Professionals' digital competences and user profiles in social agencies and their impact on professional practice, family autonomy and wellbeing.

Introduction: The health crisis of the last 3 years has revealed the weaknesses of the child and family support system based on the professional use of digital resources in social agencies. This study addresses three aims: to examine the level of professional digital competence; to analyze the user profiles in a variety of digital resources; and to test the impact of level of competences and user profiles on four aspects: professional practice, family satisfaction with the services, child and family wellbeing, and family autonomy in the exercise of the parenting role. Methods: Participants were 148 practitioners from social agencies who voluntarily responded to an online survey with 47 questions. Results and discussion: Results showed that professionals perceive themselves as more competent in areas of information / data management and communication / collaboration than in the creation of digital content, security measures, and technical problem solving. Websites, email, and instant messaging were the sources more frequently used and with higher satisfaction, than structured programs, social networks and multimedia content. Variability in the user profiles showed three clusters: Cluster 1 Social network user (n = 13), Cluster 2 Diversified user (n = 75) and Cluster 3 Communicative instant user (n = 60). Participants in Cluster 2 compared to those in the other clusters were the most proficient on their digital competences and acknowledge the positive impact of digital resources on their professional practice and the psychological and social wellbeing of families. This study points the need for improvement in professionals' digital competences in some of the measured areas and the user profile of digital resources since both provide benefits on professional practice and family autonomy and wellbeing.

[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Dental hygienists' knowledge, performance confidence and awareness of importance of assessing oral cancer risk factors.

OBJECTIVES: To assess the knowledge, confidence and awareness of the importance of assessing oral cancer risk among dental hygienists working in Korea and to provide data for the development of theoretical and technical curricula related to oral cancer prevention tasks. METHODS: Questionnaires were distributed to 195 dental hygienists, recruited from an online posting. Survey questions were related to the study objectives and demographic characteristics of the participants. An independent t-test and one-way Analysis of Variance were performed to determine the relationships between study variables and participant demographic characteristics. RESULTS: Seventy-five percent of the participants agreed that it is necessary to conduct oral cancer risk factor assessment for patients, while 46% agreed it was the duty of dental hygienists. The percentage of participants responding correctly to oral cancer risk factors and to oral cancer characteristics ranged from 98% to 31%. Participants with a master's degree or higher and those with oral cancer education experience were significantly (p < 0.003, p < 0.007, respectively) more aware of the importance of assessing oral cancer risk factors. Participants, who performed non-treatment-related work, had significantly (p < 0.046) greater performance confidence than that of clinicians. In addition, 52.5% of the participants had no prior education in oral cancer and 80.8% agreed that additional education and training were required. CONCLUSIONS: To improve dental hygienists' knowledge of oral cancer risk factors, it is important to provide specific knowledge, and an educational curriculum is necessary that allows incorporating medical interviews, visual inspections and palpation for comprehensive assessments.

Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.

AIM: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN: Observational cross-sectional study. METHODS: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education.

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

Variability of clinical practice in the care of the second stage of labor among midwives in Spain.

BACKGROUND: There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations. OBJECTIVE: The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines. METHODS: A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0. RESULTS: Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor. CONCLUSIONS: Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care.

"It doesn't matter if we're the most amazing professionals in the world " A qualitative study of professionals' perspectives on parent-child interaction assessment with deaf infants.

Introduction: Parent child interaction (PCI) is positively associated with deaf children's language development. However, there are no known, deaf-specific tools to observe how a parent interacts with their deaf child aged 0-3 years. Without a framework for professionals to use with families, it is unknown how professionals assess PCI, what they assess, why they assess, and how the assessment results relate to case management. Methods: Eighteen hearing and deaf professionals, who work with deaf and hard of hearing infants aged 0-3 years and their families, attended online focus groups. The aim of the study was to gain insight into the professional assessment of PCI. Data were analyzed using thematic analysis. Findings: Six themes were generated from the dataset. Professionals discussed how central parents were in the support offered to families in the home, the importance of knowing and understanding the individual family, and accounting for and supporting parental wellbeing. Descriptions on how to administer a best practice PCI assessment included which parent behaviors to assess and how to make adaptations for different populations. Professionals shared how the assessment and review process could be used to inform and upskill parents through video reflection and goal setting. Discussion: This study provides insight into the mechanisms and motivations for professionals assessing the interactive behaviors of parents who have deaf children aged 0-3. Professionals acknowledged that family life is multi-faceted, and that support is most meaningful to families when professionals worked with these differences and incorporated them into assessment, goal setting, and intervention plans.

Draw to Practice: A Qualitative Study Examining Factors Attracting Physicians to Rural Northern Ontario.

Introduction Physician shortages are a persisting issue in rural regions around the world, and rural Northern Ontario, Canada, is no exception. Even with significant government interventions, financial incentives, and rural-specific contracts, physician recruitment to the region remains an ongoing challenge. Refining recruitment strategies based on specific factors that attract physicians to rural practice could help address staffing shortages and, ultimately, enhance healthcare access and outcomes in rural communities. However, the draw to rural practice among physicians is poorly defined. Therefore, this study aims to bridge this knowledge gap and, in doing so, offers insight to better inform recruitment strategies for rural communities. Methodology As part of a larger qualitative study on physician retention and recruitment, semi-structured interviews were conducted with 12 physicians who had previously practiced in rural Northern Ontario communities. Interviews captured information about their individual experiences, including perspectives on factors that attracted them to establish a practice in rural Northern Ontario. Transcribed interviews were analyzed to identify recurring themes associated with the factors that affect the decision to practice in rural Northern Ontario. Results Participants described the draw to rural practice as being multifactorial and based on overlapping motivations. Key motivations described by participants could be categorized into three broad themes, including rural community connection and exposure, lifestyle and personal preferences, and career considerations. Specifically, participants emphasized the importance of pro-rural mentors and gaining firsthand experience in rural communities as important facilitators that created a connection with these areas. Interest in exploring new parts of the country, alignment with life plans, support of family, and the challenge of rural practice also played pivotal roles in the decision to pursue rural practice. Finally, the opportunity to have a broad scope of practice and serve a need in the healthcare system while receiving fair compensation within the framework of a flexible and supportive contract was also cited as a draw to practice. Conclusion The draw to rural practice is multifactorial and based on a wide array of motivations. As a result, recruitment strategies should move beyond single-pronged approaches and recognize the need to design strategies that address the multifaceted motivations and considerations that drive physicians towards rural practice. Designing and implementing recruitment approaches that consider the diverse factors influencing physicians interest in rural career paths is likely to enhance recruitment initiatives and more effectively address shortage of physicians in the region.

Kinesiología como Programa de Investigación. Una Reflexión respecto a Identidad / Physical therapy as a research program. Ideas regarding professional identity

La Kinesiología chilena ha tenido un desarrollo científico sostenido, particularmente durante las últimas décadas. Este desarrollo ha promovido progresivamente el posicionamiento de kinesiólogos y kinesiólogas como profesionales de la salud dentro de la comunidad, los cuales tienen como fundamento el estudio y aplicación de conocimiento relacionado al movimiento humano. Sin embargo, este desarrollo no ha sido azaroso, sino más bien ha respondido a la creciente actividad científica de los integrantes de la comunidad kinesiológica, además de la cada vez más indispensable utilización de información científica para la toma de decisiones clínicas. Por tanto, el presente artículo discute dos formas de analizar el desarrollo de las disciplinas científicas, y plantea que la kinesiología puede considerarse un programa de investigación, definición desde la cual se pueden analizar los desafíos actuales y futuros respecto al dinamismo necesario de la ciencia y el cómo la kinesiología se relaciona con otras disciplinas para potenciar su crecimiento, sin caer en la redundancia y/o repetición disciplinar.

The physical therapy in Chile has had sustained scientific development, particularly during the last decades. This development has progressively promoted the positioning of physical therapists as health professionals within the community, whose foundation is the study and application of knowledge related to human movement. However, this development has not been random, but rather has responded to the growing scientific activity of members of the physical therapy community, in addition to the essential use of scientific information for clinical decision making. Therefore, this article discusses two ways of analyzing the development of scientific disciplines and proposes that physical therapy can be considered a research program, a definition from which current and future challenges can be analyzed regarding the necessary dynamism of science, and how physical therapy relates to other disciplines to enhance their growth, without falling into professional redundancy and/or repetition.

Autonomia do enfermeiro no exercício das práticas de enfermagem na atenção primária à saúde / Nurses autonomy in the exercise of nursing practices in primary health care / Autonomía de las enfermeras en el ejercicio de las prácticas de enfermería en la atención primaria de salud

Objetivo: Compreender a autonomia do enfermeiro quanto as suas responsabilidades normativas legais no exercício das práticas de enfermagem na Atenção Primária à Saúde (APS) do Pará. Métodos: Estudo observacional, de delineamento transversal qualitativo, realizado em três municípios do estado do Pará. A coleta de dados foi realizada de outubro de 2020 a janeiro de 2021. Os participantes foram os enfermeiros da Atenção Primária à Saúde. Foi realizada entrevista, com roteiro semiestruturado. Foi realizada análise temática dos conteúdos, com auxílio da ferramenta IRaMuTeq Resultados: Emergiram cinco categorias temáticas: 1) Autonomia do enfermeiro no contexto da prescrição de outro profissional na APS; 2) Autonomia para prescrição nos programas e exames na APS; 3) Áreas de identificação da autonomia profissional na APS; 4) As práticas preventivas na APS e suas dificuldades; e 5) Limites da prática profissional do enfermeiro na APS. Conclusão: Os enfermeiros da APS do Pará têm práticas de enfermagem individuais com diferentes tipos de autonomia, cujos cuidados colocam em prática com o respaldo dos protocolos e regulamentos técnicos. Contudo, há necessidade de ampliar e fortalecer parcerias com outros atores sociais municipais. (AU)

Objective: To understand the autonomy of nurses regarding their legal regulatory responsibilities in the exercise of nursing practices in Primary Health Care (PHC) in Pará. Methods: Observational study with qualitative cross-sectional design, conducted in three municipalities of the state of Pará. Data collection was carried out from October 2020 to January 2021. The participants were Primary Health Care nurses. Interviews were conducted, with a semi-structured script. A thematic analysis of the contents was performed, with the help of the IRaMuTeq tool. Results: Five thematic categories emerged: 1) Nurses' autonomy in the context of another professional's prescription in PHC; 2) Autonomy for prescription in programs and exams in PHC; 3) Areas of identification of professional autonomy in PHC; 4) Preventive practices in PHC and their difficulties; and 5) Limits of nurses' professional practice in PHC. Conclusion: PHC nurses in Pará have individual nursing practices with different types of autonomy, whose care they put into practice with the support of protocols and technical regulations. However, there is a need to expand and strengthen partnerships with other municipal social actors. (AU)

Objetivo: Comprender la autonomía de los enfermeros en cuanto a sus responsabilidades normativas legales en el ejercicio de las prácticas de enfermería en la Atención Básica a la Salud (APS) en Pará. Métodos: Estudio observacional, con diseño transversal cualitativo, realizado en tres municipios del estado de Pará. La recolección de datos se realizó de octubre de 2020 a enero de 2021. Los participantes fueron enfermeros de la Atención Primaria de Salud. Se realizó una entrevista, con un guión semiestructurado. Se realizó un análisis temático de dos contenidos, con la ayuda de la herramienta IRaMuTeq. Resultados: Emergieron cinco categorías temáticas: 1) Autonomía del enfermero en el contexto de la prescripción de otro profesional en la APS; 2) Autonomía para prescribir programas y exámenes en la APS; 3) Áreas de identificación de la autonomía profesional en APS; 4) Prácticas preventivas en APS y sus dificultades; y 5) Límites del ejercicio profesional de enfermería en la APS. Conclusión: Los enfermeros de la APS de Pará tienen prácticas de enfermería individuales con diferentes tipos de autonomía, cuyo cuidado está sustentado por dos protocolos y normas técnicas. Sin embargo, existe la necesidad de ampliar y fortalecer las alianzas con otros socios municipales. (AU)

Trabalho interdisciplinar e condições de trabalho de enfermeiros que atuam na atenção primária à saúde / Interdisciplinary work and working conditions of nurses working in primary health care / Trabajo interdisciplinario y condiciones de trabajo de los enfermeros que actúan en la atención primaria de salud

Objetivo: Discutir acerca do trabalho interdisciplinar na prática do enfermeiro na Atenção Primária à Saúde e as suas condições de trabalho. Métodos: Pesquisa descritiva, qualitativa, realizada com 45 profissionais Enfermeiros, que atuam na Atenção Primária à Saúde do estado da Paraíba, de dezembro de 2020 a abril de 2021. A coleta de dados foi guiada por um roteiro semiestruturado. Os dados foram interpretados com base na Análise de Conteúdo e discutidos a partir da literatura existente. Resultados: Evidenciou-se que, apesar de os enfermeiros conseguirem firmar parceria com os outros trabalhadores da unidade, usuários e gestão, e sentirem autonomia para realizar procedimentos, existem condições que dificultam suas práticas, como o pouco reconhecimento profissional, os problemas com a gestão, a falta de insumos e a sobrecarga de função. Conclusão: Os enfermeiros na Atenção Primária vêm buscando seu espaço e melhores condições de trabalho que facilitem suas práticas e favoreçam o cuidado ao usuário. Dessa forma, tais profissionais necessitam de visibilidade e reconhecimento social de suas competências técnicas. (AU)

Objective: Discuss about the interdisciplinary work in the practice of nurses in Primary Health Care and their working conditions. Methods: Descriptive, qualitative research, carried out with 45 professional nurses, who work in Primary Health Care in the state of Paraíba, from December 2020 to April 2021. Data collection was guided by a semi-structured script. Data were interpreted based on Content Analysis and discussed from the existing literature. Results: It was evidenced that, although the nurses manage to establish a partnership with the other workers of the unit, users and management, and feel autonomy to carry out procedures, there are conditions that hinder their practices, such as little professional recognition, problems with management, the lack of inputs and the function overload. Conclusion: Nurses in Primary Care have been seeking their space and better working conditions that facilitate their practices and favor user care. Thus, such professionals need visibility and social recognition of their technical skills. (AU)

Objetivo: Discutir sobre el trabajo interdisciplinario en la práctica de los enfermeros en la Atención Primaria de Salud y sus condiciones de trabajo. Métodos: Investigación descriptiva, cualitativa, realizada con 45 enfermeros profesionales, que actúan en la Atención Primaria de Salud en el estado de Paraíba, de diciembre de 2020 a abril de 2021. La recolección de datos fue guiada por un guión semiestructurado. Los datos fueron interpretados con base en el Análisis de Contenido y discutidos a partir de la literatura existente. Resultados: Se evidenció que, aunque los enfermeros logran establecer una sociedad con los demás trabajadores de la unidad, usuarios y gerencia, y sienten autonomía para realizar los procedimientos, existen condiciones que dificultan sus prácticas, como poco reconocimiento profesional, problemas con la gestión, la falta de insumos y la sobrecarga de funciones. Conclusión: Los enfermeros en Atención Básica vienen buscando su espacio y mejores condiciones de trabajo que faciliten sus prácticas y favorezcan la atención al usuario. Por lo tanto, estos profesionales necesitan visibilidad y reconocimiento social de sus habilidades técnicas. (AU)

'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services.

BACKGROUND: Following stroke, a sense of well-being is critical for quality of life. However, people living with stroke, and health professionals, suggest that well-being is not sufficiently addressed within stroke services, contributing to persistent unmet needs. Knowing that systems and structures shape clinical practice, this study sought to understand how health professionals address well-being, and to examine how the practice context influences care practice. METHODS: Underpinned by Interpretive Description methodology, we interviewed 28 health professionals across multiple disciplines working in stroke services (acute and rehabilitation) throughout New Zealand. Data were analysed using applied tension analysis. RESULTS: Health professionals are managing multiple lines of work in stroke care: biomedical work of investigation, intervention and prevention; clinical work of assessment, monitoring and treatment; and moving people through service. While participants reported working to support well-being, this could be deprioritised amidst the time-oriented pressures of the other lines of work that were privileged within services, rendering it unsupported and invisible. CONCLUSION: Stroke care is shaped by biomedical and organisational imperatives that privilege physical recovery and patient throughput. Health professionals are not provided with the knowledge, skills, time or culture of care that enable them to privilege well-being within their work. This has implications for the well-being of people with stroke, and the well-being of health professionals. In making these discourses and culture visible, and tracing how these impact on clinical practice, we hope to provide insight into why well-being work remains other to the 'core' work of stroke, and what needs to be considered if stroke services are to better support people's well-being. PATIENT OR PUBLIC CONTRIBUTIONS: People with stroke, family members and people who provide support to people with stroke, and health professionals set priorities for this research. They advised on study conduct and have provided feedback on wider findings from the research.

Inquiry in uncertainty-nursing students' learning experience in challenge-based learning: A qualitative study.

BACKGROUND: Currently, nursing students face a significant lack of preparedness in efficiently addressing complex issues. The use of challenge-based learning, a student-centred situational learning method that utilizes practice scenarios to solve complex problems, can help alleviate the challenges in nurse education. However, there remains to be more extensive exploration on the application of challenge-based learning in nurse practice education. OBJECTIVES: This study aims to explore the learning experiences of nursing students in challenge-based learning to gain a deeper understanding of the ways and mechanisms through which challenge-based learning enhances specific learning abilities. DESIGN/METHODS: This study utilized a hermeneutic phenomenological design, employing semi-structured interviews and thematic analysis. SETTINGS: A university in Hunan, China, hosted the nursing skills competition based on the principles of challenge-based learning, targeting senior students from nursing schools in Hunan province. PARTICIPANTS: A total of 24 fourth-year students from six colleges, including one male and twenty-three female students. RESULTS: Two themes and seven sub-themes emerged from the study. Theme 1 Constructing a knowledge system in complex scenarios with sub-themes: Case-based education centred on comprehensive knowledge promotes knowledge linkage; Reverse reasoning promotes knowledge differentiation; Making mistakes helps finding the correct path of knowledge; Traps inspire identification of potential problems. Theme 2 Inquiry in uncertainty with sub-themes: Unexpected changes promote exploration of general principles; Combining knowledge with diverse case scenarios promotes flexible thinking; The uncertainty of knowledge fosters independent thinking. CONCLUSIONS: The complexity and variability inherent in challenging learning situations promote the construction of students' knowledge systems and the cultivation of an inquisitive spirit. The identification of these mechanisms contributes to the optimization of instructional environment design, the development of a culture of continuous learning and innovation, and effectively tackling complex issues within an ever-evolving global context.

Characteristics and Outcomes of Postgraduate Midwifery Fellowships: A Mixed Methods Study.

INTRODUCTION: Postgraduate fellowships are growing in midwifery and yet are poorly understood by the profession. These fellowships are optional for midwives interested in developing advanced skills, transitioning to specialty practice, or entering or re-entering professional practice. The purpose of this study was to explore the characteristics and outcomes of US postgraduate midwifery fellowships as described by midwifery fellowship program directors. METHODS: Postgraduate midwifery fellowship programs in the United States were identified through an environmental scan and snowball sampling. Directors of these fellowship programs were invited to complete a survey and an open-ended interview to determine their program's characteristics and outcomes. Quantitative data were summarized, and thematic analysis was used to explore the qualitative data. RESULTS: An environmental scan and snowball sampling identified 17 postgraduate midwifery fellowship programs. Thirteen fellowship program directors completed a survey (76.5%), and 11 completed an interview (64.7%). The findings identified program characteristics, including location, structure, funding, and educational offerings, of midwifery fellowship programs. The thematic analysis revealed the emergence of 3 themes highlighting the creation of support for midwives in transition, including new graduates and practicing midwives returning to practice after a hiatus or shifting to specialty practice: (1) stepping stones, (2) empowered and equipped, and (3) innovative future. Community birth practice was defined as specialty practice by these directors. DISCUSSION: The results of this study inform the profession of the availability of fellowships and the development of future high-quality midwifery fellowships. Postgraduate midwifery fellowships should not be required for entry to practice but have a place in the work-study opportunities available to US midwives.

["The Nidcap gave me the impression of having a fairer and more objective perception of the child"]. / « Le Nidcap m'a donné l'impression d'avoir une perception plus juste et plus objective de l'enfant ¼.

Certified Neonatal Individualized Developmental Care and Assessment Program (Nidcap) childcare worker, Fabienne Grillère first experimented with this practice in the neonatology department before doing so in maternal and child care. Indeed, the principle of Nidcap care can be applied in different professional sectors since they refer to the premature or sick newborn and its observation. Its use brings an undeniable advantage in the support offered to the child and his family.

Inspiratory muscle training for mechanically ventilated patients in the intensive care unit: Obstacles and facilitators for implementation. A mixed method quality improvement study.

BACKGROUND: Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs). OBJECTIVES: The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients. METHODS: This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed. FINDINGS: Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: "professional barriers", "external factors", and "patient barriers". CONCLUSIONS: Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.

Stakeholders' Perspective on the Key Features of Printed Educational Resources to Improve the Quality of Clinical Communication.

Social and healthcare professionals often feel ill equipped to effectively engage in difficult conversations with patients, and poor proficiency negatively affects the quality of patient care. Printed educational resources (PERs) that provide guidance on sustaining complex clinical communication may be a source of support if thoughtfully designed. This study aimed to describe the key features of PERs in order to improve the quality of clinical communication according to the perspective of meaningful stakeholders. This was a descriptive secondary analysis of data collected by three remote focus group discussions that involved 15 stakeholders in the context of developing an educational booklet to support professionals in complex communication scenarios. Focus groups were audio-recorded and transcribed verbatim, and an inductive thematic analysis was performed. Three key features of PERs that aim toward quality improvement in clinical communication were identified: (1) having the potential to provide benefits in clinical practice; (2) facilitating, encouraging, and enticing reading; and (3) meeting the need of professionals to improve or update their knowledge. These findings suggest that PERs relevant to professionals' clinical priorities and learning needs may make their efforts to apply learning in practice more likely and consequently result in improved healthcare quality.

Promoting the value of good work - an important role for occupational professionals in a post-pandemic world?

 In the wake of 3 years of societal disruptions related to COVID-19 many workers and organisations are reflecting on the value of work. Despite work generally being good for individuals, it is often framed negatively by individuals. Occupational professionals may have inadvertently contributed to this negative perception by focussing on reducing occupational risks. This editorial outlines 5 issues and invites researchers and practitioners involved in work design to reflect on the contribution they can make in a post-pandemic world.

Reviewing the Evidence on Sibling Sexual Behaviour: Impact on Research, Policy and Practice.

PURPOSE OF REVIEW: This paper reviews recent research into sibling sexual behaviour (SSB). This is an emerging professional and community issue that binds together a limited evidence base across research, practice and policy in psychology, criminology, politics, social work and policy studies. The review will demonstrate that a multi-disciplinary, life course, family system approach is the most effective way of starting to develop interventions to prevent and respond to this issue. RECENT FINDINGS: SSB has previously been researched as a form of intrafamilial abuse or sibling incest. As a result of this SSB is poorly and inconsistently defined as a concept, meaning that research, practice and policy are sometimes at odds with each other and need to pull together to develop a cohesive framing of the issue. This means that a lot of older research needs to be contextualised in new emerging frames of thinking and ways of working. Current research emphasises the importance of understanding the role of the family system in creating conditions where SSB can occur and its central role in preventing and stopping it from occurring. The research also stresses the importance of professionals understanding the family context of SSB and has the confidence to identify and work proactively with families in a multi-agency and cross-disciplinary way. The prevention of, and response to, SSB requires a multi-level, multi-disciplinary approach. Successful prevention of and response to SSB are as much about the family system as it is about the attitudes, behaviours and experiences of the siblings impacted by the abuse.