Patient Care Documentation in the Secondary School Setting: Unique Challenges and Needs

Context Athletic trainers (ATs) recognize patient care documentation as an important part of clinical practice. However, ATs using 1 electronic medical record (EMR) platform reported low accountability and lack of time as barriers to documentation. Whether ATs using paper, other EMRs, or a combined paper-electronic system exhibit similar behaviors or experience similar challenges is unclear. Objective To explore ATs' documentation behaviors and perceived challenges while using various systems to document patient care in the secondary school setting. Design Qualitative study. Setting Individual telephone interviews. Patients or Other Participants Twenty ATs (12 women, 8 men; age = 38 ± 14 years; clinical experience = 15 ± 13 years; from National Athletic Trainers' Association Districts 2, 3, 6, 7, 8, 9, and 10) were recruited via purposeful and snowball-sampling techniques. Data Collection and Analysis Two investigators conducted semistructured interviews, which were audio recorded and transcribed verbatim. Following the consensual qualitative research tradition, 3 researchers independently coded transcripts in 4 rounds using a codebook to confirm codes, themes, and data saturation. Multiple researchers, member checking, and peer reviewing were the methods used to triangulate data and enhance trustworthiness. Results The secondary school setting was central to 3 themes. The ATs identified challenges to documentation, including lack of time due to high patient volume and multiple providers or locations where care was provided. Oftentimes, these challenges affected their documentation behaviors, including the process of and criteria for whether to document or not, content documented, and location and timing of documentation. To enhance patient care documentation, ATs described the need for more professional development, including resources or specific guidelines and viewing how documentation has been used to improve clinical practice. Conclusions Challenges particular to the secondary school setting affected ATs' documentation behaviors, regardless of the system used to document care. Targeted professional development is needed to promote best practices in patient care documentation.

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Future Strategies to Enhance Patient Care Documentation Among Athletic Trainers: A Report From the Athletic Training Practice-Based Research Network

Journal of Athletic Training ◽

10.4085/1062-6050-298-17 ◽

2018 ◽

Vol 53 (6) ◽

pp. 619-626 ◽

Cited By ~ 8

Author(s):

Cailee E. Welch Bacon ◽

Tricia M. Kasamatsu ◽

Kenneth C. Lam ◽

Sara L. Nottingham

Keyword(s):

Patient Care ◽

Athletic Training ◽

Athletic Trainers ◽

School Setting ◽

Research Network ◽

High Quality ◽

Quality Patient Care ◽

Quality Of Patient Care ◽

Practice Based Research ◽

Enhance Patient Care

Context: High-quality patient care documentation is an essential component of any health care professional's daily practice. Whereas athletic trainers (ATs) recognize the importance of patient care documentation, several barriers may prevent them from producing high-quality patient care documentation. Objective: To explore beneficial strategies and techniques that ATs perceived would enhance the quality of patient care documentation in the secondary school setting. Design: Qualitative study. Setting: Individual telephone interviews. Patients or Other Participants: Ten ATs who were members of the Athletic Training Practice-Based Research Network and employed in the secondary school setting were interviewed (4 men, 6 women with 7.1 ± 7.8 years of athletic training experience). Data Collection and Analysis: An individual telephone interview was conducted with each participant. Once transcribed, data were analyzed into common themes and categories per the consensual qualitative research tradition. Trustworthiness of the data was achieved through triangulation strategies: (1) the inclusion of multiple researchers to ensure accuracy and representativeness of the data and (2) participant member checking. Results: Participants identified several documentation strategies they perceived would be helpful to improve the quality of patient care documentation, including mode and consistency of documentation and the need for a standardized process as well as the need for system standardization. In addition, participants discussed the need for more education on patient care documentation. Specifically, they identified ways of learning and strategies for future education to enhance patient care documentation across the profession. Conclusions: As athletic training continues to evolve, it is crucial that ATs are well educated on how to produce high-quality patient care documentation as a part of routine practice. Continuing professional development opportunities are needed to promote lifelong learning in the area of patient care documentation.

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Perspectives on Parenthood and Working of Female Athletic Trainers in the Secondary School and Collegiate Settings

Journal of Athletic Training ◽

10.4085/1062-6050-45.5.459 ◽

2010 ◽

Vol 45 (5) ◽

pp. 459-466 ◽

Cited By ~ 29

Author(s):

Leamor Kahanov ◽

Alice R. Loebsack ◽

Matthew A. Masucci ◽

Jeff Roberts

Keyword(s):

Secondary School ◽

Online Survey ◽

Athletic Trainers ◽

School Setting ◽

Cross Sectional Study ◽

Work And Family ◽

Cross Sectional ◽

Employment Setting ◽

National Athletic Trainers Association ◽

Original Survey

Abstract Context: Female athletic trainers (ATs) are currently underrepresented in the collegiate setting. Parenting and family obligations may play a role in this underrepresentation. Objective: To examine female ATs' perspectives on parenting and working in the secondary school and collegiate employment settings. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: A total of 1000 nonstudent, female certified ATs who were currently members of the National Athletic Trainers' Association. Main Outcome Measure(s): An original survey was developed to assess perceptions related to motherhood and work responsibilities. Descriptive statistics were used to assess age, years of experience as a certified AT, employment position, and parent or nonparent status. A correlation matrix was conducted to determine factors among parent and nonparent status, perceptions of motherhood, and employment-setting decisions. Results: Of the 1000 surveys sent via e-mail, 411 (41.1%) female ATs responded. Responses indicated that a majority of the female ATs worked in the secondary school setting. Sixty-one percent of the respondents did not have children. Past female ATs' experiences indicated a perception that motherhood created more challenges or struggles (or both) in the work and family settings. Whether parents considered children a factor in employment-setting changes produced conflicting results: no significant correlations or differences were found among responses. Conclusions: Parenting considerations had influences on both the home and employment settings. Although parents and nonparents had different views on the implications of parenting in the workplace, both groups agreed that parenting could affect the work environment and the choice to change employment settings and careers. Administrative decisions need to be considered in relation to parenting concerns. Mentoring that includes employment-setting choices relative to life goals should be provided to ATs, regardless of sex.

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Aspects of Technology That Influence Athletic Trainers' Current Patient Care Documentation Strategies in the Secondary School

Journal of Athletic Training ◽

10.4085/1062-6050-405-19 ◽

2020 ◽

Vol 55 (8) ◽

pp. 780-788

Author(s):

Sara L. Nottingham ◽

Tricia M. Kasamatsu ◽

Lindsey E. Eberman ◽

Elizabeth R. Neil ◽

Cailee E. Welch Bacon

Keyword(s):

Secondary School ◽

Patient Care ◽

Athletic Trainers ◽

School Setting ◽

Research Process ◽

Network Access ◽

Design Problems ◽

Telephone Interviews ◽

Unreliable Networks ◽

Data Saturation

Context Previous research on athletic trainers' (ATs) documentation practices in the secondary school setting has focused on users of 1 electronic medical record (EMR) platform. These studies have identified that ATs use multiple platforms for documentation, including paper, even when an EMR is available. Objective To examine the documentation practices of ATs who use various forms of patient care documentation, including paper, EMRs, or both. Design Qualitative study. Setting Individual telephone interviews. Patients or Other Participants Twenty ATs participated in this study: 12 women and 8 men who averaged 38 ± 14 years of age, 15 ± 13 years of clinical experience, and 11 ± 11 years of employment at their current secondary school. Data Collection and Analysis Semistructured telephone interviews were conducted to gain insight into ATs' documentation practices. Three researchers and 2 auditors inductively coded the transcripts using a consensual qualitative research process that consisted of 4 rounds of consensus coding and determination of data saturation. Trustworthiness was addressed with member checking, multiple-analyst triangulation, and peer review. Results The ATs' documentation practices were largely influenced by technology, organized in 3 themes. Participants' current documentation strategies included the use of both paper and EMRs, as they found different benefits to using each platform. Oftentimes documentation practices were shaped by technological challenges, including unreliable networks, software design problems, and the lack of a streamlined approach. Lastly, participants identified future strategies for improving documentation, including the need for better EMR options and streamlining their individual documentation behaviors. Conclusions Many ATs wanted to incorporate EMRs in their clinical practice but faced challenges when attempting to do so. In turn, clinicians often duplicated documentation or used 2 platforms. Athletic trainers should communicate with administrators to select an EMR that fits their documentation needs and seek resources, such as network access and educational opportunities, to learn how to use EMRs.

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Challenges for Newly Credentialed Athletic Trainers During Their Transition to Practice

Journal of Athletic Training ◽

10.4085/1062-6050-387-17 ◽

2019 ◽

Vol 54 (11) ◽

pp. 1197-1207

Author(s):

Stacy E. Walker ◽

Ashley B. Thrasher ◽

Stephanie Mazerolle Singe ◽

Jessica L. Rager

Keyword(s):

Clinical Practice ◽

Secondary School ◽

Role Ambiguity ◽

Athletic Trainers ◽

School Setting ◽

Job Descriptions ◽

Professional Programs ◽

Work Settings ◽

Data Saturation ◽

Part Time

Context Understanding the challenges faced by newly credentialed athletic trainers (ATs) as they transition into clinical practice could assist employers and professional programs in developing initiatives to enhance this transition. Objective To explore the challenges faced by newly credentialed ATs during their transition from student to autonomous practitioner. Design Qualitative study. Setting Individual phone interviews. Patients or Other Participants A total of 34 ATs certified between January and September 2013 participated in this study (18 women, 16 men; age = 24 ± 2 years; work settings = college, secondary school, clinic, and other). Data saturation guided the number of participants. Data Collection and Analysis An interview guide was used. All interviews were recorded and transcribed verbatim. Data were analyzed via phenomenologic reduction, with data coded for common themes and subthemes. Trustworthiness was established via intercoder reliability, member checks, and peer review. Results Initially, participants had difficulty making decisions independently. However, making decisions and receiving positive feedback helped them develop confidence. Communication with coaches and parents was challenging, especially for those in the secondary school setting. Participants also experienced role ambiguity, as they were unsure of basic organizational and administrative structures and expectations. Mentor inaccessibility was the final challenge described by respondents. In particular, those in the secondary school setting and with part-time employment felt they did not have a supervisor or mentor whom they could contact for support and guidance. Conclusions Professional programs should educate students on potential challenges to help them understand what they might encounter during the transition to clinical practice. Employers should provide clear expectations and job descriptions to alleviate some of the stress and role ambiguity. If a mentor is not provided by the employer, the newly credentialed AT should seek one to assist during the transition.

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Athletic Trainers' Perceptions of and Barriers to Patient Care Documentation: A Report From the Athletic Training Practice-Based Research Network

Journal of Athletic Training ◽

10.4085/1062-6050-52.3.15 ◽

2017 ◽

Vol 52 (7) ◽

pp. 667-675 ◽

Cited By ~ 14

Author(s):

Cailee E. Welch Bacon ◽

Bradly L. Eppelheimer ◽

Tricia M. Kasamatsu ◽

Kenneth C. Lam ◽

Sara L. Nottingham

Keyword(s):

Secondary School ◽

Patient Care ◽

Athletic Training ◽

Athletic Trainers ◽

School Setting ◽

Research Network ◽

High Quality ◽

Quality Patient Care ◽

Practice Based Research ◽

Training Practice

Context: For the practice characteristics of the services athletic trainers (ATs) provide to be identified, all ATs must complete high-quality patient care documentation. However, little is known about ATs' perceptions of patient care documentation or the potential barriers they may encounter while trying to ensure high-quality documentation. Objective: To explore ATs' perceptions of and barriers to patient care documentation via the Clinical Outcomes Research Education for Athletic Trainers (CORE-AT) electronic medical record system in the secondary school setting. Design: Qualitative study. Setting: Individual telephone interviews. Patients or Other Participants: We interviewed 10 ATs (4 men, 6 women; age = 32.6 ± 11.4 years, athletic training experience = 7.1 ± 7.8 years) who were members of the Athletic Training Practice-Based Research Network (AT-PBRN) and employed in the secondary school setting. Data Collection and Analysis: We conducted an individual interview with each participant. After transcription of the interviews, the data were analyzed into common themes and categories following the consensual qualitative research tradition. Data triangulation occurred through member checking and multiple researchers to ensure accuracy during data analysis. Results: Participants revealed several perceptions of patient care documentation, consisting of quality, expectations and accountability, priority, incentive, and culture of the secondary school setting. In addition, we identified barriers to quality patient care documentation: lack of time, lack of accountability for documenting patient care, inadequate facility resources, and lack of personnel. Participants discussed the volume of patients as a unique challenge in the secondary school setting. Conclusions: Whereas ATs perceived patient care documentation as important, several practical barriers may inhibit their ability to complete high-quality documentation of the services they provide. Effective strategies to improve the quality of patient care documentation among ATs are needed to ensure that their value, particularly in the secondary school setting, is accurately characterized.

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Return to Learn After Sport-Related Concussion: A Survey of Secondary School and Collegiate Athletic Trainers

Journal of Athletic Training ◽

10.4085/1062-6050-234-17 ◽

2018 ◽

Vol 53 (10) ◽

pp. 990-1003 ◽

Cited By ~ 4

Author(s):

Chelsea L. Williamson ◽

Grant E. Norte ◽

Donna K. Broshek ◽

Joseph M. Hart ◽

Jacob E. Resch

Keyword(s):

Secondary School ◽

Online Survey ◽

Current Knowledge ◽

Athletic Trainers ◽

Management Policy ◽

Annual Number ◽

Clinical Practices ◽

Cross Sectional ◽

Return To Learn ◽

National Athletic Trainers Association

Context Recent recommendations have emphasized return-to-learn (RTL) protocols to aid athletes in recovery from sport-related concussion (SRC) but have been based primarily on anecdotal evidence. Objective To investigate the RTL practices of certified athletic trainers (ATs) after an SRC. Design Cross-sectional study. Setting Online survey. Patients or Other Participants A total of 1083 individuals (27%) from a random sample of 4000 ATs in the National Athletic Trainers' Association membership database completed an electronic survey. Participants consisted of 729 self-identified secondary school ATs (SSATs; 67.3%; experience = 14.0 ± 9.7 years) and 354 self-identified collegiate ATs (CATs; 32.7%; experience = 13.4 ± 9.7 years). Main Outcome Measure(s) We used χ2 analyses to assess respondent differences related to current knowledge, current practices, and available resources. Independent t tests were used to compare SSATs and CATs on years of certification and annual number of SRCs evaluated. Results Of our total respondents, 41.2% (n = 446) correctly indicated the absence of evidence-based RTL guidelines. Whereas most (73.9%, n = 800) respondents had an established RTL policy, only 38.1% (n = 413) used such guidelines in their clinical practice. Most (97.1%, n = 708) SSATs and 82.2% (n = 291) of CATs had access to (a) mental health professional(s); however, minorities of SSATs (21.4%, n = 156) and CATs (37.0%, n = 131) never accessed these resources to care for concussed student-athletes. Conclusions Our results suggested that, despite the absence of empirical evidence, most surveyed ATs incorporated some form of RTL protocol in their SRC management policy. The varying AT knowledge, clinical practices, and resources highlighted by our results should be considered when creating or refining an RTL protocol.

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A Narrative Analysis: Examining the Transition to Practice for the Full-Time Secondary School Athletic Trainer

Journal of Athletic Training ◽

10.4085/1062-6050-45-17 ◽

2018 ◽

Vol 53 (3) ◽

pp. 303-311 ◽

Cited By ~ 2

Author(s):

Stephanie M. Mazerolle ◽

Jessica Kirby ◽

Stacy E. Walker

Keyword(s):

Clinical Practice ◽

Secondary School ◽

Narrative Analysis ◽

School Setting ◽

Transition Process ◽

Previous Experience ◽

Athletic Trainer ◽

Full Time ◽

Transition To Practice ◽

Past Experiences

Context: The transition to clinical practice is an important topic in athletic training because it is viewed as a stressful time that is accompanied by self-doubt. Mentorship and previous experience support the transition to practice, but little information is available on the organizational entry of the athletic trainer (AT) who is employed full time in the secondary school setting. Objective: To understand the experiences of newly credentialed ATs in full-time positions in the secondary school setting. Design: Qualitative study. Setting: Secondary schools. Patients or Other Participants: Seventeen ATs (4 men, 13 women; age = 25 ± 4 years) were employed full time in the secondary school setting. On average, the full-time ATs worked 40 ± 10 hours per week. Data Collection and Analysis: All participants completed a semistructured telephone interview with 1 researcher. Data were analyzed using a narrative analysis, and credibility was established by peer review and researcher triangulation. The narrative research paradigm guided our protocol and supported the rigor of the study. Results: Our analyses revealed that transition to practice was organic, such that the newly credentialed AT gained awareness by engaging in the role daily. Additionally, the transition process was facilitated by previous experience in the setting, mostly from educational training. Ongoing communication with various stakeholders (athletic directors, team physicians, and peer ATs) in the setting also assisted in the process of transitioning. Finally, mentorship from previous preceptors provided support during the transition process. Conclusions: Transitioning into full-time clinical practice in the secondary school setting was informal and supported by professional relationships and past experiences. Past experiences allowed for awareness but also the development of mentoring relationships that continued beyond the clinical education experience. Communication also assisted the newly credentialed AT, as it provided feedback for legitimation by multiple stakeholders.

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Athletic Trainers' Familiarity With and Perceptions of Academic Accommodations in Secondary School Athletes After Sport-Related Concussion

Journal of Athletic Training ◽

10.4085/1062-6050-49.3.81 ◽

2015 ◽

Vol 50 (3) ◽

pp. 262-269 ◽

Cited By ~ 33

Author(s):

Richelle M. Williams ◽

Cailee E. Welch ◽

John T. Parsons ◽

Tamara C. Valovich McLeod

Keyword(s):

Secondary School ◽

Employment Status ◽

Student Athletes ◽

Athletic Trainers ◽

School Setting ◽

Full Time ◽

Years Of Experience ◽

Academic Accommodations ◽

Cognitive Rest ◽

Perceived Familiarity

Context: Sport-related concussion can affect athletes' sport participation and academic success. With the recent emphasis on cognitive rest, student-athletes may benefit from academic accommodations (AA) in the classroom; however, athletic trainers' (ATs') perceived familiarity with, and use of, AA is unknown. Objective: To assess secondary school ATs' perceived familiarity with, attitudes and beliefs about, and incorporation of AA for student-athletes after sport-related concussion. A secondary purpose was to determine whether employment status altered familiarity and use of AA. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: Of 3286 possible respondents, 851 secondary school ATs accessed the survey (response rate = 25.9%; 308 men [36.2%], 376 women [44.2%], 167 respondents [19.6%] with sex information missing; age = 37.3 ± 10.1 years). Main Outcome Measure(s): Participants were solicited via e-mail to complete the Beliefs, Attitudes and Knowledge Following Pediatric Athlete Concussion among Athletic Trainers employed in the secondary school setting (BAKPAC-AT) survey. The BAKPAC-AT assessed ATs' perceived familiarity, perceptions, and roles regarding 504 plans, Individualized Education Programs (IEPs), and returning student-athletes to the classroom. Independent variables were employment status (full time versus part time), employment model (direct versus outreach), years certified, and years of experience in the secondary school setting. The dependent variables were participants' responses to the AA questions. Spearman rank-correlation coefficients were used to assess relationships and Mann-Whitney U and χ2 tests (P < .05) were used to identify differences. Results: Respondents reported that approximately 41% of the student-athletes whose sport-related concussions they managed received AA. Respondents employed directly by the school were more familiar with 504 plans (P < .001) and IEPs (P < .001) and had a greater belief that ATs should have a role in AA. Both the number of years certified and the years of experience at the secondary school were significantly correlated with perceived familiarity regarding 504 plans and IEPs. Conclusions: The ATs employed directly by secondary schools and those with more experience as secondary school ATs were more familiar with AA. Understanding AA is important for all ATs because cognitive rest and “return to learn” are becoming more widely recommended in concussion management.

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Athletic Trainer Perceptions of Life-Work Balance and Parenting Concerns

Journal of Athletic Training ◽

10.4085/1062-6050-48.2.01 ◽

2013 ◽

Vol 48 (3) ◽

pp. 416-423 ◽

Cited By ~ 17

Author(s):

Lindsey E. Eberman ◽

Leamor Kahanov

Keyword(s):

Secondary School ◽

Online Survey ◽

Athletic Trainers ◽

Work And Family ◽

Athletic Trainer ◽

School Settings ◽

Occupational Setting ◽

Female Employees ◽

National Athletic Trainers Association ◽

Life Work

Context: Life-work balance may be one reason for retention concerns among athletic trainers (ATs), yet evidence does not exist to support the supposition. Objective: To assess the perceptions of ATs regarding life-work balance, specifically on parenting issues. Design: Survey. Setting: Online survey at www.surveymonkey.com. Patients or Other Participants: A random sample of National Athletic Trainers' Association members (N = 9516) received the survey; 20.6% (n = 1962; male = 954, female = 816; age = 37 ± 10 years, experience = 13 ± 9 years) completed any portion of the survey. Most respondents worked in the college/university (34.5%, n = 657 of 1908) and secondary school settings (25.9%, n = 476 of 1908). A majority of participants (50.7%, n = 898 of 1770) were parents. Intervention(s): We calculated frequencies and percentages and used Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes and among job settings on life-work balance measures among parents. Main Outcome Measures: The questionnaire included 8 life-work balance items, 7 parenting challenge items, and 3 nonparent items. Results: The results indicate that sex and setting significantly affected perceptions about parenting. Males articulated a stronger sense of difficulty in finding balance as a working parent (P < .001; 1.95 ± 1.98). Females felt more strongly than males that managing work and family was stressful (P = .04; 3.86 ± 1.13) and caused burnout (P = .004; 3.50 ± 1.24), and that their energy tended to fall short of their needs (P < .001; 3.74 ± 1.15). The decision not to have children was strongly affected by the work setting (P = .014; 3.37 ± 1.42). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in other settings (P < .001). College/university ATs (P = .025; 3.17 ± 1.23) felt most strongly that their families were neglected because of work. In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (P = .027; 1.72 ± 1.97). Conclusions: Male and female employees had similar perceptions of life-work balance, but occupational setting may affect these perceptions.

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Athletic Trainers’ Perceived Challenges Toward Comprehensive Concussion Management in the Secondary School Setting

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.2017-0043 ◽

2018 ◽

Vol 23 (1) ◽

pp. 33-41 ◽

Cited By ~ 2

Author(s):

Cailee E. Welch Bacon ◽

Gary W. Cohen ◽

Melissa C. Kay ◽

Dayna K. Tierney ◽

Tamara C. Valovich McLeod

Keyword(s):

Qualitative Study ◽

Best Practices ◽

Secondary School ◽

Athletic Trainers ◽

School Setting ◽

Community Resources ◽

Concussion Management ◽

Policies And Procedures ◽

Management Procedures ◽

Education Levels

Available financial and personnel resources often dictate the specifics of concussion policies and procedures in the secondary school setting. The purpose of this qualitative study was to explore athletic trainers’ perceived challenges toward comprehensive concussion management in the secondary school setting. The findings indicate several challenges exist toward concussion management in the secondary school, including facility, personnel, and community resources, education levels of various stakeholders, and general perceptions of concussion and athletic trainers. It is important to identify challenges athletic trainers may face in order to develop strategies to align current concussion management procedures with current best practices.

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