Parental experiences of caring for their preschool children after declining vaccines: a qualitative systematic review protocol.

OBJECTIVE: This review will explore the experiences of parents after making the decision not to vaccinate their young children. This review aims to help health care providers understand parents' specific care strategies for their under-vaccinated or unvaccinated young children. INTRODUCTION: Much of the current qualitative research literature on parents who hesitate or refuse to vaccinate their young children focuses on parental perceptions about the safety and efficacy of vaccines and decision-making. However, limited attention has been paid to measures taken by parents to help their young children avoid contracting communicable diseases, promote resistance, and enhance their children's health. INCLUSION CRITERIA: This review will consider qualitative studies that describe parents' experiences of caring for their young children, aged 0 to six years, after making the decision not to vaccinate. Studies undertaken in any context will be considered. Studies that focus on young children who are unvaccinated or not fully vaccinated for reasons not related to parental refusal will be excluded. METHODS: The JBI methodology for systematic reviews of qualitative evidence will be followed. Databases will be searched from 1998 onwards, and will include Web of Science, MEDLINE, CINAHL, PsycINFO, Google Scholar, and ProQuest Dissertations and Theses, with no language limits. Following critical appraisal, findings that describe parental experiences and the care activities they perform related to their young children will be extracted. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021241781.

Interventions and programs that support the health and development of infants with prenatal substance exposure in foster care: a scoping review.

OBJECTIVE: The objective of this scoping review was to describe the characteristics of interventions and programs that support the health and development of infants in foster care who have prenatal substance exposure, their foster care providers, and birth families. INTRODUCTION: Infants in foster care may have experienced prenatal substance exposure, neglect, and maltreatment, as well as disruptions in their relationships with primary caregivers. Despite multiple vulnerabilities, they also have great capacity for overcoming early adversities. Enhanced foster care has been identified as a key influence on the positive development of infants in the child welfare system. INCLUSION CRITERIA: This scoping review considered publications that described interventions and programs designed to support foster care providers who care for infants less than 12 months of age with prenatal substance exposure. This review included research studies and gray literature. This scoping review focused on sources that described caregiving interventions and elements of programs that took place within the context of family or home-based foster care. METHODS: A three-step search strategy was used to identify publications in the English language from January 2000 to December 2019. A literature search was conducted using MEDLINE, Academic Search Premier, PsycINFO, and CINAHL databases. Titles and abstracts were initially screened to assess if publications met the inclusion criteria, followed by full-text review. Publications that met the inclusion criteria were assessed by two independent reviewers using a data extraction tool developed for this review. Findings were thematically analyzed on the basis of similarity in focus and descriptively presented with tables and figures to support the findings. RESULTS: Eighty-one publications were included, including 48 research papers and 33 gray literature sources. Thematic analysis of the focus of each publication resulted in identification of four core themes: i) mental health promotion for infants in care; ii) child welfare program elements; iii) identification of infants and families at risk of requiring foster care; and iv) outcomes for infants in care and their families. The interventions and programs identified during this scoping review were primarily focused on supporting social-emotional development. With the significant focus on infant mental health, supporting birth parents to stay attached to their infants was a key focus of the majority of publications. The concept of being able to proactively identify risk factors that were associated with infants requiring foster care emerged in relation to how family preservation could be supported. Strategies identified as contributing to the development of successful interventions and programs included having foster care providers participate as collaborators in designing services, designing services that are adaptable to a range of contexts, involving community partners outside child welfare, and having developmentally appropriate programs. CONCLUSIONS: Infants represent a significant proportion of children in foster care. A developmental perspective is needed for child welfare service planning to address their unique needs. Intervention during the early years holds significant potential for promoting positive developmental pathways and family preservation.

Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review.

OBJECTIVE: The objective was to review literature related to the dedicated education unit practice education model for undergraduate nursing students, and identify common characteristics and processes for implementing and sustaining this model. INTRODUCTION: Although practice education is central to undergraduate nursing education, evidence-informed practices for learning in the clinical setting remain elusive. Changes to health care over the past decades related to the role and scope of practice for nurses, gradual shifts to community- and population-based care delivery, and expectations for interprofessional practice require forward-looking education models. The dedicated education unit model was developed in 1997 as a potential solution to globally recognized challenges in nursing education amidst discourses of nursing resource scarcity. Despite more than two decades of innovation and expansion, there is still limited understanding of the effectiveness of the dedicated education unit as a solution to those challenges, or for the anticipated benefits for students and patients, through enhanced evidence-informed health care. This analysis of the characteristics and processes of the model is timely for evaluating and sustaining implementation of the dedicated education unit across nursing practice and education settings. INCLUSION CRITERIA: English-only publications related to the dedicated education unit practice education model for undergraduate nursing students in baccalaureate and associate degree programs using qualitative, quantitative, or mixed methods research, and quality improvement, program evaluation, and opinion publications were included. METHODS: Using selected keywords including "dedicated education unit," we searched CINAHL, Google Scholar, MEDLINE, Academic Premier Search, ERIC, Cochrane Database of Systematic Reviews, JBI EBP Database, and ProQuest Dissertations and Theses. Two independent reviewers screened titles and abstracts against inclusion criteria. We reviewed reference lists for gray literature and additional references. Data were extracted from the included articles and categorized for characteristics and processes. Eighty-two publications from January 1997 to May 2020 were included. The findings were presented descriptively with tables and figures to support the data. RESULTS: Dedicated education unit models were based on five characteristics and four processes. Characteristics of the dedicated education unit model included effective academic-practice partnership, adaptability to diverse contexts, unit culture of educational excellence, responsive and supportive unit leadership, and clarity of roles and responsibilities. Processes included building nurse and faculty capacity, facilitating student learning, communicating regularly at systems and unit levels, and evaluating and sustaining the model. CONCLUSIONS: Evidence demonstrated that the dedicated education unit practice education model is well-established. However, there were existing gaps in this evidence, specifically evaluation and economic analyses. There was also limited attention to long-term sustainability of the model. The common characteristics and processes identified in this review may be used to support planning, implementation, and evaluation, including development and validation of evaluation tools. Although administrative infrastructure was noted as central to the dedicated education unit strategy, it was rarely acknowledged as part of management and thus also requires further study.

Indigenous peoples' positive experiences of culturally safe health care: a qualitative systematic review protocol.

OBJECTIVE: The purpose of this systematic review is to explore what is known about Indigenous peoples' positive experiences with culturally safe health care. INTRODUCTION: Research indicates that Indigenous people often experience stigma and discrimination from non-Indigenous health care providers when accessing health care services. One approach that has been put forward to address Indigenous health inequities is cultural safety. Studies have been conducted to identify what comprises culturally safe care for Indigenous people, however, many of these studies target the health care provider's perspective, rather than the perspective of the Indigenous person who is receiving the care. INCLUSION CRITERIA: This review will consider studies that involve Indigenous peoples' positive experiences with culturally safe health care from any study setting. Studies that present relevant qualitative findings including descriptions, examples, or stories about how a health care provider enacted cultural safety from Indigenous perspectives will be considered. METHODS: MEDLINE, CINAHL, Embase, PsycINFO, First Nations Periodical Index, the Native Health Database, the Indigenous Studies Portal, and the Arctic and Antarctic Regions Database will be searched for published studies. The search for unpublished studies will include Google and Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Databases will be searched from 1988 onward and only studies published in English will be included. The JBI systematic review guidelines will be followed. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the review findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020173003.

Equity-oriented frameworks to inform responses to opioid overdoses: a scoping review.

OBJECTIVE: The purpose of this scoping review was to systematically identify and describe literature that uses a health equity-oriented approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids. INCLUSION CRITERIA: To be included, papers had to both: i) use a health equity-oriented approach, defined as a response that addresses health inequities and aims to reduce drug-related harms of stigma or overdose; and ii) include at least one of the following concepts: cultural safety, trauma- and violence-informed care, or harm reduction. We also looked for papers that included an Indigenous-informed perspective in addition to any of the three concepts. METHODS: An a priori protocol was published and the JBI methodology for conducting scoping reviews was employed. Published and unpublished literature from January 1, 2000, to July 31, 2019, was included. The databases searched included CINAHL (EBSCOhost), MEDLINE (Ovid), Academic Search Premier (EBSCOhost), PsycINFO (EBSCOhost), Sociological Abstracts and Social Services Abstracts (ProQuest), JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, PROSPERO, Aboriginal Health Abstract Database, First Nations Periodical Index, and the National Indigenous Studies Portal. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, and targeted web searches. Screening and data extraction were performed by two reviewers using templates developed by the authors. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. RESULTS: A total of a total of 1065 articles were identified and screened, with a total of 148 articles included. The majority were published in the previous five years (73%) and were from North America (78%). Most articles only focused on one of the three health equity-oriented approaches, most often harm reduction (n = 79), with only 16 articles including all three. There were 14 articles identified that also included an Indigenous-informed perspective. Almost one-half of the papers were qualitative (n = 65; 44%) and 26 papers included a framework. Of these, seven papers described a framework that included all three approaches, but none included an Indigenous-informed perspective. Recommendations for health equity-oriented approaches are: i) inclusion of people with lived and living experience; ii) multifaceted approaches to reduce stigma and discrimination; iii) recognize and address inequities; iv) drug policy reform and decriminalization; v) ensure harm-reduction principles are applied within comprehensive responses; and vi) proportionate universalism. Gaps in knowledge and areas for future research are discussed. CONCLUSIONS: We have identified few conceptual frameworks that are both health equity-oriented and incorporate multiple concepts that could enrich responses to the opioid poisoning emergency. More research is required to evaluate the impact of these integrated frameworks for action.

Hypersensitivity in patients receiving metal implants: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION: Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA: The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS: The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.

Characteristics of the collaborative learning unit practice education model for undergraduate nursing students: a scoping review protocol.

REVIEW QUESTION: What evidence on characteristics and processes of the collaborative learning unit practice education model for undergraduate nursing students is available?

Health equity-oriented approaches to inform responses to opioid overdoses: a scoping review protocol.

REVIEW QUESTION/OBJECTIVES: The purpose of this scoping review is to systematically identify and describe literature that uses a health equity-oriented (HEO) approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids.The question of the review is: What is currently known about the use of an HEO approach for preventing the harms of stigma or overdose when people use illicit or street drugs, or use prescription opioids for other than their intended purposes?Specifically, the review objectives are.

Reliability and validity of the Personal Wellness Profile (PWP) Questionnaire in African American college women.

BACKGROUND AND PURPOSE: The Personal Wellness Profile (PWP) is a 75-item questionnaire used to assess an individual's level of wellness in clinical and non-clinical settings. Currently, there are no published scientific data regarding the validity and reliability of the PWP. Therefore, this study was designed to assess convergence validity of the PWP using established instruments in which validity has been previously supported and to determine the reliability of the PWP using the test-retest method. METHODS: A correlational design was used with a non-probability convenience sample of 100 African American women, ages 18 to 40 years, enrolled in a university in southern Louisiana. Convergence validity of the PWP was assessed by using the Michigan Alcoholism Screening Test (MAST), Drug Abuse Screening Test (DAST), Geiselman Food Preference Questionnaire II (GFPQ II), Weekly Stress Inventory (WSI), Fagerstrom Test for Nicotine Dependence (FTND), and the 7-Day Physical Activity Recall Questionnaire (PAR) as criteria. RESULTS: The PWP had statistically significant correlations with two of the six subscales of the GFPQ II, and with the WSI, MAST, and FNTD. Findings also suggest that the PWP has moderate to moderately high internal consistency as a whole (r = .77), and that the subscale scores were also reliable over time (r = .52 to .90). CONCLUSIONS: The PWP will be valuable as a valid, standardized, highly portable tool that can be taken into the community and administered to African-Americans and other populations who do not readily have access to treatment, research and health care centers.

Interventions and programs that support the health and development of infants with prenatal alcohol and/or drug exposure in foster care: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to identify and describe caregiving interventions and program elements that support the health and development of infants with prenatal alcohol and/or drug exposure in foster care.

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence.

BACKGROUND: Although maternal-child care is a pillar of primary health care, there is a global shortage of maternal-child health care providers. Nurse educators experience difficulties providing undergraduate students with maternal-child learning experiences for a number of reasons. Simulation has the potential to complement learning in clinical and classroom settings. Although systematic reviews of simulation are available, no systematic reviews of qualitative evidence related to maternal-child simulation-based learning (SBL) for undergraduate nursing students and/or educators have been located. OBJECTIVES: The aim of this systematic review was to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate nursing students and nursing educators in educational settings to inform curriculum decision-making. The review questions are: INCLUSION CRITERIA TYPES OF PARTICIPANTS: Pre-registration or pre-licensure or undergraduate nursing or health professional students and educators. PHENOMENA OF INTEREST: Experiences of simulation in an educational setting with a focus relevant to maternal child nursing. TYPES OF STUDIES: Qualitative research and educational evaluation using qualitative methods. CONTEXT: North America, Europe, Australia and New Zealand. SEARCH STRATEGY: A three-step search strategy identified published studies in the English language from 2000 until April 2016. METHODOLOGICAL QUALITY: Identified studies that met the inclusion criteria were retrieved and critically appraised using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) by at least two independent reviewers. Overall the methodological quality of the included studies was low. DATA EXTRACTION: Qualitative findings were extracted by two independent reviewers using JBI-QARI data extraction tools. DATA SYNTHESIS: Findings were aggregated and categorized on the basis of similarity in meaning. Categories were subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings. RESULTS: Twenty-two articles from 19 studies were included in the review. A total of 112 findings were extracted from the included articles. Findings were grouped into 15 categories created on the basis of similarity of meaning. Meta-synthesis of these categories generated three synthesized findings.Synthesized finding 1 Students experienced simulated learning experiences (SLE) as preparation that enhanced their confidence in practice. When simulation was being used for evaluation purposes many students experienced anxiety about the SLE.Synthesized finding 2 Pedagogical practices thought to be appropriate and meaningful included: realistic, relevant and engaging scenarios, a safe non-threatening learning environment, supportive guidance throughout the process, and integration with curriculum.Synthesized finding 3 Barriers and enablers to incorporating SLEs into maternal child education were identified including adequate resources, technological support and faculty development. Students and educators recognized that some things, such as relationship building, could not be simulated. CONCLUSIONS: Students felt that simulation prepared them for practice through building their self-confidence related to frequently and infrequently seen maternal-child scenarios. Specific pedagogical elements support the meaningfulness of the simulation for student learning. The presence or absence of resources impacts the capacity of educators to integrate simulation activities throughout curricula.

Experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a qualitative systematic review.

BACKGROUND: Inter-professional initiatives are prevalent in the healthcare landscape, requiring professionals to collaborate effectively to provide quality patient care. Little attention has been given to intra-professional relationships, where professionals within one disciplinary domain (such as degree and diploma nursing students) collaborate to provide care. New care models are being introduced where baccalaureate and diploma students of a particular discipline (such as nursing, occupational therapy, dentistry or physiotherapy) work closely together in teams to deliver care. Questions thus arise as to how students and educators learn to work on intra-professional teams. OBJECTIVES: To identify and synthesize evidence regarding experiences of pre-licensure health professional students and their educators on intra-professional teams and to draw recommendations to enhance policy and/or curriculum development. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Pre-licensure students and educators, focusing on regulated health professions that have had more than one point of entry into practice. PHENOMENA OF INTEREST: Experiences of intra-professional team learning or teaching within various entry-to-practice categories of a particular health-related discipline. TYPES OF STUDIES: Eight qualitative studies were included in the review. Seven studies were descriptive in nature; one study was a critical analysis. SEARCH STRATEGY: A comprehensive search of various databases was conducted between June 2, 2015 and August 16, 2015, and repeated in March 2016. The search considered all studies reported and published from January 1, 2001 to March 7, 2016. Only studies published in English were included in this review. METHODOLOGICAL QUALITY: Included papers were of low-to-moderate quality; however, it is important to consider that post-positivist assumptions underpinned much of the primary research, which could explain why researcher positionality and/or influence on the research would not be addressed. DATA EXTRACTION: Data were extracted using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The data extracted included descriptive details about the phenomenon of interest, populations and study methods. DATA SYNTHESIS: Research findings were pooled using the JBI-QARI. Sixty-eight findings were organized into nine categories based on similarity in meaning. RESULTS: Four synthesized findings reveal how students value intra-professional learning experiences. These experiences build positive collaborative relationships (including trust and respect); however, educator and staff attitudes and conversations create hierarchies in academic and clinical contexts resulting in tension between student groups. CONCLUSION: Despite its challenges, shared learning experiences assist students to understand each other's roles, develop communication and collaborative competencies, develop comprehensive care plans, provide more efficient care and help prepare them for their future roles as healthcare professionals. Various contextual elements could either hinder or facilitate shared learning experiences.

Changes in blood pressure among users of lay health worker or volunteer operated community-based blood pressure programs over time: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify studies reporting on lay health worker- or volunteer-led community-based programs for blood pressure screening and cardiovascular awareness in order to determine if these programs contribute to changes in blood pressure among participants over time.The specific question for this review is: What are the changes in blood pressure among adult users of community-based blood pressure screening and awareness programs operated by lay health workers or volunteers as measured by the differences in systolic and diastolic blood pressure between the user's first visit to the program and their last visit to the program? BACKGROUND: Cardiovascular diseases, such as stroke and heart disease, are quickly becoming global diseases manifesting in countries and communities where they traditionally had not been widespread. The World Health Organization (WHO) has reported that "in the Asia/Pacific region, [cardiovascular disease] has become increasingly prevalent in recent decades, and now accounts for about one third of all deaths". One risk factor that can lead to cardiovascular disease is hypertension. Based on WHO data from 2008, hypertension is now a global problem affecting 27% of the population 25 years of age or older.The risk for cardiovascular disease also appears to be higher among people in urban areas. A recent United Nations population report indicates that in the next 40 years we could see an increase in the world's population by 2.3 billion people. The majority of these people will be residing in urban areas, particularly in developing nations. Between 2011 and 2050, "the population living in urban areas is projected to gain 2.6 billion, passing from 3.6 billion in 2011 to 6.3 billion in 2050". Population growth in urban areas is therefore not only projected to include the expected population growth but also expected to include a shift of rural population to urban centers and "most of the population growth expected in urban areas will be concentrated in the cities and towns of the less developed regions". This growth of urban areas has the potential to put enormous pressures on health care systems that are already struggling to cope with the rapid increase in diseases thought to be more prevalent in Western societies, such as cardiovascular diseases.Hypertension may be difficult to treat due to a number of factors. Globally, access to antihypertensive medications, hypertension screening, and access to medical care vary from one country to another. Lifestyle factors, such as salt and alcohol consumption, stress, smoking, body weight, and exercise, are risk factors for hypertension that may be influenced by culture, which can in turn support or hinder lifestyle decisions that could significantly affect blood pressure. Hypertension, however, is easy to detect. A trained person with access to a low-cost sphygmomanometer can detect abnormal blood pressures quickly; however, access to trained personnel is not universally guaranteed. Globally - according to one model of skilled health care worker density and total requirement offered for discussion by the Global Health Workforce Alliance and WHO - there could currently be an estimated shortage of over seven million skilled health care workers (midwifes, nurses and physicians), as measured against a theoretical density of skilled health care workers to population. The shortage of skilled health care workers in this model could grow to over 12 million by 2035 if the assumptions of the model and population growth estimates are valid. Through rapid urbanization the potential for inequities in access to healthcare is also increased.Over the last few years, a number of community-based blood pressure screening and education initiatives have been established. These initiatives have been created either as part of research, as part of community outreach programs by publicly funded agencies, or as part of an outreach by not-for-profit organizations with a particular interest in reducing cardiovascular disease in specific hard-to-reach populations. Several systematic reviews have been conducted to assess different models for delivering services to people living with high blood pressure to assess community-based programs with a focus on cardiovascular disease, and to assess effectiveness of community health workers (CHW) in a variety of settings. These systematic reviews point to the importance of distinguishing between different categories of health care providers, their training and their roles in program delivery when assessing studies for possible inclusion in a systematic review.In a systematic review of studies from the US by Brownstein et al. focusing on the effectiveness of community health workers (CHWs) in the care of people with hypertension, this category of health care providers went under many different names. Community health workers in this review were defined as "any health workers who carried out functions related to health care deliver, were trained as part of an intervention, had no formal paraprofessional or professional designation, and had a relationship with the community being served". One of the findings from this review was the wide variety of formal training of the CHWs. In other parts of the world, a CHW might be defined differently. In their review of CHW-based programs focusing on children's health, Bhattacharyya, Winch, LeBan and Tien found that "in general CHWs are not paid salaries because the MOH (Ministry of Health) or donors do not consider salaries to be sustainable. Yet CHWs are often held accountable and supervised as if they were employees. Community health worker programs must recognize that CHWs are volunteers (emphasis in original), even if they receive small monetary or nonmonetary incentives. They are volunteering their time to serve the community". One Canadian model for delivering a cardiovascular awareness program designed to reach older adults through their primary care provider is based on volunteers with basic training to perform blood pressure measurements and cardiovascular health information.In a global review of a wide range of public health and health promotion initiatives operated by lay health workers from 2005, Lewin et al. identified over 40 different names or terms for a lay health worker. However, the definition of a lay health worker used by Lewin et al. is very similar to the definition of CHWs offered by Brownstein et al. Lewin et al.'s systematic review was the only study with a global focus that was located that reviewed studies of programs with a cardiovascular component using lay health workers. In this study, the sample size of studies focusing on lay health workers and cardiovascular disease was small (N=3) and the results from two of the studies were inconclusive to the point where the authors felt they could not pool the results.While a lay health worker may or may not receive some compensation for their work, volunteers in higher income areas of the world such as in North America typically do not receive any compensation. Volunteers, as observed by Bhattacharyya et al., are common in many parts of the world, and in some areas they provide delivery of programs and services that reach hundreds of thousands of individuals. One challenge for this systematic review will therefore be to isolate those programs that are delivered by lay health workers or volunteers who receive little or no compensation and programs where staff is paid. The importance of this distinction is on one hand related to cost - as observed by Bhattacharyya et al., many organizations responsible for delivery of community-based programs do not have funding for salaried staff. On the other hand there might be other factors in the relationship between a community being served by a program and the staff delivering the program. One such factor could be linked to the role of the person delivering the program as either a paid health care professional or an unpaid lay health worker or volunteer.Through this proposed JBI systematic review, the reviewers will focus on community-based blood pressure screening and health information programs delivered by either lay health workers or volunteers. Previous systematic reviews have indicated that programs focusing on blood pressure reduction delivered in a variety of settings and delivered by a variety of health care professionals might lower blood pressure among program participants over time. This systematic review will be limited to community-based programs rather than hospital or research facility-based programs, and to programs delivered by lay health workers or volunteers rather than programs delivered by paid community health workers, nurses or teams of health care providers under direction of a primary care provider. Compared to other recent systematic reviews which focused on studies with comparison groups and included few studies where lay health workers were involved, this systematic review will attempt to fill this gap in knowledge about programs delivered by lay health workers or volunteers by focusing on non-randomized controlled studies which report blood pressure changes over time in programs targeting the general population. Community-based programs might have a variety of designs with a number of different interventions, and where possible these designs and interventions will be identified and subgroup analysis conducted as appropriate. It is hoped that this systematic review can extend the work by Lewin et al. by identifying additional studies globally, focusing on programs delivered by lay health workers or volunteers but limited to studies reporting changes in blood pressure over time. Where possible, a meta-analysis of the changes in blood pressure over time among participants in these programs will be conducted. (ABSTRACT TRUNCATED)

Student and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol.

REVIEW QUESTION/OBJECTIVE: The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making.1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators? BACKGROUND: Maternal-child care is one of the pillars of primary health care. Health promotion and illness/ injury prevention begin in the preconception period and continue through pregnancy, birth, the postpartum period and the childrearing years. Thus, lifelong wellness is promoted across the continuum of perinatal and pediatric care which influences family health and early child development. Registered nurses (RNs) are expected to have the knowledge and skills needed to provide evidence-based nursing with childbearing and child-rearing families to promote health and address health inequities in many settings, including inner city, rural, northern, indigenous and global communities. The Canadian Maternity Experiences survey and the Report by the Advisor on Healthy Children and Youth provide information on current shortages of perinatal and child health care providers and stress the importance of the role of nurses as providers of rural and remote care. From a global health perspective, continued concern with both perinatal and child health morbidities and mortalities highlight the importance of maintaining and strengthening the presence of maternal and child health learning opportunities within undergraduate nursing curriculum.Despite this importance, educators in many countries have acknowledged difficulties providing nursing students with maternal-child hospital learning experiencesdue to declining birth rates, women's changing expectations about childbirth (i.e. birth as an intimate experience), increased outpatient and community management of early childhood health conditions, and increased competition for clinical placements. Canadian nurse educators and practice leaders have also identified gaps in recent RN graduates' readiness to provide safe, competent and evidence-based care for childbearing and child-rearing families. Newly graduated RNs working in acute care hospitals and in rural/remote community practice settings report feeling unprepared for providing maternity, neonatal and early childhood care.Recent concerns about the clinical reasoning skills of new graduates and the link to poor patient outcomes (e.g. not recognizing deteriorating patients) have led to calls to reform nursing education. In the Carnegie report, Benner, Sutphen, Leonard and Day identified four essential themes needed in the thinking and approach to nursing education, including: (1) a shift in focus from covering decontextualized knowledge to "teaching for a sense of salience, situated cognition, and identifying action in particular clinical situations"; (2) better integration of classroom and clinical teaching; (3) more emphasis on clinical reasoning; and, (4) an emphasis on identity formation rather than socialization. Brown and Hartrick Doane propose that nurses need to draw on a range of knowledge that enhances the nurse's "sensitivity and ability to be responsive in particular moments of practice". Theoretical or decontextualized knowledge becomes a "pragmatic tool" used to improve nursing practice. Simulation has been identified as a promising pragmatic educational tool for practice learning that can be integrated with theoretical knowledge from nursing and other disciplines.Bland, Topping and Wood conducted a concept analysis and defined simulation in nursing education as:They also proposed that "simulated learning is a dynamic concept that deserves empirical evaluation not merely to determine its effects but to uncover its full potential as a learning strategy".Simulation usually involves student(s) providing nursing care to a simulated patient who might be a manikin or actor based on a standardized scenario. Following the experiential learning opportunity the scenario is debriefed and the clinical situation analyzed with opportunities for reflection on performance. In nursing education, simulation is usually used in a way that complements learning in practice settings. However simulation has also been used: to make up some clinical practice hours, to provide opportunities to practice and assess particular clinical skills, and for remedial learning when students encounter difficulties in practice settings. In addition simulation provides the opportunity to focus on quality and safety competencies (QSEN) that have been identified for nurses. New forms of simulation are being developed with multiple patients so that nursing students can learn to prioritize care needs and delegate care to other team members.Nurse educators have identified several advantages for learners using simulation, including: providing a safe environment to improve nursing competence, allowing learners to become more comfortable with receiving feedback about their clinical performance, providing consistent and comparable experiences for all students, and learning a mix of technical and non-technical skills including communication, teamwork and delegation. Within the Canadian context, students and instructors have reported positive learning experiences with simulation, particularly in understanding complex patient care scenarios, multidisciplinary team scenarios, team-based learning, and reflective debriefing. Furthermore, simulation technology has been proposed as a strategy for developing clinical reasoning skills, enhancing nurses' abilities to build upon previous knowledge and past experiences, and manage new or unfamiliar situations.Simulation has previously been integrated into nursing curricula in a "piecemeal" fashion that lacks an integrative pedagogy or theoretical approach. More recently a number of theoretical and pedagogical frameworks and best practice standards have been published. In April 2014 a preliminary search of literature (in CINAHL, Medline, Academic Search Complete and Web of Science) was conducted with guidance from our library specialist to test the search strategy and ensure that there would be enough qualitative findings to include in the systematic review. A preliminary scan of the abstracts from these searches demonstrated that many experiential case reports with qualitative findings were missed with the use of research limiters (including our search strategy specifically constructed to retrieve qualitative research) so the decision was made to err on the side of caution by searching more broadly and review a larger number of abstracts for inclusion in the study. However, a number of reports with qualitative findings were identified. For example, from a review of the abstracts from a CINAHL search dated April 17, qualitative research papers (including two dissertations), 12 evaluation study reports, six mixed methods studies and nine case reports with qualitative findings were identified. It is timely then to review qualitative studies to better understand the meaningfulness and appropriateness of integrating maternal-child simulation-based learning activities in undergraduate nursing education programs.A search of both the Cochrane Library of Systematic Reviews and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports has been conducted. No systematic reviews of qualitative studies of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings are evident in the literature. Although a systematic review of the meaningfulness and appropriateness of using human patient simulation manikins as a teaching and learning strategy in undergraduate nursing education had been planned and a protocol registered in October 2009, we learned from contacting the lead author that this systematic review was not completed. Currently little is known about how nursing students and/or educators have experienced maternal-child simulation or their understandings of the appropriateness and meaningfulness of particular simulation-based learning practices. Our proposed systematic review therefore fulfills all requirements for the PROSPERO database. DEFINITIONS: For this review we will use the definition of "simulation-based learning experience" adopted by the International Nursing Association for Clinical Simulation and Learning (INACSL):We will include any use of simulation in an educational setting (with pre-registration or pre-licensure or undergraduate nursing or health professional students) with a focus relevant for maternal-child nursing.Maternal-child nursing has been variously defined in literature to include maternity care and pediatric nursing. For the purposes of this review, we will include perinatal, neonatal and pediatric contexts of care that focus on families with children under the age of five. We will exclude studies that focus on school age children, adolescents and/or youth.We have adapted an earlier definition of "appropriateness" as the "best conditions under which simulation can be integrated into undergraduate nursing education". In this review "meaningfulness" refers to the experiences and reflections of undergraduate nursing or health professional students and educators as presented in the studies reviewed.