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BACKGROUND: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. PURPOSE: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. METHODS: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. RESULTS: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. CONCLUSION: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

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Objetivo: Descrever as experiências vivenciadas durante o processo de capacitação em Metas Internacionais de Segurança do Paciente focada em comunicação efetiva, realizada pelas bolsistas do PET-Saúde, para profissionais de um hospital especializado, visando estimular a formação de profissionais e docentes de elevada qualificação técnica, científica, tecnológica e acadêmica, além de praticar a indissociabilidade entre ensino, pesquisa e extensão, preconizado pelo MEC. Método: Trata-se de um relato de experiência com abordagem qualitativa e descritiva sobre atividades de educação em saúde realizadas na instituição. Resultados: As trocas de experiência entre bolsistas do PET-Saúde e profissionais da saúde, a identificação das limitações a respeito da comunicação efetiva na unidade e dificuldades no trabalho em equipe multiprofissional. Conclusão: Reafirma a importância da cultura de segurança do paciente entre os profissionais e a importância da aproximação entre instituições acadêmicas e as que promovem cuidados em saúde

Objective: To describe the experiences lived during the training process on International Patient Safety Goals focused on effective communication, carried out by PET-Saúde fellows, for professionals of a specialized hospital, aiming to stimulate the training of professionals and teachers with high technical qualification, scientific, technological and academic, in addition to practicing the inseparability between teaching, research and extension, recommended by the MEC. Method: This is an experience report with a qualitative and descriptive approach on health education activities carried out at the institution. Results: The exchange of experiences between PET-Health fellows and health professionals, the identification of limitations regarding effective communication in the unit and difficulties in working in a multidisciplinary team. Conclusion: It reaffirms the importance of a patient safety culture among professionals and the importance of approximation between academic institutions and those that promote health care

Objetivo: Describir las experiencias vividas durante el proceso de formación sobre Objetivos Internacionales de Seguridad del Paciente enfocados en la comunicación efectiva, realizado por becarios PET-Saúde, para profesionales de un hospital especializado, con el objetivo de estimular la formación de profesionales y docentes con alta calificación técnica. Científico, tecnológico y académico, además de practicar la inseparabilidad entre docencia, investigación y extensión, recomendada por el MEC. Método: Se trata de un relato de experiencia con abordaje cualitativo y descriptivo sobre las actividades de educación en salud realizadas en la institución. Resultados: El intercambio de experiencias entre los becarios del PET-Salud y los profesionales de la salud, la identificación de las limitaciones en cuanto a la comunicación efectiva en la unidad y las dificultades para trabajar en un equipo multidisciplinario. Conclusión: Se reafirma la importancia de una cultura de seguridad del paciente entre los profesionales y la importancia de la aproximación entre las instituciones académicas y las que promueven el cuidado de la salud.

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Objetivo: analisar o nível de compreensão dos estudantes de graduação em enfermagem, medicina e direito sobre o erro assistencial e a sua relação com a segurança do paciente. Metodologia: estudo quantitativo com delineamento transversal, realizado com 117 estudantes de uma universidade federal do sul do Brasil. A coleta de dados foi realizada através da aplicação da Escala do Erro Assistencial, elaborada e validada pelos autores do estudo. A análise dos dados foi realizada com auxílio de software estatístico, por meio da estatística descritiva e teste Kruskal-Wallis, com realização do post hoc, para verificar diferenciação de respostas dos três grupos de estudantes pesquisados. Resultados: em comparação com os demais cursos do estudo, os estudantes de enfermagem mostraram maior desenvolvimento sobre os pilares que favorecem a cultura de segurança do paciente. Conclusão: faz-se necessário a abordagem das questões referentes ao erro assistencial nos cursos pesquisados visando aprimorar a assistência e realizando um cuidado de qualidade.

Objective: to analyze the level of understanding of undergraduate students in nursing, medicine and law about care errors and their relationship with patient safety. Methods: Quantitative study with a cross-sectional design, conductedwith 117 students from a Federal University of Southern Brazil. Data collection was performed through the application of the Assistance Error Scale, elaborated,and validated by the study authors. Data analysis was performed with the aid of statistical software, using descriptive statistics and the Kruskal-Wallis test, with post hoc performance, to verify differentiation of responses of the three groups of students surveyed. Results: In comparison with the other courses in the study, nursing students showed greater development on the pillars that favor the patient safety culture. Conclusion: As a result, it is necessary to address issues related to care errors in the courses surveyed toimprove care and provide quality care.

Objetivo: analizar el nivel de comprensión de los estudiantes de pregrado en enfermería, medicina y derecho sobre los errores asistenciales y su relación con la seguridad del paciente. Metodología: Estudio cuantitativo con un diseño transversal, realizado con 117 estudiantes de una Universidad Federal del Sur de Brasil. La recolección de datos se realizó mediante la aplicación de la Escala de Error de Asistencia, elaborada y validada por los autores del estudio. El análisis de los datos se realizó con ayuda de software estadístico, utilizando estadística descriptiva y la prueba de Kruskal-Wallis, con pruebas post hoc, para verificar la diferenciación en las respuestas de los tres grupos de estudiantes encuestados. Resultados: En comparación con los demás cursos del estudio, los estudiantes de enfermería mostraron un mayor desarrollo en los pilares que favorecen la cultura de seguridad del paciente. Conclusión: Como resultado, es necesario abordar las cuestiones relacionadas con los errores de atención en los cursos encuestados para mejorar la atención y brindar una atención de calidad.

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Objetivo: evaluar la percepción de los estudiantes sobre un modelo educativo basado en simulación, en una escuela de medicina privada ubicada en Medellín, Colombia, respecto a su capacidad para desempeñarse en escenarios clínicos reales. Materiales y métodos: estudio transversal. La muestra fueron estudiantes de medicina del IV al XIII período académico. Los datos se recolectaron en fuentes primarias, mediante el diseño y aplicación de un cuestionario. Resultados: la muestra incluyó 300 estudiantes durante sus prácticas clínicas y pasantías y la edad promedio fue de 21,9 años. El 68,3% (n = 205) de la muestra eran mujeres. Se evaluó el nivel de satisfacción con la experiencia de usar simulación clínica; el 65,3% (n = 196) describió la experiencia como satisfactoria, el 2% (n = 6) y el 23% (n = 69) como insatisfactoria y moderadamente satisfactoria respectivamente; los participantes restantes 9,7% (n = 29) describieron la experiencia como totalmente satisfactoria. En cuanto a la percepción de las competencias desarrolladas bajo el modelo educativo se destacan el razonamiento clínico, 98% (n = 294) y la toma de decisiones, 95% (n = 285). Conclusión: los estudiantes encuestados percibieron que la simulación facilita el aprendizaje al posibilitar el desarrollo de habilidades como el trabajo en equipo y la comunicación, lo que genera un alto grado de satisfacción en los estudiantes con respecto a su proceso de formación..(Au)

Objective: to assess perception of the students on a simulation-based educational model, in a private medical school located at the municipality of Medellín, Colombia, regarding with their ability to perform in real clinical scenarios. Materials and methods: a cross sectional study. Sample were medical students from IV to the XIII academic period. Data was collected from primary sources, through the design and application of a questionnaire. Results: the sample included were 300 students during their clinical practices and clerkship, the mean age was 21.9 years. 68.3% (205) of the sample were female. We assess the level of satisfaction with the experience of using clinical simulation; 65.3% (n=196) described the experience as satisfactory, 2% (n=6) and 23% (n=69) as unsatisfactory and moderately satisfactory respectively; remaining participants described the experience as full satisfactory. Regarding the perception of the competences developed under the simulation-based education model, the main ones were 98% (n=294) clinical reasoning and 95% (n=285) decision making. Conclusion: surveyed students perceived that simulation facilitates learning by making possible the development of skills such as teamwork and communication, which generates a high degree of satisfaction in students regarding their training process..(Au)

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BACKGROUND: Oral anticoagulant drugs represent an essential tool in the prevention of thromboembolic events. The ones in widespread use are vitamin K antagonists, whose plasma level is monitored by measuring prothrombin time using the international normalized ratio. If its values are out of the recommended range, the patient will have a higher risk of suffering from thromboembolic or hemorrhagic complications. Previous research has shown that approximately 33% of patients keep having values at an inappropriate level. The purpose of the proposed study is to improve the international normalized ratio control results by a joint didactic intervention based on the Junta de Andalucía School for Patients method that will be implemented by anticoagulated patients themselves. METHODS: A randomized controlled trial will be undertaken at primary care centers from one healthcare area in Málaga (Andalusia, Spain). STUDY POPULATION: patients participating in an oral anticoagulant therapy program of vitamin K antagonists. First step: identification of patients in the oral anticoagulation therapy program with international normalized ratio control of the therapeutic level at 65% or less over total time. Second step: patients with international normalized ratio (INR) control figures under 2 or above 3 will be assigned to two different groups: Group 1 or joint intervention group: patients will be instructed in the joint didactic "from peer to peer," by a previously trained and expert anticoagulant patient. Group 2 or control group: the control group will receive the usual clinical practice. They will be evaluated by nurses about once a month, except for cases in which their INR figures are under 2 or above 3, and those patients will be evaluated more frequently. A total of 312 individuals will be required (156 in each group) to detect differences in INR figures equal to or higher than 15% between the groups. STUDY VARIABLES: time on therapeutic levels before and after the intervention; sociodemographic variables; vital signs; the existence of cardiovascular risk factors or accompanying diseases in the clinical records; laboratory test including complete blood counts, bleeding time, and prothrombin time or partial thromboplastin time; and blood chemistry, other prescribed drugs, and social support. A quasi-experimental analytic study with before-after statistical analysis of the intervention will be conducted. Linear regression models will be applied for the main variable results (international normalized ratio value, time on therapeutic level) inputting sociodemographic variables, accompanying diseases, and social support. TRIAL REGISTRATION: ClinicalTrials.gov NCT03647254 . Registered on 27 August 2018.

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Objetivo: Sintetizar o conhecimento disponível na literatura nacional e internacional sobre as competências desenvolvidas na durante a formação em Enfermagem com ênfase na segurança do paciente. Método: revisão integrativa da literatura realizada nas bases de dados eletrônicas Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science e Medline, que incluiu estudos publicados no período de 2012 a 2018. Resultados: Foram identificados 19 artigos, que desvelaram as competências como identificação, notificação, prevenção e gerenciamento de eventos, controle de infecção, trabalho em equipe, comunicação efetiva, utilização de evidências, informação, agir ético, liderança, aprendizagem contínua e compreensão humana. Conclusão: Os estudos analisados revelam as competências desenvolvidas durante a formação em Enfermagem com ênfase na segurança do paciente têm sido pouco abordadas no processo formativo, configurando-se na necessidade de reforma inovadora.

Objective: To synthesize the knowledge available in national and international literature on the skills developed during nursing education with an emphasis on patient safety. Method: integrative literature review carried out in the electronic databases Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science and Medline, which included studies published from 2012 to 2018. Results: 19 articles were identified, who unveiled competences such as identification, notification, prevention and management of events, infection control, teamwork, effective communication, use of evidence, information, ethical action, leadership, continuous learning and human understanding. Conclusion: The studies analyzed reveal the skills developed during nursing training with an emphasis on patient safety have been little addressed in the training process, configuring the need for innovative reform.

Objetivo: Sintetizar los conocimientos disponibles en la literatura nacional e internacional sobre las habilidades desarrolladas durante la formación en enfermería con énfasis en la seguridad del paciente. Método: revisión integradora de la literatura realizada en las bases de datos electrónicas Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science y Medline, que incluyó estudios publicados entre 2012 y 2018. Resultados: Se identificaron 19 artículos, quien develó competencias como identificación, notificación, prevención y gestión de eventos, control de infecciones, trabajo en equipo, comunicación efectiva, uso de evidencia, información, acción ética, liderazgo, aprendizaje continuo y entendimiento humano. Conclusión: Los estudios analizados revelan que las habilidades desarrolladas durante la formación en enfermería con énfasis en la seguridad del paciente han sido poco abordadas en el proceso formativo, configurando la necesidad de una reforma innovadora

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OBJECTIVE: To determine the effectiveness of simulation method in nursing education. . METHODS: The experimental study was conducted from February 2013 to January 2014 at the Nursing Faculty of Ege University, Izmir, Turkey, and comprised second-year students. The subjects were randomly assigned to experimental or control groups. The experimental group participated in a simulation laboratory that involved the use of a standardized patient. Data was collected and analysed using SPSS 20. RESULTS: Of the 66 subjects, with a mean age of 20}1.05 years, 62(93.9%) were females and 4(6.1%) were males. There were 32(48.5%) subjects in the experimental group and 34(51.5%) in the control group. There was no statistically significant difference between the groups in the mean scores obtained on the pretest, posttest ( and retention test (p>0.05 each). However, experimental group had higher mean retention test scores (1.90}1.96). CONCLUSIONS: The knowledge levels of both groups increased, but lack of significant difference between the scores shows that both methods are successful.

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BACKGROUND: Fast track arthroplasty is becoming increasingly accepted in German-speaking countries. By optimizing treatment processes fast track programs promise faster recovery, increased patient satisfaction, quality improvement and reduction in the length of hospital stay. OBJECTIVES: The philosophy and treatment principles of fast track hip arthroplasty during the pre, intra and postoperative phase are described in the light of the current body of evidence. The challenges concerning fast track arthroplasty within the German health system are discussed. MATERIAL AND METHODS: Besides presenting our own data concerning a patient seminar and an opiate saving pain treatment, the most relevant literature related to fast track hip arthroplasty from a pubmed search is discussed. RESULTS: Fast track concepts can only be successfully implemented through close interdisciplinary team work. Preoperatively, a patient seminar can help to prepare patients better for surgery. Postoperatively, early mobilisation and pain treatment play a central role, whereat a clear reduction in opiate application can be achieved. CONCLUSION: Fast track hip arthroplasty makes rethinking with respect to traditional treatment principles necessary and demands a high degree of interdisciplinary team work. Particularly, as result of the specifics of the health system (DRG system and stationary rehabilitation), a nationwide establishment in Germany has not taken place so far.

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Introdução: Infecções Relacionadas à Assistência à Saúde são eventos adversos que constituem riscos à segurança do paciente. O ambiente contribui na cadeia de transmissão de infecção, portanto, limpeza e desinfecção de superfícies contaminadas podem evitar a disseminação de microrganismos. Objetivo: Descrever a experiência da "Campanha de Limpeza e Desinfecção das Áreas Próximas ao Paciente" realizada entre os anos 2016­2017 pela Vigilância Sanitária de Porto Alegre e pela Comissão Municipal de Controle de Infecção. Método: Relato de experiência sobre ação educativa promovida pela Vigilância Sanitária de Porto Alegre direcionada a 27 hospitais do município. População alvo foi composta por profissionais de enfermagem. Utilizou-se a ferramenta de gestão Ciclo PDCA para conduzir a ação. Resultados: Elaborados materiais educativos como instrumentos de apoio. A implementação da campanha com ações educativas ocorreu em junho de 2017 e contou com a adesão de 20 hospitais. Constituiu-se em estratégia coletiva que aprimorou e potencializou o aprendizado no cotidiano do trabalho em saúde através de diferentes abordagens didáticas. Conclusões: A maioria dos hospitais do município participou das ações promovidas pela campanha direcionada à segurança hospitalar por meio de ações educativas diversificadas, voltadas à adesão às medidas de prevenção de agravos. A iniciativa promoveu integração da Vigilância Sanitária com os serviços e contribuiu para o fortalecimento da qualidade e segurança do paciente e profissionais.

Introduction: Health Care-Related Infections are adverse events that pose risks to patient safety. The environment contributes to the infection transmission chain, therefore, cleaning and disinfection of contaminated surfaces can prevent the spread of microorganisms. Objective: To describe the experience of the "Campaign for Cleaning and Disinfection of the Areas in the immediate vicinity of the Patient" carried out between 2016 and 2017 by the Porto Alegre Sanitary Surveillance and the Municipal Infection Control Commission. Method: Experience report on educational action promoted by the Sanitary Surveillance of Porto Alegre directed to 27 hospitals in the municipality. Target population were nursing professionals. The PDCA (plan-do-check-act) Cycle management tool was used to carry out the action. Results: Elaborated educational materials as instruments of support. The implementation of the campaign with educational actions occurred in June 2017 with the participation of 20 hospitals. It was a collective strategy that improved and enhanced learning in the daily work of health through different didactic approaches. Conclusions: Most of the hospitals in the municipality participated in the actions promoted by the hospital safety campaign, through diversified educational actions, aimed at adhering to the measures to prevent injuries. The initiative promoted the integration of Sanitary Surveillance with services and contributed to the strengthening of quality safety of patients and professionals.

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Este artigo buscou investigar sobre a percepção de residentes, preceptores e tutores da Residência Multiprofissional em Atenção à Saúde (RMAS) sobre as aprendizagens compartilhadas na formação para o trabalho em equipe de profissionais da saúde. Utilizou-se uma metodologia exploratória, descritivo-analítica, tipo corte transversal com abordagem quantitativa. A pesquisa foi realizada junto a residentes egressos, preceptores e tutores do Programa de RMAS, por intermédio de uma escala atitudinal validada estatisticamente. A escala apresentou 95,24% de asserções validadas e um coeficiente de confiabilidade de 93%. Como resultados foram apresentados os dados referentes à análise das respostas ao instrumento de avaliação, compreendendo a dimensão 1 - Aprendizagem Compartilhada na Residência Multiprofissional. Adotou-se também a formação profissional como eixo de análise. No entanto, não houve diferenças significativas entre as profissões sobre a aprendizagem compartilhada na RM, sendo a pior percepção dos enfermeiros e a melhor de fisioterapeutas e nutricionistas. A média das asserções da escala atitudinal foi de 3,20, classificadas em zona de conforto. Entretanto, aspectos divergentes nas respostas entre os participantes da pesquisa explicitam a importância de discutir elementos que compõem a formação que contempla a educação interprofissional. Conclui-se que a RMAS é um espaço de aprendizagens compartilhadas que desenvolve habilidades nos profissionais de saúde, para trabalharem em equipe a partir da educação interprofissional. A escala atitudinal validada estatisticamente também deve ser ressaltada, dada a importância de avaliar a aprendizagem e melhorar continuamente os processos formativos na Residência Multiprofissional, considerando inclusive a possibilidade de ser utilizada em outros Programas.

This article intended to investigate about the perception of the residents, preceptors and tutors of the Multiprofessional Healthcare Residency about the shared learning in training for teamwork of health professionals. An exploratory research was conducted, with descriptive and analytical nature, cross-sectional type, and a quantitative. The research was conducted of the Health Care Multiprofessional Residency of Baixada Santista campus, considering graduate residents, preceptors and tutors, through a Likert-type attitudinal scale validated by statistical methodology. The scale has presented 95.24% of validated assertions (only one loss) and a reliability coefficient of 93%. As results were presented the data regarding the analysis of the answers to the evaluation instrument, comprising the dimension 1 - Shared Learning in Multiprofessional Residence. Vocational training was also adopted as the axis of analysis, but there were no significant differences between the professions on shared learning in Multiprofessional Residency, with the worst perception of nurses and the best of physiotherapists and nutritionists. The average of the attitudinal scale assertions was 3.20, classified as a comfort zone. However, divergent aspects in the answers among the participants of the research explain the importance of discussing elements that make up the training that contemplates interprofessional education. The respondents' behavior shows that the Health Care Multiprofessional Residency is a space for shared learning, which develops skills for the health-care professionals to work in teams, starting with the interbranch education. The attitudinal scale statistically validated, product of this research, must also be highlighted, given the importance of evaluating learning and of continuously improving the formation processes in the Multiprofessional Residency, also considering the possibility that this scale might be used in other Programs.

Este artículo tiene como objetivo investigar la percepción de los residentes, los preceptores y tutores de la Residencia Multidisciplinaria, en la atención sanitaria en el aprendizaje compartido en la formación del trabajo en equipo de profesionales de la salud. Se utilizó una metodología de estudio exploratorio, descriptivo, analítico, transversal, con enfoque cuantitativo. Se realizó la encuesta con graduados residentes, preceptores y tutores del programa MRHC, a través de una escala de actitud validada estadísticamente. La escala demostró 95,24% de los reclamos validados y un coeficiente de confianza del 93%. En los resultados se presentaron los datos sobre el análisis de las respuestas a la herramienta de evaluación que comprenden la escala 1 ­ residencia multi-aprendizaje compartido. También se señaló la formación profesional como un eje de análisis. Sin embargo, no hubo diferencias significativas entre las profesiones de aprendizaje compartido en RM, con la peor percepción de las enfermeras y los mejores fisioterapeutas y nutricionistas. Las declaraciones de actitud de escala media fue de 3,20, clasificado en la zona de confort. No obstante, los aspectos divergentes en las respuestas entre los participantes de la investigación explican la importancia de discutir los elementos que componen la formación que incluye la educación interprofesional. El MRHC es un espacio de aprendizaje compartido que se desarrolla en las habilidades profesionales de la salud para trabajar en equipo, de la educación interprofesional.

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OBJETIVOS: Descrever os resultados do processo de tradução e retrotradução do questionário TeamSTEPPS® para o português brasileiro. Esse questionário norte americano tem sido utilizado mundialmente como uma ferramenta útil para o ambiente de simulação com finalidade avaliativa com o objetivo de melhorar a segurança do paciente dentro das organizações de saúde com base na efetiva comunicação e trabalho em equipe. MÉTODOS: A metodologia adotada foi a tradução e retrotradução com posterior análise semântica por docentes experientes em avaliações práticas em saúde. RESULTADOS: O instrumento traduzido demonstrou possuir formato simples e fácil leitura e compreensão ao ser analisado pelos autores, docentes e tradutores, não gerando nenhum tipo de discrepância em seus itens. Na análise posterior pelos docentes, demonstrou-se que os itens eram relevantes e claros para o uso na realidade brasileira. CONCLUSÕES: Todos os passos do processo de tradução e retrotradução foram realizados com sucesso, finalizando o instrumento de avaliação de trabalho em equipe TeamSTEPPS® em português brasileiro. O processo de tradução e consequente adaptação de qualquer instrumento é complexo e não termina na equivalência linguística. Desta forma, a segunda fase deste trabalho será a aplicação do instrumento em cenários simulados com foco no treinamento de equipes, para refazer dados de análises psicométricas no contexto educacional e análise de equivalência semântica.

AIMS: To describe the results of translation and back-translation of the TeamSTEPPS® questionnaire to Brazilian Portuguese. This North American questionnaire has been used globally as an useful tool in simulation environment with evaluation intent, aiming at improving patient safety inside health settings, based on effective communication and teamwork. METHODS: The adopted methodology consisted in translation and back-translation, with subsequent semantic analysis by experienced professors in health practice evaluations. RESULTS: The translated tool showed a simple format and easy interpretation and understanding when analyzed by authors, professors and translators, and does not generate any kind of discrepancy in their items. In the subsequent analysis by the professors, it was shown that the items were relevant and clear to the Brazilian reality. CONCLUSIONS: All the steps of the translation and back-translation process were carried out successfully, finalizing the TeamSTEPPS® teamwork assessment tool in Brazilian Portuguese. The translation process of any tool is complex, and does not end in the linguistic equivalence. Therefore, a second step of this work will be the application of this scale in simulated scenarios focused in teamwork training, to retrace data on psychometric analyses in the educational context and semantic equivalence analyses.

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A gap in information about pediatric clinical trials exists, and parents remain uncertain about what is involved in research studies involving children. We aimed to understand parent perspectives about pediatric clinical research after viewing the online Children and Clinical Studies (CaCS) program. Using a qualitative descriptive study design, we conducted focus groups with parents and phone interviews with physicians. Three themes emerged providing approaches to improve parent's understanding of clinical research by including strategies where parents (a) hear from parents like themselves to learn about pediatric research, (b) receive general clinical research information to complement study-specific details, and (c) are provided more information about the role of healthy child volunteers. Parents found the website a valuable tool that would help them make a decision about what it means to participate in research. This tool can assist parents, providers, and researchers by connecting general information with study-specific information.

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Exercise-based cardiac rehabilitation (CR) programs help patients with coronary heart disease (CHD) reduce their risk of recurrent cardiac illness, disability, and death. However, men with CHD and Type 2 diabetes mellitus (T2DM) demonstrate lower attendance and completion of CR despite having a poor prognosis. Drawing on gender and masculinity theory, we report on a qualitative study of 16 Canadian diabetic men recently enrolled in CR. Major findings reflect two discursive positions men assumed to regain a sense of competency lost in illness: (a) working with the experts, or (b) rejection of biomedical knowledge. These positions underscore the varied and sometimes contradictory responses of seriously ill men to health guidance. Findings emphasize the priority given to the rehabilitation of a positive masculine identity. The analysis argues that gender, age, and employment status are powerful mechanisms of variable CR participation.

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We conducted this qualitative study to explore children's and adolescents' perspectives about diabetes self-care, their knowledge of diabetes, and their emotions associated with having the disease. Drawing on the new sociological approach that acknowledges children's competence in discussing complex issues that concern them, we conducted individual interviews with a cross-sectional sample of 48 patients between the ages of 5 and 18 years. We recruited participants from a diabetes outpatient clinic within a large pediatric hospital in one of Canada's major urban centers. In this article, we present data from the following major themes: self-care, knowledge, and emotions. Through an in-depth analysis of these integrated themes, we offer validation that emotional support, along with disease education, provides supportive conditions for engaging in self-care and a process of acceptance.

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The Expert Patients Program (EPP), an educational intervention for chronic diseases aimed at nonprofessionals, has high nonparticipation and dropout rates. We used quantitative and qualitative methods to identify the prevalence of and reasons for nonparticipation in 100 patients with acute myocardial infarction and 69 with stroke. We confirmed a high prevalence of refusal, identifying three groups based on degree of participation: patients who refused to attend (51%), patients who attended and then dropped out (10%), and patients who attended (39%). Patients who refused to participate or dropped out were mainly women and former/current smokers with a better-than-average physical condition. In addition, they were invited to participate in the EPP long after their cardiovascular event. We found that the degree of participation depended upon the patient's individual and social context and the professional profile of the recruiter. Therefore, tailored strategic interventions should be designed for each type of participation.

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The transition from parent-controlled care to self-managed care represents an important challenge for adolescents with chronic conditions. We sought to gain a deeper understanding of the factors influencing the internalization of motivation to self-care in adolescent liver transplant recipients. We conducted a qualitative study using in-depth interviews with 18 young patients. We triangulated the data collected from the patients with data from parents and health care providers, and used an inductive approach to analyze the data. Our results illustrate three interrelated challenges that impact on young patients' motivation to self-care: (a) the cognitive challenge of fully understanding one's condition and personal health risks; (b) the behavioral challenge of developing independence regarding self-management issues; and (c) the psychological challenge of building a sense of self-ownership and purpose. The latter involves overcoming the trauma of survival and coming to terms with feelings of obligation, two challenges inherent to transplantation that warrant further investigation.

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Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.

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In this article, we present a qualitative exploration of the psychological and communication processes that occur within an intervention to improve self-care for people with asthma. In the context of a primary-care-based trial of the intervention, we collected data at three time points for 21 patients, comprising 2 audiotaped consultations (nurse and patient together) and individual semistructured interviews 3 months after the second consultation. Using framework analysis, we identified both psychological processes (illness understanding, affective response to asthma, and reasoned motivation) and patient-provider interactions (active patient involvement and individual tailoring). We use these findings to extend and refine the pre-existing theoretical model of behavior change underpinning the intervention, in particular with relation to patient-provider interaction processes. We conclude that it is important for developers and providers of asthma self-care interventions to attend to the style of delivery as well as the behavior change techniques involved.

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