Développement et évaluation d'une simulation numérique visant à améliorer les habiletés relationnelles des infirmières dans un contexte de formation continue

Les personnes vivant avec le VIH (PVVIH) doivent recourir à un traitement antirétroviral (TAR) à vie pour contrôler leur charge virale et prévenir la transmission du virus. Nombreuses interventions ont ciblé le comportement individuel des PVVIH à prendre leur TAR, mais très peu d’entre elles ont visé la pratique professionnelle des infirmières alors qu’elles sont des acteurs clés dans les soins prodigués à ces personnes. Les infirmières ont une responsabilité sociale et professionnelle de respecter les normes de formation continue afin de développer de nouvelles compétences et de les maintenir à jour pour offrir des soins sécuritaires et de qualité à leur clientèle. Les technologies représentent une modalité prometteuse pour la formation numérique et la prestation des soins. Deux revues systématiques de revues systématiques ont été réalisées pour examiner les effets des technologies de l’information et des communications en santé de même que la formation numérique sur les soins infirmiers. Ce projet doctoral poursuit deux buts généraux : 1) Développer une simulation numérique ; 2) Évaluer quantitativement et qualitativement l’acceptabilité de la simulation auprès des infirmières. Deux objectifs ont permis de développer la simulation : 1.1) Explorer la pratique infirmière et ses défis dans l’accompagnement des PVVIH sous TAR ; 1.2) Décrire le processus de codéveloppement de la simulation et les leçons apprises. L’évaluation de la simulation a été répondue à l’aide de trois objectifs : 2.1) Mesurer les perceptions des infirmières quant aux éléments composant la simulation, sa qualité globale et l’acceptation de la technologie, le rôle de la simulation pour soutenir la pratique professionnelle et l’atteinte des objectifs d’apprentissage ; 2.2) Explorer l’expérience d’apprentissage ; 2.3) Comprendre comment la simulation numérique contribue au renforcement des habiletés relationnelles, à la progression et au transfert des apprentissages en pratique. Une étude qualitative a permis d’explorer la pratique infirmière et ses défis. Parmi les défis identifiés, notons particulièrement le manque de ressources pour aider un patient dont la prise du traitement est sous-optimale. Ce défi a été transformé en opportunité d’apprentissage dans un scénario clinique simulant l’histoire d’un patient virtuel pour qui la prise du TAR est difficile. Une approche collaborative a permis le codéveloppement de cette simulation numérique, soutenue par l’entretien motivationnel. Une consultation infirmière-patient avec des schèmes de communication préprogrammés a été scénarisée pour favoriser l’application d’habiletés relationnelles auprès du patient virtuel. L’apprentissage actif est illustré par des « quiz1 » et des rétroactions qui permettent d’apprendre de ses erreurs. L’évaluation de cette simulation a été réalisée à l’aide d’une étude mixte à devis convergent. Une étude préexpérimentale à groupe unique post-intervention a permis de décrire les perceptions de 27 infirmières quant à la simulation, à l’aide d’un questionnaire en ligne (80 énoncés). Cinq infirmières sur 27 ont participé à la composante qualitative, en partageant leur expérience d’apprentissage via un groupe de discussion en ligne. Une approche narrative a facilité l’intégration des résultats quantitatifs et qualitatifs pour enrichir la compréhension de ce qui a contribué à la progression des apprentissages. Les infirmières ont évalué favorablement l’acceptabilité de la simulation, dont sa qualité globale, l’acceptation de la technologie et les rôles de la simulation sur la pratique. Les infirmières perçoivent que la simulation permet de réfléchir globalement à leur pratique, d’améliorer leurs habiletés de communication et la qualité de la relation thérapeutique. Quatre thèmes illustrent l’expérience d’apprentissage : 1) Motivations à s’engager dans la recherche ; 2) Apprentissage dans un environnement réaliste, immersif, et de non-jugement ; 3) Utilité perçue de la simulation sur le plan des connaissances, de la réflexion, des habiletés relationnelles (importance de la communication, de l’écoute, de la présence) ; 4) Difficultés à s’engager dans la recherche. Les constats mixtes interprétatifs sont les suivants : 1) Le réalisme de la simulation donne l’impression d’avoir une pratique infirmière réelle et une expérience immersive ; 2) Une simulation flexible, perçue efficace et permettant le contrôle sur son apprentissage contribuent positivement à l’expérience ; 3) Conscientisation du soi et réflexion sur sa pratique relationnelle; 4) Consolidation des apprentissages et meilleure confiance en ses capacités.People living with HIV (PLHIV) have to take antiretroviral treatment (ART) for the rest of their lives to control the viral load and prevent HIV transmission. While many interventions have targeted PLHIV’s individual behaviour in taking their ART, very few have focused on the professional practice of nurses, even though they are key actors in the healthcare provided to PLHIV. Nurses have a social and professional responsibility to respect continuing education standards, to refresh their skills, and to acquire new ones so as to provide their clients with safe, quality care. Technology is a promising avenue for digital training and delivery of care. Two systematic reviews of systematic reviews were conducted to examine the effects of information and communication technologies as well as e-learning on nursing care. This doctoral project has two general goals: 1) Develop a virtual simulation; 2) Quantitatively and qualitatively assess the simulation’s acceptability to nurses. Two objectives were achieved to reach the first goal (simulation development): 1.1) Explore nursing practice to help PLHIV adhere to ART, and the challenges faced by nurses; and 1.2) Describe the simulation codevelopment process and the lessons learned. The second goal (simulation assessment) was met by pursuing the following three objectives: 2.1) Measure the nurses’ perceptions of the simulation’s design elements, its overall quality and technology acceptance, the simulation’s role in supporting the professional practice, and the achievement of the learning objectives; 2.2) Explore nurses’ learning experience; and 2.3) Understand how the digital simulation can contribute to nurses’ uptake of relational skills, learning progress, and transfer into practice. A qualitative study was performed to explore the nursing practice and its challenges. Among the challenges identified, one was salient: the lack of resources to help patients whose treatment-taking was suboptimal. This challenge was turned into a learning opportunity in a clinical scenario simulating a virtual patient having difficulty taking their ART. A collaborative approach helped codevelop this virtual simulation, informed by motivational interviewing. A nurse-patient consultation with preprogrammed communication schemes was scripted to encourage the nurses to apply relational skills with the virtual patient. The active learning is supported by quizzes and feedback that help nurses learn from their mistakes. A convergent mixed methods study was conducted to evaluate the simulation. A pre-experimental study with a one-group post-test design was used to describe 27 nurses’ perceptions of the simulation through an online questionnaire (80 items). Five of the 27 nurses participated in the qualitative component, sharing their learning experience in an online focus group. A narrative approach facilitated the integration of the quantitative and qualitative findings to better understand what contributed to learning progression. The nurses favourably assessed the simulation’s acceptability, including its overall quality, technology acceptance, and role in supporting practice. They stated that the simulation made them reflect about their practice as a whole, and helped improve their communication skills and the quality of the therapeutic relationship. Four themes illustrate the learning experience: 1) Motivations to engage in the simulation-based research; 2) Learning in a realistic, immersive, and non-judgmental environment; 3) Perceived utility of the simulation regarding knowledge, reflection, and relational skills (importance of communicating, listening, being present); and, 4) Perceived difficulty in engaging in the simulation-based research. The mixed methods study’s interpretative findings are as follows: 1) Influence of the simulation’s fidelity on nurses’ impression of getting real practice and of having an immersive learning experience; 2) Simulation’s perceived flexibility, efficacy, and control over one’s learning led to a positive learning experience; 3) Self-awareness and reflection in relational practice; and 4) Consolidation of the knowledge acquired and greater confidence in their abilities

L'expérience du dévoilement telle que perçue par des femmes vivant avec le VIH nées au Québec

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement.Disclosure of seropositivity is a constant concern in women living with HIV; a situation further complicated by social stigma. Knowledge on this topic remains fragmented. Studies show certain patterns –such as to whom and how often women disclose this information–, the reasons for disclosure, the positive and negative consequences as well as the predisposing factors of disclosure, all of which limit the global understanding of this phenomenon. Inspired by Parse’s nursing theory (1998, 2003), the purpose of this study is to describe and gain a better understanding of the experience of disclosing the information of being seropositive as perceived by Quebec-born women living with HIV. The phenomenological method was chosen for data collection from seven participants through a semi-structured interview. Data analysis rested on two research activities suggested by van Manen (1997): reflection and writing, which allowed identification of the following seven themes: 1) Having self-respect while choosing confidants; 2) Feeling apprehension; 3) Exercising control to ensure protection; 4) Deliberately engaging in a process of revealing-concealing; 5) Exposing oneself to stigma and social exclusion; 6) Internal suffering; 7) Benefiting from the positive effects of such a decision. These themes contributed to the formulation of the essence of the phenomenon which can be read as such: Living the ambivalence of a paradoxical process of revealing-concealing, within a profound suffering intensified by stigma, while being enriched by the benefits attained. We believe that these results could have positive effects to guide nursing practice in supporting women during their experience of disclosure

Acceptabilité de la simulation numérique en formation par une analyse comparative franco-canadienne

Introduction : La simulation numérique sur écran avec patient virtuel (Foronda, 2021; Lioce et al., 2020), comme outil de formation, peut aussi bien être utilisée auprès d’étudiants en soins infirmiers qu’auprès d’infirmières graduées. Dès la mise en place de ces simulateurs, il convient d’en évaluer l’acceptabilité auprès des utilisateurs (Davis, 1985, 1989). Objectifs : Les objectifs de l’étude visent à décrire et à examiner les relations entre des mesures d’acceptabilité des simulateurs numériques et comparer cette acceptabilité perçue lors deux sessions de formation distinctes auprès d’étudiants en soins infirmiers français et d’infirmières québécoises (Canada). Résultats : Les résultats ont indiqué une relation positive entre la FU et l’IU (r de Pearson = 0,42, p = 0,001) et l’UP et les IU (r de Pearson = 0,33, p = 0,01). Les étudiants français ont déclaré une moyenne de FU supérieure aux infirmières québécoises (p = 0,01); au contraire les infirmières ont déclaré une UP supérieure aux étudiants (p = 0,009). Les deux groupes ont rapporté une IU et un P similaires (p > 0,05). Discussion et conclusion : Le simulateur numérique est bien accepté par les deux groupes, renforçant son usage en formation initiale et continue pour améliorer les habiletés relationnelles et le raisonnement clinique.Introduction : La simulation numérique sur écran avec patient virtuel (Foronda, 2021; Lioce et al., 2020), comme outil de formation, peut aussi bien être utilisée auprès d’étudiants en soins infirmiers qu’auprès d’infirmières graduées. Dès la mise en place de ces simulateurs, il convient d’en évaluer l’acceptabilité auprès des utilisateurs (Davis, 1985, 1989). Objectifs : Les objectifs de l’étude visent à décrire et à examiner les relations entre des mesures d’acceptabilité des simulateurs numériques et comparer cette acceptabilité perçue lors deux sessions de formation distinctes auprès d’étudiants en soins infirmiers français et d’infirmières québécoises (Canada). Résultats : Les résultats ont indiqué une relation positive entre la FU et l’IU (r de Pearson = 0,42, p = 0,001) et l’UP et les IU (r de Pearson = 0,33, p = 0,01). Les étudiants français ont déclaré une moyenne de FU supérieure aux infirmières québécoises (p = 0,01); au contraire les infirmières ont déclaré une UP supérieure aux étudiants (p = 0,009). Les deux groupes ont rapporté une IU et un P similaires (p > 0,05). Discussion et conclusion : Le simulateur numérique est bien accepté par les deux groupes, renforçant son usage en formation initiale et continue pour améliorer les habiletés relationnelles et le raisonnement clinique

From VIH-TAVIE™ to TAVIE-WOMAN™: Development of a Web-Based Virtual Nursing Intervention to Meet the Specific Needs of Women Living With HIV

The web-based virtual nursing intervention VIH-TAVIE™ was designed to help people living with HIV (PLWH) adhere to their antiretroviral treatment (ART). The content of the intervention is generic and gender neutral. However, it is recognised that women living with HIV (WLWH) experience their condition in a unique way and face gender-specific challenges regarding ART intake. Consequently, it seemed appropriate to adapt VIH-TAVIE™ specifically for women. The purpose of this paper is to present the qualitative results of an evaluative study of VIH-TAVIE™ that describe the experience of six WLWH who received the web-based computer-delivered intervention and to present the content and specificities of an offshoot intervention under development, TAVIE-Woman™. The following themes emerged from the content analysis of interviews with the WLWH about : 1) presence of actual nurse on site to facilitate transition to virtual mode; 2) virtual nurse humanises experience of computer-delivered intervention; 3) learners’ appreciation of medium and content; and 4) perceived benefits following participation in the intervention. To adapt VIH-TAVIETM for women, discussions were also held with a healthcare team in a mother-child university hospital centre. The gender-specific content added to TAVIE-WomanTM included digital storytelling of HIV-positive women, various topics about changing ARV medication during pregnancy, neonatal ART prophylaxis, disclosure  to children,  adapting to life with HIV, selecting a birth-control method, and social support. Ultimately, the purpose of TAVIE-WomanTM is to support WLWH by offering them 24/7 access to tailored education and reliable quality information

“What Is PER?” Patient Engagement in Research as a Hit

Engaging patients in research conduct and agenda setting is increasingly considered as an ethical imperative, and a way to transcend views of patients as passive subjects by fostering their empowerment. However, patient engagement in research (PER) is still an emerging approach with debated definitional and operational frameworks. This song addresses the sometimes difficult encounter and elusive mutual understanding between researchers and patients. “What is PER?” is an impressionistic illustration of the challenges and issues that can be found in the universe of patient engagement in research

Communicating science in the digital and social media ecosystem : scoping review and typology of strategies used by health scientists

Background: The public's understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC). Objective: This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used. Methods: This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis. Results: Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit). Conclusions: Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health-related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem

Virtual intervention to support self-management of antiretroviral therapy among people living with HIV

ABSTRACT: BACKGROUND: Living with human immunodeficiency virus (HIV) necessitates long-term health care follow-up, particularly with respect to antiretroviral therapy (ART) management. Taking advantage of the enormous possibilities afforded by information and communication technologies (ICT), we developed a virtual nursing intervention (VIH-TAVIE) intended to empower HIV patients to manage their ART and their symptoms optimally. ICT interventions hold great promise across the entire continuum of HIV patient care but further research is needed to properly evaluate their effectiveness. OBJECTIVE: The objective of the study was to compare the effectiveness of two types of follow-up--traditional and virtual--in terms of promoting ART adherence among HIV patients. METHODS: A quasi-experimental study was conducted. Participants were 179 HIV patients on ART for at least 6 months, of which 99 were recruited at a site offering virtual follow-up and 80 at another site offering only traditional follow-up. The primary outcome was medication adherence and the secondary outcomes were the following cognitive and affective variables: self-efficacy, attitude toward medication intake, symptom-related discomfort, stress, and social support. These were evaluated by self-administered questionnaire at baseline (T0), and 3 (T3) and 6 months (T6) later. RESULTS: On average, participants had been living with HIV for 14 years and had been on ART for 11 years. The groups were highly heterogeneous, differing on a number of sociodemographic dimensions: education, income, marital status, employment status, and living arrangements. Adherence at baseline was high, reaching 80% (59/74) in the traditional follow-up group and 84% (81/97) in the virtual follow-up group. A generalized estimating equations (GEE) analysis was run, controlling for sociodemographic characteristics at baseline. A time effect was detected indicating that both groups improved in adherence over time but did not differ in this regard. Improvement at 6 months was significantly greater than at 3 months in both groups. Analysis of variance revealed no significant group-by-time interaction effect on any of the secondary outcomes. A time effect was observed for the two kinds of follow-ups; both groups improved on symptom-related discomfort and social support. CONCLUSIONS: Results showed that both interventions improved adherence to ART. Thus, the two kinds of follow-up can be used to promote treatment adherence among HIV patients on ART

A multi-informant and multi-polygenic approach to understanding predictors of peer victimisation in childhood and adolescence

Introduction Peer victimisation is a prevalent occurrence in childhood and adolescence and can often have long-lasting consequences. Previous research using polygenic scores (PGSs) have revealed various genetic vulnerabilities as predictive of victimisation in childhood. However, findings were based on self-report and may therefore be influenced by varying self-perceptions. Previous investigations also focused on average victimisation across childhood, and thus do not capture variability in polygenic predictability over time. The present study, therefore, aimed to investigate associations between PGSs and victimisation using separate and combined reports from teachers and peers in childhood, as well as self-reports in later adolescence to explore trajectories of victimisation. Methods Data were derived from the Quebec Newborn Twin Study. Participants were assessed for victimisation using self-reports from 7 to 17 years and using teacher ratings and peer nominations between 7 and 10 years (n = 536). Ten PGSs related to mental health, cognitive abilities and physical traits were examined as possible predictors of victimisation using linear regressions and growth curve models. Results Findings revealed that PGSs associated with victimisation are consistent across informants, but to varying extent according to estimated effect sizes. Self-reported victimisation was predicted by PGSs related to mental health, while PGSs related to cognitive and physical traits had larger effect estimates when predicting teacher- and peer-reported victimisation. The PGS for educational attainment was consistently negatively associated with victimisation across informants, producing the largest effect estimates (β = −.104, 95% CI = −.169 to −.039) when predicting a multi-informant measure of victimisation. No PGS predicted changes in victimisation over time. Conclusion While the PGS for educational attainment is a robust predictor of victimisation, many PGSs are differentially associated with victimisation depending on the informant. Such findings highlight the need to pay close attention to the phenotypic assessment of victimisation, and show that using multiple informants can both strengthen and provide unique insight into how associations may occur

LINGO1 Variants in the French-Canadian Population

Essential tremor (ET) is a complex genetic disorder for which no causative gene has been found. Recently, a genome-wide association study reported that two variants in the LINGO1 locus were associated to this disease. The aim of the present study was to test if this specific association could be replicated using a French-Canadian cohort of 259 ET patients and 479 ethnically matched controls. Our genotyping results lead us to conclude that no association exists between the key variant rs9652490 and ET (Pcorr = 1.00)