Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review.

BACKGROUND: Policymakers and program developers in low-and lower-middle-income countries (LLMICs) are increasingly seeking evidence-based information and guidance on how to successfully develop and implement continuing professional development (CPD) systems. We conducted a rapid scoping review to map and synthesize what is known regarding the development, implementation, evaluation and sustainability of CPD systems for healthcare professionals in LLMICs. METHODS: We searched MEDLINE, CINAHL and Web of Science. Reference lists were screened and a cited reference search of included articles was conducted. Supplementary information on the CPD systems identified in the articles was also identified via an online targeted grey literature search. English, French and Spanish literature published from 2011 to 2021 were considered. Data were extracted and combined and summarized according to country/region and healthcare profession via tables and narrative text. RESULTS: We included 15 articles and 23 grey literature sources. Africa was the region most represented followed by South and Southeast Asia and the Middle East. The literature most often referred to CPD systems for nurses and midwives; CPD systems for physicians were frequently referred to as well. Findings show that leadership and buy-in from key stakeholders, including government bodies and healthcare professional organizations, and a framework are essential for the development, implementation and sustainability of a CPD system in a LLMIC. The guiding framework should incorporate a regulatory perspective, as well as a conceptual lens (that informs CPD objectives and methods), and should consider contextual factors (support for CPD, healthcare context and population health needs). In terms of important steps to undertake, these include: a needs assessment; drafting of a policy, which details the regulations (laws/norms), the CPD requirements and an approach for monitoring, including an accreditation mechanism; a financing plan; identification and production of appropriate CPD materials and activities; a communication strategy; and an evaluation process. CONCLUSION: Leadership, a framework and a clearly delineated plan that is responsive to the needs and context of the setting, are essential for the development, implementation and sustainability of a CPD system for healthcare professionals in a LLMIC.

Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R.

Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.

Assessment and care of individuals at risk of suicide in Emergency Department: The SecUrgence protocol.

Almost half (48,5%) of all individuals who die by suicide visited the Emergency Department (ED) in the year preceding their death by suicide and for almost a third (29,5%) of these individuals, the ED visit occurred within the month preceding their death by suicide. The ED is a key location for suicide prevention. The aim of this study was to develop and reach a consensus on the SecUrgence Protocol, a clinical protocol that intends to assess and provide care for individuals at risk of suicide that present themselves to the ED. This project was conducted in 3 stages: 1) Review of the literature, 2) Development of the list of the protocol statements by a first panel of experts, and 3) Validation, using the Delphi consensus method, on the final statements to include in the SecUrgence Protocol by a second panel of experts. Two rounds of the Delphi questionnaire were conducted until a final consensus of over 75% was reached. The SecUrgence Protocol is a first scientific step towards improving suicide prevention in the ED in Quebec as it was validated by a rigorous research process that included a consensus by all key stakeholders.

Measuring Quality of Care Received by Suicide Attempters in the Emergency Department.

CONTEXT: Audits conducted on medical records have been traditionally used in hospitals to assess and improve quality of medical care but have yet to be properly integrated and used for suicide prevention purposes. We aimed to (1) revise a quality of care grid and adapt it to an adult population of suicide attempters and (2) identify quality of care deficits in managing adult suicide attempters at the emergency department (ED) in two different Montreal university hospitals. METHODS: An existing checklist for quality of medical and social care in the ED was adapted. A systematic search and data extraction of all suicide attempters in two different Montreal university hospitals were then conducted. All identified individuals who attempted suicide were fully reviewed and quality of care was assessed. RESULTS: Eleven criteria were kept by the expert focus group in the revised grid that was then used to rate 369 individuals that attempted suicide. Suicide risk assessment was only present in 63% of attempters before discharge. Although family history was documented for 90% of attempters, in only 41% of the cases were interviews conducted with relatives. Most discharged patient lacked proper follow-up considering 11% of their relatives received written information on resources in case of need. DISCUSSION: Paper records may be used to systematically assess the quality of care for suicide attempters seen in ED. Results reiterate the need for better suicide prevention strategies for these individuals. The checklist proved to be an excellent assessment of best practices or identification of possible improvements.

A conceptual framework of student professionalization for health professional education and research.

OBJECTIVES: To present a conceptual framework of student professionalization for health professional education and research. METHODS: Synthesis and discussion of a program of research on competency-based education. RESULTS: Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students' encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback. CONCLUSIONS: This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices.

PhD nursing students' changing needs relative to the comprehensive doctoral examination.

Most doctoral curriculums in Canada and in the United States include a mandatory comprehensive examination (CE) meant to evaluate, after a year, the students' ability to conduct research. Although the format differs between faculties, the CE has nevertheless been described by students as anxiety provoking because in most cases, a failure terminates doctoral training. A lack of scientific literature on the experiences of PhD nursing students with the CE motivated us to explore these experience and the students' needs with regard to this exam. For that purpose, a descriptive qualitative research study was conducted at a nursing faculty in Canada. Focus groups and individual semi-directed interviews were conducted with 15 PhD nursing students. Data analysis suggests that PhD nursing students' needs evolve throughout their doctoral studies. Initially, their needs focus on understanding the general process of the CE, such as its purpose and the possible outcomes. These needs gradually shift toward specific issues, such day-to-day organization during the CE. Finally, participants express frustration about variability in the support received and in the evaluation process. Results offer insights into strategies that can be implemented to optimize PhD nursing students' experience and to develop a feeling of support regarding the CE.

Quality Standards of Nursing Care for the Use of Chemical Restraints: A Realist Review.

BACKGROUND: The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented. PURPOSE: This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool. METHODS: A realist review method was chosen. RESULTS: An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model. CONCLUSIONS: These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.

Physically aggressive behaviors in older people living with cognitive disorders: a systematic scoping review protocol.

BACKGROUND: Physically aggressive behaviors are very common among older people living with cognitive impairment. These behaviors may have significant consequences for family and formal caregivers, as well as for the other people in the older people's environment, and are also a frequent cause of institutionalization. Two relevant systematic reviews have been published on the subject but do not specifically target physically aggressive behaviors or only focus on care in nursing homes. Moreover, they do not address the causes, associated factors, and consequences of these behaviors, even though these should indeed be considered when developing interventions. Thus, the purpose of this scoping review is to map the state of knowledge on these physically aggressive behaviors with a view to developing personalized interventions. Offering a humanist and relational perspective by which these behaviors may be examined, the Senses Framework will guide this review. METHODS: The scoping review method of Levac, Colquhoun, and O'Brien will be used. Several databases (e.g., CINAHL, PubMed, PsycINFO, SCOPUS, Grey Literature Report, clinical trials registries) will be searched for literature published in the past 15 years, using a combination of keywords and descriptors. Other data sources will be used to identify non-indexed literature or unpublished results (e.g., articles references, journal tables of content, contact with key authors). The literature will be selected regardless of setting, if it concerns older people, aged 65, or older with cognitive impairment who present physically aggressive behaviors. Data will be extracted systematically by the research team. A quality assessment of the literature will be done to consider this aspect in the data synthesis. A content analysis will be used to synthesize the results. DISCUSSION: No scoping review has been found on the physically aggressive behaviors of older people living with cognitive impairment in various settings. The results of this review will identify needs for further research and for clinical and training development on this problem from a humanist standpoint. SYSTEMATIC REVIEW REGISTRATION: Currently, it is not possible to register a systematic scoping review protocol (e.g., PROSPERO).

How does questioning influence nursing students' clinical reasoning in problem-based learning? A scoping review.

BACKGROUND: Problem-based learning is an educational method promoting clinical reasoning that has been implemented in many fields of health education. Questioning is a learning strategy often employed in problem-based learning sessions. AIM: To explore what is known about the influence of questioning on the promotion of clinical reasoning of students in health care education, specifically in the field of nursing and using the educational method of problem-based learning. METHODS: A scoping review following Arksey and O'Malley's five stages was conducted. The CINAHL, EMBASE, ERIC, Medline, and PubMed databases were searched for articles published between the years of 2000 and 2017. Each article was summarized and analyzed using a data extraction sheet in relation to its purpose, population group, setting, methods, and results. A descriptive explication of the studies based on an inductive analysis of their findings to address the aim of the review was made. RESULTS: Nineteen studies were included in the analysis. The studies explored the influence of questioning on critical thinking rather than on clinical reasoning. The nature of the questions asked and the effect of higher-order questions on critical thinking were the most commonly occurring themes. Few studies addressed the use of questioning in problem-based learning. CONCLUSIONS: More empirical evidence is needed to gain a better understanding of the benefit of questioning in problem-based learning to promote students' clinical reasoning.

Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review.

AIM: To identify the theories used to explain learning in simulation and to examine how these theories guided the assessment of learning outcomes related to core competencies in undergraduate nursing students. BACKGROUND: Nurse educators face the challenge of making explicit the outcomes of competency-based education, especially when competencies are conceptualized as holistic and context dependent. DESIGN: Theoretical review. DATA SOURCES: Research papers (N = 182) published between 1999-2015 describing simulation in nursing education. REVIEW METHODS: Two members of the research team extracted data from the papers, including theories used to explain how simulation could engender learning and tools used to assess simulation outcomes. Contingency tables were created to examine the associations between theories, outcomes and tools. RESULTS: Some papers (N = 79) did not provide an explicit theory. The 103 remaining papers identified one or more learning or teaching theories; the most frequent were the National League for Nursing/Jeffries Simulation Framework, Kolb's theory of experiential learning and Bandura's social cognitive theory and concept of self-efficacy. Students' perceptions of simulation, knowledge and self-confidence were the most frequently assessed, mainly via scales designed for the study where they were used. Core competencies were mostly assessed with an observational approach. CONCLUSION: This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

Identification and Analysis of Factors Contributing to the Reduction in Seclusion and Restraint for a Population with Intellectual Disability.

BACKGROUND: A cohort of 11 patients with an intellectual disability and a psychiatric diagnosis present severe behavioural disorders in psychiatric hospital of Quebec in 2009. Control-measure use for this clientele has now been reduced. How do management personnel, families and care teams explain the changes? What clinical interventions did management and care providers implement that contributed to the reduction? METHOD: A retrospective case study was conducted. Five focus groups were held with people involved in their care, and the patient files were examined. RESULTS: The factors contributing to this change were the cohesion of the care providers, the involvement of the families and the efforts to determine the function of the behaviour. IMPLICATIONS: This study may inspire other care teams to try new approaches in dealing with patients with severe behavioural disorders. Also, the model of factors and interventions supporting a reduction in seclusion and restraint measures may inspire future studies.

A pilot study of "post-seclusion and/or restraint review" intervention with patients and staff in a mental health setting.

PURPOSE: To develop and evaluate a "post-seclusion and/or restraint review" (PSRR) intervention implemented in an acute psychiatric care unit. DESIGN AND METHODS: Twelve staff members and three patients were enrolled in a participatory case study. To evaluate PSRR intervention, qualitative analysis was carried out. Seclusion and restraint use 6 months before and after the PSRR implementation was compared. FINDINGS: Nurses reported that they were able to explore the patient's feelings during the PSRR intervention with patients, which led to restoration of the therapeutic relationship. PSRR with the treatment team was perceived as a learning opportunity, which allowed to improve the therapeutic intervention. Both the use of seclusion and the time spent in seclusion were significantly reduced 6 months after the implementation of PSRR intervention. PRACTICE IMPLICATION: Our results suggest the efficacy of PSRR in overcoming the discomfort perceived by both staff and patient and, in the meantime, in reducing the need for coercive procedures. Systematic PSRR could permit to improve the quality of care and the safety of aggressiveness management.

A Case Study: Seclusion and Restraint in Psychiatric Care.

A wide breadth of research has recognized that seclusion and restraint affects patients, staff, and organizations alike. Therefore, it is essential to understand the viewpoints of all stakeholders to improve practices. The study aimed to understand the context in which seclusion and restraint practices are employed based on the perceptions of staff and inpatients in a psychiatric ward. A case study was performed using a participatory approach. Methods included a 56-hr immersion in the practice setting and individual interviews with staff and patients ( n = 17). The main themes discussed were patient characteristics (etiology of the violence, difficult experience), staff characteristics (feelings of safety, rationalization of seclusion use), and environmental characteristics. Both explicit (e.g., hospital protocol) and implicit (e.g., ward rules) standards seem to influence seclusion and restraint management. Our results point toward the potential for developing post-seclusion and restraint review in which both patient and staff perspectives are taken into account.

Post-Seclusion and/or Restraint Review in Psychiatry: A Scoping Review.

CONTEXT: It has been suggested that after an incident in which a patient has been placed in seclusion or in restraints, an intervention should be conducted after the event to ensure continuity of care and prevent recurrences. Several terms are used, and various models have been suggested for post-seclusion and/or restraint review; however, the intervention has never been precisely defined. OBJECTIVE: This article presents a scoping review on post-seclusion and/or restraint review in psychiatry to examine existing models and the theoretical foundations on which they rely. METHOD: A scoping review of academic articles (CINAHL and Medline database) yielded 28 articles. RESULTS: Post-seclusion and/or restraint review has its origins in the concepts of debriefing in psychology and reflective practice in nursing. We propose a typology in terms of the intervention target, including the patient, the health care providers, or both. IMPLICATIONS: The analysis found that the review ought to involve both the patient and the care providers using an approach that fosters reflexivity among all those involved in order to change the practice of seclusion in psychiatric settings. ACCESSIBLE SUMMARY: • Established literature documented widely that seclusion and restraint has adverse physical and psychological consequences for patient and for health care providers. • Post-seclusion and/or restraint review is promoted in most guidelines, but there is no scoping or systematic review yet on the subject. • The origins of post-seclusion and/or restraint review are in the concepts of debriefing in psychology and reflective practice in nursing. • We propose that post-seclusion and/or restraint review should focus on both patients and health care providers.• Systematic post-seclusion and/or restraint review should be performed after each event, and its effects on patients and on mental health professionals should be rigorously assessed.

[The Humanistic Model of Nursing Care - UdeM : an innovative and pragmatic perspective]. / Le Modèle humaniste des soins infirmiers -UdeM : perspective novatrice et pragmatique.

As in many other countries, Québec is not immune to healthcare reforms, which can unfortunately hinder quality of care as well as induce some dehumanization, both for the patients and the healthcare professionals. Thus, the « Humanistic Model of Nursing Care - UdeM ¼ (HMNC-UdeM) aspires to offer an innovative perspective that aims at improving the quality and the safety of care, in addition to satisfaction and well-being for both patients and nurses. While respecting their theoretical influences, the authors present their vision of the central concepts of the discipline and the Model's key concepts, seeking to make them more understandable, accessible, and applicable in nurses' daily practice. Therefore, the aim of this article is to raise awareness of the Model into the nursing community, to promote its implantation in nursing's spheres of activities, in addition to demonstrate its applicability and impact in nursing research. It appears that this model is promising for the renewal and the development of humanistic interventions for patients' care.

Reflective Practice: A Comparative Dimensional Analysis of the Concept in Nursing and Education Studies.

AIM: This paper reports on an analysis of the concept of reflective practice. BACKGROUND: Reflective practice, a concept borrowed from the field of education, is widely used in nursing. However, to date, no study has explored whether this appropriation has resulted in a definition of the concept specific to the nursing discipline. DATA SOURCES: A sample comprised of 42 articles in the field of nursing drawn from the CINAHL database and 35 articles in education from the ERIC database (1989-2013) was analyzed. REVIEW METHOD: A concept analysis using the method proposed by Bowers and Schatzman was conducted to explore the differing meanings of reflective practice in nursing and education. RESULTS: In nursing, the dimensions of the concept differ depending on context. In the clinical context, the dimensions may be summarized as theory-practice gap, development, and caring; in training, as learning, guided process, and development; and in research, as knowledge, method, and social change. In education, the concept is also used in the contexts of training (the dimensions being development, deliberate review, emotions, and evaluation) and research (knowledge, temporal distance, and method). The humanist dimension in nursing thus reflects a use of the concept more specific to the discipline. CONCLUSION: The concept analysis helped clarify the meaning of reflective practice in nursing and its specific use in the discipline. This observation leads to a consideration of how the concept has developed since its appropriation by nursing; the adoption of a terminology particular to nursing may well be worth contemplating.

Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper.

INTRODUCTION: The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. METHODS AND ANALYSIS: The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. ETHICS AND DISSEMINATION: The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.

A competency-based approach to nurses' continuing education for clinical reasoning and leadership through reflective practice in a care situation.

Newly graduated nurses need to demonstrate high levels of competencies when they enter the workplace. A competency-based approach to their education is recommended to ensure patients' needs are met. A continuing education intervention consistent with the competency-based approach to education was designed and implemented in eight care units in two teaching hospitals. It consists of a series of 30-min reflective practice groups on clinical events that newly graduated nurses encountered in their practice. It was evaluated using a descriptive longitudinal evaluative research design, combining individual and group interviews with stakeholders, the analysis of facilitators' journal entries, and a research assistant's field notes. The results suggest that issues associated with the implementation of the continuing education intervention revolved around leadership for managers, flexibility for nursing staff, and role shifting for the facilitators. Newly graduated nurses who participated in the study noted that the reflective practice sessions contributed to the development of both clinical reasoning and leadership. Nursing managers stated the advantages of the intervention on nurses' professional development and for the quality and safety of care. Following the end of the study, participants from two units managed to pursue the activity during their work time.