Midwifery students' perceptions of clinical learning experiences and midwifery preceptors in Turkey.

BACKGROUND: The clinical education environment presents a valuable opportunity for students to learn, acquire and develop the clinical skills essential for professional midwifery practice. The presence of competent and relevant preceptors plays a pivotal role in ensuring the success of midwifery students and fostering positive clinical experiences. AIM: This study was conducted to evaluate the clinical practice experiences of midwifery students and their perceptions of midwifery preceptors. DESIGN: A descriptive and cross-sectional study. METHODS: This study was conducted with 205 students enrolled in the midwifery department of the Faculty of Health Sciences of a state university in Turkey. Data collection used a participant information form and the Clinical Learning Environment and Midwifery Preceptor Scales designed to assess factors affecting midwifery students' clinical learning. Data analysis was performed using the SPSS 22.0 program, employing methods such as the Independent Sample T-Test, One-Way Analysis of Variance and Tukey test. RESULTS: The average total score on the Clinical Learning Environment scale was 31.08±2.16 out of a possible 32, while the average total score on the Midwifery Preceptors scale was 17.60 (SD 1.27) out of a possible 18. The mean total score of the Midwifery Preceptor Scale and the mean scores of the sub-dimensions of Skill Development and Midwifery Practice Philosophy were found to be statistically significantly higher in those aged 21 years and older than aged 20 years and younger (P < 0.05). The Midwifery Preceptor Scale total score, the Clinical Learning Environment Scale total score and Skill Development sub-dimensions mean scores of the second-year students were found to be statistically significantly higher than the first and third-year students (P <0.05). Furthermore, students who received education in larger groups and willingly chose and had a passion for the midwifery profession demonstrated significant positive perceptions regarding their clinical learning environment experiences and the impact of their preceptors on their professional growth. CONCLUSIONS: Understanding the perspectives of midwifery students regarding the clinical education environment, preceptors and the teaching and learning process holds great importance for enhancing the quality of the clinical education environment and fostering the development of clinical competencies among midwifery preceptors.

Village doctors: a national telephone survey of Bangladesh's lay medical practitioners.

BACKGROUND: Bangladesh outperforms its Least Developed Country (LDC) status on a range of health measures including life expectancy. Its frontline medical practitioners, however, are not formally trained medical professionals, but instead lightly-trained 'village doctors' able to prescribe modern pharmaceuticals. This current study represents the most complete national survey of these practitioners and their informal 'clinics'. METHODS: The study is based on a national Computer Assisted Telephone Interviewing (CATI) of 1,000 informal practitioners. Participants were sampled from all eight divisions and all 64 districts of Bangladesh, including 682 participants chosen from the purposively recruited Refresher Training program conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), supplemented with 318 additional participants recruited through snowball sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: In addition to demographics, village doctors were asked about the characteristics of their 'clinics' including their equipment, their training, income and referral practices. RESULTS: Three quarters of the wholly male sample had not completed an undergraduate program, and none of the sample had received any bachelor-level university training in medicine. Medical training was confined to a range of short-course offerings. Village doctor 'clinics' are highly dependent on the sale of pharmaceuticals, with few charging a consultation fee. Income was not related to degree of short-course uptake but was related positively to degree of formal education. Finally, practitioners showed a strong tendency to refer patients to the professional medical care system. CONCLUSIONS: Bangladesh's village doctor sector provides an important pathway to professional, trained medical care, and provides some level of care to those who cannot afford or otherwise access the nation's established healthcare system. However, the degree to which relatively untrained paramedical practitioners are prescribing conventional medicines has concerning health implications.

Evaluation of the Oral Health Knowledge Network's Impact on Pediatric Clinicians and Patient Care.

PURPOSE: Oral disease has a major impact on the overall health of US children, with dental caries being the most prevalent chronic disease in this age group. Given nationwide shortages of dental professionals, interprofessional clinicians and staff with proper training can influence oral health access. The American Academy of Pediatrics created the Oral Health Knowledge Network (OHKN) in 2018 to bring together pediatric clinicians via monthly virtual sessions to learn from experts, share resources, and network. METHODS: The Center for Integration of Primary Care and Oral Health partnered with the American Academy of Pediatrics to evaluate the OHKN in 2021. The mixed method evaluation included an online survey and qualitative interviews among program participants. They were asked to provide information on their professional role and prior commitment to medical-dental integration as well as feedback on the OHKN learning sessions. RESULTS: Of the 72 program participants invited, 41 (57%) completed the survey questionnaire and 11 took part in the qualitative interviews. Analysis showed that OHKN participation supported both clinicians and nonclinicians in integrating oral health into primary care. The greatest clinical impact was incorporating oral health training for medical professionals (cited by 82% of respondents), while the greatest nonclinical impact was learning new information (cited by 85% of respondents). The qualitative interviews highlighted the participants' prior commitment to medical-dental integration as well as drivers for their current medical-dental integration work. CONCLUSIONS: Overall, the OHKN had a positive impact on pediatric clinicians and nonclinicians and, as a learning collaborative, successfully educated and motivated health care professionals to improve their patients' access to oral health through rapid resource sharing as well as clinical practice change.

Ações de humanização das enfermeiras obstétricas mineiras: resistência e contraconduta à medicalização do parto / Humanization actions of the obstetric nurses from minas gerais: resistance and counter-conduct to the medicalization of childbirth / Acciones de humanización de las enfermeras obstétricas de minas gerais: resistencia y contraconducta a la medicalización del parto

Objetivo: discutir as ações de enfermeiras obstétricas e seu potencial de resistência e contraconduta à medicalização da assistência ao parto. Método: pesquisa descritiva e exploratória, de abordagem qualitativa e fundamentação genealógica. A coleta dos dados foi feita, por meio de entrevistas semiestruturadas, junto a 11 enfermeiras obstétricas. Os dados foram analisados pela técnica de Análise de Discurso. Resultados: as ações de humanização das primeiras enfermeiras obstétricas se conformaram como resistência e contraconduta à medicalização do parto, uma vez que eram pautadas no enfrentamento das práticas médicas intervencionistas, na defesa da fisiologia do parto e na integralidade do cuidado. Conclusão: reconhece-se que, no cotidiano da prática profissional, enfermeiras obstétricas precisam adotar ações de resistência e contraconduta como tentativa de subversão do paradigma biomédico, o qual impõe a medicalização da assistência e a apropriação do corpo feminino, cerceando a autonomia das mulheres no processo de parturição.(AU)

Objective: to analyze the practices of humanization in childbirth care, developed by nurse midwives, capable of constituting actions of resistance and counter-conduct to the medicalization of the female body. Method: this is a descriptive and exploratory research, with a qualitative approach and genealogical inspiration. The research was developed in the context of hospital care. Research data were produced through semi-structured interviews with 11 nurse midwives and submitted to Discourse Analysis. Results: the actions of the first obstetric nurses conformed as resistance and counter-conduct to the medicalization of childbirth, as they were based on confronting interventionist medical practices, defending the physiology of childbirth, and providing comprehensive care. Conclusion: it is recognized that, in their daily professional practice, obstetric nurses need to adopt resistance and counter-conduct actions capable of going beyond the concept of the body under the biomedical paradigm.(AU)

Objetivo: analizar las prácticas de humanización de las enfermeras obstétricas, caracterizadas como acciones de resistencia y contraconducta a la medicalización del cuerpo femenino. Método: investigación descriptiva y exploratoria, con enfoque cualitativo e inspiración genealógica, desarrollada en el contexto de la atención hospitalaria. Los datos de la investigación se produjeron a través de entrevistas semiestructuradas con 11 enfermeras parteras y se sometieron al Análisis del Discurso. Resultados: las acciones de las primeras enfermeras obstétricas se conformaron como resistencia y contracultura a la medicalización del parto, ya que se basaban en enfrentar las prácticas médicas intervencionistas, defender la fisiología del parto y brindar cuidado integral. Conclusión: se reconoce que, en la práctica profesional diaria, las enfermeras obstétricas necesitan adoptar acciones de resistencia y contraconducta para superar el concepto de cuerpo bajo el paradigma biomédico.(AU)

Reflexão crítica da teoria de Jean Watson: estudo fundamentado no modelo de Chinn e Kramer / Critical reflection of Jean Watson's theory: a based study on the Chinn and Kramer model / Reflexión crítica de la teoría de Jean Watson: un estudio basado en el modelo de Chinn y Kramer

Objetivo: analisar a teoria do Cuidado Humano de Jean Watson, a partir do modelo de reflexão crítica proposto por Chinn e Kramer. Método: estudo teórico- reflexivo, realizado em abril de 2021, a partir do modelo de reflexão crítica elaborado por Chinn e Kramer, com ênfase nos seguintes componentes: clareza, simplicidade, generalidade, acessibilidade e importância da teoria. Resultados: da análise do modelo proposto, observou-se que a teoria do Cuidado Humano de Jean Watson apresenta relativa clareza semântica devido aos seus elementos complexos, no entanto pode ser classificada como geral, acessível, importante, valiosa e útil, podendo assim, ser empregada como importante subsídio para a atuação profissional por sua abrangência de significados e de valor prático. Conclusão: a Teoria do Cuidado Humano pode ser utilizada nas mais diversas situações de cuidados, independentemente da situação de saúde do indivíduo, permitindo a promoção de um cuidado holístico e com atenção aos aspectos biopsicossocioespirituais.

Objective: to analyze Jean Watson's theory of Human Caring, based on the critical reflection model proposed by Chinn and Kramer. Method: theoretical- reflective study, carried out in April 2021, based on the critical reflection model developed by Chinn and Kramer, with emphasis on the following components: clarity, simplicity, generality, accessibility and importance of the theory. Results: from the analysis of the proposed model, it was observed that Jean Watson's theory of Human Caring presents relative semantic clarity due to its complex elements, however it can be classified as general, accessible, important, valuable and useful, thus being able to be used as an important subsidy for professional performance due to its range of meanings and practical value. Conclusion: the Theory of Human Care can be used in the most diverse care situations, regardless of the individual's health situation, allowing the promotion of holistic care and attention to biopsychosocial-spiritual aspects.

Objetivo: analizar la teoría del Cuidado Humano de Jean Watson, a partir del modelo de reflexión crítica propuesto por Chinn y Kramer. Método: estudio teórico- reflexivo, realizado en abril de 2021, a partir del modelo de reflexión crítica desarrollado por Chinn y Kramer, con énfasis en los siguientes componentes: claridad, sencillez, generalidad, accesibilidad e importancia de la teoría. Resultados: del análisis del modelo propuesto, se observó que la teoría del Cuidado Humano de Jean Watson presenta relativa claridad semántica debido a sus elementos complejos, sin embargo, puede clasificarse como general, accesible, importante, valiosa y útil, pudiendo así ser utilizado como un importante subsidio para el desempeño profesional debido a su variedad de significados y valor práctico. Conclusión: la Teoría del Cuidado Humano puede ser utilizada en las más diversas situaciones de cuidado, independientemente de la situación de salud del individuo, permitiendo la promoción del cuidado holístico y la atención a los aspectos biopsicosociales-espirituales.

A phenomenological insight into what final year undergraduate student nurses perceive is the role of the Registered Nurse and who they learn this from.

Background: This paper considers the perceptions of 18 final year student nurses around their perception of the role of the nurse. Methods: A qualitative phenomenological research study was undertaken, with final year student nurses as the data source, undertaking semi-structured interviews from a United Kingdom Higher Education Institution. Data analysis was undertaken by using interpretative phenomenological analysis. Results: Findings indicate that student nurses had little insight as to the role of the nurse when commencing the programme. Being on the programme has led them to understand there are many aspects of a nurse's role including, surprisingly for them, much responsibility. It was also found that a lot of the learning that takes place comes from working with healthcare assistants, and due to this, the student nurses perceive that the role of the modern nurse is task orientated and there is little holistic care. Conclusions: The future practice of this group of registrants may be affected depending on how they move forward with their role, alongside the holistic role of the nurse being detracted from. While phenomenology does not account for generalisations but does seek to illuminate this phenomenon; however if this view were to be shared globally, then the caring aspect of nursing may well be in danger of being lost. If this assumption of the role of the nurse is shared globally, then there are inevitably implications for the nursing profession, and more importantly patient care may be affected.

El término kinesiología, sus implicancias en la forma profesional y en el fondo disciplinar. Segunda parte: los matices en su desarrollo / The term kinesiology, its implications in the professional practice and disciplinary background. Second part: the nuances in its the development

Los matices que ha generado el término Kinesiología en el desarrollo disciplinar han podido justificar una importante cantidad de acciones profesionales que van desde la educación física, pasando por la investigación de laboratorio, cinética, cinemática del deporte y función ventilatoria, para culminar otorgando asistencias en el extremo de la disfunción y la inmovilidad concomitante al término de la gran mayoría de las enfermedades. Así la Kinesiología ha sido el soporte argumentativo para profesores, entrenadores, científicos y terapeutas que trabajan con el movimiento humano. No exentas de contribuir al objeto de estudio se encuentran las humanidades y las ciencias sociales que parten en la antropología y se consolidan en la biopolítica de organizaciones gremiales con carácter universal para fijar lineamientos de control. Ante la importante magnitud del campo de conocimientos acumulados, es posible sostener la evidente oportunidad de generar condiciones favorables que se encarguen de reflexionar otras soluciones inspiradas en la trascendencia de la funcionalidad y el movimiento. El denominador común de estos alcances comienza cuando la funcionalidad pasa a ser la meta epistemológica de los paradigmas al servicio del movimiento humano. En este contexto, el objetivo de esta investigación fue analizar el término Kinesiología en el contexto de los matices disciplinares para recomponer sus implicancias y determinar su posibilidad de sobrevida.

SUMMARY: The nuances that the term Kinesiology has generated in disciplinary development have upheld a significant number of professional actions, ranging from physical education to laboratory research, kinetics, sport kinematics and ventilator function. Such actions have ultimately assisted in the extreme dysfunction and immobility concomitant at the end of a vast majority of diseases. Therefore, Kinesiology has been the argumentative support for teachers, coaches, scientists and therapists working with human movement. Humanities and social sciences that commence with anthropology and are consolidated in the bio politics of global union organizations to establish control guidelines are also an important contribution to its study. Given the vast amount of knowledge in this field, there is an opportunity to generate favorable conditions that reflect on further solutions inspired by the transcendence of functionality and movement. When reflecting on these achievements, the common denominator is when functionality becomes the epistemological goal ofthe paradigms at the service of human movement. In this context, the objective of this research was to analyze the term Kinesiology in the context of disciplinary nuances to recompose its implications and to determine if it can survive as a discipline.

Evidence implementation among complementary medicine practitioners: a meta-summary.

OBJECTIVES: To explore the factors impacting evidence implementation in complementary medicine (CM) practice. CONTENT: MEDLINE and CINAHL were systematically searched for cross-sectional studies examining evidence implementation among CM practitioners. Qualitative data from eligible studies were collated and analysed using a meta-summary approach. Data were coded according to the five domains of the Consolidated Framework for Implementation Research (CFIR), and translated into barriers and enablers. SUMMARY: Qualitative data were available for 614 participants (from 16 disciplines) across 14 studies. Coding identified 34 themes, with most themes aligning with the Inner Setting (11 themes) and Characteristics of the Intervention (10 themes) domains of the CFIR. The most commonly referenced barriers to evidence implementation were: 'Lack of supportive resources' (Effect size [ES]=33.3%), 'Research misalignment with profession and practice' (ES=14.5%) and 'Lack of access to knowledge and information' (ES=10.5%). The most common enablers were: 'Recognition of a need for change' (ES=8.2%) and 'Perceived adaptability of EBP to the profession' (ES=7.8%). OUTLOOK: This research offers new insights into the challenges and opportunities to implementing evidence-based practices in the field of CM. The findings underline the complexity of the phenomenon, and the need for a nuanced, multi-faceted and multi-stakeholder approach to improving evidence implementation in CM.

Cross-Sectional Survey of Opinions, Professional Changes, and Personal Hardships of COVID-19 on Chiropractors in the United States.

OBJECTIVE: The purpose of this study was to assess self-reported data from a sample of U.S. doctors of chiropractic during the COVID-19 pandemic about levels of psychological stress and beliefs of the association between chiropractic spinal manipulation and the immune system. METHODS: Chiropractors in the United States were invited via social media and e-mail to complete a survey about chiropractic and COVID-19. The survey collected demographic information, office protocols, changes made during the COVID-19 pandemic, chiropractic profession opinions, information related to stress, and personal beliefs from April 19 to May 3 of 2020. Data were analyzed using descriptive statistics. RESULTS: Of approximately 77000 U.S.-licensed chiropractors,750 responded. Of this sample, 51.2% reported moderate and 30.4% reported severe levels of psychological stress. The primary stressors were financial and business concerns. There was a mixed response regarding beliefs if there was evidence to support a connection between spinal manipulation and the immune system. A majority (76.1%) responded that there should be no advertising for immune-boosting effects of spinal manipulation during the pandemic. A minority (18.3%) reported adding use of telehealth to deliver their services. CONCLUSION: A majority of chiropractors included in this survey reported that the COVID-19 pandemic caused them psychological stress. More than half of the respondents reported moderate stress, with the second highest number of respondents reporting severe stress. Subgroup differences were noted in stress levels and causes, as well as pandemic-related practice changes. A dichotomy was noted between beliefs and recommended actions about effects on the immune system, which may represent that providers are aware of current evidence and considering association recommendations.

Reactions of physicians in the state of São Paulo to the use of telemedicine during the SARS-CoV-2 pandemic: cross-sectional study

ABSTRACT BACKGROUND: Telemedicine can be a component of integrated healthcare practices and its use is not a recent phenomenon around the world. In Brazil, its more widespread use began during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, through extraordinary authorization from the Brazilian Ministry of Health. OBJECTIVES: To describe some aspects of use of teleconsultation among a sample of physicians in the state of São Paulo during the SARS-CoV-2 pandemic. DESIGN AND SETTING: Cross-sectional study based on a survey conducted by the São Paulo Medical Association (Associação Paulista de Medicina, APM) on medical practice during the SARS-CoV-2 pandemic between December 18, 2020, and January 18, 2021. RESULTS: This survey generated responses from 2,052 physicians. Of these, 981 (47.8%) reported not practicing any form of telemedicine. Among those who reported practicing telemedicine, 274 (28.4%) reported not receiving remuneration directly for the attendance provided and 225 (23.3%) reported receiving remuneration equal to what they would have received from face-to-face consultations. Regarding the professional linkage of the physicians who undertook telemedicine attendance, the majority (499; 51.8%) only attended private patients. Regarding the resources used to provide telemedicine attendance, most of the respondents used specialized digital platforms (594; 61.6%), electronic health records (592; 61.4%) and electronic prescriptions (700; 72.6%). CONCLUSION: This study demonstrates that important issues such as professional remuneration, use of electronic platforms and medical records, ensuring data protection and relationships between physicians and other stakeholders still need to be better defined, in order to achieve the desired scale and reach the outcomes defined.

Care ethics framework for midwifery practice: A scoping review.

Background: As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity.Aim: The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a care ethics framework and definition for midwifery practice.Method: The scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was applied to the databases CINAHL, MEDLINE, PschInfo and Pubmed which were searched in September 2019 and again in July 2021. The inclusion criteria were guided by the mnemonic for search terms: Participants, Concept, and Context (PCC) and included variations of health care professionals, care ethics and utilization. The search was limited to qualitative studies published in English between 2010 and 2021. A data extraction tool was used to extract and synthesize data into categories. The articles were screened for eligibility by title, abstract and full text review, by two independent reviewers.Ethical Considerations: The scoping review was guided by ethical conduct respecting authorship and referencing sources.Results: Twelve of the initially identified 129 studies were included in the scoping review. Data synthesis yielded four categories of care ethics use by health professionals: relationship, context, attention to power and caring practices. In combination, the evidence forms a framework for care ethics use in midwifery practice.Conclusion: Care ethics use by health professionals enhances ethical sensitivity. A framework and definition for care ethics for midwifery practice is proposed. This review will be of interest to midwives and other health practitioners seeking to enhance ethical sensitivity.

Failure of the Problem-Oriented Medical Paradigm and a Person-Centered Alternative.

Our problem-oriented approach to health care, though historically reasonable and undeniably impactful, is no longer well matched to the needs of an increasing number of patients and clinicians. This situation is due, in equal parts, to advances in medical science and technologies, the evolution of the health care system, and the changing health challenges faced by individuals and societies. The signs and symptoms of the failure of problem-oriented care include clinician demoralization and burnout; patient dissatisfaction and non-adherence; overdiagnosis and labeling; polypharmacy and iatrogenesis; unnecessary and unwanted end-of-life interventions; immoral and intolerable disparities in both health and health care; and inexorably rising health care costs. A new paradigm is needed, one that humanizes care while guiding the application of medical science to meet the unique needs and challenges of individual people. Shifting the focus of care from clinician-identified abnormalities to person-relevant goals would elevate the role of patients; individualize care planning; encourage prioritization, prevention, and end-of-life planning; and facilitate teamwork. Paradigm shifts are difficult, but the time has come for a reconceptualization of health and health care that can guide an overdue transformation of the health care system.

Intentions to leave and actual turnover of community midwives in the Netherlands: A mixed method study exploring the reasons why.

BACKGROUND: In the Netherlands, the turnover of midwives of relatively young age is high. This is concerning since a lack of midwifery experience can negatively affect the quality of maternity care. AIM: To study the rate and the reasons for intending to leave, and to explore the reasons for leaving midwifery jobs in the Netherlands. METHODS: We used a mixed-methods design including a quantitative survey (N = 726) followed by qualitative interviews (N = 17) with community midwives. FINDINGS: Almost one third of the respondents considered leaving the profession. The decision to actually leave the job was the result of a process in which midwives first tried to adapt to their working conditions, followed by feelings of frustration and finally feelings of decreased engagement with the work. The reasons for leaving midwifery practice are an accumulation of job demands, lack of social resources and family responsibilities. DISCUSSION: Compared to international figures, we found a lower rate of midwives who considered leaving the profession. This could be explained by the differences in the organisation of midwifery care and the relatively high job autonomy of midwives in the Netherlands. Nevertheless, changes must be made in terms of decreasing the demands of the job and creating more job resources. CONCLUSION: Innovations in the organisational structure that focus on continuity of care for pregnant individuals, job satisfaction for midwives and building a sustainable workforce may result in an increase in the retention of midwives. These innovations would ensure that women and their babies receive the best care possible.

Sexual issues in people with haemophilia: Awareness and strategies for overcoming communication barriers.

INTRODUCTION: The Haemophilia Experiences, Results and Opportunities (HERO) Study identified sexual health as an important psychosocial issue affecting people with haemophilia (PWH) worldwide. However, sexual health is inadequately addressed at haemophilia treatment centres (HTCs), because PWH and healthcare professionals (HCPs) experience barriers to broaching the subject. There is a clear need for HCP training to support communication in this area and improve comprehensive care. AIM: The Sexual Health: Strategies for Effective Communication pilot programme was trialled in Canada to assess HCP readiness and ability to discuss sexual health issues with PWH and test communication tools to facilitate these conversations. METHODS: The pilot programme consisted of two 3-h sessions attended by seven HCPs from Calgary's Alberta Children's and Foothills Hospitals. The sessions included lectures and case scenarios and explained the check-in-affirm-clarify-answer and head-heart-body tools designed by the Centre for Sexuality to aid communication. The pilot was evaluated through discussions and an online questionnaire. RESULTS: The pilot was well received by all HCP participants. Questionnaire data showed improvements in participants' knowledge, skills and comfort level in conducting sexual health discussions. Greatest improvements were noted in knowledge (100% 'good' or 'excellent' after the pilot, compared with 29% beforehand). Importantly, 86% felt that the material presented would be applicable in clinical practice. CONCLUSION: The Canadian pilot demonstrated the effectiveness of the proposed educational programme. The underlying principles could be adapted to similar programmes for other HTCs to facilitate sexual health discussions.

Evidence-based healthcare competence of social and healthcare educators: A systematic review of mixed methods.

BACKGROUND: Social and healthcare operating environments are constantly evolving, so educators have major responsibility for ensuring that Evidence-Based Healthcare is included in the education of future healthcare professionals and applied in their practice. A holistic understanding and implementation of evidence-based healthcare competence is critical to the delivery of appropriate, relevant, and effective healthcare. AIM: To identify and describe social and healthcare educators' EBHC competence according to the five main components of the JBI model and associated factors to it. METHODS: A mixed-methods systematic review was conducted, with inclusion and exclusion criteria identified according to PICo and PEO inclusion criteria for qualitative and quantitative studies, respectively. Five databases-the CINAHL (EBSCO), PubMed, Scopus, Medic and ProQuest databases- were searched in June 2020. In total, 12 original studies (qualitative and quantitative) were included for quality appraisal, data extraction and narrative synthesis. RESULTS: Key competence areas addressed in the selected studies were integrated into the four components of the JBI model of EBHC (evidence generation, synthesis, transfer, and implementation, and focus on its ultimate goal: global health). In the majority of chosen studies', it was found that educators had a positive attitude towards EBHC and wanted to stay up-to-date in the areas of global health and collaboration. Educators demonstrated their abilities to locate, appraise, and interpret the best current relevant evidence. They knew how to integrate EBHC into their teaching and had strong communication skills in evidence transfer. Their EBHC competence was strongest in the educational context and educators could transfer evidence when teaching but were not able to translate it into how to implement EBHC in clinical care. In addition to higher academic education and work experience, organizational support and continuous education reportedly play essential roles in development of educators' EBHC competence. CONCLUSION: Measures are needed to maintain and improve social and health educators' EBHC competence and develop robust methods to reliably assess it.

Conhecimento, recomendação e uso de mindfulness por psicólogos clínicos brasileiros / Knowledge, recommendation and use of mindfulness by brazilian clinical psychologists / Conocimiento, recomendación y uso de mindfulness por psicólogos clínicos brasileños

Mindfulness tem se tornado popular na comunidade psicoterapêutica e, também, entre clientes em busca de alívio para seu sofrimento. Contudo, pouco se conhece sobre como mindfulness tem sido integrado à psicoterapia, especialmente no Brasil. O objetivo deste estudo foi identificar e caracterizar conhecimento, recomendação, uso clínico e pessoal de mindfulness por psicólogos clínicos brasileiros. Os dados foram obtidos utilizando levantamento quantitativo nacional, realizado com 417 psicólogos clínicos habilitados. O instrumento utilizado foi um questionário estruturado online, desenvolvido e testado para este estudo. Os resultados foram analisados descritivamente por meio de frequências; para a associação entre categorias de respostas utilizou-se teste exato de Fisher e nível de significância p < 0,05. Os resultados indicaram que a maior parte dos psicólogos (65,23%) relatou nenhum ou pouco conhecimento de mindfulness; quase metade (47,96%) já recomendou a seus clientes; cerca de um terço (31,18%) já aplicou na clínica, predominando o uso de técnicas isoladas com clientes individualmente; e cerca de um quarto dos profissionais (25,37%) pratica mindfulness a nível pessoal. Estes dados sugerem que o uso de mindfulness na clínica tem se distanciado do formato baseado em evidência - programas baseados em mindfulness -, cuja eficácia já foi verificada. Espera-se que os resultados contribuam para a reflexão acerca da capacitação e da regulamentação de práticas emergentes em psicologia (incluindo mindfulness) por parte dos campos regulatório, acadêmico e científico, qualificando o psicólogo para tomar melhores decisões sobre a integração de tais práticas na psicoterapia.(AU)

Mindfulness has become popular within psychotherapeutic community and among clients seeking relief from their suffering. However, little is known about how mindfulness has been integrated into psychotherapy, especially in Brazil. This study aimed to identify and characterize knowledge, recommendation, clinical and personal use of mindfulness by Brazilian clinical psychologists. Data were obtained using a national quantitative survey, carried out with 417 licensed clinical psychologists. The instrument was a structured online questionnaire, developed and tested for this study. Results were analyzed descriptively by frequencies; Fisher's exact test and significance level p < 0.05 were used for association between categories of response. Results indicated that most psychologists (65.23%) reported no or little knowledge of mindfulness; almost half of them (47.96%) have already recommended it to their clients; about a third (31.18%) has already applied it in clinical setting, mainly using isolated techniques on individual clients; and about a quarter of the professionals (25.37%) practices mindfulness at a personal level. These data suggested that the use of mindfulness in clinical setting has moved away from the evidence-based format - mindfulness-based programs -, whose effectiveness has been verified. We expect that results can contribute to the reflection about training and regulation of emerging practices in psychology (including mindfulness) on the part of regulatory, academic, and scientific fields, qualifying the psychologist to make better decisions about integrating such practices in psychotherapy.(AU)

Mindfulness se ha vuelto popular dentro de la comunidad psicoterapéutica y entre los clientes que buscan alivio de su sufrimiento. Sin embargo, se sabe poco sobre cómo mindfulness se ha integrado en la psicoterapia. El objetivo de este estudio fue identificar y caracterizar conocimiento, recomendación, uso clínico y personal de mindfulness por parte de psicólogos clínicos brasileños. Se realizó una encuesta cuantitativa nacional con 417 psicólogos clínicos utilizando un cuestionario estructurado online, desarrollado y probado para este estudio. Los resultados se analizaron estadísticamente por frecuencias; la asociación entre categorías de respuestas se analizó utilizando la prueba exacta de Fisher y significación estadística de p < 0,05. Los resultados indicaron que la mayoría de los psicólogos (65.23%) informaron poco o ningún conocimiento de mindfulness; casi la mitad (47.96%) ya lo ha recomendado a sus clientes; aproximadamente un tercio (31.18%) ya lo ha aplicado en el entorno clínico, con el uso principal de técnicas aisladas en clientes individuales; y aproximadamente una cuarta parte (25.37%) de los profesionales tienen una práctica personal de mindfulness. Los datos sugirieron que el uso de mindfulness en la clínica se ha alejado del formato basado en la evidencia a través del cual se ha verificado su eficacia. Se espera que los resultados contribuyan a la reflexión por parte de los campos regulatorio, académico y científico sobre la formación y regulación de las prácticas emergentes en psicología (incluido el mindfulness), calificando al psicólogo para tomar mejores decisiones sobre la integración de tales prácticas en la psicoterapia.(AU)

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice.

BACKGROUND: The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation. METHODS: Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach. RESULTS: A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively. CONCLUSIONS: Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

COVID-19: ¿una oportunidad para la toma de conciencia sobre el cuidado integral del odontólogo? / COVID-19: An opportunity to raise awareness about dentists' holistic wellbeing?

La pandemia de COVID-19 generó en la comunidad odon- tológica argentina un profundo desconcierto e incertidumbre frente a su práctica profesional, su economía y su cuidado. Mediante un cuestionario difundido a través de redes so- ciales en octubre de 2020, se formularon preguntas vinculadas al ejercicio profesional en ese contexto y otras en las que se incluyeron variables referidas a signos de ansiedad, depresión y resiliencia. Los odontólogos presentaron signos de estrés, ansiedad, tensión emocional, dificultad para conciliar el sueño, senti- mientos de culpa y sensación de soledad. Manifestaron casi en su totalidad que su esfuerzo y el cuidado de su persona frente a este nuevo paradigma no son valorados por el sistema de salud y que se evidencia en la escasa retribución que perciben por sus prestaciones. Las conclusiones tienen el mandato del cambio pues los datos arrojados por la encuesta y el sentir manifestado con vehemencia y desolación ponen sobre la mesa la necesidad de iniciar una nueva etapa (AU)

The COVID-19 pandemic created a profound state of be- wilderment and uncertainty among dentists regarding their professional practice, economy and personal care. An online survey posted on social media in October 2020 asked ques- tions about professional practice in this context and other variables such as signs of anxiety, depression and resilience. Dentists reported signs of stress, anxiety, emotional tension, difficulty to get to sleep, and feelings of guilt and loneliness. Most of them felt that the efforts they made to do their job and ensure their personal care in this new paradigm were not valued by the healthcare system, as reflected by the low compensation for their services. From the data obtained through the survey and the feelings of vehemence and grief expressed by respondents, it is concluded there is a need for action and change (AU)

Home care service employees' contribution to patient safety in clients with dementia who use dietary supplements: a Norwegian survey.

OBJECTIVE: To explore home care services (HCS) employees' professional experiences with the use of dietary supplements (DSs) in their clients with dementia. We also investigated their attributed professional responsibility concerning this use and their attitudes toward DSs in general. Differences between nurses and nurse assistants were investigated. DESIGN: A cross-sectional survey with self-administered questionnaires. SETTING: Home care services in six Norwegian municipalities in the period August-December 2016. SUBJECTS: A total of 231 (64% response rate) HCS employees; 78 nurses and 153 nurse assistants (auxiliary nurses and employees without formal education).Main outcome measures: Health care employees' experiences with patient safety in clients with dementia who use DSs. RESULTS: Fifty per cent were concerned that clients with dementia might harm their health due to DS use. Thirty-one per cent reported having intervened in order to reduce the risk. Seventy-one per cent preferred to administer DSs to clients with dementia rather than leaving this responsibility to the clients. The respondents placed the responsibility for patient safety in clients with dementia using DSs mainly with the general practitioners, while they ascribed themselves and pharmacies a medium level of responsibility. There were only minor difference between nurses and nurse assistants, and no difference in attitudes towards DSs. CONCLUSION: Employees in HCS were concerned about the DS use in clients with dementia. Moreover, almost one-third had intervened to improve clients' patient safety. The majority indicated that HCS should administer DSs rather than the clients with dementia themselves.KEY POINTSTo our knowledge, this is the first study investigating the role of home care services with regard to patient safety in clients with dementia who use dietary supplements (DSs).•Home care service employees worried about patient safety related to DS use in clients with dementia.•Home care service employees attributed to themselves medium responsibility to ensure the safe use of DSs in these clients.•Lack of knowledge was the most important reason why home care service employees did not recommend DSs to clients.

The Danish sports chiropractic landscape: an exploration of practice characteristics and salient developmental issues.

BACKGROUND: As is the case around the globe, the Danish chiropractic community appears to be an active service provider for the athletic sub-population. However, a paucity of evidence elucidating the experiences, perceptions, and practices of individuals who identify as 'sports chiropractors' complicates strategic development efforts. METHODS: A sequential mixed-methods study was conceptualized in which interview responses from seven purposefully selected stakeholders provided context and informed a national descriptive survey exploring practice characteristics and opinions regarding sports chiropractic among Danish chiropractors. RESULTS: Thematic highlights included divided opinions on the criteria that define a sports chiropractor, the role of a chiropractor functioning beyond the clinic setting, and the need for a structured approach to developing sports chiropractic as a legitimate sub-specialty. The survey response rate was 34.9% (227 of 651), with 27% of responders identifying as a 'sports chiropractor'. Compared to non-sports chiropractors, sports chiropractors engaged in a significantly higher level of interprofessional practice (3.8 versus 2.7 partners), in particular medical doctors (p = 0.016) and personal trainers (p <  0.001). Whether participants identified as a sports chiropractor or not, there was consensus that a high-quality post-graduate qualification and continued education was important. Generally speaking, the framing of sports chiropractic into a protected title was not a priority. CONCLUSION: The Danish sports chiropractor tends to be male, has a specialist education and engages other chiropractors, medical practitioners and professional trainers more often as practice partners than generalist chiropractors. The position of the sports chiropractor as a 'knowledgeable expert' was seen as more important than establishing a protected title. Experiential training appears to be an untapped resource for developing real-world competency and gaining greater professional exposure. Given the potential for development across Europe, more focus is required on a strategic plan for embedding chiropractic professionals in inter-professional athletic health and performance practice settings.