How does implementation of an electronic medical record system impact nurses’ work motivation, engagement, satisfaction and well-being? A realist review protocol

IntroductionElectronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being?Methods and analysisThe five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation.Ethics and disseminationThe larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines.PROSPERO registration numberCRD42020131875.

A Vertical Peer Mentorship Model to Promote Early Career Development: Implementation and Initial Outcomes

Mentorship is critical for career enhancement and professional development among early career researchers in the behavioral sciences. However, many barriers exist to securing appropriate mentorship, including inadequate supply of advanced mentors, inconsistent quality of mentorship, and diverse mentorship needs. Additionally, there are few training experiences that provide an opportunity to learn effective mentorship approaches and techniques. Vertical peer mentorship programs can provide one potential solution to these common mentorship pitfalls. In this approach, slightly more advanced early career professionals (e.g., post-doctoral fellows) provide mentorship to more junior colleagues (e.g., graduate students), permitting opportunities for both mentorship and mentorship training within the same dyad. Here, we detail one such early career vertical peer mentorship program developed within a subspecialty of psychology (eating disorders). We provide details about the iterative process of developing and refining this program to support mentor and mentee goals. We also provide initial program evaluation data from a subsample of participants completing post-program assessments (n = 109) that indicates that the program was highly acceptable (M = 8.22, SD = 4.25 acceptability on a 10-point Likert scale) and generative of early career productivity (producing > 25 manuscripts published or under review and > 21 conference abstracts) in its initial four years. This manuscript serves to provide a model for developing a successful vertical peer mentorship program and to encourage research in the under-investigated area of efficacious mentorship practices.

Development of program for “Global Lesson Study” in mathematics education

PurposeThe purpose of this exploratory study was to develop Global Lesson Study (GLS) defined as an international collaborative lesson study through international exchange of teachers using ICT. Its purpose is to nurture teachers from different countries with intercultural competence to conduct lesson study.Design/methodology/approachWe developed an initial program for GLS in the subject of mathematics education between elementary school teachers in Japan and Singapore. The qualitative analysis of activities at each stage of the Pilot GLS was conducted from two perspectives: (1) intercultural competence for lesson study and (2) teacher's competency for subject instruction.FindingsThrough GLS, a new lesson was created that was only possible with discussions from teachers from different locations. It was clarified that GLS was not only useful for training teachers with intercultural competence for lesson study but also has led to the improvement of teacher's competency for subject instruction in mathematics.Originality/valueThe GLS is a new attempt in the sense of developing a high-quality lesson study method for creating new lessons as well as improving qualities and abilities of teachers through international exchange.

Coping Strategies Used by Older Adults to Deal with Contact Isolation in the Hospital during the COVID-19 Pandemic

Due to the COVID-19 pandemic, many older adults have experienced contact isolation in a hospital setting which leads to separation from relatives, loss of freedom, and uncertainty regarding disease status. The objective of this study was to explore how older adults (55+) cope with contact isolation in a hospital setting during the COVID-19 pandemic in order to improve their physical and psychological wellbeing. The realist evaluation approach was used to formulate initial program theories on coping strategies used by (older) adults in an isolation setting. Twenty-one semi-structured interviews with older patients (n = 21) were analysed. This study revealed that both emotion-focused coping strategies as well as problem-focused coping strategies were used by older adults during contact isolation. The study also uncovered some new specific coping strategies. The results have useful implications for hospital staff seeking to improve the wellbeing of older adults in contact isolation in hospitals. Problem-focused coping strategies could be stimulated through staff performing care in a person-centred way. Trust in staff, as part of emotion-focused coping strategies, could be stimulated by improving the relationship between patients and staff.

Specialized Medical Weight Management Intervention for High-Risk Obesity

Background: Bundled payments are services rendered at pre-determined costs with the goal of providing high value care. Our institution’s Episodes of Care team partnered with its tertiary care obesity center to design a novel medical weight management bundle for employers that would collectively deliver high value obesity services. Objective: As a first step, we sought to evaluate short-term medical weight loss outcomes over 6 months at the obesity center. Methods: We retrospectively analyzed weight loss outcomes on 157 patients with commercial insurance coverage over a period of 6 months. Results: Patients ranged in age from 18-72 years, and 77.7% were female. Patients ranged in weight from 160-443 pounds, with a mean body mass index (BMI) of 42.7 kg/m2 (Class 3a severe obesity; BMI range 28.4-74.5). The prevalence of any obesity-related medical condition was 54.1%; at least a quarter of the patients had either prediabetes or Type 2 diabetes mellitus, approximately a third had hypertension, and over 8% had hyperlipidemia. Mean weight loss from the initial program start date was 6.28% (+/-0.48% standard error of mean [SEM]; 95% confidence interval [CI] 5.34-7.23%). Completers (defined as having at least 6 visits with a medical provider) achieved a higher percentage of weight loss (7.06%) from the initial program start compared to non-completers (4.68%; at least 4-5 visits with a medical provider; P<0.0158). Approximately 50% of patients were able to achieve >7% weight loss, with over 55% of patients achieving at least 3% weight loss or higher irrespective of BMI classification. Conclusions: Specialized medical weight intervention is effective in treating high-risk obesity with complications. This has implications for enhanced long-term cost savings related to employer coverage of such programs for their employees with obesity.

“There’s Somebody Like Me:” Perspectives of a Peer-to-peer Gynecologic Cancer Mentorship Program

Purpose: The Ovarian Cancer Research Alliance’s Woman to Woman (W2W) program is a peer mentorship program for women with gynecological cancer that was founded in 2004 and has expanded to 43 sites nationwide. An initial program survey was conducted in 2013, but no qualitative studies have investigated patient experiences with peer support programs for gynecologic cancer in the United States. The aim of this qualitative study was to capture mentor and mentee experiences giving and receiving peer support, including how relationships were initiated and developed.Methods: Hour-long, semi-structured interviews were conducted with both mentors and mentees. Interviews focused on the dynamics of the mentor-mentee relationship. Interviews were recorded, transcribed verbatim, and open-coded. A qualitative descriptive approach was used to organize findings into themes. Results: Sixteen participants (N=16) were interviewed (seven mentors and nine mentees.) Three broad themes emerged: (i) pathways to the program; (ii) how connection occurred; (iii) themes of compatibility. While program participants universally valued their match experience, frequency and mode of communication, as well as expectations of the match relationship were widely divergent among the program participants. Conclusion: The W2W peer mentorship program is a valuable resource for patients with gynecologic cancer. Refining the wants and needs of mentees including mode of communication, frequency of communication, type of support desired, identifying topics of mutual interest, and introducing the concept of recurrence may improve the connectivity experienced by mentor-mentee dyads.

The Implementation of Healthy Start-Départ Santé intervention in Canadian Childcare Centres: A Realist Evaluation

BackgroundHealthy Start-Départ Santé (HSDS) is a 10-month, bilingual (English and French) program which aims to educate childcare centre staff about the activity and nutritional needs of young children, as well as teaching them how to incorporate healthy practices into their daily routines. This study examines “How, for whom, and in what contexts is the HSDS intervention effectively implemented and sustained in early learning childcare centers?”MethodsWe conducted a realist evaluation to assess the HSDS program. After formulating an initial program theory (described in a previously published paper) we tested and refined the theory using interview data from childcare centre directors and staff. Purposive sampling was used to recruit centres with differing characteristics (levels of engagement with HSDS, length of time since training, and geographic and cultural diversity in clientele). Twenty-five interviews from 23 centres were completed. Participants were asked questions directly related to the program theory (e.g., Does the program line up with your personal values and goals around healthy child development?) to confirm, refute, or refine elements of the initial theory. Interviews were coded by context, mechanisms, and outcomes and separated according to the stages of Training, Implementation, and Sustainability. Codes specific to physical activity and nutrition were created. NVivo 11 was used for data management. ResultsOur study found that the HSDS program was effectively implemented and sustained when staff had positive attitudes toward the program, identified with its goals and values, and were willing to actively participate in activities. Other key components for staff included a sense of responsibility for child health, increased understanding of the benefits of promoting healthy behaviours, and access to resources in support of behavioural change. For children, the program was successful when they had multiple opportunities to be physically active and try a variety of foods, and when they could develop competence in physical activities. ConclusionsThe HSDS final program theory can be tailored to various contexts and/or similar programs to facilitate improved physical activity and healthy eating in childcare centres.

Realist Review of Interventions Influencing Waste Management and Minimization Practices in New Zealand: Protocol and Initial Program Theory

Background: The effects of waste on the environment and human health continue to increase despite behavioral, technological and policy actions for the management and minimization of waste. We plan to undertake a realist review of waste management and minimization interventions within New Zealand to inform effective approaches to waste minimization and management interventions. This protocol paper describes the steps of the realist review, including the objectives, theoretical frameworks and steps used. Methods: Realist review is a theory guided approach that seeks to understand the context-mechanism-outcome configuration of an intervention and generate insights on what works for whom, under what conditions and how. The protocol presents an integrated working theoretical framework comprising of three social theories (Social Learning Theory, Collective Action Theory and Social Practice theory), set within an indigenous Māori implementation framework, He Pikinga Waiora. The initial program theory generated from a first stage rapid review is presented. This initial program theory will be tested through a full literature review and analysis, as well as participatory sense making workshops with key stakeholders. Discussion: The review will help to generate insights on the generative causal mechanisms of waste minimization interventions in the context of New Zealand. This protocol emphasizes the initial program theory of change as a starting point for further review and design of improved interventions for waste minimization. Through identifying and testing the program theory, with insights from both indigenous and social practice theories, the proposed review will support the design of policies, programs and activities required to achieve the desired outcome of waste minimization in the context of New Zealand.