A motivational approach to understanding problematic smartphone use and negative outcomes in university students.

Considering the rising integration of smartphones into classrooms, the purpose of this research was to explore the relationship between problematic smartphone use (PSU) and negative outcomes through the lens of self-determination theory. This study examined 1,039 students' reported academic motivation, PSU, anxiety, insomnia, and perceived stress. The first objective of this study was to examine how motivational orientations could predict PSU. Then, we examined how motivational orientations and PSU, when used as a mediating variable, could be modeled to predict negative student mental health outcomes (anxiety, insomnia, and perceived stress). As predicted, statistically significant results suggested that autonomous academic motivation was associated with less PSU (ß = -0.16), as well as less anxiety (ß = -0.12), insomnia (ß = -0.16), and stress (ß = -0.10). In contrast, higher levels of controlled academic motivation were associated with more PSU (ß = 0.37), as well as higher levels of anxiety (ß = 0.49) and insomnia (ß = 0.41). Amotivation was also positively related to PSU (ß = 0.17), anxiety (ß = 0.36), insomnia (ß = 0.62), and stress (ß = 0.22). All indirect effects (mediation effects) were statistically significant and in the predicted direction: the impact of autonomous motivation on negative outcomes was mediated by lower levels of PSU while controlled motivation and amotivation were mediated by higher levels of PSU. Overall, this study advanced the understanding of PSU in university classrooms by demonstrating a link with academic motivation and mental health outcomes.

The essential role of nurses in supporting physical examination in telemedicine: Insights from an interaction analysis of postsurgical consultations in orthopedics.

Telemedicine changes clinical practice and introduces new ways of distributing tasks between physicians and nurses, and particularly the delegation of sensory assessments during remote physical examinations. As nurses become more involved in patient assessment and clinical decision-making, the quality of physician-nurse collaboration has been recognized as essential to ensure quality patient care. However, few studies have examined physician-nurse interactions during teleconsultations. This article presents the results of an empirical study of nurse-physician communication during remote physical examinations. In partnership with a university-affiliated hospital in Ontario, Canada, we observed and recorded 10 simulated postsurgical consultations in orthopedics (involving a physician, a patient, and an on-site nurse) and conducted auto-confrontation interviews with physicians. The results of the thematic analysis of the interviews informed the selection of consultation sequences for in-depth interaction analysis. The findings demonstrate the nurse's essential role during remote physical examinations and reveal specific practices accomplished by the nurse to ensure successful nurse-physician collaboration. The interview data shows how physicians view the nurse's role and contributions. The findings contribute to our understanding of the collaborative nature of sensory assessments during remote physical examinations in telemedicine and can inform the development of training programs for professionals focusing on communication skills. Implications for clinical practice are discussed.

Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues.

Organizational health literacy is described as an organization-wide effort to transform organization and delivery of care and services to make it easier for people to navigate, understand, and use information and services to take care of their health. Several health literacy guides have been developed to assist healthcare organizations with this effort, but their content has not been systematically reviewed to understand the scope and practical implications of this transformation. The objective of this study was to review (1) theories and frameworks that inform the concept of organizational health literacy, (2) the attributes of organizational health literacy as described in the guides, (3) the evidence for the effectiveness of the guides, and (4) the barriers and facilitators to implementing organizational health literacy. Drawing on a metanarrative review method, 48 publications were reviewed, of which 15 dealt with the theories and operational frameworks, 20 presented health literacy guides, and 13 addressed guided implementation of organizational health literacy. Seven theories and 9 operational frameworks have been identified. Six health literacy dimensions and 9 quality-improvement characteristics were reviewed for each health literacy guide. Evidence about the effectiveness of health literacy guides is limited at this time, but experiences with the guides were positive. Thirteen key barriers (conceived also as facilitators) were identified. Further development of organizational health literacy requires a strong and a clear connection between its vision and operationalization as an implementation strategy to patient-centered care. For many organizations, becoming health literate will require multiple, simultaneous, and radical changes. Organizational health literacy has to make sense from clinical and financial perspectives in order for organizations to embark on such transformative journey.

Success Strategies for Linguistically Competent Healthcare: The Magic Bullets and Cautionary Tales of the Active Offer of French-Language Health Services in Ontario.

An active offer of French-language health services (FLHS) was introduced in several Canadian provinces to help create an environment that will anticipate the needs of Francophones in their community and will stimulate the demand for services in French. For the active offer to be implemented, changes in how health services are organized and managed at both organizational and system levels must be introduced. In this perspective paper, we identify several success strategies and potential pitfalls with regards to the implementation of the active offer of FLHS primarily at the level of healthcare organization. Our recommendations are based on a recent health services research study exploring reorganization and management strategies for the delivery of the active offer of FLHS in Ontario and insights from a focus group with healthcare administrators conducted as part of this research. We propose a ";wrap-around strategy" called organizational health literacy to help reorient organizational culture and improve management and sustainability of the active offer of FLHS. These strategies have relevance for advocates and professionals working to promote an active offer of FLHS, including healthcare administrators, human resource professionals, quality-improvement specialists and others.

Active offer of health services in French in Ontario: Analysis of reorganization and management strategies of health care organizations.

BACKGROUND: The availability of health services in French is not only weak but also inexistent in some regions in Canada. As a result, estimated 78% of more than a million of Francophones living in a minority situation in Canada experience difficulties accessing health care in French. To promote the delivery of health services in French, publicly funded organizations are encouraged to take measures to ensure that French-language services are clearly visible, available, easily accessible, and equivalent to the quality of services offered in English. OBJECTIVE: This study examines the reorganization and management strategies taken by health care organizations in Ontario that provide health services in French. METHODS: Review and analysis of designation plans of a sample of health care organizations. RESULTS: Few health care organizations providing services in French have concrete strategies to guarantee availability, visibility, and accessibility of French-language services. CONCLUSIONS: Implementation of the active offer of French-language services is likely to be difficult and slow. The Ontario government must strengthen collaboration with health care organizations, Francophone communities, and other key actors participating in the designation process to help health care organizations build capacities for the effective offer of French-language services.

Socioeconomic stakes in the development of telemedicine.

This brief article points out that more empirical knowledge is required about the diverse factors that influence the diffusion, implementation, outcomes and behaviours associated with the spread of information and communication technologies (ICT). This includes the domain of telemedicine and ICT-based outpatient care. A detailed understanding of these processes and the participants involved offers the potential to illuminate the multiplicity of inter-related issues with which medical practitioners and health-care policy makers must contend. More important, it is only through such a detailed, user-centred understanding--as opposed to abstract assessments of technological potential--that we can formulate effective strategies that do not lose sight of the clinical and therapeutic aspects of health care in the quest to improve its delivery.

A paradigm shift in the evaluation of information technology in health care.

This paper examines the notion of productivity, which underlies the reorganization of Quebec's health care system around an information technology-driven virage ambulatoire, or shift to ambulatory (outpatient) care. The reorganization may be traced to a policy decision to address the health care's productivity crisis, a crisis diagnosed in the 1970s based on macroeconomic expenditure trend lines highlighting the "obstacle" to economic growth and to balanced budgets. The information technology-driven virage ambulatoire is aimed at a structural reorganization, based on the principle of: boosting productivity in a service- or information-based economy. The State, thus, relied on analytic categories developed for a particular mode of economic analysis to lead a hospital restructuring program oriented around information technology-based ambulatory care. The result was a refocus from clinical and therapeutic efficiency to administrative imperatives of time, cost, and optimization. Hence, Québec moved to neoliberal productivist system in which clinical and therapeutic effectiveness are subordinated to economic imperatives.