Mentoring Graduate Students to Become Effective Teaching Assistants: Developing and Implementing a Student-Centred Program for Nursing

Teaching in the health professions, including nursing, requires specialized educational strategies that meet the needs of the current generation of learners. Currently there is a shortage of experienced post-secondary educators in nursing, possibly exacerbated by inadequate Teaching Assistant (TA) professional development programs. Most literature describes TA professional development programs that involve undergraduate students employed as TAs, and few consider how programs can mentor graduate students to develop their instructional skills, contribute to courses, and enhance their careers. There are limited reports in the Canadian context. In this article we outline the rationale, development, and implementation of a Graduate Teaching Assistant (GTA) mentorship program for graduate students at a school of nursing located in western Canada. Our aim is to provide mentorship and experience in educational strategies to graduate students, to help mentor and educate future nursing educators who are experienced post-secondary teachers. We discuss the rationale for offering the GTA mentorship program, followed by a description of the GTA mentorship program components. We highlight the role of the Senior TA, an experienced GTA who takes a leadership role in coordinating the program. Importantly, we discuss how knowledge related to cultural safety is presented, and how it has been adapted over time to meet GTAs’ needs. Finally, we discuss the evolution of a school of nursing GTA mentorship program, located in western Canada and we describe future changes to the program in order to remain relevant to the needs of graduate students in nursing, faculty and administration, and undergraduate nursing students. L’enseignement dans les professions de la santé, y compris les sciences infirmières, nécessite des stratégies pédagogiques répondant aux besoins de la génération actuelle d’apprenantes. Nous connaissons actuellement une pénurie d’enseignantes en sciences infirmières, possiblement aggravée par l’inadéquation des programmes de développement professionnel pour les auxiliaires d’enseignement (Teaching Assistant; TA). La littérature sur le sujet décrit surtout les programmes de développement professionnel pour les étudiantes de premier cycle qui sont embauchées comme auxiliaires d’enseignement; peu considèrent la façon dont les programmes peuvent soutenir les étudiantes des cycles supérieurs pour leur permettre de développer leurs habiletés d’enseignement, de contribuer aux cours, et d’améliorer leurs perspectives de carrière. Peu de rapports font état du contexte canadien. Dans cet article, nous justifions et exposons brièvement l’élaboration et la mise en œuvre d’un programme de mentorat pour les auxiliaires d’enseignement qui sont étudiantes aux cycles supérieurs (Graduate Teaching Assistant; GTA) dans une école de sciences infirmières de l’Ouest canadien. Notre objectif est d’offrir du mentorat ainsi qu’une expérience permettant à des étudiantes des cycles supérieurs de pratiquer des stratégies pédagogiques, afin de contribuer à la formation de nouvelles enseignantes chevronnées en sciences infirmières. Nous présentons le rationnel pour offrir un tel programme de mentorat pour les étudiants des cycles supérieurs et en décrivons les composantes. Nous soulignons le rôle de l’auxiliaire sénior, une auxiliaire expérimentée jouant un rôle de leader dans la coordination du programme. Chose importante, nous discutons de la manière de présenter les connaissances sur la sécurité culturelle, ainsi que de l’adaptation au fil du temps pour répondre aux besoins des auxiliaires d’enseignement. Enfin, nous abordons l’évolution du programme de mentorat pour les étudiantes des cycles supérieurs d’une école de sciences infirmières de l’Ouest du Canada; nous décrivons également les changements qui seront apportés au programme, afin qu’il réponde toujours aux besoins des étudiantes des cycles supérieurs en sciences infirmières, du corps professoral, de la direction et des étudiantes du premier cycle

Family physicians’ and trainees’ experiences regarding cancer screening with patients with intellectual disability: an interpretive description study

People with intellectual disability receive breast, cervical, and colorectal cancer screening at lower rates relative to the general population, although the reasons for this disparity are largely unknown. Research, both with the general population and specific to people with intellectual disability, has revealed that a family physician’s recommendation for cancer screening or continuity of primary care may increase screening rates. We interviewed family physicians and family medicine trainees regarding their experiences recommending cancer screening to patients with intellectual disability. We concluded that the decision to recommend cancer screening is complex, and includes physicians weighing their clinical judgement as to the best provision of care for patients with a patient’s eligibility for screening, while continuing to respect patients’ autonomy. This patient-physician interaction occurs within the larger medical environment. Further research with experienced family physicians is warranted to better understand this complex phenomenon

Primary care providers’ attitudes and experiences recommending cancer screening to patients with Intellectual Disabilities

Individuals with Intellectual Disabilities receive breast, cervical, and colorectal cancer screening at rates lower than the general population. The reasons for this disparity are poorly understood. Additionally, in the general population, a primary care provider’s recommendation for cancer screening is one of the key determinants of whether an individual obtains cancer screening. This mixed methods study explored the role of primary care providers in recommending cancer screening to patients with Intellectual Disabilities. First, 106 primary care providers (family physicians, family medicine residents, and nurse practitioner students from across British Columbia) were surveyed regarding their attitudes towards people with Intellectual Disabilities in general, and their anticipated likelihood of recommending breast, cervical, and colorectal cancer screening to fictional patients with Intellectual Disabilities presented in vignettes. In the second phase, 10 family medicine residents and two family physicians were interviewed regarding their experiences recommending cancer screening to patients with Intellectual Disabilities. The quantitative and qualitative analysis revealed that: (1) participants with negative attitudes towards the community inclusion of individuals with Intellectual Disabilities were less likely to recommend breast and colorectal cancer screening to fictional patients with Intellectual Disabilities; and (2) participants balance applying evidence-based guidelines with exercising clinical judgement to determine the best course of care for each patient, and this balance is situated within the larger medical environment that physicians practice within. In conclusion, this study determined that aspects of attitudes are related to cancer screening recommendations, but given that attitudes are one of many factors related to screening recommendations, future studies should not solely focus on this factor. Second, it appears that clinicians individualize care for all patients, and a patient’s Intellectual Disability is one of many factors considered prior to a screening recommendation. Finally, participants were aware of the evolving nature of cancer screening guidelines, and changed their practice accordingly as guidelines change. More research is needed to determine if these findings are applicable to more experienced primary care providers, given that the majority of participants in the interview phase were residents.Medicine, Faculty ofGraduat

Health systems, health policies, and health issues for people with intellectual disabilities in England

People with intellectual disabilities face health disparities, including in high-income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010, the, the Mental Capacity Act 2005, and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally the recent changes to healthcare organization in the UK, the COVID-19 pandemic, and the implementation of the Valuing People white paper are discusse

Access to maternal health services for indigenous women in low and middle income countries: an updated integrative review of the literature from 2018-2023

Introduction Ninety-seven per cent of Indigenous peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review, of papers published between 2000 and 2017, identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage (UHC), in six years’ time, by 2030, to undertake another review. This paper updates the previous review exploring the recent available literature on Indigenous women’s access to maternal health services in LMICs identifying barriers to services. Methods An integrative review of literature published between 2018-2023 was undertaken. This review followed a systematic process using Whittemore and Knafl’s five step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nine hundred and forty-four (944) articles were identified from six data-bases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text, APA PsycArticles (through EBSOhost). The search was undertaken on the 16th of January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria twenty-six articles were identified. Critical appraisal resulted in twenty-four (24) articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas’s taxonomy, extended by Saurman, which focused on six dimensions of access to healthcare: affordability, accessibility, availability, accommodation, acceptability, awareness. Ten studies took place in Asia, ten studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative. two were quantitative, and five mixed methods. The methods for the integrative review were pre-specified in a protocol, registered at Open Science Framework. Results Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services with staff often missing from the facilities; poor quality services which did not take on board the cultural and spiritual needs of Indigenous peoples; an over-reliance on the bio-medical model; a lack of facilities to enable appropriate maternal care; services which did not accommodate the everyday needs of women including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women. Discussion Barriers to Indigenous women’s access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous peoples. Empowerment of Indigenous women and communities in LMICs are required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and sub-Saharan Africa especially hunter-gatherer groups as well as the impact of COVID 19 on access to services

Women’s preferences and design recommendations for a postpartum depression psychoeducation intervention: user involvement study

Background: Postpartum depression (PPD) is one of the leading causes of maternal morbidity, affecting up to 18% of Canadian new mothers. Yet, PPD often remains untreated due to numerous barriers in access to care, including location and cost. Development of eHealth interventions in collaboration with patient partners offers an exciting opportunity to fill this care gap and provide effective and affordable care to new parents across British Columbia (BC). Objective: Our aim was to determine the content and design preferences of women previously diagnosed with PPD to inform changes to the development of a web-enabled intervention for education and management of PPD. Methods: Webpage prototypes were created to mimic the web-enabled resource using findings from completed focus group research that assessed what women want in a web-enabled support resource for PPD. A convenience sample of women >18 years, previously diagnosed with PPD was recruited. Feedback was collected on the content and design of the prototypes via semi-structured interviews and online surveys. Qualitative, inductive analytic and quantitative methods were used. Results: A total of nine women (mean age 37.2 years, SD 4.8) completed the interview and a majority of the survey. A total of six themes were identified: inefficacy of text-heavy layouts; highlighting key information; clarity/understandability of the language; finding support groups; validation and immediate help for feelings of isolation; helpfulness and accessibility of the resource. Each theme identified elements of content or design that were either effective or may be improved upon. Most women (N=8, 89%) favored content relating to foundational knowledge of PPD, such as symptoms and management options. The layout, language, and content were found to be generally easy to understand, clear, trustworthy, and helpful. Conclusions: Six key areas were identified by women previously diagnosed with PPD as requiring focus in a web-enabled psychoeducation program. Consistent with past research, this study also found support and enthusiasm for web-enabled programs to support PPD management as an adjunct to other evidence-based treatments

Effectiveness of a web-enabled psychoeducational resource for postpartum depression and anxiety among women in British Columbia

Purpose: Postpartum depression (PPD) and anxiety (PPA) affect nearly one-quarter (23%) of women in Canada. eHealth is a promising solution for increasing access to postpartum mental healthcare. However, a user-centered approach is not routinely taken in the development of web-enabled resources, leaving postpartum women out of critical decision-making processes. This study aimed to evaluate the effectiveness, usability, and user satisfaction of PostpartumCare.ca, a web-enabled psychoeducational resource for PPD and PPA, created in partnership with postpartum women in British Columbia. Methods: Participants were randomized to either an intervention group (n = 52) receiving access to PostpartumCare.ca for four weeks, or to a waitlist control group (n = 51). Measures evaluating PPD (Edinburgh Postnatal Depression Scale) and PPA symptoms (Perinatal Anxiety Screening Scale) were completed at baseline, after four weeks, and after a two-week follow-up. User ratings of website usability and satisfaction and website metrics were also collected. Results: PPD and PPA symptoms were significantly reduced for the intervention group only after four weeks, with improvements maintained after a two-week follow-up, corresponding with small-to-medium effect sizes (PPD: partial η2 = .03; PPA: partial η2 = .04). Intervention participants were also more likely than waitlist controls to recover from clinical levels of PPD symptoms (χ2(1, n = 63) = 4.58, p = .032) and PostpartumCare.ca’s usability and satisfaction were rated favourably overall. Conclusion: Findings suggest that a web-enabled psychoeducational resource, created in collaboration with patient partners, can effectively reduce PPD and PPA symptoms, supporting its potential use as a low-barrier option for postpartum women

Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: a scoping review of knowledge syntheses

Objective: Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. Methods: Scoping review of reviews: systematically searched six databases. Inclusion criteria: systematic searches and syntheses of literature, one or more providers and communicatively-vulnerable patients, synchronous in-person communication, intermediate or health outcome linked to communication. Results: The search yielded 14,614 citations; 47 reviews – with wide range of providers, communication vulnerabilities, communication practices, and health outcomes – met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. Conclusion: Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient’s communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. Practice Implications: Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups

CCR2/CCR5-mediated macrophage-smooth muscle cell crosstalk in pulmonary hypertension

Macrophages are major players in the pathogenesis of pulmonary arterial hypertension (PAH).To investigate whether lung macrophages and pulmonary-artery smooth muscle cells (PASMCs) collaborate to stimulate PASMC growth and whether the CCL2-CCR2 and CCL5-CCR5 pathways inhibited macrophage-PASMC interactions and PAH development, we used human CCR5-knock-in mice and PASMCs from patients with PAH and controls.Conditioned media from murine M1 or M2 macrophages stimulated PASMC growth. This effect was markedly amplified with conditioned media from M2 macrophage/PASMC co-cultures. CCR2, CCR5, CCL2 and CCL5 were upregulated in macrophage/PASMC co-cultures. Compared to inhibiting either receptor, dual CCR2 and CCR5 inhibition more strongly attenuated the growth-promoting effect of conditioned media from M2-macrophage/PASMC co-cultures. Deleting either CCR2 or CCR5 in macrophages or PASMCs attenuated the growth response. In mice with hypoxia- or SUGEN/hypoxia-induced PH, targeting both CCR2 and CCR5 prevented or reversed PH more efficiently than targeting either receptor alone. Patients with PAH exhibited CCR2 and CCR5 upregulation in PASMCs and perivascular macrophages compared to controls. The PASMC growth-promoting effect of conditioned media from M2-macrophage/PASMC co-cultures was greater when PASMCs from PAH patients were used in the co-cultures or as the target cells and was dependent on CCR2 and CCR5. PASMC migration toward M2-macrophages was greater with PASMCs from PAH patients and was attenuated by blocking CCR2 and CCR5.CCR2 and CCR5 are required for collaboration between macrophages and PASMCs to initiate and amplify PASMC migration and proliferation during PAH development. Dual targeting of CCR2 and CCR5 may hold promise for treating human PAH.status: publishe

CCR2/CCR5-mediated macrophage–smooth muscle cell crosstalk in pulmonary hypertension

International audienceMacrophages are major players in the pathogenesis of pulmonary arterial hypertension (PAH).To investigate whether lung macrophages and pulmonary-artery smooth muscle cells (PASMCs) collaborate to stimulate PASMC growth and whether the CCL2-CCR2 and CCL5-CCR5 pathways inhibited macrophage-PASMC interactions and PAH development, we used human CCR5-knock-in mice and PASMCs from patients with PAH and controls.Conditioned media from murine M1 or M2 macrophages stimulated PASMC growth. This effect was markedly amplified with conditioned media from M2 macrophage/PASMC co-cultures. CCR2, CCR5, CCL2 and CCL5 were upregulated in macrophage/PASMC co-cultures. Compared to inhibiting either receptor, dual CCR2 and CCR5 inhibition more strongly attenuated the growth-promoting effect of conditioned media from M2-macrophage/PASMC co-cultures. Deleting either CCR2 or CCR5 in macrophages or PASMCs attenuated the growth response. In mice with hypoxia- or SUGEN/hypoxia-induced PH, targeting both CCR2 and CCR5 prevented or reversed PH more efficiently than targeting either receptor alone. Patients with PAH exhibited CCR2 and CCR5 upregulation in PASMCs and perivascular macrophages compared to controls. The PASMC growth-promoting effect of conditioned media from M2-macrophage/PASMC co-cultures was greater when PASMCs from PAH patients were used in the co-cultures or as the target cells and was dependent on CCR2 and CCR5. PASMC migration toward M2-macrophages was greater with PASMCs from PAH patients and was attenuated by blocking CCR2 and CCR5.CCR2 and CCR5 are required for collaboration between macrophages and PASMCs to initiate and amplify PASMC migration and proliferation during PAH development. Dual targeting of CCR2 and CCR5 may hold promise for treating human PAH