Establishing and Facilitating Large-Scale Manuscript Collaborations via Social Media: Novel Method and Tools for Replication.

BACKGROUND: Authorship teams in the health professions are typically composed of scholars who are acquainted with one another before a manuscript is written. Even if a scholar has identified a diverse group of collaborators outside their usual network, writing an article with a large number of co-authors poses significant logistical challenges. OBJECTIVE: This paper describes a novel method for establishing and facilitating large-scale manuscript collaborations via social media. METHODS: On September 11, 2020, I used the social media platform Twitter to invite people to collaborate on an article I had drafted. Anyone who wanted to collaborate was welcome, regardless of discipline, specialty, title, country of residence, or degree completion. During the 25 days that followed, I used Google Docs, Google Sheets, and Google Forms to manage all aspects of the collaboration. RESULTS: The collaboration resulted in the completion of 2 manuscripts in a 25-day period. The International Council of Medical Journal Editors authorship criteria were met by 40 collaborators for the first article ("Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions") and 35 collaborators for the second article ("The Benefits of Using Social Media as a Health Professional in Academia"). The authorship teams for both articles were notably diverse, with 17%-18% (7/40 and 6/35, respectively) of authors identifying as a person of color and/or underrepresented minority, 37%-38% (15/40 and 13/35, respectively) identifying as LGBTQ+ (lesbian, gay, bisexual, transgender, gender non-conforming, queer and/or questioning), 73%-74% (29/40 and 26/35, respectively) using she/her pronouns, and 20%-23% (9/40 and 7/35, respectively) identifying as a person with a disability. CONCLUSIONS: Scholars in the health professions can use this paper in conjunction with the tools provided to replicate this process in carrying out their own large-scale manuscript collaborations.

Correction: Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions.

[This corrects the article DOI: 10.2196/25070.].

Documenting Social Media Engagement as Scholarship: A New Model for Assessing Academic Accomplishment for the Health Professions.

BACKGROUND: The traditional model of promotion and tenure in the health professions relies heavily on formal scholarship through teaching, research, and service. Institutions consider how much weight to give activities in each of these areas and determine a threshold for advancement. With the emergence of social media, scholars can engage wider audiences in creative ways and have a broader impact. Conventional metrics like the h-index do not account for social media impact. Social media engagement is poorly represented in most curricula vitae (CV) and therefore is undervalued in promotion and tenure reviews. OBJECTIVE: The objective was to develop crowdsourced guidelines for documenting social media scholarship. These guidelines aimed to provide a structure for documenting a scholar's general impact on social media, as well as methods of documenting individual social media contributions exemplifying innovation, education, mentorship, advocacy, and dissemination. METHODS: To create unifying guidelines, we created a crowdsourced process that capitalized on the strengths of social media and generated a case example of successful use of the medium for academic collaboration. The primary author created a draft of the guidelines and then sought input from users on Twitter via a publicly accessible Google Document. There was no limitation on who could provide input and the work was done in a democratic, collaborative fashion. Contributors edited the draft over a period of 1 week (September 12-18, 2020). The primary and secondary authors then revised the draft to make it more concise. The guidelines and manuscript were then distributed to the contributors for edits and adopted by the group. All contributors were given the opportunity to serve as coauthors on the publication and were told upfront that authorship would depend on whether they were able to document the ways in which they met the 4 International Committee of Medical Journal Editors authorship criteria. RESULTS: We developed 2 sets of guidelines: Guidelines for Listing All Social Media Scholarship Under Public Scholarship (in Research/Scholarship Section of CV) and Guidelines for Listing Social Media Scholarship Under Research, Teaching, and Service Sections of CV. Institutions can choose which set fits their existing CV format. CONCLUSIONS: With more uniformity, scholars can better represent the full scope and impact of their work. These guidelines are not intended to dictate how individual institutions should weigh social media contributions within promotion and tenure cases. Instead, by providing an initial set of guidelines, we hope to provide scholars and their institutions with a common format and language to document social media scholarship.

Using a student-faculty collaborative learning model to teach grant development in graduate nursing education.

Graduate nurses are employed in clinical, research, educational, and policy roles. As leaders, they are expected to develop and sustain projects that support translating research to practice and policy. Funding to support initiatives is tight and requires innovative solutions to cover salaries, benefits, equipment purchases, and other program expenses. In an effort to teach grant writing while developing skilled leaders who are effective and competitive in securing funds, the George Washington University School of Nursing offers a graduate-level grant writing course. In the summer of 2011, a collaborative learning model was developed within the course. The joint approach was foundational to securing an Agency for Healthcare Research and Quality grant to support development and implementation of a patient engagement project by the Nursing Alliance for Quality Care. This article describes the project and offers hints for those seeking to develop a collaborative educational experience that affords new leadership skills for RNs from all backgrounds.

End-of-Life Care for Transgender Older Adults.

As the number of transgender older adults increases, the need for respectful and inclusive end-of-life (EOL) care for this population is becoming more apparent. Aging transgender adults often face discrimination, inadequate access to care, and poor quality of care. In response, we organized a think tank that invited participation from 19 transgender older adults, scholars in EOL care, and palliative care providers in the United States to generate recommendations for EOL care for transgender older adults. Subsequently, we conducted a qualitative descriptive exploration of the written record of think tank discussions for the purpose of identifying key EOL care considerations for transgender older adults. We identified four themes that highlight the importance of understanding the experiences of transgender older adults for the advancement of future research, policy, and education initiatives aiming to ensure inclusive and equitable provision of EOL care by nurses and other clinicians for this population.

Project Respect: experiences of seriously ill LGBTQ+ patients and partners with their health care providers.

Discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons in health care creates barriers to serious illness care, including patients avoiding or delaying necessary care, providers disrespecting wishes of surrogates, and adverse outcomes for patients and families. A cross-sectional mixed-methods study using an online survey was used to determine the extent to which LGBTQ+ patients and spouses, partners, and widows experienced disrespectful or inadequate care due to sexual orientation or gender identity. A total of 290 LGBTQ+ patients and partners reported high levels of disrespectful and inadequate care, including 35.2% stating their provider was insensitive to them because of their identity; 30% reporting their provider was unaware of LGBTQ+ health needs; 23.1% feeling judged; 20.7% experiencing rudeness; 20.3% stating providers did not use their correct pronouns; and 19.7% reporting their treatment decisions were disregarded. Black and Hispanic patients were 2-4 times more likely than non-Hispanic White patients to report discrimination. This study demonstrated high levels of disrespectful and inadequate care towards patients and partners due to being LGBTQ+, which was especially problematic for Black and Hispanic patients and those living in politically conservative regions. Recommendations include federal and state civil rights laws to prohibit LGBTQ+ discrimination and institutional practices to address discrimination, including cultural sensitivity training for staff.

Using algorithmic practice maps to teach emergency preparedness skills to nurses.

In 2004, The George Washington University received funding from the U.S. Department of Homeland Security to develop a web-based emergency preparedness course for nurses. The purpose of the course was to provide training that would be accessible regardless of work setting or location. In designing the course, the development team used algorithmic decision making as a conceptual framework to transcend the linear, didactic focus of traditional online preparedness training to provide learners with a learning experience crafted around the decision-making process. This article describes the design of the algorithmic practice maps underlying this course and provides a replicable structure for those interested in developing similar offerings for nurses.

Exploring the Use of Psilocybin Therapy for Existential Distress: A Qualitative Study of Palliative Care Provider Perceptions.

There is a growing body of research suggesting that palliative care patients coping with existential distress may benefit from psilocybin. However, there is a large gap regarding the perceptions of palliative care providers who may provide education, counseling services, recommendations, and/or prescriptions for psilocybin if it is decriminalized, commercialized, and/or federally rescheduled and legalized. The aim of this study was to explore the experiences and perceptions of interdisciplinary palliative care providers regarding existential distress and the use of psilocybin therapy. Five (n = 5) health care providers from a hospital-based palliative care team completed a semi-structured interview related to their experiences supporting patients with existential distress and their beliefs and attitudes related to psilocybin as a possible treatment modality. A qualitative descriptive approach was used to identify key themes which included: 1) multiple barriers to addressing existential distress at the cultural, institutional/organizational, relational, and individual levels, 2) the duality and power of presence, 3) suffering as an intrinsically subjective phenomenon, and 4) uncertainty about the risks and benefits of psilocybin. To inform an inclusive, safe, and holistic approach, more research is needed regarding the possible integration of psilocybin therapy within palliative care for the treatment of existential distress.

Erratum: Addendum to the Acknowledgments: Comparison of Intercom and Megaphone Hashtags Using Four Years of Tweets From the Top 44 Schools of Nursing: Thematic Analysis.

[This corrects the article DOI: 10.2196/25114.].

Comparison of Intercom and Megaphone Hashtags Using Four Years of Tweets From the Top 44 Schools of Nursing: Thematic Analysis.

BACKGROUND: When this study began in 2018, I sought to determine the extent to which the top 50 schools of nursing were using hashtags that could attract attention from journalists on Twitter. In December 2020, the timeframe was expanded to encompass 2 more years of data, and an analysis was conducted of the types of hashtags used. OBJECTIVE: The study attempted to answer the following question: to what extent are top-ranked schools of nursing using hashtags that could attract attention from journalists, policy makers, and the public on Twitter? METHODS: In February 2018, 47 of the top 50 schools of nursing had public Twitter accounts. The most recent 3200 tweets were extracted from each account and analyzed. There were 31,762 tweets in the time period covered (September 29, 2016, through February 22, 2018). After 13,429 retweets were excluded, 18,333 tweets remained. In December 2020, 44 of the original 47 schools of nursing still had public Twitter accounts under the same name used in the first phase of the study. Three accounts that were no longer active were removed from the 2016-2018 data set, resulting in 16,939 tweets from 44 schools of nursing. The Twitter data for the 44 schools of nursing were obtained for the time period covered in the second phase of the study (February 23, 2018, through December 13, 2020), and the most recent 3200 tweets were extracted from each of the accounts. On excluding retweets, there were 40,368 tweets in the 2018-2020 data set. The 2016-2018 data set containing 16,939 tweets was merged with the 2018-2020 data set containing 40,368 tweets, resulting in 57,307 tweets in the 2016-2020 data set. RESULTS: Each hashtag used 100 times or more in the 2016-2020 data set was categorized as one of the following seven types: nursing, school, conference or tweet chat, health, illness/disease/condition, population, and something else. These types were then broken down into the following two categories: intercom hashtags and megaphone hashtags. Approximately 83% of the time, schools of nursing used intercom hashtags (inward-facing hashtags focused on in-group discussion within and about the profession). Schools of nursing rarely used outward-facing megaphone hashtags. There was no discernible shift in the way that schools of nursing used hashtags after the publication of The Woodhull Study Revisited. CONCLUSIONS: Top schools of nursing use hashtags more like intercoms to communicate with other nurses rather than megaphones to invite attention from journalists, policy makers, and the public. If schools of nursing want the media to showcase their faculty members as experts, they need to increase their use of megaphone hashtags to connect the work of their faculty with topics of interest to the public.

LGBTQ+ Inclusive Palliative Care in the Context of COVID-19: Pragmatic Recommendations for Clinicians.

As coronavirus disease 2019 (COVID-19) continues to impact the seriously ill and their families on a global scale, considerations given to marginalized groups amid the pandemic are essential to ensure the provision of high-quality and dignified care. Lesbian, gay, bisexual, transgender, gender-nonconforming, and queer/questioning-identified (LGBTQ+) persons are particularly vulnerable to health inequities across settings, including palliative care and at the end of life. There is a crucial gap in the literature pertaining to palliative care for LGBTQ+ populations during COVID-19. We aim to fill this gap by providing essential health inequity and social support background pertaining to LGBTQ+ persons and practical recommendations for immediate implementation that support inclusive and respectful care for these populations. Using these recommendations is a pragmatic pathway to promote trust, transparency, patient and family engagement, and value concordant care amid the health system strain caused by COVID-19.

Benefits of training family caregivers on experiences of closure during end-of-life care.

Caregiving at Life's End (CGLE) is a program for family caregivers caring for someone during the last years of life that focuses on the emotional, spiritual, and practical aspects of life and relationship completion and closure. This study evaluated the effectiveness of CGLE in improving three major outcomes: comfort with caregiving, closure, and caregiver gain. Family caregivers (n=2,025) participated in programs facilitated by health and human service professionals (n=142) who completed a CGLE train-the-trainer workshop conducted by The Hospice Institute of the Florida Suncoast. The caregivers completed training rosters and pre- and/or post-surveys. Group differences are reported in baseline characteristics and change in three outcomes for caregivers who completed 1) both pre- and post-survey, 2) pre-survey only, and 3) post-survey only. For those who completed both surveys (n=926), paired t-tests and multiple linear regression tested the impact of program length on caregiver outcomes. Caregivers participated in, on average, four sessions and 7.7 hours of training. The majority of caregivers were Caucasian (88%), female (81%), and on average, 60 years old. Significant improvement was found in all three outcomes (P<0.001). The program length made a difference for improvement in comfort with caregiving and closure but not in caregiver gain. Caregivers who are caring for someone during the last years of life benefit from a program that focuses on the life-changing or transformative aspects of caregiving in the last years of life, as well as practical aspects of caregiving. The ability to support caregivers in this relatively low impact intervention can be used in hospice and nonhospice settings.

Transformative aspects of caregiving at life's end.

We do not know to what extent the needs of caregivers involved with patients at the end of life are being met by care providers and whether caregiving at life's end can be a positive experience. We used the Hospice Experience Model of Care as a framework for understanding the effect of transformative tasks on caregiving at life's end. We compared current and bereaved caregivers and then, holding background characteristics constant, tested the independent effects of three transformative mediators: self-acceptance, meaning, and closure, as well as comfort with caregiving on several stressors when explaining differences in caregiver burden and gain. Transformative aspects of caregiving do not mediate the stressors associated with burden but do mediate one stressor associated with caregiver gain. Two mediators reduce caregiver burden and all four of the mediators improve caregiver gain. Caregivers who are able to attend to these transformative aspects find more gain in the caregiving experience.

Validation of the caregiving at life's end questionnaire.

The researchers in this study developed and validated a questionnaire to measure the needs of end-of-life (EOL) caregivers. The model is used to facilitate meaningful and supportive experiences for both the patient and caregiver The questionnaire was developed using existing scales of meaning, self-acceptance, burden, and gain as well as new scales of caregiver comfort, importance of caregiving tasks, and caregiver closure. The sample included 34 current and 17 bereaved caregivers affiliated with The Hospice Institute of the Florida Suncoast. The scales performed well in terms of concurrent validity, internal consistency, and reliability.

Human cognition and the dynamics of failure to rescue: the Lewis Blackman case.

Lewis Blackman was a 15-year-old boy who died 4 days after having surgery to correct a congenital deformity of the chest. The story of his death serves as a chilling reminder that quality and safety are not abstract ideals but rather tangible goals designed to prevent tragedies like the one experienced by Lewis Blackman's family. The authors sought to find an explanatory model for the events that transpired and posit that the answer lies at the intersection of several distinct yet interrelated phenomena: (a) the failure of dual process theory; (b) anchoring and belief perseverance; (c) the role of power and authority; and (d) the fragmented care delivery system in the hospital setting. To prevent similar tragedies in the future, the authors propose 5 strategies for nursing educators: incorporate "cognitive unmooring" questions into student assessments of patients; integrate information about System 1 and System 2 thinking into the didactic portion of the curriculum; include cases similar to Lewis Blackman's into simulation experiences; ensure that students learn how to recognize and address authority gradients with supervisors, physicians, and other members of the health care team; and provide students with experiences including the patient/family as members of the care team.

Perspective: are we teaching racial profiling? The dangers of subjective determinations of race and ethnicity in case presentations.

Physicians make subjective visual assessments concerning the race and/or ethnicity of their patients and document these assessments in patient histories every day. Medical students learn this practice through textbooks and the example set by their educators. Although physicians may believe that they are helping their patients, the practice of using visual clues concerning race and/or ethnicity to determine whether a patient is at risk of certain diseases lacks scientific rigor and may put the patient at significant risk of receiving substandard medical care. The authors argue that if the patient's race or ethnicity is of critical importance, the data should be collected through more objective, scientifically rigorous means, such as genetic testing. In this article, the authors call for the widespread transformation of the way medical schools teach tomorrow's physicians about the role of race and ethnicity in taking medical histories, and they challenge physicians to change their current practices.

Screening, diagnosis, and treatment of depression in patients with end-stage renal disease.

Depression is common in patients with end-stage renal disease and has been linked to increased mortality. Screening for depression in the general medical population remains controversial; however, given the high prevalence of depression and its significant impact on morbidity and mortality, a strong case for depression screening in patients with end-stage renal disease can be made. Several studies have been performed to validate the more common depression screening measures in patients with chronic kidney disease. The Beck Depression Inventory, the Hamilton Rating Scale for Depression, the Nine-Question Patient Health Questionnaire, and the Center for Epidemiologic Studies Depression Scale are some of the measures that have been used to screen for depression in patients with end-stage renal disease. Data suggest a higher Beck Depression Inventory cutoff score, of >14 to 16, will have increased positive predictive value at diagnosing depression in patients with end-stage renal disease. There are limited data on the treatment of depression in this patient population. Pharmacotherapy, including selective serotonin reuptake inhibitors, can be used if deemed clinically indicated, and no active contraindication exists. There are even fewer data to support the role of cognitive behavioral therapy, social support group interventions, and electroconvulsive therapy for treatment of depression in patients with chronic kidney disease. Larger randomized, controlled clinical trials aimed at the treatment of depression in patients with end-stage renal disease are desperately needed.