Development of the "Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills" (TEAM-ENTS) behavioral marker system.

BACKGROUND: Non-technical skills (NTS) are integral to team performance and subsequent quality and safety of care. Behavioral marker systems (BMSs) are now increasingly used in healthcare to support the training and assessment of team NTS. Within gastrointestinal endoscopy, this is an area of novel research. The aims of this study were to define the core relevant NTS for endoscopy teams and develop a preliminary framework for a team-based BMS known as TEAM-ENTS (Teamwork in Endoscopy Assessment Module for Endoscopic Non-Technical Skills). METHODS: This study was conducted in two phases. In phase 1, a literature review of team-based BMSs was performed to inform an interview study of core endoscopy team members. Cognitive task analysis was used to break down the NTS relevant to endoscopy teams. Framework analysis generated the structure for the preliminary TEAM-ENTS framework. In phase 2, a modified Delphi process was undertaken to refine the items of the framework. RESULTS: Seven consultant endoscopists and six nurses were interviewed. The final coding framework consisted of 88 codes grouped into five overarching categories. In total, 58 participants were recruited to the Delphi panel. In the first round, nine elements and 37 behavioral descriptors did not meet consensus. Following item adjustment, merging and deletion, all remaining items met consensus thresholds after the second round. The refined TEAM-ENTS BMS consists of five categories, 16 elements, and 47 behavioral descriptors. CONCLUSIONS: The refined TEAM-ENTS behavioral marker system was developed to reflect the core NTS relevant to endoscopy teams. Future studies will aim to fully validate this tool.

"It Helps Make the Fuzzy Go Away": Autistic Adults' Perspectives on Nature's Relationship with Well-being Through the Life Course.

Background: While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults' perspectives on the relationship between nature and well-being in both childhood and adulthood. Methods: We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis. Results: We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence. Conclusion: This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people.

Why is this an important issue? Autistic adults often experience poorer mental health and overall well-being than neurotypical adults. Since some autistic adults are very interested in nature and often report that they feel better after spending time in nature, natural spaces and activities taking place outside could be one way of improving well-being for autistic adults. What was the purpose of this study? There is very little research on how autistic adults experience nature, although some autistic people have written about their experiences. The purpose of this study was to develop an understanding of how autistic people experience nature and how nature might benefit their well-being. What did the researchers do? We created a survey that asked 26 questions about how autistic adults experience nature. This survey included questions about how often they visited nature, if they had a focused interest in nature, whether and how nature was related to their well-being, and childhood experiences of nature. Focusing on three of the questions, we used reflexive thematic analysis (a way of identifying patterns in data) to develop three themes. What were the results of the study? The three themes we developed were: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. These themes illustrate the different ways that autistic adults experienced nature. For some, nature was a way of relating to others and relating more deeply with themselves. Nature was also a way of escaping from people who were unkind, from situations that were uncomfortable, and from other stresses in life. Many autistic participants reported that nature was helpful to their well-being, because they experienced less judgment from natural spaces and creatures­though other people were sometimes judgmental, which made nature experiences worse. What do these findings add to what was already known? These findings confirm previous research showing that many autistic people have focused interests in nature. The findings not only add to the numerous existing anecdotal accounts about how autistic people feel in nature but also demonstrate a diverse range of perspectives. Not all autistic participants in this study felt that nature was beneficial to their well-being. What are the potential weaknesses of the study? Unfortunately, surveys are only accessible to people who have Wi-Fi/internet access, can use a computer or phone, and have the time to complete the survey. The survey might also have drawn in participants who were specifically interested in this topic, which might influence the findings. How will these findings help autistic adults now or in the future? These findings will help autistic adults, practitioners, and carers to identify a potential source of support for well-being. As autistic adults in this study used nature to meet different needs related to their well-being, natural space and nature-based activities may help improve well-being in autistic adults who enjoy nature.