Trends in the delivery of care to oncology patients in the United States: Emphasis on the role pharmacists on the healthcare team.

OBJECTIVE: The purpose of this study was to identify trends in oncology care that allow one to forecast workforce supply and demand, the training and skills needed by the oncology pharmacist for the likely future of oncology care. METHODS: Interviews were conducted with experienced oncology pharmacists in leadership roles at 20 organizations balanced by geographic region and type of practice site (academic or community/ambulatory). Results were analyzed using descriptive statistics and theme identification. RESULTS: Practice sites differed widely in numbers of patient visits, practitioner/patient ratios, residency program presence, and other structural features. Despite this, the majority reported an expectation of growth in cancer patients, oncology physicians, oncology pharmacists, pharmacy technicians, oncology nurses, and advanced practice practitioners in the next two to five years. Fifty percent of sites currently support Post Graduate Year 2 (PGY2) oncology residencies. At least 50% reported routine pharmacist involvement in 12 clinical functions. More future involvement was predicted for immunotherapy (80%) and oral oncolytic therapy (90%). Interprofessional involvement was reported for a broad variety of practice-related committees and patient education teams. Limited pharmacist involvement in credentialing, quality measurement, and value-based reimbursement systems was found. CONCLUSION: Anticipated increases in demand for oncology pharmacists strongly suggest the need for more PGY2 oncology residency programs and on-the-job oncology training programs. Oncology pharmacists are currently involved in many clinical and administrative functions including multidisciplinary management. While a core set of clinical functions has been identified, oncology pharmacists must prepare for the increased use of oral oncology agents and immunotherapy. Pharmacist involvement in value-based reimbursement and other data-based quality outcome measurements should be increased to optimize involvement in team-based patient care.

Creating a Statewide Nurse Residency: Using an Apprenticeship Model.

The Institute of Medicine recommends residency programs be implemented for new graduates across all settings, yet hospitals have not consistently hardwired this into their organizations. The value proposition is in recruitment, retention, and the conservation of resources. New Jersey's experiences using the US Department of Labor apprenticeship model for nurse residency programs provides a strategy that can be implemented on a statewide basis.

A 1-Year Accredited Nurse Residency Program's Effect on Intent to Leave.

OBJECTIVE: This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization. BACKGROUND: Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment. METHODS: The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months. RESULTS: Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time. CONCLUSIONS: Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave.

Benefits of a joint health sciences practicum for students in library and information sciences: a case report.

BACKGROUND: A joint practicum gives library and information science (LIS) students the opportunity to compare two health sciences libraries' structures and workflows. The goal of this case report is to describe how a joint health sciences practicum can help LIS students and recent graduates develop skills that may be beneficial for their future positions in health sciences or other libraries.Case Presentation: Six participants in a joint health sciences library practicum underwent two interviews: the first interview focused on their practicum experiences, and the second interview sought to determine whether the participants had found employment and were using any skills in their new positions that they acquired during their practicums. Participants gave mostly positive feedback regarding their practicum experiences and expressed openness to applying for health sciences library positions. Although the participants who found employment did not work in health sciences libraries, their practicum projects served as supporting materials for their job applications, and they were using the skills they had gained from their practicums in their new positions. CONCLUSIONS: While most joint practicum participants were not working in a health sciences library, the practicum was beneficial to their new careers. This case report highlights that a joint health sciences practicum program can be beneficial in showing LIS students different approaches to health sciences librarianship.

Toward a nuanced understanding of nondisclosure in psychotherapy supervision.

Previous research indicates that trainees often withhold important information related to their clients' progress and their reactions to supervision. Moreover, factors associated with the occurrence of supervisee nondisclosure (SND) are not well established. As one of the few studies to compare clinically related with supervision-related nondisclosure, we tested the relation of these two dimensions of the construct, as measured by Siembor and Ellis's (2012) Supervisee Nondisclosure Scales, to three important process variables: perceptions of (a) the supervisory alliance, as measured by Bahrick's (1989) Working Alliance Inventory-Trainee; (b) collaborative supervision, as measured by Rousmaniere and Ellis's (2013) Collaborative Supervision Behavior Scale; and (c) explicitly relational supervisor behaviors, as measured by Shaffer and Friedlander's (2017) Relational Behavior Scale. Participants were 257 North American trainees, predominately White female doctoral students receiving supervision in a practicum or internship setting. As hypothesized, the three process variables inversely contributed to the multivariate composite of SND, jointly accounting for roughly one quarter of the variability; alliance and relational behavior were uniquely significant contributors (24.5% and 7%, respectively). Follow-up analyses indicated that only alliance perceptions contributed unique variance (23%) to supervision-related nondisclosures, which were endorsed much more frequently than clinically related nondisclosures in this sample. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Educating Engineers for the Public Good Through International Internships: Evidence from a Case Study at Universitat Politècnica de València.

At Universitat Politècnica de València, Meridies, an internship programme that places engineering students in countries of Latin America, is one of the few opportunities the students have to explore the implications of being a professional in society in a different cultural and social context. This programme was analyzed using the capabilities approach as a frame of reference for examining the effects of the programme on eight student participants. The eight pro-public-good capabilities proposed by Melanie Walker were investigated through semi-structured interviews. The internship is an environment in which students can put into practice the knowledge they have acquired in undergraduate studies and to find practical relevance in what they studied. Occasionally, this also entails a critical questioning of what they have learned, a greater awareness of the limits of the contents of their studies and of the way things were taught, and interest in less explored issues that are closely linked to social justice. However, tensions can arise between the pro-public-good oriented perspectives of this programme, and a more instrumental vision. One way to overcome these tensions is to foster consideration of reflexivity, that is, the dynamic relationship between technology and society. To do so, the programme must create space before and during the internship, and upon the return of the students, to discuss and collectively reflect upon their lived experience. Additionally, it ought to engage supervisors in this educational journey, both at the university and in the host institutions, and also involve socially committed organisations in this task.

Perceptions of acute care nurse residencies: Perspectives from one state.

AIM: To describe how new nurses transition into practice in acute care settings. BACKGROUND: The Institute of Medicine (2010) landmark report, Future of Nursing: Leading Change, Advancing Health recommends implementing nurse residency programs. However, not all organizations in the state have offered them. Evaluation of the effectiveness of them has been weak. METHOD: A qualitative study using content analysis was conducted. Six focus groups were held 19 educators, 21 nurse residents and 10 chief nursing officers. Co-investigators reviewed the data separately and then met to analyse common categories to gain consensus. RESULTS: Five major categories were identified: pre-residency, program structure, preceptor, resident support and evaluation with additional sub-categories. Although the participants agreed that a residency program was important, the results showed an incongruence between what was needed and what was provided. CONCLUSION: An adequate supply of nurses for the future in health care systems is needed. Addressing transition to practice models can be one strategy that assists with retention of the new graduate. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders need to evaluate the effectiveness of their current nurse residency programs. Standardizing curricula and data collection can improve measurement of outcomes.

Trainees' use of supervision for therapy with sexual minority clients: A qualitative study.

In the supervision literature, research on sexual orientation considerations often focuses on sexual minority supervisees and less often on their work with sexual minority clients. Yet both heterosexual and sexual minority supervisees serve sexual minority clients and may have different supervision needs. Twelve predoctoral interns from 12 APA-accredited counseling center internships were interviewed about how they made use of supervision for their work with a sexual minority client. The sample consisted of 6 heterosexual-identified supervisees and 6 supervisees who identified as lesbian, gay, or queer (LGQ). Data were analyzed using consensual qualitative research. All participants reported positive gains from supervision that carried over to their work with heterosexual and sexual minority clients, even when not all supervisors disclosed or discussed their own sexual orientation. Heterosexual supervisees used supervision to ensure that their heterosexuality does not interfere with an affirmative experience for their sexual minority client, whereas LGQ supervisees used supervision to explore differences in sexual identity development between themselves and their client to minimize the negative impact of overidentification. Thus, affirmative supervision may unfold with different foci depending on supervisees' sexual identity. Implications for training and supervision are discussed. (PsycINFO Database Record

Dietetic interns' perceptions and use of evidence-based practice: an exploratory study.

OBJECTIVE: This study explored dietetic interns' perceptions and knowledge of evidence-based practice (EBP), their use and observation of EBP principles during their clinical rotations, and their intentions to use EBP in their careers. METHODS: A mixed methods design combining a survey and focus group was employed. Dietetic interns (n=16) from a large Midwestern university were recruited in person and via email to participate in the survey, focus group, or both. Perceptions and experiences of EBP were analyzed through the focus group (qualitative), and EBP knowledge and clinical practice behaviors were analyzed through the survey (quantitative). The focus group discussion was recorded, transcribed, and analyzed using thematic analysis. RESULTS: Four major themes emerged from the focus group data: (1) observations of EBP in clinical practice, (2) use of EBP during clinical rotations, (3) barriers to EBP, and (4) perceived use of EBP as future registered dietitians. Interns considered EBP important for their profession and future careers. They struggled, however, with the discrepancies between current research and practice, and highlighted differences that they observed and barriers that they experienced across different clinical settings. CONCLUSIONS: This exploratory study is the first to examine dietetic interns' perceptions of and experiences with EBP in the clinical setting. Future research is needed to identify how dietetics educators, librarians, and preceptors can address the barriers that interns perceive in applying EBP in their internships.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

The impact of a Role Emerging Placement while a student occupational therapist, on subsequent qualified employability, practice and career path.

BACKGROUND: Although Role Emerging Placements (REP) are now a common feature in pre-registration occupational therapy curricula, there is a need to expand the understanding of the impact of this experience on employability, practice and career path of qualified occupational therapists. METHOD: A case finding online survey was used to create a purposive sample for Thematic Analysis of semi-structured interviews with practising occupational therapists from one UK Masters' level pre-registration occupational therapy program. RESULTS: The case finding survey (n = 19) led to recruitment of six participants to be interviewed. The qualitative findings reflected the impact of a REP experience on occupational therapists' employability, practice and career path. The complementary features of the more traditional placement and the role emergent type of placement were considered as being useful and beneficial to qualified practice regardless of setting. However, the REP additionally, had an internal and outward impact. Internally, the therapist gains a passion for occupation-focussed practice and builds confidence to promote both self and the profession. Outwardly, the therapist can offer extra skills in qualified practice, particularly in innovative service development and delivery, thereby offering added value for employability. CONCLUSION: A REP experience as an occupational therapy student, can develop additional skills for qualified professional practice than traditional practice placements alone. The impact of such a placement matches with the 'Generation Y' traits of young adults who are now starting to emerge into training and the work place, translates well into a variety of working environments and lasts into career development. The placement model of occupation-focussed project development and the less apprentice style learning of a REP may be influential, and could be a suitable model within traditional placements.

A Predictive Model to Identify Skilled Nursing Facility Residents for Pharmacist Intervention.

Objective Develop a predictive model to identify patients in a skilled nursing facility (SNF) who require a clinical pharmacist intervention. Design Retrospective, cross-sectional. Setting Nine freestanding SNFs within an integrated health care delivery system. Patients Patients who received a clinical pharmacist medication review between January 1, 2016, and April 30, 2017. Identified patients (n = 2,594) were randomly assigned to derivation and validation cohorts. Interventions Multivariable logistic regression modeling was performed to identify factors predictive of patients who required an intervention (i.e., medication dose adjustment, initiation, or discontinuation). Patient-specific factors (e.g., demographics, medication dispensings, diagnoses) were collected from administrative databases. A parsimonious model based on clinical judgment and statistical assessment was developed in the derivation cohort and assessed for fit in the validation cohort. Main Outcome Measures Model to predict patients requiring clinical pharmacist intervention. Secondary outcome was a comparison of factors between patients who did and did not receive a clinical pharmacist intervention. Results Ninety-five factors were assessed. The derivation (n = 1,299) model comprised 22 factors (area under the curve [AUC] = 0.79, 95% confidence interval [CI] 0.74-0.84). A clopidogrel dispensing (odds ratio [OR] = 2.42, 95% CI 1.19-4.91), fall (OR = 2.47, 95% CI 1.59-3.83), or diagnosis for vertebral fracture (OR = 2.33, 95% CI 1.34-4.05) in the 180 days prior to clinical pharmacist medication review were predictive of requiring an intervention. The model fit the validation cohort (n = 1,295) well, AUC = 0.79 (95% CI 0.74-0.84). Conclusion Administrative data predicted patients in a SNF who required clinical pharmacist intervention. Application of this model in real-time could result in clinical pharmacist time-savings and improved pharmacy services through more directed patient care.

Representations of resident professionals regarding the pedagogical strategies used in the multiprofessional residency training process. / Representações de profissionais residentes acerca das estratégias pedagógicas utilizadas no processo formativo da residência multiprofissional.

OBJECTIVE: To evaluate the social representations of residents regarding the pedagogical strategies of a Multiprofessional Health Residency program. METHOD: A case study with a qualitative approach supported by the Theory of Social Representations. Data collection was performed by applying a questionnaire to the resident professionals. ALCESTE software was used for the lexical content analysis. RESULTS: Questionnaires were applied to 15 resident professionals. The analysis showed the educational potential of a Distance Education tool, the need to prioritize theoretical content and its planning, aligning it with the experience in the territory, and the preference of the subjects for dynamic spaces that favor communication and critical-reflective analysis of day-to-day routines. CONCLUSION: There is a need to value strategies and teaching-learning methodologies that are significant for the resident professional and which contribute to health education.

Longitudinal Outcomes of an Institutionally Developed Nurse Residency Program.

Nurse residency programs are widely implemented to enhance integration of new graduate nurses entering the workforce. This article presents a retrospective analysis of 10 years of residency data from an internally developed residency program that used the Casey-Fink Graduate Nurse Experience Survey. Outcomes of this program were similar to those from studies using commercially available products, suggesting that an internally developed residency curricula may be equally beneficial to the development of new graduate nurses.

Sport science internships for learning: a critical view.

Sport science has gained vast popularity with students who have an interest in both physiology and the underpinning mechanisms of exercise concerning performance and health. The high numbers of graduates each year, coupled with the low number of graduate positions working in sports, has led to a high level of competition between students. To stand out from the crowd, sport science students may undertake an internship placement as part of their course, designed to enhance theoretical, practical, and soft skills in an applied setting. In the present article, we highlight some of the positives and negatives of sport science internships and ways in which they can be implemented and facilitated. Suggestions have also been provided to make students more aware of the reality of working in professional sports, which includes awareness of the potential for long and unsociable hours of work.

Promoting Health Through Policy and Systems Change: Public Health Students and Mentors on the Value of Policy Advocacy Experience in Academic Internships.

Emerging professionals and new Certified Health Education Specialists often lack academic training in and actual experience in National Commission for Health Education Credentialing Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession. For undergraduate and graduate students who have an opportunity to complete an internship or practicum experience, gaining experience in Competencies 7.2: Engage in advocacy for health and health education/promotion and 7.3: Influence policy and/or systems change to promote health and health education can have a profound impact on their career development and their ability to advocate for policies that promote health and health equity. Compelling evidence suggests that interventions that address social determinants of health such as poverty and education and those that change the context through improved policy or healthier environments have the greatest impact on public health, making it vital for emerging public health professionals to gain experience in policy advocacy and systems change. In this commentary, students and faculty from two large universities in the U.S.-Mexico border region reflect on the value of policy advocacy in academic internship/fieldwork experiences. Based on their experiences, they highly recommend that students seek out internship opportunities where they can participate in policy advocacy, and they encourage university faculty and practicum preceptors to provide more opportunities for policy advocacy in both classroom and fieldwork settings.

Succession Planning: Creating A Case for Hiring New Graduates.

With an aging nursing workforce and rising patient acuity levels, healthcare institutions are challenged to meet the demand for competent nursing care Swedish Medical Center (SMC) adopted an aggressive approach for building a new graduate residency program to promote new graduates' opportunity to tap into the valuable expert knowledge and wisdom of retiring nurses. Nursing leadership chose to take an unorthodox approach by identifying new graduates as their hires of choice, citing the ability to create and influence the values and professional practice of the novice nurse as a desired advantage. The program's success focused on adding three key elements to the traditional 1:1 preceptor support model: cohort hiring, monitoring progression to competence, and simulation. SMC is confident this strategy for workforce succession planning will continue to be successful both financially and with regard to patient care quality.

Improving Quality Outcomes in Veteran-Centric Care.

The University of Alabama at Birmingham (UAB) School of Nursing and the Birmingham Veterans Affairs Medical Center (BVAMC) created a Psychiatric-Mental Health Nurse Practitioner (PMHNP) Residency Continuity Clinic tasked with providing Veteran-centric mental health outpatient treatment informed by measurement-based care (MBC) to provide quality outcomes. Approved by the BVAMC, the UAB Institutional Review Board also approved and exempted the project as quality improvement. PMHNP residents administered the Patient Stress Questionnaire (PSQ)-an MBC tool that incorporates validated tools for assessing depression, anxiety, posttraumatic stress, alcohol use, and pain-to each Veteran from March to August 2016. Patient outcomes focused on depression and anxiety. PSQ scores were reviewed retrospectively via descriptive statistics, paired t tests, and Wilcoxon signed ranks tests. Analysis showed improvement in depression and anxiety that approached significance, and in several national Veterans Affairs mental health performance measures, reinforcing the importance of using MBC in psychiatric assessment. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 37-44.].

Health Service Management Interns Serve as Practice Facilitators for Patient-Centered Medical Home Recognition: East Carolina University-Appalachian State University Initiative.

East Carolina University College of Allied Health Science's Department of Health Services Management program is partnering with Community Care of North Carolina and Access East to transform medical practices and educate students on the Patient-Centered Medical Home (PCMH) model of health care delivery. Why now? The Affordable Care Act (2010) and other health care reform changes brought to the forefront the need to focus on improving the quality of care while lowering the overall cost of care. This article describes the first year of implementation of a PCMH initiative where students in a health services management internship program act as facilitators to assist practices in the PCMH recognition process. Lessons learned were the importance of provider and staff endorsement of the PCMH model. In addition, educational needs, time constraints, electronic health record training, understanding practice workflow, and understanding of the National Committee on Quality Assurance PCMH standards were important aspects of the prerequisite knowledge necessary for success. This article compares the ECU Practicum in Primary Care and the Appalachian State University Practicum in Primary Care to build a best practice model based upon the commonalities and uniqueness of each of the individual university programs and their practice sites.

[Selection and optimal sequence of critical elements for medication review: A simulation with hospital pharmacy residents]. / Sélection et séquence optimale des éléments critiques de validation des ordonnances : une simulation avec des résidents en pharmacie hospitalière.

OBJECTIVES: The main objective of this study was to compare the responses of pharmacy residents regarding critical steps for medication order review, in the presence or absence of clinical pharmacists on patient care units, to describe the sequence of these steps and to compare them to an optimal sequence. The secondary objectives were to test this sequence in a simulation and to assess the residents' level of agreement on medication order review. METHODS: Twenty-two validation steps were selected from guidelines. A simulation on order review was organized in three steps: selecting elements judged to be necessary or not for the order review critical path, then organizing this sequence in chronological order, implementation of this critical path on two simulated practical cases, resident perceptions about order review in their training. RESULTS: Forty-one residents participated in the activity. Responses were heterogeneous regarding the elements' sequence and the time required for the review of a simulated case (3-13minutes). A majority of residents considered that their training was insufficient (29/41), that pharmacists validated differently (27/41), and that it was impossible to review the 22 proposed items for each prescription (30/41). CONCLUSIONS: This article highlights heterogeneous medication order review practices among pharmacy residents, due to a lack of training in their curriculum according to them. It is essential to acquire medication order review standard both locally and nationally.