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1.
Qual Health Res ; : 10497323241244669, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38775392

RESUMO

The impact of ChatGPT and other large language model-based applications on scientific work is being debated across contexts and disciplines. However, despite ChatGPT's inherent focus on language generation and processing, insights regarding its potential for supporting qualitative research and analysis remain limited. In this article, we advocate for an open discourse on chances and pitfalls of AI-supported qualitative analysis by exploring ChatGPT's performance when analyzing an interview transcript based on various prompts and comparing results to those derived by an experienced human researcher. Themes identified by the human researcher and ChatGPT across analytic prompts overlapped to a considerable degree, with ChatGPT leaning toward descriptive themes but also identifying more nuanced dynamics (e.g., 'trust and responsibility' and 'acceptance and resistance'). ChatGPT was able to propose a codebook and key quotes from the transcript which had considerable face validity but would require careful review. When prompted to embed findings into broader theoretical discourses, ChatGPT could convincingly argue how identified themes linked to the provided theories, even in cases of (seemingly) unfitting models. In general, despite challenges, ChatGPT performed better than we had expected, especially on identifying themes which generally overlapped with those of an experienced researcher, and when embedding these themes into specific theoretical debates. Based on our results, we discuss several ideas on how ChatGPT could contribute to but also challenge established best-practice approaches for rigorous and nuanced qualitative research and teaching.

2.
Front Robot AI ; 11: 1289414, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38721392

RESUMO

Introduction: Older adults are engaging more and more with voice-based agent and social robot technologies, and roboticists are increasingly designing interactions for these systems with older adults in mind. Older adults are often not included in these design processes, yet there are many opportunities for older adults to collaborate with design teams to design future robot interactions and help guide directions for robot development. Methods: Through a year-long co-design project, we collaborated with 28 older adults to understand the key focus areas that older adults see promise in for older adult-robot interaction in their everyday lives and how they would like these interactions to be designed. This paper describes and explores the robot-interaction guidelines and future directions identified by older adults, specifically investigating the change and trajectory of these guidelines through the course of the co-design process from the initial interview to the design guideline generation session to the final interview. Results were analyzed through an adapted ethnographic decision tree modeling approach to understand older adults' decision making surrounding the various focus areas and guidelines for social robots. Results: Overall, over the course of the co-design process between the beginning and end, older adults developed a better understanding of the robot that translated to them being more certain of their attitudes of how they would like a robot to engage with them in their lives. Older adults were more accepting of transactional functions such as reminders and scheduling and less open to functions that would involve sharing sensitive information and tracking and/or monitoring of them, expressing concerns around surveillance. There was some promise in robot interactions for connecting with others, body signal monitoring, and emotional wellness, though older adults brought up concerns around autonomy, privacy, and naturalness of the interaction with a robot that need to be further explored. Discussion: This work provides guidance for future interaction development for robots that are being designed to interact with older adults and highlights areas that need to be further investigated with older adults to understand how best to design for user concerns.

3.
BMC Med ; 22(1): 177, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38715000

RESUMO

BACKGROUND: Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS: The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS: Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS: HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.


Assuntos
Pesquisa Qualitativa , Humanos , Inglaterra , Lactente , Feminino , Pré-Escolar , Masculino , Pobreza
4.
J Environ Manage ; 360: 121098, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38776657

RESUMO

Remediation activities, particularly in megasites, may induce substantial secondary environmental impacts that must be addressed for green and sustainable remediation (GSR) practices. Only limited studies are available quantitatively assessing the environmental footprint and environmental benefits of implementing Best Management Practices (BMPs) in megasite remediation. This study used the SiteWise™ tool, a quantitative environmental footprint assessment for scenario simulation and benefit quantification of BMPs, on a contaminated megasite in Hebei Province, China. We observed a considerable environmental footprint and energy from the remediation. Taking the final implementation alternative (Alt 1) as an example, which is characterized by combining multiple remediation techniques, the greenhouse gas (GHG) emissions reached 113,474 t, the energy used was 2,082,841 million metric British thermal units (MMBTU), and other air pollutant emissions (NOx, SOx, and PM10) amounted to 856 t. Further BMP analyses highlighted the benefits of substituting the conventional solidification/stabilization agent with willow woodchip-based biochar, which could reduce GHG emissions by 50,806 t and energy used by 926,648 MMBTU. The overall environmental benefits of implementing all applicable BMPs in the remediation were significant, with a 66.85%, 50.15%, and 56.05% reduction in GHG emissions, energy used, and other air pollutants, respectively. Our study provides insights into quantifying the environmental footprint and exploring emission reduction pathways for contaminated megasite remediation. It also offers a feasible path for quantifying the environmental benefits of BMPs, promoting the development of GSR of contaminated sites.

5.
Front Rehabil Sci ; 5: 1377218, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38742041

RESUMO

Introduction: Self-management programs for spinal cord injury (SCI) are a growing adjunct to traditional healthcare services aiding individuals with SCI in learning and managing symptoms and medical care. A benefit of self-management programs is that they can be facilitated by peers, offering a unique lived experience of adjusting to and managing SCI. While a growing body of literature highlights the effectiveness of peer led programs, there is limited understanding of how individuals engage with peer programs or critical components of peer support. The current study seeks to understand how individuals engaged with peers in the context of a self-management program. Methods: Secondary qualitative analysis of online forum posts resultant from a peer led self-management course for SCI. Results: Content analysis revealed several themes of how participants engaged with members of the group, including skill building, resource sharing, and problem solving. A process level theme of emotional connection to others living with similar SCI-related challenges was defined as "bearing witness." Participants commented frequently that groups were the first time they engaged with a community with lived experience, and shared experience was frequently highlighted in the responses from individuals as one of the most unique and important aspects of the intervention. Discussion: Themes identified suggest that bearing witness was a critical component of peer led intervention. While self-management content provided structure for engagement and discussion, participants report that connectedness and shared experience made content more impactful and relevant. Future research should examine if alignment of peer and participant experience increases the impact of interventions and explore if this theme is important for other chronic medical populations.

6.
Health Serv Manage Res ; : 9514848241254928, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38749492

RESUMO

Healthcare delivery is currently undergoing major structural reform, and the Learning Health System (LHS) has been proposed as an aspirational model to guide healthcare transformation. As efforts to build LHS take considerable investment from health systems, it is critical to understand their leaders' perspectives on the rationale for pursuing an LHS and the potential benefits for doing so. This paper describes the qualitative analysis of semi-structured interviews (n = 17) with health system leaders about their general perceptions of the LHS, description of key attributes and potential benefits, and perception of barriers to and facilitators for advancing the model. Participants universally endorsed the goal of the local health system aspiring to become an LHS. Participants identified many recognized attributes of LHS, though they emphasized unique attributes and potential benefits. There was also heterogeneity in participants' views on what to prioritize, how to structure the local LHS within existing initiatives, and how new initiatives should be implemented. Improving conceptual clarity of attributes of the LHS would improve its potential in guiding future reform.

7.
J Prev Health Promot ; 5(1): 66-92, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38756911

RESUMO

Sexual assault (SA), particularly alcohol-involved SA, remains prevalent among college women. Because SA often begins in social contexts, bystander intervention has become a popular approach to prevention. Bystander interventions train individuals to intervene on behalf of others, including strangers, despite research indicating that intervention is more likely to occur when the bystander has a relationship with the target. Shifting the focus to friends as potential bystanders capitalizes on the qualities of relationship and responsibility that facilitate intervention. College women (N = 35) participated in focus groups (N = 8) during which they viewed a video prototype of a friend-based motivational interviewing (FMI) intervention session conducted with a friend dyad and provided feedback about the relevance and feasibility of using such an approach to reduce SA among friends who drink together in social settings. Content analysis of focus group transcripts yielded three themes: a) Friends as Natural Bystanders; b) The Role of Alcohol in Intervention, and c) Receptivity to FMI intervention. Women indicated that they feel responsible for keeping their friends safe, and that this sense of responsibility facilitates helping behaviors. Women also described ways through which alcohol intoxication can affect helping behavior. Women expressed enthusiasm for the FMI intervention approach and identified its emphasis on friendship and flexible approaches to personal safety as strengths. Findings highlight the promise of FMI intervention approaches that capitalize on the strengths of women's friendship to create safety goals that align with participants' values and overcome barriers to intervention, including alcohol intoxication.

8.
J Nephrol ; 2024 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-38735001

RESUMO

BACKGROUND: Patient perspectives on their post-operative health are acknowledged as valuable healthcare outcomes and should be scrupulously considered when designing interventions for patient-centered healthcare. Yet, following the COVID-19 lockdown and in the absence of standardized guidelines on how to best provide virtual chronic care to kidney transplant recipients, little is known about how this unique population coped and managed to comply with public health indications during confinement. METHODS: This study addresses this shortcoming by examining the experiences of patients from a tertiary hospital in Spain during the initial weeks of the lockdown decreed by the national government. Specifically, we focus our attention on the perceptions and experiences of these patients by retrieving robust qualitative and quantitative data: the former based on a thematic analysis of focus group transcripts, the latter obtained from a large-scale survey. RESULTS: Our findings identify opportunities for improvement in the quality of care and point to the provisions that might be made when facing future pandemics or lockdown-requiring situations. CONCLUSIONS: As healthcare services navigate evolving landscapes, our findings on the experience of kidney transplant recipients should enable hospital services to improve the quality of care they are able to provide to such patients during periods of restricted mobility, especially those associated with future disease emergencies, and considering that home confinement is often part of the natural course of post-operative care of these patients.

9.
J Homosex ; : 1-24, 2024 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-38573799

RESUMO

Parents' perspective on their child's coming out (CO) remains an under-researched area, especially the investigation of parents adapting to their role post-CO years. The study qualitatively explored parents' recollections of their children's CO, spanning over 15 years. The study involved 15 parents (9 mothers, 6 fathers) of 4 lesbian daughters (Mage = 20.7; SDage = 7.8) and 11 gay sons (Mage = 23.0; SDage = 6.2). A semi-structured interview was employed to probe parents' responses to their child's CO and the long-term evolution of their CO experiences (M = 20.1; SD = 4.8). A thematic analysis was conducted through the software ATLAS.ti. Four themes were observed: (1) risk and protective factors; (2) effects of CO on relationships; (3) parents' generativity; (4) life balance. Acceptance challenges included a lack of LGBQ+ awareness and difficulties in sharing the disclosure with extended family, particularly grandparents. Parents reported numerous strategies, some involving parental generativity, like LGBQ+ activism. Milestones like marriage and the arrival of grandchildren reinforced parents' protective role as they aged, with the child's LGBQ+ disclosure marking a transformative moment leading to a more authentic relationship.

10.
J Adv Nurs ; 2024 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-38570936

RESUMO

AIM: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. DESIGN: A concurrent mixed-methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. METHOD: Eighteen RMs across Canada completed a demographic survey and the Midwifery-Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery-Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi-structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. RESULTS: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife-physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician-midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter-Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. CONCLUSION: This study provides support for the Midwifery-Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. IMPLICATIONS: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. REPORTING METHOD: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ).

11.
Artigo em Inglês | MEDLINE | ID: mdl-38594960

RESUMO

BACKGROUND: Nitrous oxide use is shifting from general anesthesia to sedation and pain control. Interest in novel uses of nitrous oxide in psychiatry is also growing. Thus, understanding the consequences of using nitrous oxide remains relevant. Previous quantitative research might not have fully captured the whole spectrum of nitrous oxide, whereas qualitative analysis can provide a more comprehensive description. This qualitative study aims to describe the subjective experiences of nitrous oxide use in healthy volunteers who have no prior history of recreational substance misuse. METHODS: Twenty healthy male volunteers inhaled 50% nitrous oxide for 20 min. Females were excluded due to higher incidence of nausea with nitrous oxide. Afterwards, all participants answered an open-ended question about their experiences during sedation. The answers were then analyzed with inductive qualitative content analysis to identify emergent subcategories, categories, and overarching themes. RESULTS: We identified two themes: nitrous oxide is mind-altering and produces sensory overload. The mind-altering properties were represented by dreamlike states and heightened emotions. Dreamlike states comprised changes in consciousness and scary, bizarre, or transcendental dreams. Pleasant dreams were not reported. Heightened emotions included euphoria, anxiety, and fear of losing control. Sensory overload consists of distorted perception, bodily sensations, and a heightened sense of surroundings. CONCLUSIONS: Experiences under nitrous oxide sedation are extremely variable and not always pleasant. These findings can improve our understanding of the likes/dislikes of patients undergoing nitrous oxide sedation. Further qualitative studies should focus on the experiences of other groups, such as children or women in labor.

12.
Int J Drug Policy ; 127: 104399, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38636315

RESUMO

BACKGROUND: Long-acting injectable depot buprenorphine has become an important treatment option for the management of opioid dependence. However, little is known about patients' experiences of depot buprenorphine and its embodied effects. This qualitative study aims to explore patients' experiences of depot buprenorphine treatment, including how it feels within the body, experiences of dosing cycles across time, and how this form of treatment relies on wider ecologies of care beyond the clinical encounter. METHODS: Participants were recruited from sites in Sydney, regional New South Wales, and Melbourne, Victoria, Australia. Thirty participants (16 men, 14 women) participated in semi-structured interviews. Participants had histories of both heroin and prescription opioid consumption, and opioid agonist therapy including daily dosing of buprenorphine and methadone. RESULTS: Our analysis illuminates: (1) how patients' expectations and concerns about treatment are linked to past embodied experiences of withdrawal and uncertainty about the effectiveness of depot buprenorphine; (2) the diverse meanings patients attribute to the depot buprenorphine substrate 'under the skin'; and, (3) how depot buprenorphine is embedded within wider ecologies of care, such as counselling and social supports. CONCLUSION: Our analysis destabilises commonplace assumptions about a linear, causal relationship between the pharmacological action of depot buprenorphine and experiences of treatment. Instead, it highlights patients' variable experiences of depot buprenorphine, tracing the everyday practices, embodied feelings, expectations and wider networks of care that shape patient experiences. We conclude with some reflections on the implications of our analysis for alcohol and other drug treatment, specifically how they might inform the design of client education materials and care.

13.
Aten Primaria ; 56(8): 102931, 2024 Apr 10.
Artigo em Espanhol | MEDLINE | ID: mdl-38603940

RESUMO

OBJECTIVE: To find out the motivations of adolescents for alcohol consumption. DESIGN: Qualitative methodology with discussion groups. PARTICIPANTS AND CONTEXT: 131 adolescents (15-17 years old) enrolled in nine schools in Tarragona (Spain). METHOD: Systematic coding strategy, adapted to focus groups. Educational centers were selected through a stratified purposive sampling by educational levels (segmentation criterion) and ownership of the center (public or private). Participants within the educational levels were randomly selected for the groups. Content analysis was conducted using an open and flexible coding strategy. RESULTS: Motivations for alcohol consumption were identified, revolving around six fundamental dimensions: a) seeking fun and new sensations, b) alleviating discomfort, c) consumption due to social contagion and group pressure, d) consumption as a rite of passage into adulthood, e) environmental availability of alcohol, and f) low perception of risk. This motivation varied according to the adolescent's gender. In girls, drinking behavior appeared related to overcoming negative emotional states, while for boys, belonging to the peer group took precedence: drinking reinforces hegemonic masculinity and ensures complicity among peers. Adolescents considered that the information they receive from educational centers is sufficient, but it does not motivate change. CONCLUSIONS: Public health strategies focused on preventing alcohol consumption in adolescents should incorporate their motivations to achieve greater efficiency, paying due attention to sex/gender variables.

14.
J Occup Rehabil ; 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664361

RESUMO

PURPOSE: Return-to-work (RTW) after absence due to a mental illness is a largely understudied area, especially in industries already struggling with retention like those posing unique and high risks for public or personal safety (i.e., pilots, police officers, and health professionals), otherwise known as safety-sensitive sectors. The goal of this paper is to examine how RTW coordinators work with individuals who took a leave of absence for mental illness in safety-sensitive occupations and navigate the RTW process. METHODS: Qualitative methodology was utilized to explore the experiences of 47 RTW coordinators who had worked with individuals employed in safety-sensitive industries. The participants were recruited across Canada using convenience sampling to participate in semi-structured interviews. The interviews were transcribed, anonymized, uploaded to NVIVO 11, and coded using inductive thematic analysis. RESULTS: Our analysis shows that despite the presumed rigidity of occupational health and safety standards for safety-sensitive positions, the notion of "safety" becomes ambiguous in navigating RTW processes, and concerns about safety are often interpreted as the potential risk workers may pose to themselves, other individuals, or the workplace image. Institutional constraints of safety-sensitive jobs shape the ability of RTW coordinators to advocate on behalf of the workers, ultimately placing the workers at a disadvantage by prioritizing safety concerns for organizations over employees' needs. CONCLUSION: It is important to consider how to protect workers in safety-sensitive occupations during the RTW process after absence due to a mental illness to ensure effective integration to the workplace.

15.
BMC Med Educ ; 24(1): 423, 2024 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-38641798

RESUMO

BACKGROUND: Since the release of ChatGPT, numerous positive applications for this artificial intelligence (AI) tool in higher education have emerged. Faculty can reduce workload by implementing the use of AI. While course evaluations are a common tool used across higher education, the process of identifying useful information from multiple open-ended comments is often time consuming. The purpose of this study was to explore the use of ChatGPT in analyzing course evaluation comments, including the time required to generate themes and the level of agreement between instructor-identified and AI-identified themes. METHODS: Course instructors independently analyzed open-ended student course evaluation comments. Five prompts were provided to guide the coding process. Instructors were asked to note the time required to complete the analysis, the general process they used, and how they felt during their analysis. Student comments were also analyzed through two independent Open-AI ChatGPT user accounts. Thematic analysis was used to analyze the themes generated by instructors and ChatGPT. Percent agreement between the instructor and ChatGPT themes were calculated for each prompt, along with an overall agreement statistic between the instructor and two ChatGPT themes. RESULTS: There was high agreement between the instructor and ChatGPT results. The highest agreement was for course-related topics (range 0.71-0.82) and lowest agreement was for weaknesses of the course (range 0.53-0.81). For all prompts except themes related to student experience, the two ChatGPT accounts demonstrated higher agreement with one another than with the instructors. On average, instructors took 27.50 ± 15.00 min to analyze their data (range 20-50). The ChatGPT users took 10.50 ± 1.00 min (range 10-12) and 12.50 ± 2.89 min (range 10-15) to analyze the data. In relation to reviewing and analyzing their own open-ended course evaluations, instructors reported feeling anxiety prior to the process, satisfaction during the process, and frustration related to findings. CONCLUSIONS: This study offers valuable insights into the potential of ChatGPT as a tool for analyzing open-ended student course evaluation comments in health professions education. However, it is crucial to ensure ChatGPT is used as a tool to assist with the analysis and to avoid relying solely on its outputs for conclusions.


Assuntos
Inteligência Artificial , Pessoal de Educação , Humanos , Estudantes , Emoções , Ansiedade
16.
Talanta ; 275: 126138, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38677164

RESUMO

Raman spectroscopy is a general and non-destructive detection technique that can obtain detailed information of the chemical structure of materials. In the past, when using chemometric algorithms to analyze the Raman spectra of mixtures, the challenges of complex spectral overlap and noise often limited the accurate identification of components. The emergence of deep learning has introduced a novel approach to qualitative analysis of mixed Raman spectra. In this paper, we propose a deep learning-based Raman spectroscopy qualitative analysis algorithm (RST) by borrowing the ideas of convolutional neural network and Transformer. By transforming the Raman spectrum into 64 word vectors, the contribution weights of each word vector to the components are obtained. For the 75 spectral data used for validation, the positive identification rate can reach 100.00 %, the recall rate can reach 99.3 %, the average identification score can reach 9.51, and it is applicable to the fields of Raman and surface-enhanced Raman spectroscopy. Furthermore, compared with traditional CNN models, RST has excellent accuracy and robustness in identifying components in complex mixtures. The model's interpretability has been enhanced, aiding in a deeper understanding of spectroscopic learning patterns for future analysis of more complex mixtures.

17.
BMC Health Serv Res ; 24(1): 535, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38671473

RESUMO

BACKGROUND: Electronic health record (EHR) transitions are known to be highly disruptive, can drastically impact clinician and staff experiences, and may influence patients' experiences using the electronic patient portal. Clinicians and staff can gain insights into patient experiences and be influenced by what they see and hear from patients. Through the lens of an emergency preparedness framework, we examined clinician and staff reactions to and perceptions of their patients' experiences with the portal during an EHR transition at the Department of Veterans Affairs (VA). METHODS: This qualitative case study was situated within a larger multi-methods evaluation of the EHR transition. We conducted a total of 122 interviews with 30 clinicians and staff across disciplines at the initial VA EHR transition site before, immediately after, and up to 12 months after go-live (September 2020-November 2021). Interview transcripts were coded using a priori and emergent codes. The coded text segments relevant to patient experience and clinician interactions with patients were extracted and analyzed to identify themes. For each theme, recommendations were defined based on each stage of an emergency preparedness framework (mitigate, prepare, respond, recover). RESULTS: In post-go-live interviews participants expressed concerns about the reliability of communicating with their patients via secure messaging within the new EHR portal. Participants felt ill-equipped to field patients' questions and frustrations navigating the new portal. Participants learned that patients experienced difficulties learning to use and accessing the portal; when unsuccessful, some had difficulties obtaining medication refills via the portal and used the call center as an alternative. However, long telephone wait times provoked patients to walk into the clinic for care, often frustrated and without an appointment. Patients needing increased in-person attention heightened participants' daily workload and their concern for patients' well-being. Recommendations for each theme fit within a stage of the emergency preparedness framework. CONCLUSIONS: Application of an emergency preparedness framework to EHR transitions could help address the concerns raised by the participants, (1) mitigating disruptions by identifying at-risk patients before the transition, (2) preparing end-users by disseminating patient-centered informational resources, (3) responding by building capacity for disrupted services, and (4) recovering by monitoring integrity of the new portal function.


Assuntos
Registros Eletrônicos de Saúde , Pesquisa Qualitativa , United States Department of Veterans Affairs , Humanos , Estados Unidos , Masculino , Feminino , Entrevistas como Assunto , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Portais do Paciente , Adulto
18.
Nurs Rep ; 14(2): 733-743, 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38651468

RESUMO

(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered.

19.
Artigo em Inglês | MEDLINE | ID: mdl-38589737

RESUMO

Despite its demonstrated value, many mental health institutions struggle to implement progress feedback effectively. There is also insufficient information about how therapists utilize progress feedback. To gain more insight, two qualitative studies were conducted. The first study compared the attitudes and motives of therapists who used and those who did not use progress feedback. The second study examined how psychologists incorporated progress feedback into their practice. In total, 23 therapists were interviewed, and the data were analyzed using thematic analysis. The first study found that almost all the therapists had a positive attitude about progress feedback. Those who did not use it indicated reasons such as a heavy workload and patient-related factors, and they also lacked sufficient information about the potential benefits of progress feedback. The second study revealed four major ways in which the therapists utilized feedback, namely: supporting actions to discuss progress feedback, discussing progress feedback with patients, modifications in the ongoing treatment, and peer consultation. However, discussions during peer consultations about using progress feedback for patients who were not benefitting from treatment and how the treatment might be adjusted accordingly were often lacking. In conclusion, it is crucial that training and education be provided to therapists on how to use progress feedback effectively. Having regular discussions about progress feedback during peer consultations could also facilitate its integration into clinical practice.

20.
AIDS Patient Care STDS ; 38(5): 238-248, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38662471

RESUMO

Youth with HIV (YWH) face challenges in achieving viral suppression, particularly in the Southern United States, and welcome novel interventions responsive to community needs. The Theory of Planned Behavior (TPB) describes factors that influence behavior change, and the Positive Youth Development (PYD) supports youth-focused program design. We applied TPB and PYD to explore factors supporting care engagement and challenges for YWH in South Texas. We conducted 14 semi-structured interviews with YWH and 7 focus groups with 26 stakeholders informed by TPB, PYD, and themes from a youth advisory board (YAB). The research team and YAB reviewed emerging themes, and feedback-aided iterative revision of interview guides and codebook. Thematic analysis compared code families by respondent type, TPB, and PYD. All study methods were reviewed by the UT Health San Antonio and University Health Institutional Review Boards. Emerging themes associated with care engagement included: varied reactions to HIV diagnosis from acceptance to fear/grief; financial, insurance, and mental health challenges; history of trauma; high self-efficacy; desire for independence; and desire for engagement with clinic staff from their age group. Stakeholders perceived YWH lifestyle, including partying and substance use, as care barriers. In contrast, YWH viewed "partying" as an unwelcome stereotype, and barriers to care included multiple jobs and family responsibilities. Two key themes captured in PYD but not in TPB were the importance of youth voice in program design and structural barriers to care (e.g., insurance, transportation). Based on these findings, we provide critical and relevant guidance for those seeking to design more effective youth-centered HIV care engagement interventions. By considering the perspectives of YWH in program design and incorporating the PYD framework, stakeholders can better align with YWHs' desire for representation and agency. Our findings provide important and relevant guidance for those seeking to design more effective HIV care engagement interventions for YWH.


Assuntos
Grupos Focais , Infecções por HIV , Entrevistas como Assunto , Pesquisa Qualitativa , Humanos , Infecções por HIV/psicologia , Infecções por HIV/terapia , Adolescente , Masculino , Feminino , Texas/epidemiologia , Adulto Jovem , Adulto , Estigma Social , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia
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