Patients' perspectives on quality and patient safety failures: lessons learned from an inquiry into transvaginal mesh in Australia.

BACKGROUND: Transvaginal mesh (TVM) surgeries emerged as an innovative treatment for stress urine incontinency and/or pelvic organ prolapse in 1996. Years after rapid adoption of these surgeries into practice, they are a key example of worldwide failure of healthcare quality and patient safety. The prevalence of TVM-associated harms eventually prompted action globally, including an Australian Commonwealth Government Senate Inquiry in 2017. METHOD: We analysed 425 submissions made by women (n = 417) and their advocates (n = 8) to the Australian Senate Inquiry, and documents from 5 public hearings, using deductive and inductive coding, categorisation and thematic analysis informed by three 'linked dilemmas' from healthcare quality and safety theory. We focused on women's accounts of: a) how harms arose from TVM procedures, and b) micro, meso and macro factors that contributed to their experience. Our aim was to explain, from a patient perspective, how these harms persisted in Australian healthcare, and to identify mechanisms at micro, meso and macro levels explaining quality and safety system failure. RESULTS: Our findings suggest three mechanisms explaining quality and safety failure: 1. Individual clinicians could ignore cases of TVM injury or define them as 'non-preventable'; 2. Women could not go beyond their treating clinicians to participate in defining and governing quality and safety; and. 3. Health services set thresholds for concern based on proportion of cases harmed, not absolute number or severity of harms. CONCLUSION: We argue that privileging clinical perspectives over patient perspectives in evaluating TVM outcomes allowed micro-level actors to dismiss women's lived experience, such that women's accounts of harms had insufficient or no weight at meso and macro levels. Establishing system-wide expectations regarding responsiveness to patients, and communication of patient reported outcomes in evaluation of healthcare delivery, may help prevent similar failures.

Experiences of Menopausal Transition Among Vietnamese Women: A Grounded Theory Analysis.

Background and Purpose: Complaints about menopause vary between cultures, and the experience of menopause changes significantly in women living in different countries. Limited evidence is available regarding the menopausal experience among Asian women. This study aims to explore the menopausal transition experiences of Vietnamese women. Methods: A qualitative inquiry was undertaken using the grounded theory approach. Semi-structured interviews were conducted and analyzed following constructivist grounded theory methods. Results: In the early transition, women's lives underwent many challenges. They had physical manifestations of menopause and difficulty in their sexual life. Later, women identified that their psychosocial impacts were affected, leading to emotional changes and changes in perceptions of others about the menopausal transition. The study also showed that each woman had their own beliefs and religion. Finally, after experiencing physical and mental changes, women found methods for discomfort relief. These methods included seeking information, applying strategies to manage menopausal challenges and consequences, and maintaining balance. Implications for Practice: The diverse perspectives on women's menopausal transition can help nurses and other health care professionals to provide culturally appropriate care for women.

It's not a lie If you believe it: Narrative analysis of autobiographical memories reveals over-confidence disposition in patients who confabulate.

Humans perceive their personal memories as fundamentally true, and although memory is prone to inaccuracies, flagrant memory errors are rare. Some patients with damage to the ventromedial prefrontal cortex (vmPFC) recall and act upon patently erroneous memories (spontaneous confabulations). Clinical observations suggest these memories carry a strong sense of confidence, a function ascribed to vmPFC in studies of memory and decision making. However, most studies of the underlying mechanisms of memory overconfidence do not directly probe personal recollections and resort instead to laboratory-based tasks and contrived rating scales. We analyzed naturalistic word use of patients with focal vmPFC damage (N = 18) and matched healthy controls (N = 23) while they recalled autobiographical memories using the Linguistic Inquiry and Word Count (LIWC) method. We found that patients with spontaneous confabulation (N = 7) tended to over-use words related to the categories of 'certainty' and of 'swearwords' compared to both non-confabulating vmPFC patients (N = 11) and control participants. Certainty related expressions among confabulating patients were at normal levels during erroneous memories and were over-expressed during accurate memories, contrary to our predictions. We found no elevation in expressions of affect (positive or negative), temporality or drive as would be predicted by some models of confabulation. Thus, erroneous memories may be associated with subjectively lower certainty, but still exceed patients' report criterion because of a global proclivity for overconfidence. This may be compounded by disinhibition reflected by elevated use of swearwords. These findings demonstrate that analysis of naturalistic expressions of memory content can illuminate global meta-mnemonic contributions to memory accuracy complementing indirect laboratory-based correlates of behavior. Memory accuracy is the result of complex interactions among multiple meta-mnemonic processes such as monitoring, report criteria, and control processes which may be shared across decision-making domains.

What are the roles of positive psychological construct in blended learning contexts? Integrating academic buoyancy into the Community of Inquiry framework.

Introduction: In the post-epidemic era, blended learning has become a social trend for the future of higher education, and scholars have endeavored to understand the factors that influence student learning in these blended communities. Communities of Inquiry is a conceptual framework that describes the components of blended learning environments, indicating teaching presence, social presence, and cognitive presence. However, the framework fails to adequately explore how individual learning motivational factors influence student learning. Therefore, this study extends the Community of Inquiry framework by drawing on a positive psychological construct-academic buoyancy to reveal the relationship between academic buoyancy and the three presences through empirical research. Methods: The theoretical model was validated by SPSS 26.0 and smartPLS4.0. To evaluate the measurement and structural models, structural equation modeling (SEM) was carried out using the partial least squares (PLS) method. Findings: (a) Teaching presence positively predicts academic buoyancy, and academic buoyancy positively predicts social presence and cognitive presence; (b) academic buoyancy mediates teaching presence and social presence, as well as teaching presence and cognitive presence; and (c) academic buoyancy acts as a chain mediator between teaching presence and cognitive presence through social presence. Discussion: The results of this study fill a gap in the multiple roles of individual positive psychological construct-academic buoyancy in blended learning communities, extend the Community of Inquiry theoretical framework, and provide empirical evidence for blended learning quality and practical improvement strategies.

"Unable to Feed My Hungry Child": Experiences of Mothers Caring for Children With Prader-Willi Syndrome.

Mothers' experiences of caring for children with Prader-Willi Syndrome (PWS) is largely unknown. With no treatment for PWS, parents undertake (extra)ordinary care practices to keep children safe from overeating and self harm. Knowledge of these care practices could lead to effective interventions. Narrative inquiry was used to study everyday experience with Canadian mothers. Participants cared for a child 3 to 17 years old who had hyperphagia. Participants were interviewed 8 to 12 times each over the course of a year. Narrative accounts were co-composed through a collaborative process of analysis. Engaging with participants' everyday experiences amplified complex care needs for families and gaps in health and social care systems. Narrative threads focused on engaging in (extra)ordinary care practices, rigid care work to keep children healthy and safe, tension from others while enacting these care practices, and difficulty conforming to social expectations with childrearing and care work. Recommendations for practice and policy include (a) shifting from untenable care practices, (b) reconceptualizing care work, and (c) alternative care models.

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry.

OBJECTIVES: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.

A Multimethodological Approach to Assist the Design of Systemic Governance in Agroextractivist Settlement Projects in the Brazilian Amazon Landscape.

Coping with complex landscape situations in the Anthropocene increasingly demands innovative governance practices that can be facilitated by investment in new epistemological and methodological approaches and capacities. This paper explores the use of a multimethodological research approach organized as a systemic co-inquiry to assist in the design of systemic governance for Agroextractivist Settlement Projects (PAEs) in the municipality of Abaetetuba, Pará, in the Brazilian Amazon. In the PAEs, the systemic co-inquiry was conducted alongside interested and influential stakeholders through the combined use of the Soft Systems Methodology and Strategic Options Development and Analysis problem structuring methods. The use of these methods and their tools allowed stakeholders to articulate major issues around the situation of concern, engaging in reflective practices about the opportunities of governing the PAEs systemically. By valuing stakeholder perspectives and participation in all phases of the research, the proposed multimethodology approach helped them express their views on the problem situation and allowed for their active engagement in the design of systemic governance of the PAEs. As a result of adopting a multimethodological approach, distinctive albeit coupled realms of governing are explored, a key issue when designing systemic governance practices of social-ecological systems such as the PAEs.

Facilitators and barriers to online group work in higher education within health sciences - a scoping review.

INTRODUCTION: In health education, group work is essential to prepare students for working in health care and medical teams. Following the widespread adoption of online teaching, group work increasingly takes place in online environments. Although successful group work can provide good learning outcomes, it is unclear what facilitates or hinders online group work in health science education, and to what extent this topic has been addressed. Thus, this scoping review aimed to identify the facilitators and barriers to online group work in higher health education, provide an overview of the scientific literature related to the topic, and identify knowledge gaps in the research. METHODS: This scoping review was guided by the methodological framework described by Arksey and O'Malley, and reporting is in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Eight online databases were searched for scientific articles published between 2012 and 2022. At least two researchers independently screened records and full-text articles and charted data including article characteristics and key information related to the research question. Findings were categorized and summarized based on the Community of Inquiry Framework. RESULTS: After screening 3671 records and 466 full-text articles, 39 articles met the inclusion criteria. The review revealed smaller group size, consistency in group composition and joint responsibility to be facilitators. Challenges with group communication, scheduling synchronous meetings and technical issues were identified as barriers. Our findings supported the importance of all three elements of the Community of Inquiry Framework: social, cognitive, and teaching presence. CONCLUSION: This review provides an overview of facilitators and barriers to online group work in health science education. However, there is a need for further investigation of these factors and studies addressing this topic from the teachers' perspective.

UK survey on experiences of men with non-cancer-related lymphoedema: part one.

This initial article delves into the methodology, methods and theories, while the subsequent article will centre on the discoveries, discussion and conclusion. The study aimed to address the research question: how do men perceive their engagement in the self-management of non-cancer-related lymphoedema? An interpretivist qualitative methodology was employed, utilising an online survey based on the validated lymphoedema quality of life tool (LYMQoL). The data underwent inductive narrative inquiry. The study incorporated theories such as hegemonic masculinity and the health, illness, men and masculinities (HIMM) framework. The findings will be detailed in the second article in this series. This article has delineated the objective, methodologyand methods, employing a qualitative interpretivist approach through narrative inquiry. The study incorporated masculinity theories, including hegemonic masculinity and HIMM. The second article will present the findings and their significance within the broader literature.

What do recently housed young people imagine for the future of third places? Using game-based inquiry to (re)imagine affirming, youth-centered third places.

Third places-public and community settings like parks and libraries-are theorized to serve as sources of social connection, community, and play. Yet, young people who hold marginalized identities, such as those experiencing homelessness and housing instability, often endure discrimination in third place settings. This study used game-based inquiry to partner with recently housed young people who have experienced chronic housing instability (N = 21) to understand how they would (re)imagine future third places. We then analyzed transcripts from these game sessions through qualitative thematic analysis. Participants suggested that certain tenets must be present in third places: they must offer opportunities for agency and individualization; they must meet everyday needs; and they must be explicitly inclusive. To actualize these tenets, participants imagined places that meet many needs and do many things; portable and adaptable physical spaces; freedom to choose how to play; attending to and subverting oppressive social hierarchies; providing choice for privacy or connection; knowing people will be around; and free amenities. These findings have implications for theoretical development, practices in present and future third places, and methodological development of games in research.

Entangling Reciprocity With the Relational in Narrative Inquiry.

In this article, we develop, through drawing forward fragments of our experiences, a concept of reciprocity as always situated within the relational ontology of narrative inquiry. Reciprocity is most commonly understood within a transactional sense, an exchange of goods. We show important aspects of reciprocity in narrative inquiry, including the importance of intentionally creating and responding to spaces where reciprocity occurs and can be sustained over time and place, and the potential reciprocity holds to change who we, and those with whom we work, are. As we reconsider the ways in which reciprocity is not understood as a transaction in a relational methodology, new questions about the entanglement of reciprocity and recognition emerge. We understand that recognition does not necessarily have to be reciprocal, but recognition is necessary to compose a space where reciprocity can live in our ordinary interactions with others.

Discovering clinical phronesis.

Phronesis is often described as a 'practical wisdom' adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes 'Clinical phronesis' as a descriptor for its appearance and role in the daily practice of (exemplary) physicians.

Develop Your CORE2 for Career Flourishing: A Career Development Workshop for Hospitalists.

Introduction: Appreciative inquiry harnesses an individual's strengths to realize positive change, and a flourishing-focused mindset emphasizes engagement, social connectivity, and seeking meaningful work. Though the impact of these models on physician well-being and career planning has been evaluated in graduate medical education, their integration into career development initiatives for faculty has been limited. We designed a workshop to nurture hospitalist career development, based on our CORE2 conceptual framework (character strengths, overall vision, role assessment, explicit goals, and evaluation). Methods: We presented the workshop at the 2022 and 2023 Society of Hospital Medicine (SHM) annual conferences. This 1.5-hour workshop comprised four modules and three small-group activities designed to help participants identify their signature character strengths, draft a professional vision statement, prioritize professional roles, and develop SMART goals aligned with these roles. Results: At the 2023 SHM annual conference, 36 participants attended the workshop, and 32 (89%) completed pre- and postworkshop surveys. After workshop completion, participants' self-assessed familiarity with their signature character strengths, knowledge of evidence-based principles to develop SMART goals, and confidence in their ability to write a vision statement and SMART goals all increased significantly (p < .05). Discussion: This workshop provides a valuable framework for self-directed longitudinal career development and reflection. We build on prior curricula on educator identity formation by guiding participants from identity definition to professional vision development to professional role evaluation to aligned goal creation and iterative evaluation. Our workshop's principles are readily generalizable to clinician-educators across medical disciplines.

Guided inquiry-based learning to enhance student engagement, confidence, and learning.

PURPOSE: This study explores the impact of guided inquiry-based learning (IBL) on student engagement and performance in a dental hygiene program. The research was conducted with 36 dental hygiene students, focusing on enhancing student engagement using a guided IBL methodology that could ultimately lead to improved student performance and confidence. METHODS: Delivered through two interventions, pre-, post-, and delayed post-tests evaluated student performance and confidence, while the ASPECT survey assessed student engagement. The interventions included a lecture (intervention #1) and a group-based IBL worksheet activity (intervention #2). Statistical analyses using analysis of variance (ANOVA) tested the impact of these interventions on student performance and confidence-adjusted scores. RESULTS: Results showed significant improvements in student performance and confidence following both interventions, with notably higher gains after the IBL activity. Analysis of ASPECT survey data revealed positive perceptions of engagement, emphasizing the importance of group dynamics, instructor roles, and the activity's value. Students reported enhanced understanding and engagement through group interactions and individual study. The study also highlighted the critical role of the instructor in facilitating and guiding the IBL activity. CONCLUSION: In conclusion, the study demonstrates that guided IBL strategies can significantly enhance student confidence and performance, suggesting a sustainable impact on learning outcomes. These findings underscore the importance of active, engaged learning methodologies in healthcare education, particularly in enhancing long-term retention and understanding of complex topics. The study advocates for integrating such strategies into academic curricula to foster deeper student engagement and improved educational experiences.

" full of opportunities, but not for everyone": A narrative inquiry into mechanisms of labor market inequity among precariously employed gay, bisexual, and queer men.

BACKGROUND: This study brings lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ+) populations into scholarly discourse related to precarious employment through a political economy of queer struggle. METHODS: Drawing on narrative inquiry, 20 gay, bisexual, and queer men shared stories of precarious employment that were analyzed using Polkinghorne's narrative analysis. RESULTS: Results tell an overarching narrative in three parts that follow the trajectory of participants' early life experiences, entering the labor market and being precariously employed. Part 1: Devaluation of LGBTQ+ identities and adverse life experiences impacted participants' abilities to plan their careers and complete postsecondary education. Part 2: Participants experienced restricted opportunities due to safety concerns and learned to navigate white, cis, straight, Canadian ideals that are valued in the labor market. Part 3: Participants were without protections to respond to hostile treatment for fear of losing their employment. CONCLUSIONS: These stories of precarious employment illustrate unique ways that LGBTQ+ people might be particularly susceptible to exploitative labor markets.

The implementation of an active inquiry learning centered "7E" teaching mode in the cell biology course enhances the learning effects of postgraduate students.

The primary objective of science postgraduate education is to foster students' capacity for creative thinking and problem-solving, particularly in the context of scientific research quality. In order to achieve this goal, the "7E" teaching mood has been implemented in the cell biology course for postgraduate students to promote student-centered active inquiry learning instead of breaking away from traditional indoctrination-based teaching methods. This study demonstrates that the implementation of the "7E" teaching mode, through content programming, process design, and effect evaluation, effectively meets the needs of the majority of students, fosters their interest in learning, enhances their performance in comprehensive questioning, and enhances their innovative abilities in scientific research. Consequently, this research offers a theoretical framework and practical foundation for the development of the "7E" teaching mode in postgraduate courses, aiming to cultivate highly skilled scientific professionals.

In-hospital end-of-life care: an appreciative analysis of bereaved family feedback.

Experience feedback data is increasingly recognised as being helpful in improving healthcare services, and in meeting patient and family needs. This end-of-life care project, based on the principles of appreciative inquiry, sought to learn from the experiences of bereaved people whose relative had died in an acute hospital setting. Informal feedback, offered during a routine telephone call, was thematically analysed and interpreted in an appreciative manner. Confirmatory representations of caring practices and behaviours were identified, categorised and disseminated in a way that enabled staff to come to know and understand end-of-life care at its best, rather than as a set of problematised events. The findings served as a benchmark for individuals and teams to assess and progress their practice reflectively. The authors conclude that staff receptiveness to informal bereaved family feedback may be enhanced by focusing on the positive qualities of end-of-life care within existing practices.

Strategies used by midwives to enhance knowledge and skill development in midwifery students: an appreciative inquiry study.

BACKGROUND: Midwifery practice experience for midwifery students is an important component of education to enhance knowledge and skill development. Practicing midwives provide student support in the clinical setting, there is minimal literature relating to strategies midwives use to support students. OBJECTIVE: To explore midwifery student experiences of the strategies used by midwives to facilitate knowledge and skill development in the clinical practice setting. METHODS: Qualitative approach based on Appreciative Inquiry. The setting is one University in Australia. Participants, thirteen Graduate Diploma in Midwifery students. Individual interviews followed by thematic analysis. RESULTS: Data analysis identified six themes, Willingness to share knowledge and develop skills; The positive use of questioning; Moderating support; Teaching through the woman; Learning through problematisation and Providing constructive affirmation. CONCLUSIONS: Midwives incorporated varied strategies to support student development in the clinical setting. For an equitable clinical experience, all midwives need support to develop skills and confidence in facilitating student learning.

Barriers to research among residents in oral and maxillofacial surgery.

PURPOSE/OBJECTIVES: Research is an integral part of oral and maxillofacial surgery (OMS) residency training. This study aimed to identify the current barriers perceived by OMS residents toward conducting research during training. METHODS: A cross-sectional, questionnaire-based study was conducted. The survey was distributed to 670 OMS residents across the United States in 2021 and consisted of questions regarding demographics, residency program requirements and resources, and perceived barriers to research. Data were analyzed using descriptive statistics, Fisher's exact tests, Kruskal-Wallis tests, and post hoc Dunn's test with a statistical significance of P < 0.05. RESULTS: The response rate was 24.2%. Most participants' programs had a minimum research requirement to complete a residency (80%). The top three reported barriers to completing research were lack of time (84%), limited access to research mentors or supervisors (37%), and lack of access to biostatistical support (31%). Factors associated with these barriers included the lack of a research director, supervisor, mentor, assistant, or statistician. There was no significant difference between residents in programs with protected research time versus those without. CONCLUSIONS: OMS residents generally viewed research experience during residency as beneficial but reported important barriers, most notably: insufficient time. Although most OMS training programs in the US require research for completion, many do not provide adequate time to facilitate this process. Compared with literature from over a decade ago, it appears little progress has been made to remedy similar barriers to research. Addressing this deficiency may increase the quantity and quality of research, furthering the profession.

Assessing the intention to accept inquiry-based teaching pedagogy among Chinese university students: an extension of technology acceptance model.

Introduction: Due to the limitations of traditional didactic teaching, inquiry-based teaching has attracted increasing attention and has become an important content of curriculum teaching reform in college education. Nevertheless, it is vital to investigate students' subjective acceptance of inquiry-based instruction and its influencing factors before inquiry-based teaching methods are widely implemented. Methods: In light of this, taking into account the psychological factors of students, an acceptance model of inquiry-based teaching pedagogy was established based on the extended technology acceptance model (TAM). Three additional variables, namely self-efficacy, implementation quality, and risk perception, were incorporated into the TAM. Firstly, subjective evaluation data of the influencing factors of inquiry teaching acceptance were obtained through a network questionnaire survey from university students in Guangdong, China, using snowball sampling and convenient sampling. A total of 485 valid questionnaires were retrieved, with an effective response rate of 88.2%. Then, internal consistency and reliability, convergent validity and discriminant validity of the model and its hypothesis were tested with reliability and validity tests. Finally, path analysis was used to examine key determinants of students' acceptance of inquiry teaching and moderators. Results: Results indicated that the constructed model can explain the acceptability of inquiry teaching for college students by 88.6%; Attitude has a positive significant impact on behavioral intention; Perceived ease of use indirectly affects behavioral intention through perceived usefulness, while perceived usefulness indirectly affects behavioral intention through attitude; self-efficacy not only directly affects behavioral intention but also indirectly affects behavioral intention through implementation quality; implementation quality indirectly affects behavioral intention through perceived usefulness and attitude; students' risk perception of inquiry-based teaching has no negative impact on behavioral intention. Conclusion: Overall, this study has implications for policymakers, teachers or learners in terms of the implementation and promotion of inquiry-based teaching in college classroom.