➊ Point Fortin Extended Care Centre: A Case Study

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Point Fortin Extended Care Centre: A Case Study

Some studies show the potential of including patient advisors in clinical oncology teams to facilitate communication between patients and their health and social care team, and to improve the experience of What Were The Jews Dbq Analysis for patients with cancer as well as those Point Fortin Extended Care Centre: A Case Study high risk for developing this disease, particularly Personal Narrative: My Presentation terms of information sharing, Point Fortin Extended Care Centre: A Case Study support [ 6789 Point Fortin Extended Care Centre: A Case Study, 101112 ], and engagement in their care [ 13 ]. Bruce Point Fortin Extended Care Centre: A Case StudyJill Buyon 11Ann E. The secure online platform REDCAP Research Electronic Data Capturean application for building and managing online surveys and databases, will be used Point Fortin Extended Care Centre: A Case Study administer the questionnaires, Point Fortin Extended Care Centre: A Case Study the data Point Fortin Extended Care Centre: A Case Study and analyze the data [ 52 ]. Mayo Psychiatric Illness: Social Media Analysis Proc. The relationship between chronic respiratory disease and Point Fortin Extended Care Centre: A Case Study most Point Fortin Extended Care Centre: A Case Study diseases and mental health What Purpose Do Reflexes Have In Newborns is likely nick carraway analysis be bidirectional; patients with chronic respiratory conditions may develop depression and anxiety as a result of Point Fortin Extended Care Centre: A Case Study respiratory conditions, perhaps due to functional limitations, inability to work, etc. Taco Bell serves Point Fortin Extended Care Centre: A Case Study estimated amount of customers of over 35 million a week. Family Med.

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Some were able to give detailed descriptions of how they had used MI to achieve rehabilitation goals with certain individuals. These varied from enhancing commitment to inpatient rehabilitation, to exploring longer term physical activity options, and incorporated a range of MI skills. Many more described using specific MI techniques especially reflections and open questions in therapy interactions, indicating that perhaps some MI components were more helpful or accessible to novice practitioners.

On placement I only really used open questions and reflections, because that helped me guide a conversation…I was doing it more to actually get more information out, so I was just sort of like used the principles to help me in my situation Physio FG2. Nevertheless, a number of barriers were identified that restricted their ability to use MI in practice. Students felt that their MI training assumed that patients perceived the need for a health behaviour change at some level , had an interest in achieving that change although possibly resistant , and required help.

The reality on practice placements was different, and students questioned the idea that every conversation could be made to count. They observed patients typically falling into different categories, for example those able to change without help, those whose expectation that therapists would fix the problem hindered their engagement, those too ill to engage or lacking cognitive capacity, and those with life-changing illness who were unable to engage with a difficult and uncertain future. In these circumstances, they felt unable to use MI skills. When confronted with patients who were not typically ambivalent as presented in the training , students struggled to see the relevance of the approach.

My placement was in orthopaedics and […] sometimes patients are discharged on day two, and you barely even see them. The patient, in these circumstances, was framed within an institutional to-do list where engaging with their aspirations and needs was given little importance or space. Students had difficulty getting advice on the appropriate use of MI in specific circumstances, or were explicitly directed to take an expert role despite indications that a collaborative approach would have been appropriate as the following extended quote demonstrates. Physio FG1. Students perceived that educators wanted them to focus on rehabilitation, with general health issues such as weight management or smoking cessation seen as the remit of dietitians, nurses and other members of the multi-disciplinary team.

Taken together this theme demonstrates the potential that the short training has to impact on practice placements. Nevertheless, these narratives also highlight very practical challenges that faced students on placement which may impact on their capacity to incorporate approaches such as MI. This examination of neophyte OT and PT student experiences of pre-registration training in MI suggests that it has promise as a communication approach, which students perceive enhances their skills as a professional, and can be applied in some contexts of practice.

In addition, this study highlights a number of key points which can inform consideration of wider implementation in AHP training. First is the importance of practice within the training. This emphasis was both clear in this study and supported by other related papers [ 18 , 23 , 29 ]. For Schoo and colleagues [ 18 ], the relevance of this practice was enhanced through the addition of a reflective piece and that could be considered. Critical here was the utility of the practice scenarios. In an attempt to ameliorate these barriers real-play was utilised but this lacked specificity to the clinical environment. As a consequence, the simulations used through both role and real play did not reflect clinical conversations for therapists and therefore were difficult to transition to practice.

It was evident that efforts need to be made to create scenarios more relevant to the students, either personally or to their practice, to facilitate development and that transition. The need for skill specific examples has been noted previously [ 19 ]. Given the paucity of educational literature on MI with AHPs and its still limited use in practice, development of such resources is work to be done. A second point noted was the experiential nature of the training. In line with existing research [ 6 , 8 , 29 ] guided experiential practice and opportunities to directly apply skills were highly valued by participants. These experiences, facilitated by a skilled trainer through observation, standardised patient exercises and role play promoted understanding of the MI process and enhanced student engagement.

The importance of the skilled trainer for both demonstrating MI in practice but also facilitating the students to experience MI personally was evident. Literature from other forms of simulation also note the importance of such experience [ 19 ]. The implications of this for delivery of training are clear in relation to trainer expertise, but also maintaining a trainer student ratio that allows for that personal interaction. Third, the findings related to the transfer to practice are particularly important given the noted dearth in this area. The evidence that a number of the students tried to implement MI while on placement is positive.

Previous studies noted that students had not successfully negotiated this transfer, in part related to a lack of confidence in their ability [ 23 ]. This was not explicitly identified in this study and indeed opportunities to reflect on individual competence and confidence were notably absent. Interestingly Schoo and colleagues [ 18 ], found that the OT and PT students over-rated their skill level post training. While this was not assessed in this study, it may suggest that consideration of perceived confidence in specific skills is worth further exploration to enhance appropriate self-awareness.

Within this study and across other related research, there was a strong sense that on clinical placement students related to the spirit of MI and specific skills OARS which they had drawn from their training, rather than taken directly from the training scenarios. Something similar is noted even in simulated environments [ 18 ]. The students in this study linked this in part to the lack of specificity of scenarios discussed above but also the practicalities of transfer into the clinical environment. Barriers such as time, a focus on patient education as an expert, tensions when other professionals do not use it and the underpinning philosophy of the setting have been identified in previous research [ 19 , 29 ] and are supported in this study.

These suggest a need for further training in the wider clinical environment, potential adjustments to training to explicitly discuss these areas and ways to manage them in practice, but also increase dialogue between University-based education and that within the clinical environment. If enhanced communication skills such as MI are to be effectively incorporated into pre-registration training with an expectation of development while on placement, then this may need to be negotiated with clinical educators. Furthermore, consideration in future could also be given to explicit documentation within assessment criteria where and if appropriate. However, adjusting learning outcomes of placements to incorporate the use of MI assumes that the placement has capacity to deliver on this both in relation to client case-load and supervisor expertise, neither of which were fully supported by this study.

Finally, while the literature base is small, there is a general sense that students perceive that MI is a valuable tool that should be incorporated in pre-registration training as it has the potential to improve patient care [ 19 , 20 , 23 , 29 ]. This study adds to that call and gives explicit focus on how students feel that could be done more effectively. The students volunteered for this training and the potential influence of motivation is noted. While the training was undertaken by external personnel, the involvement of staff members may have influenced the students because of perceived institutional investment.

Nevertheless, the range of responses would challenge that concern. MI was seen as a useful addition to pre-registration therapy students. Key skills were adopted and in some cases effectively transferred into practice. The study highlights facilitators and barriers to effective learning and hidden curricula effects that hinder skills transferability to clinical placement. Suggestions to address these include consideration of skill level of facilitator, specificity of scenarios, closer links between educators and those in practice and understanding and negotiation of institutional demands.

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MN and JF prepared the manuscript. All authors contributed to drafts of the paper and approved the final draft. All participants gave informed written consent. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Norris, M. We will also benefit from the contextual knowledge and support of the clinical researcher members of our team. Finally, this study will collect an important quantity of data from various sites and sources which can lead to storage and data management challenges. Thanks to the qualitative data software QDA Miner and the quantitative data online platform and REDCap, we will be able to aptly manage, analyze, and integrate all data collected. In addition, to consider the COVID pandemic, we will follow the sites rules regarding research activities.

This study will evaluate the feasibility of integrating PAs into clinical oncology teams and highlight this integration procedure to identify the factors which enable or hinder their integration, to identify ethical and legal issues and means to address them, and to explore the effects of PA on patients, the PAs themselves, the care team, the administrators, and the organization of care. Should the results be promising, we will use them to plan and conduct a pragmatic randomized trial of the integration of PAs into clinical oncology care teams, to measure the impact of PAs integration on the teams on patients, and to better understand how this integration can improve the quality, safety and performance of our healthcare systems.

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J Bioeth Inq. Healthc Q. Download references. Finally, we thank Paula L. Bush, PhD, for her substantive and editorial comments and revisions to a previous version of this manuscript and Paloma Fernandez-Mc Auley for the translation. The six health and social care organizations involved in the project provided in-kind resources to realize the study. The funding body had no role in the design of the study; collection, analysis, and interpretation of data; and in writing the manuscript. Pomey, C. Vialaron, L. Normandin, M. Iliescu-Nelea, A. Pomey, A. Boivin, J. You can also search for this author in PubMed Google Scholar.

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Pomey, M. The patient advisor, an organizational resource as a lever for an enhanced oncology patient experience PAROLE-onco : a longitudinal multiple case study protocol. Download citation. Received : 09 October Accepted : 09 December Published : 04 January Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

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