouraged to consider these differences in their interactions with patients. Recommended reading list Benarif, S. and Eeles, R. 2016. Genetic predisposition to prostate cancer. British Medical Bulletin 120, pp. 75-89 UK National Screening Committee. 2014. UK NSC prostate cancer screening recommendation. www.legacyscreening.phe.org.uk/prostatecancer: NHS England