As third-year medical students transition from the classroom to the high-stakes, high-stress environment of the emergency department (ED), they confront a unique set of challenges that result in significant personal trauma. The literature offers limited insight into the trauma experienced specifically during the shift to emergency medicine (EM) as medical students’ first clinical rotation. The purpose of this study was to bridge this gap by examining the interplay between students’ perceived psychological safety of their ED teams and their own self-efficacy on the trauma they experienced as learners when working in this unique learning environment. This mixed-methods study included interviews with 17 third-year medical students who immediately completed the EM clerkship at an urban, academic ED. The study addressed four main questions: 1) What types of trauma do students experience in the EM clerkship as they transition from the classroom into the clinical learning environment for the first time in their training? What are the factors of the learning environment that trigger trauma? 2) In what ways, if any, do students’ intersectional demographics affect their experiences of trauma during the EM clerkship? 3) To what extent does general self-efficacy predict medical students’ perceptions of the psychological safety afforded by their clinical team during the EM clerkship? 4) How are students’ experiences of trauma associated, if at all, with perceived psychological safety? What factors in the clinical learning environment contribute to psychological safety or its lack? This study utilized several data collection methods: (a) a pre-interview questionnaire soliciting information on student demographics and responses to items on the General Self-Efficacy Scale, (b) in-depth interviews using the critical incident technique, and (c) responses to items from the Team Psychological Safety Questionnaire. Several key findings emerged. A substantial amount of trauma that students experienced was rooted in a lack of peer support and student empowerment. Various triggers for trauma were identified that transcended different types of trauma. Demographic factors, such as race/ethnicity and gender, influenced the prevalence and nature of these traumatic experiences, with students from underrepresented backgrounds reporting deeper emotional connections with patients. While student self-efficacy was generally high, it did not correlate with the perceived psychological safety provided by their clinical teams. Furthermore, the perception of psychological safety within ED teams correlated with the nature of trauma experienced; those with lower safety scores reported trauma connected to peer support or issues related to cultural, historical, and gender considerations. Lastly, the opportunity for students to safely take risks or learn from mistakes, coupled with their own medical knowledge limitations, emerged as central to their perception of psychological safety within the team dynamic. Deeper insights into the data were revealed through a cross-interview analysis, and several analytical categories were used to further synthesize and interpret the data. Six conclusions were drawn from the study’s findings and analysis: 1) Medical students experience different types of primary trauma when immersed in the ED. 2) Several forces that are intrinsic to the ED workplace influence the trauma students experience. 3) Clerkship leadership must be aware of the unique experiences underrepresented students have in the EM clerkship. 4) The psychological safety provided to students by their teams impacts their experiences of trauma in the ED. 5) Self-efficacy offers a lens to understand students’ experiences of trauma in the ED, but it is insufficient. 6) Clerkship-specific interventions exist to amplify the team psychological safety afforded to medical students.

Indiana University-Purdue University Indianapolis (IUPUI) / Intimate partner violence (IPV) has been declared a public health epidemic. Initial and annual training of healthcare providers regarding guidelines for identification and response to intimate partner violence has been mandated by the Joint Commission and endorsed by the Institute of Medicine. However, many providers/institutions lack the preparation necessary to implement such guidelines. The purpose of the feasibility study was to test the efficacy of an existing IPV training curriculum on participants’ perception of knowledge, cultural competence, confidence (self-efficacy), and attitudes related to identifying and responding to victims of IPV. A sample of convenience including twenty-three registered nurse home-visitors and one social work intern participated in the mandatory one-day training program. However, consent to enroll in the study was voluntary and indicated by completing the study instruments. Participants were asked to complete three evaluative measures: The 11-item Plunkett Demographic Questionnaire (pre-training), a 15-item Training Program Evaluation (post-training), and the 21-item Instructional Measurement Subscales across three time points (pre-Training, post-Training, and six weeks follow-up). All items were numerically coded so the higher the score, the more favorable the response. Data were analyzed using descriptive and inferential statistics (percentages; minimum-maximum, mean, and composite scores; standard deviations; repeated measures analysis of variance; and, paired samples dependent t tests). Four hypothesis statements were made regarding participation in the training program on IPV: “There will be an overall increase in healthcare providers’ perceived level of knowledge and cultural competence,” (hypothesis 1); “There will be an overall increase in healthcare providers’ perceived level of confidence in implementing routine enquiry,” (hypothesis 2); “There will be an overall positive change in healthcare providers’ attitudes towards routine enquiry,” (hypothesis 3); and, “There will be an overall positive change in healthcare providers’ attitudes towards victims of abuse following participation in Improving the Health Care Response to Domestic Violence,” (hypothesis 4). Findings supported previous research outcomes that presently recognized barriers to routine screening/ assessment for IPV can be overcome and positive changes can persist over time as a result of participation in a standard IPV training program. Future research involving larger, random sample populations, are needed to confirm these results.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-12-15T11:37:54Z No. of bitstreams: 1 Patricia Lima Dubeux Abensur.pdf: 1737151 bytes, checksum: 481d233fd44d8b9dc3c3c0250df0260d (MD5) / Made available in DSpace on 2017-12-15T11:37:54Z (GMT). No. of bitstreams: 1 Patricia Lima Dubeux Abensur.pdf: 1737151 bytes, checksum: 481d233fd44d8b9dc3c3c0250df0260d (MD5) Previous issue date: 2017-12-08 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This work is part of a national research, under the responsibility of Paulo Freire Chair of PUC-SP, supervised by professor Dra. Ana Maria Saul, which seeks to contribute to a review and reinvention of Paulo Freire’s thought on educational policies and practices. It aimed to investigate the possibilities and limits of constructing and experiencing a didactic-pedagogical practice for health professionals, based on Paulo Freire’s Pedagogy The theoretical reference considered Paulo Freire’s teaching-learning category as the main point of the research that together with the concepts of participation, dialogue, thematic investigation, knowledge and “ser mais” made Paulo Freire’s conceptual framework of research, which guided the construction of the didactic-pedagogical proposal and, in addition, the production, analysis and data presentation. The qualitative approach was adopted in the area of thematic investigation (FREIRE, [1970] 2003). The research proposal was achieved by the course “Formação didático-pedagógica em Saúde”, that has been developed in ten classes, with thirty-one graduate students of strito sensu courses in the health area of the Federal University of São Paulo at São Paulo city. In order to generate data, some methodological resources were used such as open and closed survey, classroom audio, written activities that were developed during the course and field diary. The first step of data generation was done during the development of the discipline in the second semester of 2016. A second moment of assessment of the didactic-pedagogical practice took place six months after the end of the course (May/2017), through the application of an open questionnaire to verify if and how this teaching experience has changed the practices of health professionals in terms of care or teaching. The reading and interpretation of the data showed us the importance of considering, as a start point of didactic-pedagogical work, the reality of the students; the need to create practical proposals for sharing, discussion and reflection on aspects of the professional environment of the learners, the appreciation of the collective dimension in the construction of individual knowledge and the need to look at practice as an object of knowledge and reflection with the aim of transforming it. This work can contribute for what has been researched in the didactic-pedagogical training area of health professionals, because it has built and developed a didactic-pedagogical practice that provoked the reflection and analysis of teaching and assistance, promoting changes, from a theoretical-methodological option that opposes the traditional way of thinking, showing its limits and possibilities / Este estudo integrou uma pesquisa nacional, sob a responsabilidade da Cátedra Paulo Freire da PUC-SP, coordenada pela professora Dra. Ana Maria Saul, que busca contribuir para a releitura e reinvenção do pensamento de Paulo Freire nas políticas e práticas educativas. Teve como objetivo investigar as possibilidades e os limites de se construir e vivenciar uma prática didático-pedagógica para profissionais da área da saúde, subsidiada pelos pressupostos da Pedagogia Freireana. O referencial teórico assumiu a categoria ensino-aprendizagem freireana como central para a pesquisa, que, junto com os conceitos de participação, diálogo, investigação temática, conhecimento e “ser mais” compuseram a trama conceitual freireana da pesquisa, que orientou a construção da proposta didático-pedagógica e, além dela, a produção, a análise e a apresentação dos dados. Adotou-se a abordagem qualitativa na vertente da investigação temática (FREIRE, [1970] 2003). A proposta de pesquisa concretizou-se na disciplina “Formação Didático-pedagógica em Saúde”, desenvolvida em dez aulas, com trinta e um estudantes de pós-graduação de cursos strito sensu da área da saúde do campus São Paulo da Universidade Federal de São Paulo. Na produção dos dados foram utilizados questionário aberto e fechado, áudio de aula, atividades escritas desenvolvidas no decorrer da disciplina e diário de campo. A primeira fase da produção dos dados foi realizada durante o desenvolvimento da disciplina, no 2º semestre de 2016. Um segundo momento - de avaliação da prática didático-pedagógica desenvolvida - ocorreu seis meses após o término da disciplina (maio/2017), por meio da aplicação de um questionário aberto para verificar se e como essa experiência docente provocou mudanças nas práticas dos profissionais da saúde, seja na assistência ou na docência. A leitura e interpretação dos dados mostraram-nos a importância de se assumir como ponto de partida do trabalho didático- pedagógico a realidade dos educandos; a necessidade de se criarem condições concretas para que ocorra a partilha, a discussão e a reflexão sobre aspectos do contexto profissional dos educandos, o reconhecimento da dimensão coletiva na construção do conhecimento individual e a necessidade de se olhar para a prática como objeto de conhecimento e reflexão, com o intuito de transformá-la. Este estudo pode oferecer contribuições ao que vem sendo pesquisado na área da formação didático-pedagógica dos profissionais da saúde, porque construiu e desenvolveu uma prática didático-pedagógica que provocou a reflexão e análise do fazer docente e assistencial, com vistas a promover mudanças, a partir de uma opção teórico-metodológica contra-hegemônica, mostrando seus limites e possibilidades

The study was to investigate the effectiveness of Sociocultural Competency Training (SCCT) as an intervention in enhancing self-efficacy among trainees in the health care profession. The purposes of the study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning ofthe sociocultural competencies, and (c) to identify the factors that contribute to effective outcomes. A sample of 84 participants in the Health Sciences program at the Vancouver Community College was recruited. There were 26 local born Canadians and 32 immigrants in the experimental group, whereas 11 local born Canadians and 15 immigrants were in the control group. Experimental group participants took part in an 18- hour training over a 6-week period as part of their regular Human Relations Skills course curriculum. The control group also took the same training course after post-test data collection. This study used both quantitative and qualitative methods. Self-efficacy and behavioural performance were assessed quantitatively by the results from the General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedback from 28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group. The results of this study supported the hypotheses that the Sociocultural Competency Training was effective in improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The hypothesis that there would be more significant change in participants' social self-efficacy was also supported. The Sociocultural Competency Training offered effective ways of helping people develop positive self-efficacy and behavioural competencies. Participants reported the training enabled them to have the sociocultural competencies to conduct their professional career in a multicultural community. In the future, the training can be used with high school students, college and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success.

[Truncated abstract] Objective: To investigate the demographics, success rate of application, nature and frequency of complication and the survival outcome of patients receiving advanced airway management in the pre-hospital setting. Design: Prospective observational cohort study. Participants: Patients who were attended to by St. John Ambulance Paramedics in the Perth Metropolitan area and selected regional areas within Western Australia. The patients were unconscious, unresponsive with no gag reflex and where application of an advanced airway would improve ventilation. Methods: Ambulance Paramedics received mannequin training within the classroom environment on the techniques for the application of the Endo-Tracheal Tube and the Laryngeal Mask Airway. The indication for the application of an advanced airway was any patient whose ventilation may be improved by intubation. These patients would be either deeply unconscious and areflexic, long term transport, severely injured (especially head injured) or cardiac arrest patients. Results: ... Paramedic assessment demonstrated that 14 (7.4%) 3 patients had an improvement in outcome. Of the 14 patients, 5 (2.7%) cardiac arrest patients survived to discharge from hospital compared to a 2.1 % survival rate for all cardiac arrest cases attended by the WAAS in 2002. Conclusion: Ambulance Paramedics can successfully apply an advanced airway apparatus in the pre-hospital environment. There was no statistical significance to demonstrate whether the introduction of advanced airway skills was beneficial or detrimental to patient survival outcome.

The study was to investigate the effectiveness of Sociocultural Competency Training (SCCT) as an intervention in enhancing self-efficacy among trainees in the health care profession. The purposes of the study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning ofthe sociocultural competencies, and (c) to identify the factors that contribute to effective outcomes. A sample of 84 participants in the Health Sciences program at the Vancouver Community College was recruited. There were 26 local born Canadians and 32 immigrants in the experimental group, whereas 11 local born Canadians and 15 immigrants were in the control group. Experimental group participants took part in an 18- hour training over a 6-week period as part of their regular Human Relations Skills course curriculum. The control group also took the same training course after post-test data collection. This study used both quantitative and qualitative methods. Self-efficacy and behavioural performance were assessed quantitatively by the results from the General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedback from 28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group. The results of this study supported the hypotheses that the Sociocultural Competency Training was effective in improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The hypothesis that there would be more significant change in participants' social self-efficacy was also supported. The Sociocultural Competency Training offered effective ways of helping people develop positive self-efficacy and behavioural competencies. Participants reported the training enabled them to have the sociocultural competencies to conduct their professional career in a multicultural community. In the future, the training can be used with high school students, college and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

O imageamento por tensor de difusão (DTI) por ressonância magnética (RM) é um método de aquisição recente e de utilização bastante reduzida nos serviços que possuem equipamentos os softwares paro DTI. A partir desta situação notou-se a necessidade de um guia para os profissionais envolvidos RM; que servisse como fonte de consulta para auxiliar na aquisição do DTI. Para criação deste guia um referencial fez necessário e foi obtido apenas como norteador por meio de um questionário aplicado a profissionais que trabalham com RM, de uma clínica de Curitiba. Através do questionário foi possível levantar que conceitos e parâmetros o guia poderia explanar, notoriamente precisando dar ênfase aos parâmetros básicos da técnica, as formas de reconstrução dos dados e as formas de visualização. O guia foi montado explicando o processo de aquisição do DTI, os principais parâmetros envolvidos e os termos comuns aos exames desta natureza. Também foram elaboradas 15 perguntas frequentes sobre o DTI, com tabelas de consulta rápida. O resultado final é um guia de fácil manuseio e entendimento que visa auxiliar os profissionais da área a pesquisarem, apreenderem e utilizarem a técnica de imageamento por tensor de difusão. Apesar de pronto, existe ainda a necessidade de introduzir o guia e coletar sugestões e ainda aprimorar os questionamentos iniciais aos profissionais da área de modo a enriquecer o guia. / Diffusion tensor imaging (DTI) by magnetic resonance (MR) is a recent method of acquisition whose utilization has been fairly reduced in services that use equipment with DTI software. From this situation, one observed the need to develop a guide for professionals involved in MR, which would serve as a reference source to assist in the acquisition of DTI. In order to make this guide, a reference was necessary to be given a steer and it was obtained through a questionnaire administered to professionals who work with MRI in a clinic in Curitiba. Through the questionnaire, it was possible to raise the concepts and parameters the guide could explain, especially emphasizing technique basic parameters, forms of data reconstruction and visualization forms. The guide was made explaining the acquisition of DTI, the main parameters involved and the common terms for these kinds of tests. In addition, 15 commonly asked questions about the DTI were prepared with quick reference tables. The final result is an easy-to-understand guide which aims to help the area professionals to search, apprehend and use the diffusion tensor imaging technique. Although it is ready, there is the need to introduce the guide and collect suggestions, and still, improve the professionals’ early questions to enhance the guide.

The purpose of this study is to explore and describe the knowledge, attitudes and experiences of health care workers who care for patients receiving treatment under DOTS strategy at public health facilities in the Windhoek District of the Khomas Region. A qualitative explorative, descriptive and contextual research design was used in this study. A purposive sampling was used to select participants who met the inclusion criteria for the study. The inclusion criteria was to be a health care worker who at the time of the study was working with patients who are on DOT for at least 6 months. A semi-structured interview guide was used to collect data. The study was conducted in the Windhoek district of the Khomas region, with a sample of 14 health care workers. Data was analysed by means of content analysis, a process of organizing and integrating narrative, qualitative data according to emerging themes and concepts. The three themes, which emerged from data analysis, were the knowledge of health care workers regarding the implementation of DOTS, the attitudes of health care workers towards patients on DOT which may affect the success of their treatments, and the experiences of health care workers when attending to patients on DOTS. The findings from the study may be used to engage stakeholders to address the shortcomings that exist in the implementation of the DOTS strategy in the district. / Health Studies / M.A. (Nursing Science)

Within medical facilities in South Africa, including the Western Cape, language barriers often exist between healthcare professionals and their patients. This can cause a barrier to efficient patient treatment. In order to address this problem, educational institutions in the Western Cape have started to introduce Xhosa language facilitation for healthcare professionals. In order to facilitate the learning of this additional language, the use of e-learning as a complement to traditional classroom lectures was investigated. The students who participated in this Xhosa language facilitation were specifically identified. This study was quantitative in nature and questionnaires were used. It was concluded that the combination of lectures and the complementary e-learning component helps to improve the student’s ability to learn an additional language, in this case Xhosa. Recommendations were made that would possibly alleviate the problem of language barriers in healthcare settings in the Western Cape. / Curriculum and Instructional Studies / M. Ed. (Curriculum Studies)

Within medical facilities in South Africa, including the Western Cape, language barriers often exist between healthcare professionals and their patients. This can cause a barrier to efficient patient treatment. In order to address this problem, educational institutions in the Western Cape have started to introduce Xhosa language facilitation for healthcare professionals. In order to facilitate the learning of this additional language, the use of e-learning as a complement to traditional classroom lectures was investigated. The students who participated in this Xhosa language facilitation were specifically identified. This study was quantitative in nature and questionnaires were used. It was concluded that the combination of lectures and the complementary e-learning component helps to improve the student’s ability to learn an additional language, in this case Xhosa. Recommendations were made that would possibly alleviate the problem of language barriers in healthcare settings in the Western Cape. / Curriculum and Instructional Studies / M. Ed. (Curriculum Studies)