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To evaluate and synthesize research that has investigated interventions to train registered health professionals to effectively communicate with patients in acute settings who are establishing their goals of care, to develop an understanding of current practices and their effectiveness.
Design
Integrative review.
Methods
Medline, Embase, PsycINFO, SCOPUS, CINAHL, and ProQuest, searched from the date each database was available to December 2023. Forty-seven (n = 47) research studies investigating interventions to train registered health professionals to effectively communicate with patients in acute settings who are establishing their goals of care were critically appraised for methodological quality using the Joanna Briggs Institute Quality Appraisal Framework. Minimum essential criteria and scores were agreed prior to appraisal.
Results
Twenty-eight studies were excluded due to methodological quality. The 19 studies included comprised quasi experimental (n = 9), qualitative (n = 4), RCT (n = 2), text and opinion (n = 1), and mixed methods (n = 3). From these included studies 4 themes with embedded sub-themes were derived: (a) delivery of training programs, (b) clinician outcomes, (c) patient outcomes, and (d) system outcomes.
Significance of the results
Communication training is essential and beneficial however its effectiveness depends on overcoming existing barriers, providing continuous learning opportunities, and embedding these into clinical practice. Addressing these factors will ensure that clinicians and healthcare organizations can improve patient and system outcomes. When clinicians and organizations prioritize regular, context-specific communication training, which promotes the use of conversation guides and available technologies, Goals of Patient Care conversations are more likely to be embedded in practice, promoting effective and patient-centered communication.
This chapter provides a theory of the ethics of revolution and the ethics of interventions in revolutions. It sets the stage for the ethical discussion by using the descriptive-explanatory theory of revolution laid out in Chapter 3 to identify the special ethical problems revolutionaries face and the consequences for intervention of the ways in which revolutionaries will typically address those problems. The chapter states and criticizes two widely accepted principles that are supposed to provide guidance to potential interveners in revolutions. The first is the principle that no intervention should be undertaken without the consent of the people in the country that is the target of the intervention. The second is the principle, advocated by John Stuart Mill, that widespread participation in a movement to overthrow the existing regime, understood as an indication of a pervading commitment to revolution, is a necessary condition for justified intervention. This chapter argues that neither principle provides useful guidance as to intervention because both ignore certain features of real-world revolutions. This conclusion confirms an important thesis of the book, namely, that normative inquiries about social change, including investigations to articulate the ethics of revolution and intervention in revolution, must be grounded in an accurate understanding of the morally relevant facts about the phenomena in question. This chapter also extends and deepens the discussions of the explanatory power of the concept of ideology first developed in Chapters 2 and 3, arguing that ideologies can serve to rationalize the use of coercion and violence that otherwise would be regarded as morally prohibited. Finally, this chapter explains how the choice is not between morality and self-interest as drives of social change but is rather a matter of understanding how self-interest can be served by the strategic employment of moral concepts and principles.
Mental illness continues to be a leading cause of illness in Australia and Aotearoa New Zealand. The effects of reduced mental health have significant consequences for individuals, families and the community. Prevention and early intervention are crucial to improve health outcomes. Much of the support and care for individuals and families experiencing mental health illness occurs within the community, and nurses are major providers of that care. This chapter focuses on the role of community mental health nurses in providing recovery-orientated care for individuals living with mental illness and their families.
Patent ductus arteriosus is a common condition in preterm neonates, often necessitating medical or surgical intervention. This report presents a case of a preterm neonate born at 27 gestational weeks and who experienced patent ductus arteriosus rupture during a device closure procedure. Patent ductus arteriosus rupturing during device closure is rare and life threatening but can be successfully managed with prompt recognition and intervention.
Healthcare workers in Africa face considerable stress due to factors like long working hours, heavy workloads and limited resources, leading to psychological distress. Generally, countries in the global north have well-established policies and employee wellness programs for mental health compared to countries in the global south. This scoping review aimed to synthesize evidence from published and grey literature on workplace mental health promotion interventions targeting African healthcare workers using Social Ecological Model (SEM) and the Job Demands-Resources (JD-R) model as an underlying theoretical framework for analysis. Arksey and O’Malley framework for scoping reviews was used. The search was conducted across multiple databases. A total of 5590 results were retrieved from Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, Cochrane Library, CINAHL, Scopus and Web of Science. Seventeen (17) studies from ten (10) African countries were included after title, abstract and full text screening. Thematic analysis identified 5 key themes namely training programs, counselling services, peer support programs, relaxation techniques and informational resources. In conclusion, even though limited workplace mental health interventions for healthcare professionals were identified in Africa, individual-level interventions have been notably substantial in comparison to organizational and policy-level initiatives. Moving forward, a multi-faceted approach unique to the African context is essential.
An introduction to attachment theory while completing an undergraduate degree in South Africa opened an opportunity to study at Johns Hopkins University with the recognized mother of attachment theory, Mary Ainsworth. My tenure with her was intensive but short, as she decided to leave Hopkins for Virginia, leading me to head further north to Yale, though not until Ainsworth had introduced me to both Melvin Konner (a distinguished anthropologist) and Urie Bronfenbrenner, a doyen of developmental psychology then determined to radically transform stuffy developmental psychology into a contextually sensitive sub-discipline. With Ainsworth and Bronfenbrenner as off-site mentors, William Kessen introduced sophisticated developmental theory while Edward Zigler expounded the importance of using research to inform social policy in pursuit of a better world for children.
Interprofessional teams in the pediatric cardiac ICU consolidate their management plans in pre-family meeting huddles, a process that affects the course of family meetings but often lacks optimal communication and teamwork.
Methods:
Cardiac ICU clinicians participated in an interprofessional intervention to improve how they prepared for and conducted family meetings. We conducted a pretest–posttest study with clinicians participating in huddles before family meetings. We assessed feasibility of clinician enrollment, assessed clinician perception of acceptability of the intervention via questionnaire and semi-structured interviews, and impact on team performance using a validated tool. Wilcoxon rank sum test assessed intervention impact on team performance at meeting level comparing pre- and post-intervention data.
Results:
Totally, 24 clinicians enrolled in the intervention (92% retention) with 100% completion of training. All participants recommend cardiac ICU Teams and Loved ones Communicating to others and 96% believe it improved their participation in family meetings. We exceeded an acceptable level of protocol fidelity (>75%). Team performance was significantly (p < 0.001) higher in post-intervention huddles (n = 30) than in pre-intervention (n = 28) in all domains. Median comparisons: Team structure [2 vs. 5], Leadership [3 vs. 5], Situation Monitoring [3 vs. 5], Mutual Support [ 3 vs. 5], and Communication [3 vs. 5].
Conclusion:
Implementing an interprofessional team intervention to improve team performance in pre-family meeting huddles is feasible, acceptable, and improves team function. Future research should further assess impact on clinicians, patients, and families.
In home-based care for severely ill patients, family caregivers’ contributions are crucial. This study aimed to explore how a web-based psychoeducational intervention influences family caregivers’ experiences in addressing challenges while caring for a patient with life-threatening illnesses during specialized home care.
Methods
This qualitative study undertook semi-structured interviews with family caregivers of patients with life-threatening illness receiving specialized home care. Family caregivers participated in a randomized controlled trial evaluating a psychoeducational intervention delivered through a website. Interviews were performed with 17 family caregivers; 13 spouses, 2 adult children, 1 parent, and 1 sibling, and analyzed using qualitative content analysis.
Results
The results indicate that the intervention resonated with the family caregivers’ situation which gave them comfort and awareness. It inspired self-reflection on the caregiver role that provided new insights and encouraged communication with the patient. The intervention prepared family caregivers for the patient’s progressing illness and death. While preparing was a help for some, others did not feel ready to face this, which led them to avoid parts of the website.
Significance of results
This psychoeducational web-based intervention guided family caregivers as they addressed challenges in caregiving and prepared for the future, and they valued having access to such an intervention. In a time of decreasing healthcare resources, web-based support may be a useful alternative to in-person interventions. It is important to continue developing, evaluating, and implementing web-based interventions to meet the needs of family caregivers.
Chapter 3 presents localized peace enforcement theory. It first discusses the challenges facing individuals involved in a communal dispute. Reflecting on these obstacles to peaceful dispute resolution, the chapter outlines a formal micro-level theory of dispute escalation between two individuals from different social groups who live in the same community. It explains how international intervention shapes escalation dynamics. The chapter then shifts the focus to local perceptions of intervener impartiality, which the theory posits are a key determinant of whether a UN intervention succeeds in preventing the onset of violence. The identifies the importance of multilateralism, diversity, and the nonuse of force as critical factors shaping local perceptions and, as a result, UN peacekeeping effectiveness. Critically, the theory does not suggest that UN peacekeepers will always succeed, or that all kinds of UN peacekeepers will succeed. Indeed, perceptions of UN peacekeepers vary depending on the troop-contributing country and the identity of the civilians involved in the dispute. The chapter closes with a discussion of the most important hypotheses derived from the theory.
A primary goal of prejudice and stereotyping research is to reduce intergroup disparities arising from various forms of bias. For the last thirty years, much, perhaps most, of this research has focused on implicit bias as the crucial construct of interest. There has been, however, considerable confusion and debate about what this construct is, how to measure it, whether it predicts behavior, how much it contributes to intergroup disparities, and what would signify successful intervention against it. We argue that this confusion arises in part because much work in this area has focused narrowly on the automatic processes of implicit bias without sufficient attention to other relevant psychological constructs and processes, such as people’s values, goals, knowledge, and self-regulation (Devine, 1989). We believe that basic research on implicit bias itself is important and can contribute to reducing intergroup disparities, but those potential contributions diminish if and when the research disregards controlled processes and the personal dilemma faced by sincerely nonprejudiced people who express bias unintentionally. We advocate a renewed focus on this personal dilemma as an important avenue for progress.
Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.
Aims:
To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.
Method:
Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.
Results:
No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).
Conclusions:
These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.
Breast cancer patients and survivors deal with physical and psychological challenges due to oncological treatments. The existing literature highlights the importance of compassion in reducing the main cancer-related effects in terms of emotions, quality of life, and dysfunctional coping skills. Over the past few years, compassion-based interventions (CBIs) have been considered an interesting approach to reduce anxiety and depression symptoms and improve quality of life and well-being. However, there have not been many studies that show the benefits of these interventions in breast cancer patients and survivors. The primary objective of this systematic review is to provide evidence of the impact of CBIs on specific variables identified in the literature as affected by this pathology. The variables that will be studied are (a) emotional issues (e.g., anxiety, stress, and depression symptoms); (b) quality of life; and (c) positive coping skills. A systematic search during the previous 10 years up to November 2023 was conducted following the PRISMA guidelines across multiple databases, such as PubMed, Web of Science, PsycINFO, and Scopus. Nine eligible randomized controlled trials were included in this article, with a total of 813 breast cancer patients and survivors. Findings show that CBIs increased compassion, mindful observation, and acting with awareness skills, leading to a significant reduction of anxiety and stress levels, depression, and negative affect. Additionally, less body image distress and greater body appreciation were reported as a consequence of the interventions. This review shows the CBI’s efficacy on emotions, positive coping skills, and quality of life in breast cancer patients and survivors. Guidelines for future studies are listed to promote CBIs as a clinically useful intervention for breast cancer patients and survivors.
Nontyphoidal Salmonella enterica infections are a leading cause of enteric disease in Canada, most commonly associated with foodborne exposures. Raw frozen breaded chicken products (FBCP) have been implicated in 16 Salmonella outbreaks between 2017 and 2019. This study quantified the impact of the 1 April 2019 requirement by the Canadian Food Inspection Agency (CFIA) for manufacturers to reduce Salmonella in raw FBCP. An intervention study approach utilizing the pre–post intervention data with a comparison group methodology was used to: (1) estimate the reduction in FBCP Salmonella prevalence using retail meat FoodNet Canada data; (2) estimate the reduction in the human salmonellosis incidence rate using data from the Canadian National Enteric Surveillance Program; and (3) estimate the proportion of reported cases attributed to FBCP if the human exposure to Salmonella through FBCP was completely eliminated. The FBCP Salmonella prevalence decreased from 28% observed before 1 April 2019 to 2.9% after the requirement implementation. The CFIA requirement was estimated to reduce the human salmonellosis incidence rate by 23%. An estimated 26% of cases during the pre-intervention period can be attributed to FBCP. The CFIA requirement was successful at significantly reducing Salmonella prevalence in retail FBCP, and at reducing salmonellosis burden.
To examine feasibility, acceptability, and preliminary effectiveness of a novel group-based telemedicine psychoeducation programme aimed at supporting psychological well-being among adolescents with Fontan-palliated CHD.
Study design:
A 5-week telemedicine psychoeducation group-based programme (WE BEAT) was developed for adolescents (N = 20; 13–18 years) with Fontan-palliated CHD aimed at improving resiliency and psychological well-being. Outcome measures included surveys of resilience (Connor–Davidson Resilience Scale), benefit finding (Benefit/Burden Scale for Children), depression, anxiety, peer relationships, and life satisfaction (National Institutes of Health Patient-Reported Outcomes Measurement Information System scales). Within-subject changes in these outcomes were compared pre- to post-intervention using Cohen’s d effect size. In addition, acceptability in the form of satisfaction measures and qualitative feedback was assessed.
Results:
Among eligible patients reached, 68% expressed interest in study participation. Of those consented, 77% have been scheduled for a group programme to date with 87% programme completion. Twenty adolescents (mean age 16.1 ± SD 1.6 years) participated across five WE BEAT group cohorts (range: 3–6 participants per group). The majority (80%) attended 4–5 sessions in the 5-session programme, and the median programme rating was a 9 out of 10 (10 = most favourable rating). Following WE BEAT participation, resiliency (d = 0.44) and perceptions of purpose in life increased (d = 0.26), while depressive symptoms reduced (d = 0.36). No other changes in assessed outcome measures were noted.
Conclusions:
These findings provide preliminary support that a group-based, telemedicine delivered psychoeducation programme to support psychological well-being among adolescents with CHD is feasible, acceptable, and effective. Future directions include examining intervention effects across diverse centres, populations, and implementation methods.
In this chapter, I reflect on how to go about applying Conversation Analysis (hereafter CA). When applying CA, we are concerned with the management of social institutions in interaction. However, the applied nature of our work means going beyond description, using the theories, principles, and methods of CA to address or ‘solve’ professional/practical ‘problems’ with roots or bases in interaction. For example, addressing public-health challenges, such as how physicians can resist ‘pressure’ for unwarranted antibiotic prescriptions during consultations for respiratory illnesses; or solving difficult or sensitive organizational tasks, such as how best to ask callers about their backgrounds in the service of ethnic monitoring on a telephone helpline. Here, the analyst is guided by professional/practical ‘problems’ or concerns. In the absence of existing guidance, I propose six key methodological steps for applying CA. These steps characterize the different kinds of ‘backstage’ and ‘frontstage’ work that support our attempts to address such ‘problems,’ and to identify and share ‘solutions.’ Along the way I provide illustrative examples, both historical and contemporary. Finally, I highlight some of the ethical and moral dilemmas we might need to navigate in the service of such work.
This chapter focuses on the Black Parenting Strengths and Strategies (BPSS), a parenting intervention developed to incorporate the most successful strategies used by parenting and child development specialists, while drawing on the strengths, unique parental strategies, and processes inherent in Black families (e.g., racial socialization). Interested in how BPSS fairs when implemented in less controlled settings (real-world contexts), BPSS was subsequently evaluated via an effectiveness study (Coard et al., ), which provided additional support for the feasibility and receptibility of the BPSS program and highlighted the potential effectiveness. We describe the process undertaken as part of the effectiveness study to evaluate BPSS and describe its “real-world” implementation across multiple community centers/settings servicing Black/African American families. Informed by a community-based participatory approach, we (a) provide the rationale for and an overview of the BPSS, (b) describe the translational process in implementing BPSS, (c) outline lessons learned, and (d) summarize the recommendations for practitioners’ use of BPSS.
from
Part I
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The Philosophy and Methodology of Experimentation in Sociology
Davide Barrera, Università degli Studi di Torino, Italy,Klarita Gërxhani, Vrije Universiteit, Amsterdam,Bernhard Kittel, Universität Wien, Austria,Luis Miller, Institute of Public Goods and Policies, Spanish National Research Council,Tobias Wolbring, School of Business, Economics and Society at the Friedrich-Alexander-University Erlangen-Nürnberg
Sociology is a science concerning itself with the interpretive understanding of social action and thereby with a causal explanation of its course and consequences. Empirically, a key goal is to find relations between variables. This is often done using naturally occurring data, survey data, or in-depth interviews. With such data, the challenge is to establish whether a relation between variables is causal or merely a correlation. One approach is to address the causality issue by applying proper statistical or econometric techniques, which is possible under certain conditions for some research questions. Alternatively, one can generate new data with experimental control in a laboratory or the field. It is precisely through this control via randomization and the manipulation of the causal factors of interest that the experimental method ensures – with a high degree of confidence – tests of causal explanations. In this chapter, the canonical approach to causality in randomized experiments (the Neyman–Rubin causal model) is first introduced. This model formalizes the idea of causality using the "potential outcomes" or "counterfactual" approach. The chapter then discusses the limits of the counterfactual approach and the key role of theory in establishing causal explanations in experimental sociology.
Charisma, often seen as an innate trait, is now understood as leader signaling grounded in values, symbols, and emotions, suggesting it can be developed through interventions. However, the method for cultivating charisma remains unclear. This study examines nonverbal communication strategies, highlighting the potential of body language, facial expressions, and vocal modulation to enhance charisma. Additionally, we introduce a virtual reality training program focused on these cues and explore the role of audience presence in boosting the intervention’s effectiveness by fostering self-awareness and behavioral adjustments. Results of a controlled randomized experiment with virtual reality-trained participants and online charisma assessors demonstrated significant improvements in observer-rated charisma from pre- to post-training compared to the control group. Moreover, training in front of a virtual audience yielded the expected outcomes. This study sheds light on charisma theory, its potential virtual reality training application, and its implications for leadership development.
We have previously demonstrated that calcium plus vitamin D supplementation during adolescent pregnancy reduces the magnitude of transient postpartum bone mass loss. In the present post hoc analysis, we further investigated the effect of calcium plus vitamin D supplementation during pregnancy in hip geometry throughout one year postpartum in Brazilian adolescents with low daily calcium intake (∼600 mg/d). Pregnant adolescents (14–19 years) were randomly assigned to receive calcium (600 mg/d) plus vitamin D3 (200 μg/d) or a placebo from 26 weeks of gestation until parturition. Dual-energy X-ray absorptiometry images were obtained at 5 (n 30 and 26 for calcium plus vitamin D and placebo, respectively), 20 (n 26 and 21) and 56 (n 18 and 12) weeks postpartum, and hip geometry parameters were analysed by Advanced Hip Assessment software. The effects of the intervention, time point and their interaction were assessed using repeated-measures mixed-effects models. No significant intervention effects or intervention × time interactions were observed on hip geometry parameters (P > 0·05). Time effects were observed in cross-sectional area, cross-sectional moment of inertia and section modulus parameters with decreases from the 5th to the 20th week postpartum followed by recovery from the 20th to the 56th week (P < 0·05). Our findings indicate that the postpartum period is associated with transient changes in the hip geometry of lactating adolescent mothers, regardless of the low calcium intake and the supplementation offered during pregnancy, suggesting that a physiological adaptation of these adolescents to low calcium intake is at play.
This study aimed to assess feasibility, acceptability and potential for impact of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA), a co-designed intervention for pregnant adolescents in Malawi. We used a mixed-methods interventional pre-post cohort design. We recruited pregnant adolescents from a rural health centre in Zomba district, Malawi, all of whom were offered a five-session psychosocial intervention delivered by community healthcare workers. Quantitative feasibility indicators related to participant enrolment, session attendance and intervention completion. Feasibility of intervention delivery was explored using in-depth semi-structured interviews with healthcare workers. Acceptability was investigated through in-depth semi-structured interviews with intervention participants and a service user satisfaction questionnaire. Intervention outcomes were assessed using standardised measures of common mental disorders, financial distress and poor mental health and perceived social support. 19 adolescents aged 15–19 years (mean=17.21, SD=1.18) started the intervention, with 18 (94.7%) completing the programme. Significant improvements (p<0.05) were reported across all outcome measures, with moderate to high pre-post effect sizes. Intervention participants reported high levels of service satisfaction, although healthcare workers (n = 6) reported that some feasibility challenges emerged during recruitment and delivery. The FOR MAMA intervention proved to be an acceptable and feasible psychosocial intervention for pregnant adolescents in Malawi.