Introducing LADER: A Structured Approach to Effective Professional Interactions for Behavior Analysts.

Applied behavior analysis (ABA) is a human service profession using the science of behaviorism to promote meaningful changes in the lives of clients. However, misconceptions, misunderstandings, and false information have plagued our field since its inception and challenge the efficacy of our continued dissemination efforts. Effective science communication skills, especially for fields with a highly technical language such as ABA, promote marked improvements in client outcomes. Herein we introduce LADER, a structured and scaffolded approach to effective professional interactions for behavior analysts. The five components of LADER (listen, ask questions, determine misconceptions, engage, and reflect and evaluate) support analysts in navigating complex and potentially challenging conversations with clients, caregivers, collaborative professionals, and other stakeholders. The experiences and insights of current behavior professionals, and empirical research on effective science communication, underpins the components of LADER. Following a description of LADER, a hypothetical scenario provides readers with a vignette on how to apply LADER in practice.

Strategies to enhance risk communication about medicines in Malaysia: a Delphi study among multinational experts.

BACKGROUND: Effective risk communication about medicines is crucial to the success of all pharmacovigilance activities but remains a worldwide challenge. Risk communication has been conducted in Malaysia for decades, yet awareness on the communication methods remains low among healthcare professionals. While international guidelines are available, clear guidance on effectively communicating the risks of medicines in specific countries is scarce. This study aimed to establish a consensus on the priority strategies for enhancing risk communication about medicines by regulators. METHODS: We conducted a two-round modified Delphi survey among local and international communication experts, and also recipients of medicines risk communication in Malaysia. We developed a list of 37 strategies based on the findings of our previous studies. In Round 1, participants were asked to rate the priority for each strategy using a 5-point Likert scale and suggest additional strategies via free-text comments. Strategies scoring a mean of ≥ 3.75 were included in Round 2. We defined consensus for the final list of strategies a priori as > 75% agreement. Data were analysed using descriptive statistics and thematic analysis. RESULTS: Our final Delphi panel (n = 39, 93% response rate) comprised medicines communication experts from nine countries and Malaysian healthcare professionals. Following Round 1, we dropped 14 strategies and added 11 strategies proposed by panellists. In the second round, 21 strategies achieved consensus. The priority areas identified were to improve the format and content of risk communication, increase the use of technology, and increase collaboration with various stakeholders. Priority ratings for the strategy "to offer incentives to pharmaceutical companies which maintain effective communication systems" were significantly higher among recipients compared to communicators [χ2(1, N = 39) = 10.1; p = 0.039] and among local versus international panellists [χ2(1, N = 39) = 14.3; p = 0.007]. CONCLUSIONS: Our study identified 21 priority strategies, which were used to develop a strategic plan for enhancing medicines risk communication. This plan is potentially adaptable to all countries with developing pharmacovigilance systems. The difference in views between communicators and recipients, as well as local and international panellists, highlights the importance of involving multiple stakeholders in research.

Navigating Accountable Conversations in Health Care: Balancing Power Dynamics.

Effective communication is crucial in health care and contributes to safe patient care and organizational excellence. Hierarchical differences can negatively affect communication among clinicians; however, recognizing and addressing power imbalances can improve patient safety. Individuals can feel empowered to express concerns and provide constructive feedback through clear communication with active listening. Perioperative nurses and leaders can use a variety of strategies to enhance accountable (or critical) conversations, such as structured communication models that guide participants through conversations and standardized procedures and tools to enhance the quality of team communication. This article provides an overview of accountable conversations, discusses the importance of structured communication models, and offers scenario-based examples using two structured models to enhance the reader's understanding. Finally, the article describes cultural competence and the leader's role in developing a culture of accountability.

Attending to Persons with Intellectual and/or Other Developmental Disorders in Crisis Settings.

Crisis response is growing across the United States with increasingly broad phone, text, and chat response systems that lead to triaging callers who may be in need of further outreach. This might include deploying a mobile crisis response team and/or referring a caller to a crisis stabilization unit. The information set forth earlier aims to help advance the field and individual practices to ensure that persons with intellectual and/or other developmental disorders receive equivalent care and treatment with information that helps focus on this population's unique features and needs.

Illuminating their reality: the use of metaphor by parents of children with disabilities to express their experiences of health care.

PURPOSE: To explore the nature and meaning of metaphors used by parents of children with disabilities when describing their healthcare experiences. METHOD: A systematic procedure was used to identify and analyze metaphors spontaneously mentioned by parents in 13 focus groups held with 65 Canadian parents of children with disabilities. Attention was paid to identifying deep (i.e., meaningful) metaphors rather than common expressions. RESULTS: A total of 214 deep metaphors were identified and categorized into four target-source groupings. Parents used journey metaphors to describe experiences of uncertainty, conflict and harm metaphors to describe confrontational, harmful, and demeaning experiences of care, games and puzzles to describe the unknowns of care and attempts to resolve these unknowns, and metaphors concerning environmental barriers (i.e., walls and doors) to express feelings of exclusion and difficulties accessing care. CONCLUSIONS: Parents' metaphors expressed experiences of uncertainty, powerlessness, and attempts to exert agency in healthcare interactions. The metaphorical groupings provide new insights into how and why lack of family-centeredness in service delivery is bewildering, distressing, and disempowering to parents. Implications for service providers include paying attention to what metaphor use reveals about parents' experiences, and discussing parents' metaphors with them to create joint understanding, providing a fertile ground for collaboration.

Study findings indicated a clear lack of family-centeredness in gaining access to services, communicating with service providers and being listened to, and in decision-making power.Given that many service providers believe they are family-centered, the strong negative connotations of the metaphors used by parents are surprising and worrisome.Parents' use of metaphors not only reflects a lack of family-centered care, but indicates that parents experience unintentional harm in their interactions with service providers.Service providers can benefit from knowing the fundamental issues of uncertainty and power that underlie parents' use of metaphors to communicate vividly the tensions and issues they face.

The power of virtual connections: A randomized controlled trial of online positive psychotherapy training on effective communication skills of nursing students.

AIM: This research aimed to assess the impact of the online "Positive Psychotherapy- Based Key Model of Courtesy and Integrity" (KMCI)" program on the effective communication skills of nursing students. BACKGROUND: With the growing integration of virtual platforms in psychotherapy education, there is a burgeoning interest in understanding their influence on nursing student's communication abilities. Recognizing how online positive psychotherapy education shapes these skills is pivotal for enriching nursing education and practice. DESIGN: The study adopted a pre-test-post-test randomized controlled design and involved 64 undergraduate nursing students from a state university's nursing department during the 2021-2022 academic year, all enrolled in psychiatric nursing courses. METHODS: Students were divided into experimental and control groups through simple randomization. Pre-tests, encompassing a "Personal Information Form" and an "Effective Communication Skills Scale," were administered to both groups. Subsequently, the experimental group received the "Positive Psychotherapy- Based Key Model of Courtesy and Integrity" program online for five weeks, while no intervention was provided to the control group during this period. Post-tests were then conducted for both groups after five weeks. RESULTS: The findings revealed a significant increase (p<0.05) in the total scores of sub-dimensions, including "Ego-Enhancing Language, Active Listening, Self-Disclosure and Recognition, Empathy and Self-Language Scale" in the experimental group in both intra-group and inter-group comparisons. CONCLUSION: In conclusion, the "Positive Psychotherapy- Based Key Model of Courtesy and Integrity" program effectively enhances practical communication skills among nursing students. Equipping students with the ability to integrate courtesy and integrity isn't effective.

Brief report: Improving communication of diagnostic uncertainty to families of hospitalized children.

OBJECTIVES: Diagnostic uncertainty is not reliably communicated to patients and caregivers. This study aims to identify barriers and facilitators to effective communication of diagnostic uncertainty, including development of potential tools and strategies for improvement, as perceived by healthcare professionals and caregivers. METHODS: We completed structured interviews with providers and caregivers of hospitalized children with uncertain diagnoses (UD). The interview guides addressed barriers to communication, key components for communication of uncertainty, and qualities of effective communication. The interviews concluded with respondents prioritizing potential interventions to improve communication of uncertainty. Interviews were audio recorded, transcribed, and independently analyzed by two team members to identify common themes. RESULTS: Ten provider and five caregiver interviews were conducted. Common barriers to communication of uncertainty included time constraints, language barriers, and lack of clear definition of UD. Caregiver suggestions for improvement included sharing expectations of the diagnostic process and use of both written and visual communication tools. Interview respondents favored interventions of a sign summarizing the key components of diagnostic uncertainty for display in patient rooms and a structured diagnostic pause during daily rounds. CONCLUSIONS: We identified several potential interventions that may enhance communication of diagnostic uncertainty and better engage patients and caregivers in the diagnostic process.

Ethical Practice for Postgraduate Students in Orthopedics: Nurturing Professionalism and Patient Care.

Background: In the domain of orthopedics, ethical practice significantly influences professionalism and the quality of patient care delivered by postgraduate students. This narrative review aimed to investigate the implementation and impact of an ethics-centric curriculum tailored for orthopedic postgraduate students. Methods: The proposed curriculum incorporates methodologies such as case-based learning, interactive discussions, and dedicated mentoring sessions, focusing on the unique ethical challenges encountered in orthopedics. Results: Introducing the curriculum provided postgraduate students with a robust foundation in ethical principles, enhancing effective communication, and fostering better doctor-patient relationships. Consequently, the students displayed an increased aptitude in navigating intricate ethical dilemmas in their clinical practice. Conclusion: There is a crucial need for continuous ethics education in orthopedics. Creating a supportive learning environment is essential to cultivate professionalism and promote patient-centered care. This study underscores the transformative potential of ethics training in molding orthopedic professionals who are both competent and deeply committed to maintaining the highest ethical standards.

Seeing the light versus being in the dark: parent, child, and service providers' use of metaphors to express system complexity, therapy engagement, and personal experiences of adaptation.

Purpose: To describe parent, child, and service providers' use of metaphors to communicate the meaning of participation in life and therapy engagement in the field of childhood disability.Methods: Metaphors concerning participation and engagement were extracted from 59 qualitative articles recommended by a group of experts in pediatric rehabilitation. A systematic process of metaphor analysis was used, involving identification of source and target domains, categorization into target-source groupings, and interpretation.Results: 209 metaphors were identified and categorized into seven target-source groupings. These seven groupings reflected environmental, interpersonal, and personal domains of experience: (a) the service system and life context, (b) the interpersonal therapy context, and (c) personal aspects. Together, the groupings expressed experiences concerning service system complexity, therapy engagement, and personal experiences of adaptation. Speakers used several metaphor dichotomies to express different experiences (e.g., open vs closed doors to opportunities).Conclusions: When service providers pay attention to clients' use of metaphors, this can lead to a deeper, more evocative understanding of the meaning of their participation and engagement experiences. Service providers can use metaphors generated by clients to communicate their understanding to clients, thereby creating a common ground for collaboration and assisting clients to interpret their experiences in different ways.Implications for RehabilitationMetaphors are useful clinically as they provide a bridge to joint understanding between a speaker and listener(s), due to their cognitive and communicative functionsService providers can note and attend to clients' use of metaphors to understand clients' experiences in deeper waysService providers can themselves use metaphors to express new ideas to clients, thereby encouraging clients to adopt new perspectives on their experiencesBy paralleling clients' use of metaphors, service providers can communicate that they understand clients' experience and provide them with a sense of support.

Quality communication can improve patient-centred health outcomes among older patients: a rapid review.

BACKGROUND: Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients. METHODS: Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like "effective communication," "elderly," and "well-being." Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool. RESULTS: The search strategy yielded seven studies. Five studies were qualitative (two phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, and one was an experimental study. The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes. CONCLUSION: Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.

An exploration of communication skills development for student diagnostic radiographers using simulation-based training with a standardised patient: UK-based focus-group study.

INTRODUCTION: Communication is an essential skill for all healthcare professionals but is particularly challenging for diagnostic radiographers since their role involves conveying extensive information within a relatively short amount of time. One method to develop communication skills in radiography is through simulation-based training using high fidelity simulation activities. The use of video recording for reflection and debriefing are also important elements that can be utilised to enhance learning. The aim of this project was to explore student radiographers' experiences of a simulation-based activity utilising a standardised patient designed to aid development of communication skills. METHODS: Fifty-two undergraduate 3rd year diagnostic radiography students at a single Higher Education Institution undertook a simulation roleplay exercise with an expert by experience (EBE) who acted in an anxious manner in order to challenge the student's communication skills following the simulation, students received a debrief session where detailed feedback was provided from the EBE and an academic. Students were also able to watch their video of the simulation and reflect. Students were invited to participate in a focus group to discuss their experience and the learning they had developed and 12 students participated. Transcribed material from the focus groups was thematically analysed to deduce themes of learning developed and ways to improve for future simulations. FINDINGS: Six main themes were identified from the thematic analysis of the transcripts from 12 diagnostic radiography students. These were patient care, radiographer's role and responsibilities, personal development, feelings, fidelity, and pedagogy. The themes represented the key learning points expressed by students and also aspects of the simulation which could be improved. Overall, the simulation provided a positive learning experience for the students. Having a video recording of the scenario was regarded as beneficial to enable a depth of reflection on non-verbal communication skills, which would be beneficial in future simulation scenarios. Students were aware that even though they used appropriate language their overall manner affected the interaction with the expert by experience more significantly. Students also considered methods to improve their communication if they encountered a similar patient interaction in their future practice. CONCLUSION: There is great potential for simulation-based training in developing communication skills for diagnostic radiography students. EBEs are a vital addition to simulation and educational activities in Higher Education Institutions and should be involved with the design of simulation activities also, as they can bring unique patient insight.

Effective communication with linguistically diverse patients: A concept analysis.

OBJECTIVE: Effective communication is essential to providing high-quality healthcare. For linguistically diverse patients, communication remains a barrier to receiving equitable healthcare throughout the globe. It is necessary to examine the concept of effective communication with linguistically diverse patients. METHODS: The Walker and Avant method was used to analyze the concept. RESULTS: We define effective communication with linguistically diverse patients as any verbal or written communication between two or more individuals who do not speak the same language that utilizes accurate translation techniques to reach a shared message or understanding, where all parties involved are listened to and actively engaged. The antecedents, attributes, consequences, and empirical referents are mapped. CONCLUSION: Effective communication with linguistically diverse patients is limited by a lack of access to professional language assistance, structural racism/discrimination, and policy barriers. PRACTICE IMPLICATIONS: Healthcare workers hold the power to provide language assistance to patients and should therefore receive training in cultural competency, cultural humility, and how to work with professional medical interpreters and language access programs. Institutions should invest in multimodal approaches to provide equitable healthcare to linguistically diverse patients.

Communicating without words: Measuring nonverbal communication between veterinarians and farmers during routine herd health consultations.

Uptake of advice and the ability to facilitate change on-farm are key elements for successful veterinary practice. However, having the necessary clinical skills and knowledge is not enough to achieve this: effective communication skills are essential for veterinarians to realize their advisory role by exploring and understanding the farmer's worldview. Research of verbal aspects of veterinarian communication supports the use of a relationship-centered communication style; we next need to study how veterinarian-farmer nonverbal communication (NVC) can influence interactions and their outcomes, which has been examined in medical and companion animal practice. In this study, we considered which aspects of NVC should be measured, and how, to provide an essential first step toward understanding the significance of NVC for veterinarians working in dairy practice, which should be of interest to researchers, veterinary educators, and practitioners. Eleven video recordings of routine consultations in the UK were analyzed for farmer and veterinarian NVC. The NVC attributes with established links to positive patient and client outcomes from medical and social science studies were chosen, and a methodology developed for their measurement, by adapting measures typically used in NVC research. Each consultation was segmented into intervals defined by the main activity and location on farm: introduction, fertility examination, discussion, and closing. This approach allowed us to analyze the content more consistently, establish which aspects of NVC featured within each interval, and whether the activity and location influenced the observed NVC. We measured 12 NVC attributes, including body orientation, interpersonal distance, head position, and body lean, which have been shown to influence empathy, rapport, and trust: key components of relationship-centered communication. Future research should seek to establish the significance of NVC in effective communication between veterinarian and farmer, building on our findings that show it is possible to measure nonverbal attributes. Veterinarians may benefit from becoming skilled nonverbal communicators and have more effective conversations during routine consultations, motivating farmers to make changes and improve herd health.

Quality of obstetric and newborn care in health centers of Addis Ababa City: using the WHO quality framework.

OBJECTIVE: The study aims to assess the quality of obstetric and newborn care using the WHO quality framework. DESIGN: The study used explanatory sequential mixed methods design. SETTING: This study was conducted in 50 health centers in Addis Ababa city administration from January 25 to December 31, 2021. METHODS: A total of 50 health centers were surveyed using a structured questionnaire and 500 women in the postpartum period were interviewed using a structured questionnaire. Delivery records of the 500 women were reviewed using a structured checklist. A total of 338 midwives were interviewed using a structured questionnaire. The quantitative data was analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The study revealed that only a third of the 50 health centers were providing good quality care (a quality score ≥ 75%). All the health centers had the physical resources (100%) to deliver obstetric and newborn care. The majority of the health centers had a system for actionable information (92%), functional referral (80%), and providing dignified care (80%). On the other hand, only a few of the health centers met the quality threshold for effective communication (24%), evidence-based practice of routine obstetric and newborn care (36%), and availability of mechanisms to support and motivate skilled birth attendants (24%). None of the health centers met the quality threshold for emotional support during labour and delivery. Obstetric caregivers' high workload and job dissatisfaction were barriers to quality care. CONCLUSION: Ensuring quality obstetric and newborn care needs effective quality improvement interventions that aim to ensure women had effective communication, emotional support, and dignity during labour and delivery. Reducing the workload and increasing motivation of birth attendants play a critical role in improving the quality of care.

Effective communications on invasive alien species: Identifying communication needs of Swedish domestic garden owners.

Invasive alien species threaten biodiversity with domestic gardens acting as a major pathway for the introduction of alien species. Even though the Nordic region is not currently a hotspot for biological invasions, the number of invasions in the Nordic area has been predicted to increase due to climate change. Given a time lag between introduction and invasion, many non-invasive horticultural alien species already introduced into gardens may become invasive in the future. This study aimed to identify the communication needs of Swedish garden owners regarding their management of invasive alien species. A survey among domestic garden owners, informed by topic specialists and local area experts, and interviews with garden owners were conducted in three different bio-climatic areas in a latitudinal gradient across Sweden. The questions targeted invasive alien species and their relations to biodiversity loss and climate change, as well as measures taken to control these species. Analysing the survey data collected in relation to measures taken to control invasive species, Bayesian Additive Regression Tree (BART) modelling was used to identify geographically varying communication needs of the domestic garden owners. In all study areas, the garden owners' measures taken to control invasive alien species were correlated with their strength of beliefs in having experienced local biodiversity loss. A majority of the garden owners were, moreover, uncertain about the impact of climate change on the invasiveness of alien species. In addition, the garden owners' capacity for identifying invasive alien species was often in need of improvement, in particular with respect to the species Impatiens glandulifera, Reynoutria japonica and Rosa rugosa. The results suggest that the evidence-based guidelines for effective communications we developed, have the potential to help communicators meet the local communication needs of garden owners across Sweden, in relation to the management of invasive alien garden species.

"Tortured phrases" in preprints.

This commentary takes note of the existence of "tortured phrases" (i.e. unspecific jargon or confusing alternative phrases), as indexed in the Tortured Phrases Detector of the Problematic Paper Screener (PPS) (sourced on January 10, 2023) in 213 preprints, 13 of which are related to COVID-19. Select "tortured phrases" in 11 preprints are highlighted, to offer readers an appreciation of this phenomenon. The incorrect representation of jargon in the medical and health literature may risk confusing readers by reducing the impact of effective and precise communication. Whereas some "tortured phrases" might represent simple mistranslations, in other cases, an abundance of such terms in a single preprint might reveal a more serious ethical issue, such as the undeclared use of a paper mill or an unprofessional editing service. This commentary is thus only a spring-board to introduce this linguistic phenomenon and to encourage interested academics to explore more cases, the practical implications of their existence, and even the weaknesses and strengths of PPS. Caution is needed about excessive extrapolation of the existence of "tortured phrases", so as not to automatically associate them with ethical infractions or misconduct.

Brain Tumor at Diagnosis: From Cognition and Behavior to Quality of Life.

BACKGROUND: The present narrative review aims to discuss cognitive-emotional-behavioral symptoms in adults with brain tumors at the time of diagnosis. METHODS: The PubMed database was searched considering glioma, pituitary adenoma, and meningioma in adulthood as pathologies, together with cognitive, neuropsychological, or behavioral aspects. RESULTS: Although a significant number of studies describe cognitive impairment after surgery or treatment in adults with brain tumors, only few focus on cognitive-emotional-behavioral symptoms at diagnosis. Furthermore, the importance of an effective communication and its impact on patients' quality of life and compliance with treatment are seldom discussed. CONCLUSIONS: Adults with brain tumors have needs in terms of cognitive-emotional-behavioral features that are detectable at the time of diagnosis; more research is needed to identify effective communication protocols in order to allow a higher perceived quality of life in these patients.

Accommodating hearing loss in outpatient physician offices in the U.S.

BACKGROUND: Approximately 16.2 million Americans ages 18 and older (5.7%) report being deaf or having serious difficulty hearing. Hearing loss impedes effective communication during clinical encounters putting patients' safety at risk. A large fraction of Americans with Disabilities Act lawsuits addresses whether providers offered auxiliary aids and services required to ensure effective communication. OBJECTIVE: Examine use of different hearing accommodations for deaf or hard of hearing patients by U.S. physicians. METHODS: We surveyed randomly selected physicians nationwide representing 7 specialties about their reported use of 8 types of accommodations when communicating with adult outpatients who are deaf or have significant difficulty hearing, even with hearing aids (overall weighted response rate = 61.0%). We performed a descriptive analysis of responses, using survey sampling weights. RESULTS: Among the 526 physicians in this analysis, most were male, white, urban, and practiced in community-based practices. Overall, 81.5% (SE = 1.9) reported that patients with significant hearing limitations get worse quality health care than others. Among participants, 49.8% (2.4) reported never using an in-person sign language interpreter hired by the practice, and 63.2% (2.4) never use video remote interpreting. In contrast, 30.7% (2.1) always and 29.8% (2.2) usually speak louder and slower to patients with significant hearing limitations. None of the 8 accommodations were always or usually used by 8.9% (1.3) of participants. CONCLUSIONS: More than 32 years after the Americans with Disabilities Act, most physicians do not offer accommodations sufficient to ensure effective communication with adult outpatients with significant hearing limitations.

A comunicação da equipa de cuidados na promoção da segurança da pessoa em situação crítica / Care team communication in promoting the safety of people in critical situations

A segurança do doente é um aspeto central na prática clínica e um elemento crucial na garantia de sistemas de saúde eficientes. A prestação de cuidados de saúde reveste-se cada vez mais de grande complexidade e elevada imprevisibilidade, propensos à ocorrência de incidentes que podem significar resultados negativos com danos para o doente e profissionais, assim como, no desempenho e credibilidade das instituições. A comunicação desempenha um desafio em saúde, sendo que as falhas na comunicação representam a etiologia de 70% dos eventos adversos na transferência de informação entre a equipa de cuidados. Os processos de comunicação nos serviços de urgência e cuidados intensivos são complexos e dinâmicos, caracterizados pelo alto fluxo de informações, entre equipas multiprofissionais, associada a uma vasta necessidade de cuidados da pessoa/família, parte integrante da equipa de cuidados. Por isso, a comunicação entre os profissionais, doente/familia, ou seja, a equipa de cuidados, é prioritária. A comunicação eficaz nos momentos de transição de cuidados, assente numa abordagem estruturada, facilita o desenvolvimento de boas práticas e sustenta a tomada de decisão para uma prestação de cuidados segura e de qualidade. Atendendo à promoção da segurança da pessoa em situação crítica, a intervenção especializada do enfermeiro compreende a promoção de uma comunicação eficaz na equipa, reduzindo desta forma a ocorrência de erros e eventos adversos, intervindo atempadamente na prevenção de complicações e aumentando a satisfação da pessoa e da família, tal como demonstra o documento dos padrões de qualidade da Ordem dos Enfermeiros. Esta visão encontra-se sustentada nas teorias de enfermagem: Conceptual System and The Theory of Goal Attainment e Vigilance: the essence of Nursing. O desenvolvimento desta temática constituiu uma estratégia para o desenvolvimento de competências de mestre e especialista na área da pessoa em situação crítica, tendo por base o modelo de Dreyfus de aquisição de competências, adaptado por Benner para a prática de enfermagem. Foram assim realizados dois estágios ­ serviço de urgência e cuidados intensivos - onde foi possivel desenvolver várias atividades que possibilitaram o desenvolvimento dessas competências. (AUT)

Patient safety is a central aspect of clinical practice and a crucial element in ensuring efficient health systems. The provision of health care is increasingly complex and unpredictable, prone to the occurrence of incidents that can mean negative outcomes with damage to the patient and professionals, as well as in the performance and credibility of institutions. Communication plays a challenge in healthcare, with communication failures representing the etiology of 70% of adverse events in the transfer of information between the care team. Communication processes in emergency and intensive care services are complex and dynamic, characterized by a high flow of information, between multiprofessional teams, associated with a vast need of care of the person/family, an integral part of the care team. Therefore, communication between professionals, patient/family, and the care team, is a priority. Effective communication at times of transition of care, based on a structured approach, facilitates the development of good practices, and supports decision making for safe and quality care. Taking into account the promotion of the safety of critically ill patients, the nurse's specialized intervention includes the promotion of an effective communication within the team, thus reducing the occurrence of errors and adverse events, intervening in a timely manner to prevent complications and also to increasing the patient and family's satisfaction, as shown in the Ordem dos Enfermeiros quality standards document. This view is based on two nursing theories: Conceptual System and The Theory of Goal Attainment and Vigilance: the essence of Nursing. The development of this theme was a strategy for the development of master and specialized nursing skills in critical care, based on the Dreyfus model of skill acquisition adapted for nursing practice. Thus, two internships - emergency and intensive care units - were conducted, where it was possible to develop several activities that enabled the development of these competencies. (AUT)

The effects of providing peer feedback on learners' genre awareness in English as a foreign language business letter writing.

Despite the important role of the genre awareness in facilitating the effective communication in the global business context and the need to teach and practice writing for various social purposes, there was scant classroom-based research on effects of providing peer feedback on EFL learners' genre awareness in business writing for fulfilling the particular communicative purpose. This study examined whether student reviewers could improve their genre awareness in business letter writing by providing peer feedback to other students' writings at varying levels. Sixty business English majors, taking the business writing course for 1 year under the tutelage of the same instructor, participated in the current study. They were randomly assigned to the experimental group who reviewed the students' drafts at different levels (high, medium and low) and gave written comments and the control group who received no treatment but did self-revision. Both groups followed the genre-specific evaluation criteria during peer feedback and self-revision. Repeated-measures ANOVA on the two groups' writing performances at different timepoints (pretest, immediate posttest, transfer posttest and delayed transfer posttest) demonstrated that the participants in the experimental group had better performance than those in the control group at the transfer posttest as well as the delayed transfer posttest. Moreover, providing weakness comments on both the low-quality and the medium-quality drafts had significant effects on their own writing quality at the subsequent tests, whereas providing strength feedback on the high-quality drafts had statistically significant impacts on their own writing quality at the immediate posttest and the delayed transfer posttest. However, multiple linear regression analyses demonstrated that only offering weakness comments to the medium-quality drafts could effectively predict the reviewers' overall writing quality in the immediate posttest, the transfer posttest, and the delayed transfer posttest. Tentative research and pedagogical implications of the findings were discussed.