A self-perpetuating cycle of poor health literacy and poor oral health knowledge and behavior affects approximately 90 million people in the United States, most especially those from low-income groups and other at-risk populations such as those with addiction. Poor oral health can result from lack of access to regular preventive dental appointments, lack of access to restorative care when dental diseases are treatable, and low oral health knowledge that leads to poor oral health self-care behaviors. In addition, patients' dental anxiety can impede care, because highly anxious people often avoid dental appointments. To address these issues, this inquiry examined oral health knowledge, attitudes toward oral health, and levels of dental anxiety among women in two residential chemical dependency treatment programs. Participants engaged in oral health intervention sessions to determine possible efficacy of the educational intervention. Results indicate positive outcomes in increases in oral health knowledge and behavior. The frequency of high-to-severe dental anxiety is much higher in this sample than in the general population. Implications are discussed, including use of economically efficient small-group oral health education training.

Simulation, in its many forms, has been a part of nursing education and practice for many years. The use of games, computer-assisted instruction, standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins have appeared in the past 40 years, whereas anatomical models, partial task trainers, and role playing were used earlier. A historical examination of these many forms of simulation in nursing is presented, followed by a discussion of the roles of simulation in both nursing education and practice. A viewpoint concerning the future of simulation in nursing concludes this article.

La durée du séjour pour des soins pédiatriques hospitaliers est de plus en plus courte ce qui a pour conséquence que des soins sont prodigués en soins ambulatoires ou à la maison. Les infirmières en soins ambulatoires doivent réaliser des interventions éducatives en vue de préparer les familles à administrer certains soins à l’enfant. Le but de cette étude était d'explorer les éléments contraignants et facilitants les interventions éducatives d’infirmières oeuvrant en soins ambulatoires d’un centre hospitalier universitaire pédiatrique. Le Modèle de Partenariat Humaniste en Santé (MPHS) a été utilisé comme perspective disciplinaire, alors que le modèle d'une intervention éducative en matière de santé de Ndengeyingoma et al. (2017) a guidé cette étude par la mise en évidence des moments éducatifs charnières. Utilisant une approche qualitative et un devis descriptif exploratoire, cette étude a permis d’explorer la perception de sept infirmières (n=7), et ce, dans leur milieu naturel. Les méthodes de collecte de données qui ont été utilisées sont le questionnaire sociodémographique, l’entrevue semi-structurée, le journal de bord et la validation du sommaire des entrevues. Les résultats de cette recherche ont permis d’identifier quatre grandes catégories d’éléments contraignants et facilitants les interventions éducatives d’infirmières oeuvrant en soins ambulatoires d’un centre hospitalier universitaire pédiatrique, soit 1) le rôle de l’infirmière, 2) la famille, 3) la gestion des ressources humaines et matérielles, et 4) les stratégies éducatives. Cette étude apporte un nouvel éclairage quant aux connaissances déjà existantes sur la pratique clinique des infirmières en soins ambulatoires, particulièrement au niveau des interventions éducatives réalisées auprès des familles qui doivent apprendre à prodiguer des soins à la maison. Ces résultats offrent d’abord une meilleure compréhension de la pratique clinique d’infirmières en soins ambulatoires, en plus de faire avancer l’état des connaissances sur les soins ambulatoires. Ensuite, elle permet de mieux comprendre la réalité des familles, de proposer des stratégies afin d’améliorer les interventions éducatives réalisées auprès d’elles, de proposer des avenues de recherche prometteuses, de dégager des pistes de développement pour la formation infirmière dans une approche d’amélioration continue, de conscientiser les gestionnaires de soins ambulatoires pour une gestion efficiente des soins et services de santé offerts en soins ambulatoires. / The care previously provided in hospitals to the family, has been redirected to the home. Before returning home, the family must learn how to provide the care required by the child's illness. Ambulatory care nurses carry out educational interventions to prepare families for these new responsibilities. The aim of this study was to explore the constraining and facilitating elements of the educational interventions of nurses working in ambulatory care in a pediatric university hospital center. The Humanistic Partnership Model in Health Care (HPMHC) was used as a disciplinary perspective, while the model of a health education intervention by Ndengeyingoma et al. (2017) guided this study by highlighting key educational moments. Using a qualitative approach and an exploratory descriptive design, this study explored the perception of seven nurses (n = 7), in their natural environment. The data collection methods used were the socio-demographic questionnaire, the semi-structured interview, the logbook and the validation of the interview summary. The results of this research made it possible to identify, in four main themes, the constraining and facilitating elements of the educational interventions of nurses working in ambulatory care of a pediatric university hospital center, namely 1) the role of the nurse, 2) the family, 3) the management of human and material resources, and 4) educational strategies. This study sheds new light on the already existing knowledge on the clinical practice of ambulatory care nurses, particularly at the level of educational interventions carried out with families who must learn to provide care at home. These results first provide a better understanding of the clinical practice of ambulatory care nurses, in addition to advancing the state of knowledge on ambulatory care. Then, it makes it possible to better understand the reality of families, to recommend approaches to improve the educational strategies carried out with families, to propose other promising avenues of research, to identify interesting avenues for nursing training and, in a continuous improvement approach, to make ambulatory care managers aware of the efficient management of health care and services offered in ambulatory care.

Introduktion: Den sexuella hälsan kan förslagsvis främjas genom insatser som en god sexualundervisning. Skolan har ingen kursplan i sexualitet, samtycke och relationer vilket medför att skillnaden på sexualundervisningen i Sveriges skolor är stor vilket kan leda till riskfyllda sexualvanor, fler partners och låg kondomanvändning.  Syfte: Det primära syftet var att undersöka hur människor upplever den nuvarande sexualundervisningen i skolan. Det sekundära syftet var att ta fram ett konkret material som skolväsendet kan använda för att kunna bedriva en hälsofrämjande sexualundervisning för barn och unga.  Metod: En empirisk kvantitativ enkätstudie har tillämpats. En webbenkät lades ut på Facebook och resultatet sammanställdes i Google Forms. Sen användes enkätresultaten från denna studie tillsammans med resultat från tidigare studier som har granskats i samband med detta arbete för att skriva en kursplan.  Resultat: 51 stycken respondenter svarade på enkäten i åldrarna 20-41 år. Majoriteten av respondenterna upplevde att de inte var nöjda med den sexualundervisning de har fått. Många av respondenterna uppgav att samtliga ämnen inte har tagits upp i tillräckligt stor utsträckning och många upplevde att de inte hade tillräckligt med information i dessa ämnen. 1 av 3 tyckte att undervisningen saknade en övergripande kvalitet och flertalet lyfte att de saknade en behörig lärare.  Diskussion: En möjlighet är att den sexuella hälsan blir lidande av den bristfälliga undervisningen i form av att eleverna missar tillfällen att utveckla empowerment och säkerhet kring sin sexualitet och identitet. En kursplan i sexualitet, samtycke och relationer kan skapa en ökad trygghet hos lärarna vilket också ökar kvaliteten på undervisningen. Ett förslag är att universitetsstudenter som har kompetens inom detta område, exempelvis studenter på sjuksköterskeprogrammet, hälsovägledarprogrammet eller andra studenter inom andra relevanta utbildningar, undervisar studenter på grundskolenivå som en del av båda parters utbildning. / Introduction: Sexual health can be promoted through initiatives such as good sex education. The school has no curriculum in sexuality, consent and relationships, which means that the difference in sexuality education in Sweden's schools is large, which can lead to risky sexual habits, more partners and low condom use. Purpose: The primary purpose was to investigate how people experience the current sex education in school. The secondary aim was to produce concrete material that the school system can use to be able to conduct health-promoting sex education for children and young people. Method: An empirical quantitative survey study has been applied. A web survey was posted on Facebook and the results were compiled in Google Forms. The survey results from this study were then used together with results from previous studies that have been reviewed in connection with this work to write a course plan. Results: 51 respondents answered the survey aged 20-41. The majority of respondents felt that they were not satisfied with the sex education they have received. Many of the respondents stated that all topics have not been covered to a sufficient extent and many felt that they did not have enough information on these topics. 1 in 3 thought that the teaching lacked an overall quality and the majority pointed out that they lacked a qualified teacher. Discussion: One possibility is that sexual health suffers from the inadequate teaching in the form of students missing opportunities to develop empowerment and security around their sexuality and identity. A curriculum in sexuality, consent and relationships can create increased security among teachers, which also increases the quality of teaching. One suggestion is that university students who have competence in this area, for example students in the nursing program, the health guidance program or other students in other relevant educations, teach students at primary school level as part of both parties' education.

Problem-based learning (PBL) was developed for use in medical education to incorporate more active, learner-centered instruction. Central to problem-based learning is the problem, which in medical education is usually case a case presentation, revealed in stages to allow learners to form and research learning objectives. The purpose of this study was to identify themes present across the PBL cases, including the patient-centeredness of the cases. Content analysis was used to examine 62 PBL cases that comprised the first and second years' core curriculum at a public medical school. The cases included a patient population similar to the local population, but care was more hospital-centric than would be expected from the actual patterns of medical utilization in the United States. Analyzing along two axes of patient-centeredness, the PBL cases demonstrated a good understanding of the patient (knowing the patient), but other qualities such as shared decision making was not as exemplified. Medical educators can use the results to understand elements that contribute to patient-centeredness and apply the analysis framework to evaluate future cases.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background - Student nurses indicated that the clinical environment was not conducive to learning because they were part of the ward staff ratio and clinical supervision was inadequate. Upon observations by the researcher and feedback from student nurses’ a study was planned to identify the clinical experiences and supervision. The study itself was conducted within private health care settings in the Western Cape Province of South Africa. Objectives - The objective of this study was to determine the experiences of student nurses of the clinical learning environment. To also identify the support and clinical supervision that the student nurses received from ward staff, clinical facilitators and lecturers. Methods and analysis - The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 234 student nurses within the selected sites. A quantitative, descriptive cross-sectional survey was conducted by making use of the CLES+T evaluation scale. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the Learning environment, (2) the Supervisory relationship and (3) the Role of the nurse teacher (lecturer). Results - The clinical learning environment was experienced as mostly positive by the student nurses; however the format and type of clinical accompaniment and supervision students received varied. Conclusion - This study gave valuable insights into the status of the clinical learning environment, the clinical accompaniment and supervision of student nurses which can be useful to the nursing school in order to enhance existing nursing programmes.

Dans plusieurs milieux on s’attend à ce que les infirmières récemment diplômées fassent du préceptorat (Cubit et Ryan, 2011). Ainsi, les infirmières sont fréquemment affectées à ce rôle tôt après leur intégration sur le marché du travail et souvent sans préparation adéquate (Debra, 2014; Elmers, 2010). Le but de la présente étude était d’explorer l’expérience de devenir infirmières préceptrices auprès de Candidates à l’exercice de la profession infirmière [CEPI], dans un délai de 0 à 3 ans après avoir elles-mêmes été CEPI. La théorie de la transition d’Afaf Ibrahim Meleis (2010) a servi de cadre de référence en guidant la formulation du but de cette étude qualitative interprétative. La théorie de Meleis (2010) a également accompagné la discussion des résultats de notre recherche. Cinq infirmières nouvellement préceptrices âgées de 24 à 27 ans ont participé à des entretiens semi-structurés. L’analyse des données a été conduite selon les étapes d’analyse thématique proposée par Benner (1994) et Paillé et Muchielli (2006). D’abord, il résulte de notre étude que l’expérience de devenir préceptrice suscite chez les jeunes infirmières l’occasion d’un engagement réflexif sur leur propre expérience d’infirmière et de préceptrice. Puis, elles font l’expérience du sens des responsabilités pour «façonner» la CEPI. Finalement, une proximité avec l’expérience de la CEPI influence l’expérience de devenir préceptrice. Devenir préceptrice tôt dans la carrière d’infirmière semble être le moment opportun. Toutefois, il importe d’essayer d’uniformiser et de standardiser la préparation de l’infirmière soignante à devenir préceptrice. Également, jumeler une infirmière préceptrice plus aînée pour guider la nouvelle préceptrice dans cette expérience serait un atout. Finalement, l’approfondissement du besoin de soutien dans l’accompagnement de l’infirmière dans son expérience de devenir préceptrices est une des pistes pour la future recherche. / In today’s reality, nurses start to precept soon in their career (Cubit and Ryan, 2011), and often without any prior notice or preparation (Debra, 2014; Elmers, 2010). The purpose of the present study is to explore the experience of nurses becoming a preceptor for a Candidate to the Profession of Nursing Practice [CPNP], within 0 to 3 years of being CPNP themselves. Five young nurses who were newly preceptors participated in semi-structured interviews. Participants were between 24 et 27 years of age. Data was analysed using Benner`s (1994) and Paillé et Muchielli’s (2006) thematic analysis. The theoretical framework of Transition theory by Afaf Ibrahim Meleis (2010) directed the formulation of the purpose of this qualitative interpretive study. Meleis’s theory also accompanied the discussion of the results of the present study. The results of the present study suggest that the young nurses who are newly preceptors are living through the sense of responsibility of shaping the CPNP, they find themselves situated close to the CPNP experience and their experience of becoming a preceptor leads them to reflect on their personal experience as a nurse and a preceptor. Becoming a nurse preceptor early in their career seems to be an opportune moment. However, it would be recommended to standardise the preparation of the nurses for this new responsibility which could ease their experience of becoming a preceptor. Also pairing a more experienced nurse preceptor to guide the new nurse in the process of acquiring the new role of a preceptor would be an asset. Finally a further research could explore the need for support during the experience of becoming a preceptor.

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Si l’approche par compétences au Canada et aux États-Unis est particulièrement valorisée pour orienter la pratique des professionnels de la santé (PDS) – et en bioéthique clinique –, les travaux permettant de mieux comprendre les fondements psychologiques, ontologiques et philosophiques de ces compétences sont peu présents dans la littérature en bioéthique. Les principaux outils actuellement disponibles se divisent généralement en quatre principales catégories : 1) les documents officiels (codes de déontologie, règlements institutionnels, etc.); 2) les principales théories éthiques (éthique de la discussion, éthique de la vertu, principisme, etc.); 3) les ouvrages de référence scientifiques; 4) les outils de prise de décision éthique. Ces documents sont des incontournables pour les bioéthiciens et les PDS, mais leur disparité, voire leur contenu parfois contradictoire, jumelée à une compréhension limitée de l’éthique, est souvent source de confusion dans les processus décisionnels et peut être la cause de comportements ne répondant pas aux standards éthiques des pratiques professionnelles. Notre recherche constitue une réflexion qui s’inscrit en amont de ces outils dont le caractère pragmatique a le désavantage de simplifier la réflexion théorique au profit de données plus concrètes. Nos travaux visent à développer les bases d’un modèle flexible et inclusif – le modèle de la déontologie réflexive (MDR) – permettant de : 1) poser les principaux repères philosophiques, sociaux et déontologiques des problématiques éthiques rencontrées en pratique; 2) saisir les principales tensions éthiques inhérentes à cette complexité; 3) mieux comprendre, dans une perspective psychologique et développementale, les exigences personnelles et professionnelles qu’impose le statut de professionnel de la santé dans le contexte actuel des soins de santé. Entreprise théorique, ce projet consiste principalement à mettre en relation dynamique un ensemble de dimensions (légale, éthique, clinique, sociale, psychologique) à l’oeuvre dans la rencontre du bioéthicien et du PDS avec la complexité des situations éthiques, en s’inspirant du concept de sensibilité éthique de la « petite éthique » de Paul Ricoeur (1990), du modèle des quatre composantes de Rest (1994) et de la théorie du soi et des modes identitaires d’Augusto Blasi (1993). Ce processus implique trois étapes successives : 1) une mise en ii perspective de la posture épistémologique particulière du bioéthicien et du PDS à la lumière de la « petite éthique » de Ricoeur; 2) une revue de la littérature interdisciplinaire sur le concept de sensibilité éthique afin d’en proposer une définition et de le mettre en perspective avec d’autres compétences éthiques; 3) le développement d’un cadre de référence en matière d’identité éthique professionnelle (professional ethics identity tendencies, PEIT), inspiré de la théorie du soi et des modes identitaires de Blasi. Ces PEIT proposent un repère normatif aux exigences liées à la construction de l'identité en contexte de pratique des PDS et suggèrent des pistes de réflexion quant à la formation et à la recherche en éthique professionnelle. Cette recherche souhaite établir des fondements théoriques pour le développement ultérieur du modèle de la déontologie réflexive (MDR). / If the competency approach seems to be particularly valorised in Canada and in the United States for orienting the practice of health care professionals (HCP) – and in clinical bioethics – material that could provide with a better understanding of the psychological, ontological and philosophical foundations of these competencies seems rather limited in the bioethical literature. The tools that are generally available can be divided into four main categories: 1) official documents (e.g., code of ethics, institutional policies); 2) the main ethical theories (e.g., virtue ethics, theories of justice, principlism); 3) scientific references (e.g., journals, books); 4) decision-making tools. These documents are important for bioethicists and HCPs, but their disparities and even contradictions, coupled with poor knowledge in professional ethics, may be a significant source of confusion in the decision making process and even lead to behaviour that does not meet the ethical standards of HCP. This thesis is an upstream reflection regarding these tools, whose pragmatic character has the disadvantage of simplifying theoretical reflection at the benefit of more concrete evidence useful for practical decision making. This project aims at developing the foundations for a flexible and inclusive model – a model of deontological reflexivity (MDR) – that will: 1) present the main philosophical, psychological, sociological and deontological landmarks characterising ethical issues encountered in practice; 2) understand, from a psychological and developmental perspective, the personal and professional requirements inherent to the status of the health care professional in the current context of health care. A theoretical enterprise, this project primarily consists in relating, in a dynamic manner, a variety of dimensions (legal, ethical, clinical, psychological) at work in complex ethical situations encountered by HCPs and bioethicists, inspired by the concept of ethical sensitivity, the “petite éthique” of Paul Ricoeur (1990), the self theory along with Blasi's Identity modes (Blasi, 1993). The analysis process will consist in three successive phases: 1) a putting into perspective of the bioethicist's and HCPs’ epistemological posture in light of the “petite éthique” of Paul Ricoeur (1990); 2) an interdisciplinary literature review of “ethical sensitivity” in order to propose a definition of the concept and place it into perspective with other ethical competencies; 3) the development of a framework regarding professional ethics iv and identity (professional ethics identity tendencies, PEIT), inspired both by the self theory and Blasi's Identity modes. These PEITs provide a normative benchmark related to the construction of identity in the health care context and suggest some innovative avenues for professional ethics research and education. This research wish to elaborate the theoretical foundations that will be utilised further in the future to develop the model of deontological reflexivity (MDR).