Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation.

Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.

Can philosophy benefit nurses and/or nursing? Heidegger and Strauss, problems of knowledge and context.

When researchers and scholars claim their work is based on a philosophical idea or a philosopher's corpus of ideas (and theory/theorist can be substituted for philosophy/philosopher), and when 'basing' signifies something significant rather than subsidiary or inconsequential, what level of understanding and expertise can readers reasonably expect authors to possess? In this paper, some of the uses to which philosophical ideas and named philosophers (Martin Heidegger and Leo Strauss) are put in exegesis is critiqued. Considering problematic instances of idea-name use may enable the question: 'Can philosophy benefit nurses and/or nursing?' to be better understood if not answered.

Scholarly practice in healthcare professions: findings from a scoping review.

Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

Allied health professionals' research capacity: open to interpretation?

Allied health professional research capacity and culture has been the focus of growing research interest of late. The recent study by Comer et al. represents the largest survey of allied health research capacity and culture to date. We congratulate the authors on this work and would like to raise some discussion points in relation to their study.The authors have interpreted their research capacity and culture survey results using cut-off values to indicate a degree of adequacy in relation to perceived research success and/or skill level. To our knowledge, the constructs of the research capacity and culture tool have not been validated to an extent that would enable such an inference to be made.Comer et al. describe perceived individual research success and/or skill as adequate, but the rating of skills in areas necessary for the conduct of original research, such as writing research protocols, ethics submissions, securing funding, and writing for publication range from median scores one to three, which is considered 'less than adequate' on the interpretation scale used by the authors.The survey results for the individual and organisational domains reported in Comer et al. are comparable to other similar studies. However, they uniquely conclude research success and/or skill to be adequate in both domains, which is contrary to the interpretation of the other studies.The interpretation of allied health professional research success and skill offered by Cromer et al. differs from studies with similar results and is contrary to previous reports of insufficient research capacity in terms of research trained and active practitioners within these professions in the UK.

Effectiveness of Pediatric Competency-Based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses.

PURPOSE: To evaluate the effectiveness of the American Society of Perianesthesia Nurses (ASPAN) pediatric competency-based orientation (PCBO) education program on knowledge, confidence, and early recognition of nursing expertise among perianesthesia nurses in an acute care setting. DESIGN: A quasi-experimental pre/post survey-intervention design. METHODS: Sixty perianesthesia nurses with experience ranging from less than 5 years to more than 20 years were included. A chapter review survey was completed to assess knowledge before reviewing the chapters and again after reviewing the ASPAN PCBO materials. A presurvey assessing confidence levels, decision making abilities, and early detection of knowledge regarding pediatric patients' expertise were obtained at the beginning of the study. At the end of the study, a post-study survey was completed to evaluate the effectiveness of the intervention. Random codes were assigned to each participant to ensure that the participants' information was blinded. FINDINGS: Perianesthesia nurses' knowledge increased from pre to post intervention with one of the three sets of chapters (Set 2) statistically significant. Perianesthesia nurses' confidence and recognition of nursing expertise scores increased statistically significant from pre to post intervention. Both confidence (with 33 items [P value ≤ .001]) and recognition of nursing expertise (with 16 items [P value ≤ 0.001]) were statistically significant. CONCLUSIONS: The ASPAN PCBO was shown to be statistically effective at increasing knowledge, building expertise, promoting confidence, and improving decision making skills. The plan is for the ASPAN PCBO to be incorporated into the new-hire perianesthesia orientation didactic and the competency plan.

"The sins of our forefathers": reimagining research in health professions education.

As HPE begins to turn their attention to the lived experiences of minoritized groups in society, health professions education (HPE) researchers need to be aware of the history of social science research and the ways it contributes to creating systems of oppression. This is because as 'knowledge producers,' we make decisions about how to design our studies, analyze and interpret data, and report it in ways that are frequently oblivious to the harmful legacy of social science research, and how it continues to bring harm to minoritized communities. To not do so is to perpetuate a system that has historically served the dominant group at the expense of those who are limited in representing the world for themselves. This article proposes that HPE researchers engage in disruptive research practices by delinking with their disciplinary training, and reimagine their role in the research process. To accomplish this, I suggest that they engage in three strategies: attend to the research team's composition, embrace critical theory and investigate epistemological ignorance. These strategies are nowhere close to exhaustive, and they do not extend as far as the conversation must go in reimagining our role in the research enterprise. However, in providing some initial thoughts on this topic, I hope to invite the HPE community into discussion on how we might harness our collective responsibility to resist research practices that are harmful and unjust to minoritized communities.

Nurses as bridge builders: Advancing nursing through the diffusion of knowledge.

AIMS: In 2001, the Institute of Medicine concluded that the American healthcare system failed in translating new knowledge into practice and applying for new technological advances. The Institute of Medicine suggested that knowledge dissemination in healthcare systems may never reach clinicians or patients because the available tools and incentives do not promote rapid dissemination efforts that improve clinical outcomes. This article describes a practical strategy that can bring the benefits of medical science and technology to all healthcare systems in the US and abroad. This involves building the capacity of thousands of new nurse doctors to use social network analysis and work as bridge builders in healthcare systems. BACKGROUND: Nurses have been working in research on evidence-based practice since the time of Florence Nightingale. Since then, there have been many challenges that have limited progress in disseminating nursing knowledge from research to practice. One limitation has been the underutilization of social network analysis, an inter-disciplinary approach used to leverage social structures and the linkages between "actors." DESIGN: The article includes a literature review of social network analysis in healthcare and dissertation formats used in nursing programs. METHODS: Literature review and analysis. RESULTS: Although the use of social network analysis in healthcare dates back to 1957, research has found that reference to social network analysis was rare in the nursing literature and that there was poor knowledge diffusion about social network analysis in the nursing profession. This represents an untapped potential to improve the dissemination of new knowledge in nursing. CONCLUSIONS: The use of social network analysis can help nurses advance care delivery, create more efficient healthcare facilities, and improve clinical outcomes. Nurse bridges represent ideal users of social network analysis because nurses enjoy a high level of interaction with patients, families, hospital personnel, and providers. To successfully build nursing's capacity as bridge builders, the nursing profession will need to change the traditional dissertation format to a publication format, build a new curriculum for nurses who will work as bridges in healthcare, and create a national academic-practice campaign focused on the diffusion of new knowledge in nursing.

Health equity knowledge development: A conversation with Black nurse researchers.

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. Over a series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question.

General practice - a fertile lagoon in the ocean of medical knowledge.

General practitioners (GPs) often find that linear, deductive knowledge does not provide a sufficient map for clinical management. But experience, accompanied by enduring familiarity with individual patients, may offer unique complementary skills to interpret a patient's symptoms and navigate skilfully through diagnosis, treatment, follow-up and prevention.In this article, we draw attention to the nature of this tacit knowing that is executed by many GPs every day. We argue that the nonlinear, unpredictable complexity of this domain nurtures a particular logic of clinical knowing. This kind of knowledge is not intuition and can to some extent be intersubjectively accessible. We substantiate and discuss how and why general practice research can contribute to knowledge development by transforming reflection-in-action to reflection-on-action.We briefly present some concepts for reflection-on-action of clinical knowing in general practice. The VUCA model (volatility, uncertainty, complexity, ambiguity) embraces dynamic and confusing situations in which agile work (adaptive, flexible and responsive behaviour and cognitive creativity) is assumed to be an appropriate response. Using such perspectives, we may sharpen our gaze and apply reflexivity and analytic elaboration to interpret unique incidents and experiences and appreciate the complexity of general practice. In this way, exploratory research can fertilize general practice and offer innovation to the entire domain of clinical knowledge.

Enabling visibility of the clinician-scientists' knowledge broker role: a participatory design research in the Dutch nursing-home sector.

BACKGROUND: A group of clinician-scientists and managers working within a Dutch academic network, experienced difficulties in clearly defining the knowledge broker role of the clinician-scientists. They found no role clarity in literature, nor did they find tools or methods suitable for clinician-scientists. Clarifying role expectations and providing accountability for funding these knowledge broker positions was difficult. The aim of this research was to design a theory-informed tool that allowed clinician-scientists to make their knowledge broker role visible. METHODS: A participatory design research was conducted in three phases, over a 21-month period, with a design group consisting of an external independent researcher, clinician-scientists and their managers from within the academic network. Phase 1 constituted a literature review, a context analysis and a needs analysis. Phase 2 constituted the design and development of a suitable tool and phase 3 was an evaluation of the tool's perceived usefulness. Throughout the research process, the researcher logged the theoretic basis for all design decisions. RESULTS: The clinician-scientist's knowledge broker role is a knowledge-intensive role and work-tasks associated with this role are not automatically visible (phase 1). A tool (the SP-tool) was developed in Microsoft Excel. This allowed clinician-scientists to log their knowledge broker activities as distinct from their clinical work and research related activities (phase 2). The SP-tool contributed to the clinician-scientists' ability to make their knowledge broker role visible to themselves and their stakeholders (phase 3). The theoretic contribution of the design research is a conceptual model of professionalisation of the clinician-scientist's knowledge broker role. This model presents the relationship between work visibility and the clarification of functions of the knowledge broker role. In the professionalisation of knowledge-intensive work, visibility contributes to the definition of clinician-scientists broker functions, which is an element necessary for the professionalisation of an occupation. CONCLUSIONS: The SP-tool that was developed in this research, contributes to creating work visibility of the clinician-scientists' knowledge broker role. Further research using the SP-tool could establish a clearer description of the knowledge broker role at the day-to-day professional level and improved ability to support this role within organisations.

Twelve tips for institutional approach to outcome-based education in health professions programmes.

Outcome-based education (OBE) has brought along a significant development in health professions education in the past decade. The shift from a process-driven to product-driven model of education is valuable for ensuring graduate quality and facilitating global movement of healthcare workers. Such a model can align the expectations of key stakeholders in an era of rapid knowledge expansion and technological advancement. Nevertheless, the experienced benefits of OBE depend on the effectiveness of its implementation. This article therefore provides practical tips and strategies for implementing OBE in order to maximize its potential.

Le savoir expérientiel : exploration épistémologique d'une expression répandue dans le domaine de la santé.

Among the different forms of knowledge, experiential knowledge is widely used in certain activities in the field of health. Most often connected to patients, it is also discussed in relation to health professionals, but less frequently. This article offers some points of reference and clarifies what underlies experiential knowledge. These points of reference are based on definitions of experience and knowledge, as well as work on the type of knowledge created by experience. An exploration of the contexts in which “experiential knowledge” has emerged and the focus of the disciplines that discuss it finds few epistemological connections between knowledge and experience. In the humanities and social sciences, experiential knowledge is most often connected to patients or adults in educational situations. With regard to nursing knowledge, the analysis of Carper and Lechasseur’s work on the nature of nursing knowledge reveals how the characteristics of experience are integrated into their typologies, particularly when it comes to artistic and personal knowledge. The explicit absence of experience in these typologies is then questioned with regard to the scientific imperatives that nursing science, at this particular period in its construction, is determined to promote.

Resisting Corporeal Boundaries in Body Work and Knowledge Work.

This essay summarizes two worker injury narratives: (a) one in a bodywork context and (b) the other in a knowledge work context. Framed by these narratives, the essay integrates unobtrusive control theory with recent research on organizational health and wellness Discourses1. The author highlights how the material quality of corporeal resistance may be a conduit for change in unobtrusive organizational contexts. The essay concludes with practical recommendations for workers to question hidden, problematic, work norms as well as maintain authentic health and wellness as an organizational member.

My work in continence nursing: raising issues and disseminating knowledge.

Helen Cowan, Registered Nurse and Freelance Writer, Oxford (helen.cowan@new-oxford.com) Runner-up in the BJN Awards Continence Nurse of the Year category.

The Locksmith, the Surgeon, and the Mechanical Hand: Communicating Technical Knowledge in Early Modern Europe.

This article uses a locksmith's design for a mechanical hand in the surgeon Ambroise Paré's widely influential Oeuvres (1575) to examine the transmission of technical knowledge in early modern Europe. The article interprets Paré's chapter on artificial limbs through the lens of material culture, and then uses its findings to explore the movement of craft knowledge through print. A comparison between Paré's woodcut image of the prosthesis and an extant sixteenth-century mechanical hand from Kassel, Germany grounds Paré's woodcut in ongoing practices of making prosthetic technology. Analyzing the transmission of Paré's Oeuvres in light of the creative environment of artificial limb design and construction transforms our understanding of the potential utility of the printed image for different viewers. The dissemination of this woodcut design reveals a form of technical knowledge transfer that was endlessly adaptable to the experiences of artisans from different craft groups.

Awareness of Paid Sick Leave among New York City Restaurant Workers.

Restaurant workers are less likely to have paid sick leave (PSL) benefits than other professions, despite the fact that they handle food and interact with the public. In this study, we collected and analyzed quantitative and qualitative data on PSL awareness among New York City's restaurant workers and the factors that produced these levels of awareness. We found that 62% of surveyed workers were aware of NYC's law, and that successful outreach requires building broad awareness and ensuring trustworthy sources of information with multiple points of contact. Our research also highlights the importance of immigrant populations in PSL outreach.

Relevant evidence, reasonable policy and the right to emigrate.

In this article I respond to commentaries by Javier Hidalgo and Phillip Cole. Javier Hidalgo believes that we would be justified in restricting the liberties of health personnel if we had compelling evidence that this would bring about beneficial consequences. He is sceptical that this evidence exists or would ever be forthcoming. Hidalgo therefore supports my position, at least in theory, that where there is good evidence concerning relevant beneficial consequences for remedying important losses associated with high skill migration, we may permissibly restrict health personnel's freedom to migrate through introduction of carefully crafted compulsory service and taxation programmes. So one important issue is whether such evidence is or could ever become available in a form useful to members of government. By contrast, Phillip Cole expresses significant reservations about the policies I argue are permissible under certain conditions. He believes that health workers should never be required to comply with the sorts of taxation and compulsory services programmes I recommend. I show that the programmes for which I argue are not as onerous as Cole imagines and therefore that they can be justified. I also show that relevant evidence exists to address Hidalgo's concerns.

Montaigne on Medicine: Insights of a 16th-Century Skeptic.

Michel de Montaigne (1533-1592) viewed the medicine of his time with a well-merited skepticism and had remarkable insight into its best resource, the placebo effect. Because less separates biomedicine from its Early Modern counterpart than commonly supposed, Montaigne still has much to tell us about the workings of this potent variable. When people improve as a result of surgery that did not take place, or for that matter sicken as a result of fumes that elude detection, they behave much like their counterparts in Montaigne's world. But doctors as well as patients are subject to errors of perception and inference. It was the goal of correcting misleading impressions by more reliable knowledge that led mid-20th-century investigators of the placebo effect to propose the sort of methodologically demanding trials through which drugs are now run before being brought to market. Montaigne's awareness of the weak foundations of claimed knowledge, prominently including medical knowledge, was central to his philosophy of the human.

Putting it into practice: Infection control professionals' perspectives on early career nursing graduates' microbiology and infection control knowledge and practice.

BACKGROUND: The microbiology component of Australian undergraduate nursing programmes varies considerably. Any actual or potential impact of this variation on infection control practice, as a nursing graduate, is relatively unknown. AIMS: The aim of this study was to explore infection control professionals' perceptions of the importance of microbiology and infection control training in undergraduate nursing curricula and the perceived retention of that knowledge and its transferability to practice. METHOD: Semi-structured interviews were conducted with eight infection control professionals from a range of hospital settings in Australia. FINDINGS: Four main themes emerged: Theory versus practice, importance of role modelling, disjunction between university curricula and 'the real world,' and learning in context. CONCLUSION: As the underpinning element of infection control practice, the role of microbiology education and training in nursing education will benefit from review. Further discussions about the nature and timing of theoretical microbiology content and assessment of undergraduate students' microbiology knowledge to ensure retention and appropriate application of that knowledge in practice are urgently needed.

A Scoping Review for Debate-Style Journal Clubs in Health Professional Education.

OBJECTIVES: The objectives of this scoping review are to (1) describe the available literature regarding the utility of the debate-style journal club for health professional learners on literature evaluation skills and (2) report the themes found within debate-style journal club research and assessments in the context of professional education. FINDINGS: A total of 27 articles written in the English language were included in this scoping review. Published evaluations of debate-style journal clubs have been predominantly based in the pharmacy profession (48%, n = 13), but are reported in other health professions, such as medicine (22%, n = 6), dentistry (15%, n = 4), nursing (7%, n = 2), occupational therapy (4%, n = 1), and physical therapy (4%, n = 1), as well. The skills assessed in these studies often included critical literature evaluation, application of literature to patient care, critical thinking, knowledge retention, use of supporting literature, and debate-specific skills. Learners typically reported better understanding and application of the literature, and enjoying the experience more than traditional journal clubs, but note the increased assessor and learner time requirement for debating. Pharmacy learner-specific articles more often utilized a traditional, team-based debate format, incorporated grading rubrics for skill assessment and debate performance, and included a grading component for the debate in the course. SUMMARY: Debate-style journal clubs are well-received by learners but require an additional time commitment. Debate platforms, format, rubric use and validation, and outcome assessment vary across published reports.