Technology readiness is a well-established construct that refers to individuals' ability to embrace and adopt new technology. Given the increasing use of advanced technologies in the delivery of health care, this study uses the Technology Readiness Index (Parasuraman, 2000) to explore the technology readiness of nursing and medical students from the fall 2006 cohort at Memorial University of Newfoundland. The three major findings from this study are that (i) rural nursing students are more insecure with technology than their urban counterparts, (ii) male medical students score higher on innovation than their female counterparts and have a higher overall technology readiness attitude than female medical students, and (iii) medical students who are older than 25 have a negative technology readiness score whereas those under 25 had a positive score. These findings suggest health care professional schools would be well served to implement curricular changes designed to support the needs of rural students, women, and those entering school at a non-traditional age. In addition, patterns such as those observed in this study highlight areas of emphasis for current practitioners as health care organizations develop continuing education offerings for staff.

BackgroundPatient satisfaction is an important element of quality improvement and patient-centered care, and is an indicator of the public’s confidence in the health care system. Although shorter wait times are believed intuitively to lead to higher satisfaction, studies have demonstrated the importance of many other factors which contribute to patients’ satisfaction with their wait time experiences. The current study explores the factors that shape patients’ satisfaction with their overall wait times (i.e. from symptom to treatment).MethodsWe conducted qualitative interviews with 60 breast, prostate, lung, or colorectal cancer patients to examine the reasons behind patients’ satisfaction or dissatisfaction with their wait time experiences. We purposefully recruited satisfied and unsatisfied participants from our larger survey sample. Using a semi-structured interview guide, patients were asked about their wait time experiences and the reasons behind their (dis)satisfaction. Interviews were transcribed verbatim and coded using a thematic approach.ResultsPatients’ perceptions of satisfaction with wait times were influenced by three interrelated dimensions: the interpersonal skills of treating physicians (which included expressions/demonstrations of empathy and concern, quality of information exchange, accountability for errors), coordination (which included assistance navigating the health system, scheduling of appointments, sharing information between providers, coordination in scheduling appointments, and sharing of information ), and timeliness of care (which referred to providers’ responsiveness to patients’ symptoms, coverage during provider absences, and shared sense of urgency between patient and providers). Providers’ willingness to “trouble shoot” and acknowledge errors/delays were particularly influential in patients' overall perception of their wait times.ConclusionsWe described three dimensions of wait-related satisfaction: physicians’ interpersonal skills, coordination of care, and timeliness of care, which are often interrelated and overlapping. Furthermore, while patients wait-related satisfaction was typically based on multiple interactions with different providers, positive or negative experiences with a single provider, often (but not always) the family physician, had a substantial impact on the overall satisfaction or dissatisfaction with wait time experiences. The findings provide a conceptual basis for the development of validated instruments to measure wait time-related patient satisfaction.

The objectives of the present study were to examine the factors that parents identify as promoting or hindering participation in Sure Start programmes, and to identify methods for enhancing parents' engagement with Sure Start. A qualitative, in-depth interview study was conducted with parents registered with two local Sure Start programmes based in the East Midlands, UK, and located in inner city areas with a range of health and social problems associated with social exclusion and disadvantage. Sixty parents, guardians or carers of children living in both Sure Start areas were recruited during autumn of 2004 on the basis of whether they were identified as a 'frequent user' or 'non-frequent user' of Sure Start services. The data were analysed using a thematic approach supported by NVivo computer software, and explanatory themes were subsequently tested for completeness and adequacy. The results of the study indicated that parents who used Sure Start services were positive about the benefits that they obtained for themselves and their children, in particular in overcoming a sense of isolation. Parents who were non-frequent users identified a number of practical reasons that prevented them using Sure Start services, although parents also recognised a loss of confidence and trust in the local communities summarised in the phrase 'keeping myself to myself'. Parents' awareness of the targeted nature of Sure Start can also lead to stigma and reluctance to use services. It is concluded that continued investment of time and effort in maintaining communication networks between Sure Start staff and local parents is vital if parents and children are to make the best use of Sure Start services.

Individuals with advanced dementias resulting from neurodegenerative disorders (NDs) occasionally surprise caregivers with episodes of clarity and cognitive function that are not usually present. Lucid episodes—aptly named paradoxical lucidity in the literature—seem to involve a return of the “old self” during advanced neurodegenerative changes. Lucid episodes pose a problem for theories of neurological degeneration, which position dementias as progressive, incurable, and irreversible. In addition, lucid episodes raise ethical questions about whether information gleaned during lucid episodes is appropriate to direct future patient-centered care. The concept requires analysis and clarification if it is to guide future theorizing and research. The underlying goals of the current concept analysis are twofold: (a) to clarify the meaning of lucidity in the context of advanced NDs; and (b) to develop a theoretical definition that can guide future practice, research, and policy development. Walker and Avant's method is used to identify uses of the concept, defining attributes, antecedents, consequences, and empirical referents. [ Journal of Gerontological Nursing, 46 (12), 42–50.]

BackgroundThis study set out to identify patterns in the causes of waits and wait-related satisfaction.MethodsWe conducted qualitative interviews with urban, semi-urban, and rural patients (n = 60) to explore their perceptions of the waits they experienced in the detection and treatment of their breast, prostate, lung, or colorectal cancer. We asked participants to describe their experiences from the onset of symptoms to the start of treatment at the cancer clinic and their satisfaction with waits at various intervals. Interview transcripts were coded using a thematic approach.ResultsPatients identified five groups of wait-time causes:Patient-related (beliefs, preferences, and non-cancer health issues)Treatment-related (natural consequences of treatment)System-related (the organization or functioning of groups, workforce, institution, or infrastructure in the health care system)Physician-related (a single physician responsible for a specific element in the patient’s care)Other causes (disruptions to normal operations of a city or community as a whole) With the limited exception of physician-related absences, the nature of the cause was not linked to overall satisfaction or dissatisfaction with waits.ConclusionsCauses in themselves do not explain wait-related satisfaction. Further work is needed to explore the underlying reasons for wait-related satisfaction or dissatisfaction. Although our findings shed light on patient experiences with the health system and identify where interventions could help to inform the expectations of patients and the public with respect to wait time, more research is needed to understand wait-related satisfaction among cancer patients.

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Background and Objectives This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods Walker & Avant’s method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across four electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this paper is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that results in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident’s safety and dignity. Discussion and Implications The definition of iatrogenesis proposed in this paper is an initial step toward developing evidence-based practice for the provision of non-consensual assistance in residential dementia care. A theoretical definition like the one proposed in this paper may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of healthcare-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of non-consensual care.