The Application of Kirkpatrick's Evaluation Model in the Assessment of Interprofessional Simulation Activities Involving Pharmacy Students: A Systematic Review.

OBJECTIVES: To our knowledge, this systematic review is the first to assess pharmacy-involved interprofessional education (IPE) simulation activities in establishing current methodological effectiveness using Kirkpatrick's Evaluation Model. This is a training evaluative model that assesses educational training activities according to 4 levels: reaction, learning, behavior, and results. FINDINGS: From the 3108 studies retrieved, 14 studies met the inclusion criteria. Thirteen studies achieved levels 1 and 2 of Kirkpatrick's Evaluation Model, and 1 achieved level 3. One study only achieved level 1. Single-group, pre- and posttest studies were the most common study designs (n = 9), and 1 study followed a longitudinal approach. IPE duration ranged from 45 min to 5 days, and most of the studies were conducted in the United States (n = 10). Most studies alluded to an underpinning theory behind IPE simulation design and chose surveys as their mode of data collection. SUMMARY: The most common limitation reported was the uneven representation of professions and a lack of data on the studies' effect in practice. To demonstrate the achievement of outcomes in relation to levels 3 and 4, there is a need for longitudinal studies of IPE simulation activities. Although evaluative studies showed a positive response to IPE simulation at a basic level, there is a lack of effective integration of theory behind IPE design. Future studies need to consider this when setting the infrastructure of IPE design, as well as making efforts to mobilize stakeholders in the workplace to help facilitate transfer of learning.

Health-Promoting Behaviours following Primary Treatment for Cancer: A Rural-Urban Comparison from a Cross-Sectional Study.

AIM: To compare health-promoting behaviours among rural and urban residents following primary treatment for cancer. METHODS: A cross-sectional survey collecting demographic variables and data pertaining to health-promoting behaviours, documented using the 52-item Health Promotion Lifestyle Profile II (HPLP-II) measure, which is categorised into six subscales: (1) health responsibility, (2) spiritual growth, (3) physical activity, (4) interpersonal relations, (5) nutrition, and (6) stress management. Residence was defined using the U.K. Office for National Statistics RUC 2011 Rural Urban Classifications. The Index of Multiple Deprivation (IMD) Decile was used to measure deprivation. Quantitative data were analysed using independent samples t-test and multiple linear regression. Qualitative data from open-ended questions were analysed thematically. RESULTS: In total, 227 participants with a range of cancer types completed the questionnaire. Fifty-three percent were residents in urban areas and forty-five percent in rural areas. Rural participants scored significantly higher on health responsibility (p = 0.001), nutrition (p = 0.001), spiritual growth (p = 0.004), and interpersonal relationships (p = 0.001), as well as on the overall HPLP-II (p = 0.001). When controlling for deprivation, age, marital status, and education, rural-urban residence was a significant predictor of exhibiting health-promoting behaviours. A central theme from the qualitative data was the concept of "moving on" from cancer following treatment, by making adjustments to physical, social, psychological, spiritual, and emotional wellbeing. CONCLUSIONS: This research revealed, for the first time, differences in health-promoting behaviours among rural and urban U.K. populations who have completed primary cancer treatment. Rural residence can provide a positive environment for engaging with health-promoting behaviours following a cancer diagnosis and treatment.

An Exploration of Rural-Urban Residence on Self-Reported Health Status with UK Cancer Survivors Following Treatment: A Brief Report.

Objective: To explore the effect of rural−urban residence on the self-reported health status of UK cancer survivors following primary treatment. Design: A post-positivist approach utilizing a cross-sectional survey that collected data on demographics, postcode and self-reported health status. Methods: An independent samples t test was used to detect differences in health status between rural and urban respondents. Pearson's χ2 was used to control for confounding variables and a multivariate analysis was conducted using Stepwise linear regression. Setting: East Midlands of England. Participants: Adult cancer survivors who had undergone primary treatment in the last five years. Participants were excluded if they had recurrence or metastatic spread, started active oncology treatment in the last twelve months, and/or were in receipt of palliative or end-of-life care. Main outcome: Residence was measured using the UK Office for National Statistics (ONS) RUC2011 Rural−Urban Classifications and Health Status via the UK ONS self-reported health status measure. Ethics: The study was reviewed and approved (Ref: 17/WS/0054) by an NHS Research Ethics Committee and the Health Research Authority (HRA) prior to recruitment and data collection taking place. Results: 227 respondents returned a questionnaire (response rate 27%). Forty-five percent (n = 103) were resident in a rural area and fifty-three percent (n = 120) in an urban area. Rural (4.11 ± 0.85) respondents had significantly (p < 0.001) higher self-reported health statuses compared to urban (3.65 ± 0.93) respondents (MD 0.47; 95% CI 0.23, 0.70). Conclusion: It is hoped that the results will stimulate further work in this area and that researchers will be encouraged to collect data on rural−urban residency where appropriate.

A rural-urban comparison of self-management in people living with cancer following primary treatment: A mixed methods study.

OBJECTIVE: To investigate and compare self-management in people living with cancer following treatment, from rural and urban areas in the United Kingdom where there is a significant evidence gap. METHODS: A cross-sectional explanatory sequential mixed methods design. This involved a self-completion questionnaire that collected data on demographics, self-management using the PAM-13 and rural-urban residence and 34 in-depth interviews that aimed to explore and compare the barriers and facilitators to self-management in rural and urban settings. RESULTS: 227 participants completed the questionnaire: mean age 66.86 (±11.22). Fifty-two percent (n = 119) were female and 48% (n = 108) were male. Fifty-three percent (n = 120) resided in urban areas and 45 % (n = 103) in rural areas. Participants had a range of different types of cancer but the three most common were breast (n = 73), urological (n = 53), upper and lower gastrointestinal (n = 41). Rural respondents (63.31 ± 13.66) were significantly (p < 0.05) more activated than those in urban areas (59.59 ± 12.75). The barriers and facilitators to self-management identified in the interviews were prevalent in both rural and urban settings but some barriers were more explicit in rural settings. For example, there was a lack of bespoke support in rural areas and participants acknowledged how travelling long distances to urban centres for support groups was problematic. Equally, there were barriers and facilitators that were not necessarily unique to either geographic setting. CONCLUSION: Whilst the active treatment phase can present considerable challenges for people living with cancer in rural areas the findings suggest that the rural environment has the potential to increase engagement with self-management in the transition to survivorship. The rigorous mixed methods design has led to different and complementary conclusions that would not have been possible had either quantitative or qualitative methods been used in isolation.

What is known about the role of rural-urban residency in relation to self-management in people affected by cancer who have completed primary treatment? A scoping review.

PURPOSE: Despite wide acknowledgement of differences in levels of support and health outcomes between urban and rural areas, there is a lack of research that explicitly examines these differences in relation to self-management in people affected by cancer following treatment. This scoping review aimed to map the existing literature that examines self-management in people affected by cancer who were post-treatment from rural and urban areas. METHODS: Arksey and O'Malley's framework for conducting a scoping review was utilised. Keyword searches were performed in the following: Academic Search Complete, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science. Supplementary searching activities were also conducted. RESULTS: A total of 438 articles were initially retrieved and 249 duplicates removed leaving 192 articles that were screened by title, abstract and full text. Nine met the eligibility criteria and were included in the review. They were published from 2011 to 2018 and conducted in the USA (n = 6), Australia (n = 2) and Canada (n = 1). None of the studies offered insight into self-managing cancer within a rural-urban context in the UK. Studies used qualitative (n = 4), mixed methods (n = 4) and quantitative designs (n = 1). CONCLUSION: If rural and urban populations define their health in different ways as some of the extant literature suggests, then efforts to support self-management in both populations will need to be better informed by robust evidence given the increasing focus on patient-centred care. It is important to consider if residency can be a predictor of as well as a barrier or facilitator to self-management.

The Effect of Rural Residence on Cancer-Related Self-Efficacy With UK Cancer Survivors Following Treatment.

PURPOSE: To examine rural and urban differences in cancer-related self-efficacy with UK cancer survivors following treatment. METHODS: A cross-sectional postal survey with posttreatment cancer survivors in the East Midlands of England. The survey collected data on demographics and cancer-related self-efficacy using the Cancer Survivors Self-Efficacy Scale. Rural-urban residence was determined using Office for National Statistics classifications. Linear Regression models were developed using a Directed Acyclic Graph that determined confounding variables. When the model deviated from normal the outcome variable was transformed using the Box-Cox transformation. FINDINGS: Of those surveyed, 227 responded, of whom 58% were female and 45% lived in a rural area. A linear regression model showed a significant increase in cancer-related self-efficacy in cancer survivors living in rural areas compared to urban residents (0.76, 95% CI: 0.25-1.27), although the residual plot deviated from a normal distribution. A model of the effect of rural living on a Box-Cox transformed outcome variable confirmed an increased cancer-related self-efficacy score in rural regions (9.06, 95% CI: 2.97-15.14). Rural living remained significant (7.98, 95% CI: 1.78-14.19) after adjustment for the respondents' income. Similarly adjusting for deprivation led to a significant increase in cancer-related self-efficacy in rural regions (8.64, 95% CI: 2.48-14.79). CONCLUSION: This study has important implications when considering the impact of location of residence on cancer-related self-efficacy in cancer survivorship. The role of deprivation had some impact for sample respondents in both the urban and rural environment and merits further analysis.

Conscientious object in nursing: Regulations and practice in two European countries.

BACKGROUND: The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery. AIM: To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice. DESIGN: Discussion paper. ETHICAL CONSIDERATIONS: Ethical guidelines has been followed at each stage of this study. FINDINGS: Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient's rights. DISCUSSION AND CONCLUSION: Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.

Patterns of clinical mentorship in undergraduate nurse education: A comparative case analysis of eleven EU and non-EU countries.

BACKGROUND: In spite of the number of studies available in the field and policy documents developed both at the national and the international levels, there is no reliable data available regarding the variation of roles occupied by clinical mentors (CMs) across countries. OBJECTIVES: To describe and compare the CM's role; responsibilities; qualifications; employment requirements and experience in undergraduate nurse education as enacted in 11 European Union (EU) and non- EU countries. DESIGN: A case study design. PARTICIPANTS AND SETTING: A panel of expert nurse educators from 11 countries within and outside of the EU (Croatia, Czech Republic, England, Iceland, Ireland, Italy, Poland, Serbia, Slovenia, Spain, and the USA). METHODS: A questionnaire containing both quantitative and qualitative questions was developed and agreed by the panel using a Nominal Group Technique (NGT); four cycles of data collection and analysis were conducted involving key experts in nursing education in each country. RESULTS: In all countries, there are at least two types of clinical mentorship dedicated to undergraduate nursing students: the first is offered by higher education institutions, and the second is offered by health care providers. Variation was noted in terms of profile, responsibilities and professional requirements to act as a CM; however, the CM role is mainly carried out by registered nurses, and in most countries there are no special requirements in terms of education and experience. Those who act as CMs at the bedside continue to manage their usual caseload, thus the role adds to their work burden. CONCLUSIONS: Whilst it is imperative to have respect for the different national traditions in undergraduate nurse education, the globalisation of the nursing workforce and greater opportunities for student mobility during the course of their undergraduate education suggests that in areas such as clinical mentorship, jurisdictions, particularly within the EU, should work towards greater system harmonisation.

The Ten Essential Shared Capabilities: reflections on education in values based practice: a qualitative study.

BACKGROUND: This paper presents the findings of a study exploring the impact of a values-based training initiative on the practice of mental health workers. This work is set within the context of increasing attention on the values of nurses and other health care workers as a response to national reports on care failure and negative media attention. OBJECTIVE: To examine written response feedback from participants on a national training programme for values-based practice (VBP) in order to examine any intention to change practice. DESIGN: A national evaluation using quantitative and qualitative methodologies was conducted to gather data on reflections and self-report impact of the Ten Essential Shared Capabilities' training programme. SETTING: The training was delivered in a range of hospital, community and third sector training programmes across eight regions in England. PARTICIPANTS: The participants were predominantly nurses but all sectors in the mental health community including service users as co-facilitators and participants were represented. METHODS: This study presents the qualitative findings from a cross-sectional survey. Using NVIVO 10 software, data were analysed using the framework method of qualitative analysis. RESULTS: Four principal themes emerged from the data'Thinking differently''Changes to practice''Creating an effective learning environment and skills for practice development' and 'Increasing self-awareness'. CONCLUSIONS: The quality and safety drive in the NHS has an emphasis on delivery of evidence based practice. It was concluded that an active focus on values based practice merits equal attention and status.

Care concept in medical and nursing students' descriptions--philosophical approach and implications for medical education.

INTRODUCTION: Care is seen as something that is peculiar to the medical sciences but its meaning and status for physicians and nurses differs. OBJECTIVES: The aim of this research was to learn how nursing and medical students understand and define care, and how their definition and views on their practice of caring change as they advance through their studies. MATERIAL AND METHODS: The study was conducted among two groups of students: before and after their first practicum (n=102). Analysis of the students' answers was carried out using Colaizzi's phenomenological descriptive methodology, which means that a qualitative approach was used. RESULTS: The qualitative analysis shows that the medical and nursing students define care in the same way, using 9 main categories: compassion, commitment, competence, confidence, conscience, communication, patience, courage and support. The nursing students viewed their caring to be within both practical and emotional dimensions and this was a core feature of their identity as nurses. Medical students, on the other hand, viewed the practical dimension of care as an additional activity. All the students in the study underlined the importance of having time to care and showed that, for them, 'time' in this context has a moral meaning. What was interesting to the research team centered on the initial attitudes to 'caring' from both medical and nursing students. CONCLUSIONS: We found that students of both nursing and medicine do not begin their studies with different attitudes and concepts of care. However, after their initial exposure to practical placements a process begins which forges different identities around the concept of care. This implies trends in the division of professional roles during their initial education.