Clinician-Patient Relationships in Virtual Care: A Dimensional Analysis of the Symbolic World of Cancer Care.

Rapid uptake of telehealth technologies has shifted clinician-patient relationships, a well-studied topic of sociological inquiry. The purpose of this dimensional analysis study was to understand the symbolic interaction of clinicians and patients within virtual supportive cancer care. Seventeen clinicians, eighteen patients, and three care partners receiving or providing care at a multi-site cancer center in the United States participated in interviews. Our analysis of supportive cancer care experiences reveals a key tension: clinicians need to rely on patients in order to share clinical tasks in a virtual care setting but can be reluctant to do so. We posit that dimming the light on cancer is a process that enables clinicians to overcome their reluctance to engage in clinician-patient task sharing by strengthening the relationship. Taken together, these findings reconceptualize the symbolic interaction of the clinician-patient relationship and highlight opportunities to actualize models of relationship-centered virtual care. We discuss implications for clinical practice, ethical relational care, and the literature on clinician-patient relationships and trust.

Fostering Scholarly Development in Nursing Science: The Promise of Dimensional Analysis.

BACKGROUND: Scholarly development in nursing science is a challenging process of academic evolution. In doctoral programs, students move from mastering technical research skills toward developing scholarly identities. This article explores the utility of dimensional analysis as a method of inquiry for nursing PhD students seeking to deepen their scholarly development when completing course assignments and reaching doctoral program milestones. METHOD: Using a brief case study, dimensional analysis was described as an interactionist method used to develop grounded theory and illustrate application of the method throughout a 3-year nursing PhD program. RESULTS: Nursing PhD students have the opportunity to drive the depth of their own scholarly development through engaging with theory, method, and independent inquiry. CONCLUSION: Dimensional analysis holds promise for scholars to simultaneously develop methodological skill, derive situation-specific theory, ground a program of research, and anchor that program of research with theory and method. [J Nurs Educ. 2023;62(2):112-115.].

A mixed-methods program evaluation of the Alda Healthcare Experience- a program to improve healthcare team communication.

BACKGROUND: Communication among interprofessional healthcare worker teams is critical to ensure a thriving and resilient workforce. We will evaluate the implementation and effectiveness of the Alda Healthcare Experience (AHE), a novel medical improvisation (improv) workshop designed to improve interprofessional communication skills among healthcare professionals. The AHE workshop includes a two-hour experiential training workshop led by an improv specialist and a clinical co-facilitator. In July 2022 we began implementing the AHE workshop by training 18 clinical co-facilitators who will co-facilitate the workshops for 550 healthcare workers from five hospital departments at Stony Brook University Hospital over the course of a year and a half. Using mixed-methods, we will conduct an Effectiveness-Implementation Hybrid Design project that includes an outcome evaluation (effectiveness) and a process evaluation (implementation). METHODS: Our outcome evaluation will assess the impact of the AHE workshop on short- and long-term improvement in interprofessional communication, stress, and professional fulfillment. The process evaluation component will examine programmatic, organizational, and individual facilitators or barriers to effective implementation of the AHE workshop. Qualitative methods will include dimensional analysis employing individual interviews of 20-40 AHE Project Participants, 5-10 Selected Informants, and all the clinical co-facilitators. Quantitative methods will use a quasi-experimental longitudinal design with an intervention group and surveillance of a control group (wait-list) and repeated assessments using validated instruments measuring communications skills, professional fulfillment, stress, burnout, uncertainty tolerance, and teamwork. DISCUSSION: Effective and efficient communication within healthcare teams is fundamental to building team cohesion that, in turn, supports individual resilience and builds positive organizational culture. The AHE program is an innovative approach to improve interprofessional healthcare communication and reduce healthcare worker burnout. In addition to institutional buy-in, rigorous evaluations of medical improv programs are necessary as a critical step in making such programs scalable. TRIAL REGISTRATION: N/A.

The impact and implications of virtual supportive cancer care during the COVID-19 pandemic: integrating patient and clinician perspectives.

PURPOSE: Many cancer centers made rapid shifts in supportive care delivery modalities at the onset of the COVID-19 pandemic. Improving virtual supportive cancer care requires deeply understanding both patient's and clinician's experiences. We aimed to integrate the perspectives of clinicians and patients to describe the transition to virtual supportive cancer care during COVID-19. METHODS: In clinical-academic partnership between a multi-site cancer care center in the Northeastern USA and a school of nursing, we conducted a study using dimensional analysis method. Theoretical sampling drove recruitment of patients and clinicians who engaged in virtual supportive cancer care from March 15, 2020 to December 15, 2020. In this sub-analysis, we coded the dimensional analysis data from semi-structured interviews using a descriptive approach with inductive conventional content analysis. RESULTS: We interviewed 17 clinicians, 18 patients, and 3 care partners about their experiences. We integrate patient and clinician perspectives in four in vivo categories: "When COVID hit," "Not an IT expert," "Those little moments," and "The mothership." CONCLUSION: The findings uncover shared patient and clinician fears of missing or sub-optimal care at the onset of COVID-19, technological and relational challenges to engaging in care, and the mixed impacts of virtual care on access, convenience, and efficiency. This analysis suggests concrete action items to improve virtual supportive care for patients and clinicians. The findings corroborate the importance of convenience, access, and efficiency as care quality indicators and suggest potential to emphasize the clinician-patient relationship as an additional indicator of care quality.

Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships.

Objectives: Comprehensive screening of psychosocial vulnerabilities and substance use in prenatal care is critical to promote the health and well-being of pregnant patients. Effective implementation of new screening procedures and instruments should be accompanied by an in-depth investigation to assess their feasibility and impact on care delivery. Methods: In 2020, following implementation of the Profile for Maternal and Obstetric Treatment Effectiveness (PROMOTE) an innovative self-report screening instrument developed for outpatient prenatal clinics in the U.S., we conducted individual interviews and focus groups with twenty-two midwives, nurse practitioners, and obstetric residents focused on the PROMOTE and its impacts on care delivery. We used interpretive description for the qualitative analysis of the interviews. Results: Five themes were identified: Guiding Time Efficiently: "The Time I Don't Have," Preventing Missed Care, Signaling Trustworthiness, Establishing Trauma-Informed Foundations, and Promoting "Honest" Patient Disclosure. Conclusion: Interviews suggest that patient completion of the PROMOTE before the medical encounter helps reduce previously reported barriers, is more time-effective, and makes history-taking easier. It also facilitates the patient-provider relationship. Innovation: Findings offer insight into the breadth and depth of clinical impact resulting from the PROMOTE, and provide guidance for the implementation of such tools to optimize health outcomes.

Leveraging immersive technology to expand access to opioid overdose reversal training in community settings: Results from a randomized controlled equivalence trial.

BACKGROUND: Immersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in-person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. METHODS: A team of nurses and communication researchers developed a 9-minute immersive video OOPP. To test whether this immersive video OOPP (treatment) demonstrated equivalent gains in opioid overdose response knowledge and attitudes as in-person OOPPs (standard of care control), researchers deployed a two-day field experiment in Philadelphia, Pennsylvania, USA. In this equivalence trial, 9 libraries were randomly assigned to offer treatment or control OOPP to community members attending naloxone giveaway events. In this equivalence design, a difference between treatment and control groups pre- to post-training scores within -1.0 to 1.0 supports equivalence between the trainings. RESULTS: Results demonstrate participants (N = 94) exposed to the immersive video OOPP had equivalent improvements on posttest knowledge (ß=-0.18, p = .61) and more favorable attitudes about responding to an opioid overdose (ß=0.26, p = .02) than those exposed to the standard OOPP. However, these minor differences in knowledge and attitudes were within the equivalence interval indicating that the immersive video OOPP remained equivalently effective for community members. CONCLUSIONS: Community partnerships, like those between public health departments and libraries, can provide opportunities for deploying novel immersive video OOPP that, alongside standard offerings, can strengthen community response to the opioid crisis.

A pilot study to compare virtual reality to hybrid simulation for opioid-related overdose and naloxone training.

BACKGROUND: In the midst of the international opioid-related overdose (OOD) crisis, appropriate naloxone training is needed by both healthcare professionals and community members to better leverage its life-saving potential. OBJECTIVE: Pilot the use of a virtual reality simulation for training student nurses to identify signs and symptoms of an OOD, properly administer intranasal naloxone, and provide immediate recovery care after revival. DESIGN: This quasi-experimental pretest-posttest study evaluated knowledge and attitudes towards intervening during an opioid-related overdose among student nurses before and after participating in a traditional hybrid simulation or virtual reality simulation. SETTING: A medium sized urban university's school of nursing in the Northeastern United States. PARTICIPANTS: Fifty (N = 50) senior Bachelor of Nursing Science (BSN) students. METHODS: Knowledge and attitudes were assessed using the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS). Students completed measures 3 weeks prior to training and 3 weeks after. Appropriate t-tests evaluated changes in OOAS and OOKS scores both within and between training groups (e.g. hybrid simulation compared to virtual reality). RESULTS: Sample characteristics were well balanced in both the hybrid simulation group (n = 31) and virtual reality group (n = 19). There were no statistically significant differences in average OOKS and OOAS scores at baseline or at follow up between those receiving hybrid simulation or the virtual reality training. All participants' attitudes scores decreased from baseline to follow up by <2 points. However, there was no difference in the change in knowledge scores between the training groups. CONCLUSIONS: Individuals participating in the virtual reality simulation had similar knowledge retention and attitudes towards responding during an opioid-related overdose and administering intranasal naloxone when compared to individuals participating in hybrid simulation. The lack of significant findings between training groups indicates that the mobile virtual reality training is comparable to the in-person hybrid simulation for training nursing students to appropriately administer naloxone to reverse OOD and provide immediate recovery care after revival.