Browsing by Author "West, Andrew"

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    Clinical Simulation-Based Assessment in Respiratory Therapy Education
    (2017) West, Andrew; Parchoma, Gale; Koh, Kim; Kim, Beaumie; Sharma, Nishan
    The manuscripts that comprise this dissertation collectively investigate clinical simulation-based assessment in respiratory therapy education. Clinical simulation, characterized by debriefing that engages learners in self- and collaborative peer-assessment in addition to formative instructor assessment, is a well-established set of practices in respiratory therapy education. Contextual factors within the profession of respiratory therapy in Canada, in particular its regulatory environment, are prompting a move from using formative debriefing sessions that support learning in simulation, to employing high-stakes testing intended to assess entry-to-practice competencies. There exists a need for the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments. It is proposed that several important social elements of the clinical simulation-based learning environment, including trust, ontological security, and fidelity, may be at risk in the face of the evolving assessment practices in health professions education. As an at once undertheorized yet highly technologically enhanced and connected approach to learning, a shift towards socio-cultural perspectives on clinical simulation assessment, research, and practice is needed to better understand the social phenomena inherent in clinical simulation. This shift can benefit from the adoption of networked learning theory to encourage deeper understanding of the interrelationships that exist among sociomaterial dimensions of clinical simulation. The findings of a qualitative case study are presented, examining the experiences of respiratory therapy students in clinical simulation learning environments where comparable instructional designs are characterized by differences between two important assessment approaches used in the field: formative debriefing for learning and summative debriefing for high-stakes testing. The findings indicate that social aspects of participants’ experiences in clinical simulation are characterized by: their comfort levels, their senses of ontological security, and their degrees of immersion in the simulation. Each of these experiential dimensions were impacted in some manner by the assessment design, a phenomenon that was further modulated by individuals’ self-reflexive capacity. These phenomena appear to coalesce to impact learners’ perceptions of their own performance in the clinical simulation context, which was also related to the approach to assessment built into in the instructional design.
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    Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review
    (2024-08-15) Krewulak, Karla D.; Jaworska, Natalia; Lee, Laurie; Louis, Julia S.; Dmitrieva, Olesya; Leia, Madison P.; Doig, Christopher; Niven, Daniel J.; Parhar, Ken K. S.; Rochwerg, Bram; West, Andrew; Stelfox, Henry T.; Leigh, Jeanna P.; Fiest, Kirsten M.
    Abstract Background We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. Methods We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. Results We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. Conclusion This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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    Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review
    (2021-09-25) Moss, Stephana J.; Krewulak, Karla D.; Stelfox, Henry T.; Ahmed, Sofia B.; Anglin, Melanie C.; Bagshaw, Sean M.; Burns, Karen E. A.; Cook, Deborah J.; Doig, Christopher J.; Fox-Robichaud, Alison; Fowler, Robert; Hernández, Laura; Kho, Michelle E.; Kredentser, Maia; Makuk, Kira; Murthy, Srinivas; Niven, Daniel J.; Olafson, Kendiss; Parhar, Ken K. S.; Patten, Scott B.; Rewa, Oleksa G.; Rochwerg, Bram; Sept, Bonnie; Soo, Andrea; Spence, Krista; Spence, Sean; Straus, Sharon; West, Andrew; Parsons Leigh, Jeanna; Fiest, Kirsten M.
    Abstract Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.