Health behaviors, such as diet, tobacco, and physical activity, may serve to prevent disease and promote wellness throughout the population including athletic trainers (AT). Good health behaviors act as disease prevention measures to decrease prevalence of pathologies. Hours of sleep, substance use, nutritional intake, and physical activity are behaviors that may impact the health of athletic trainers (AT). The objective of the study was to describe health behaviors of ATs in comparison to the general population and recommended behaviors. Method: We used a crosssectional, web-based survey of clinically practicing ATs recruited from the National Athletic Trainers' Association member database. A total of 1,229 ATs completed the web-based survey. The survey contained the Healthy Eating Vital Sign (HEVS) Questionnaire with physical activity items and Center for Disease Control Annual Consensus Survey. We calculated statistics of central tendency (means, frequency, and mode) to describe the characteristics of the athletic training population represented by our sample. The main outcome measures were hours of sleep, frequency of alcohol consumption and number of drinks consumed while drinking, weekly consumption of fast food, daily consumption of vegetables, daily servings of caffeine, smoking behavior in the last month, and exercise in the last day and week. Results: We found that the majority of ATs sleep 5-8 hours per night. From the sample, 66.2% of ATs reported eating fast food at least one time per week, while 95.7% ate vegetables at least one time per day. Only 1.9% of ATs reported smoking a cigarette in the last 30 days as compared to the national average of 15.5%. Finally, 50% of ATs performed physical activity on three or more occurrences per week. ATs most frequently report drinking alcohol weekly with an average of three alcohol beverages per sitting. Conclusion(s): Overall, the health of ATs is similar to the general population except ATs consume fast food more frequently and fewer athletic trainers smoke compared to the general population. Despite ATs base knowledge, many ATs do not engage in at the recommended health behaviors and may place themselves at the increased risk of poorer health and chronic disease.
Context: Previous research indicates athletic trainers have a favorable view of treating transgender patients, yet do not feel competent in their patient care knowledge or abilities. Objective: To gain more depth of information about athletic trainers' knowledge and experiences regarding the health care needs of transgender student-athletes. Design: Sequential, explanatory mixed methods. Setting: Individual, semi-structured follow-up interviews. Participants: Fifteen athletic trainers who previously took part in a cross-sectional survey in April 2018 (male=8, female=7, age=24±2, years of experience=3±3). Main Outcome Measure(s): The interviews were audio recorded and transcribed verbatim. Member checking was completed to ensure trustworthiness of the data. Next, the data were analyzed using a multi-phased process and a 3-member coding team following the consensual qualitative research tradition. The coding team analyzed the transcripts for domains and categories. The final consensus codebook and coded transcripts were audited by a member of the research team for credibility. Results: Four main domains were identified: 1) perceived deficiencies, 2) misconceptions, 3) concerns, and 4) creating safety. Participants described knowledge deficiencies in themselves, health care providers within their unit, and providers able to provide safe transition care. Participants demonstrated misconceptions when characterizing the definitions of transgender and transitioning and when describing how the body responds to hormone replacement therapy. Participants expressed concern for the mental health and wellness, self-image of transgender student-athletes, and potential cost of transgender health care. However, participants also described efforts to create safety within their unit by validation, instilling trust, adjusting the physical environment, and by engaging in professional development to improve their knowledge. Conclusions: Athletic trainers want to create a safe space for transgender student-athletes but lack the necessary knowledge to treat transgender patients. Professional resources to improve athletic trainer knowledge, skills, and abilities in caring for transgender patients are a continued need. Key Points
Context: Currently, the National Collegiate Athletic Association (NCAA) recommends written policies and procedures that outline steps to support student athletes facing a mental health challenge and the referral processes for emergency and non-emergency mental health situations. Objective: To assess the mental health policies and procedures implemented and athletic trainers' perceived confidence in preventing, recognizing and managing routine and crisis mental health cases across all three divisions of NCAA athletics. Design: Cross-sectional survey design and chart review. Setting: Online survey Participants: Athletic trainers with clinical responsibility at NCAA member institutions (n=1091, 21.5% response rate). Main Outcome Measure(s): Confidence in screening, preventative patient education, recognizing and referring routine and emergency mental health conditions (5-point Likert scale: 1= not at all confident, 2= hardly confident, 3= somewhat confident, 4= fairly confident, 5=very confident) using a content-validated survey (Cronbach's α=0.904) and mental health policy and procedure chart review. Results: Respondents indicated they felt “fairly confident” with screening (40.21%, n=76/189) for risk of any mental health condition and “fairly confident” in implementing preventative patient education (42.11%, n=80/190). Respondents were “fairly confident” they could recognize (48.95%, n=93/190) and refer (45.79%, n=87/190) routine mental health conditions. Respondents were “fairly confident” they could recognize (46.84%, n=89/190), but “very confident” (46.32%, n=88/190) they could refer mental health emergencies. Policies lacked separate procedures for specific emergency mental health situations such as suicidal/homicidal ideation (36.1%), sexual assault (33.3%), substance abuse (19.4%), and confusional state (13.9%). Policies lacked prevention measures such as student athlete involvement (16.7%) in annual mental health education (16.7%). Conclusions: While athletic trainers were generally confident in their ability to address emergency and routine mental health conditions, opportunities exist to improve policies for prevention, screening, and referral. Best practice guidelines should be used as a guide to develop policies that foster an environment of mental health wellness.
Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to identify the emerging domains and categories. Results: Two emergent domains were identified from the study. External support referenced multiple personnel resources available after a critical incident occurred, specifically, trained mental health professionals, untrained personnel, and trusted colleagues/coworkers. Coping with the emotional response included debriefing, spirituality, and complementary mental health strategies. Conclusion: In preparation for critical incidents, emergency action planning and after-action planning for healthcare delivery and the emotional response are both essential. Many ATs do not have the formal training, but continuing education courses, community-based mental health resources, and the promotion of professional organization resources can assist ATs in critical incident management.
Context Previous research has found simulation with debriefing to be helpful in developing self-confidence, improving clinical competence, identifying knowledge deficits, and implementing knowledge into practice in the short term. However, the long-term implications of simulation curation and participation are unknown. Objective The purpose of this study was to evaluate the long-term effect of large-scale simulation curation and participation as part of an advanced-practice athletic training course. Design Qualitative phenomenological approach. Setting Video-conferencing software. Patients or Other Participants From among 60 potential participants, 11 individuals participated in a long-term, follow-up interview to explore their recollections, perceptions, and subsequent experiences from curating and participation in large-scale simulation. Main Outcome Measures Deidentified transcripts were checked for accuracy and sent for member checking. Subsequently, a 3-person data analysis team used several sequenced rounds of review, aligned with consensual qualitative research, to the analyze data. Trustworthiness was established with member checking, multianalyst triangulation, and auditing. Results Three domains emerged from the data: emotional reaction, improvements to practice, and the value of debriefing. When the emotional reaction domain was described, learners focused on the reality, overload, and need to maintain composure of the encounter. Within their clinical practice, improvements were made primarily regarding mindset, teaching, collaboration, emergency planning, and triage. Finally, learners noted the value of debriefing as humbling, a time for realized deficiency, and a time of emotional decompression. Conclusions Simulation-based learning in advanced-practice clinicians leads to perceived increase in skills such as intra- and interpersonal skills and emotional readiness. Long-term effects of simulation demonstrated that learners could translate these skills into clinical practice even 2 to 3 years post experience. Finally, the use of debriefing is a critical component to both the learner's skill acquisition and translation of knowledge in all simulation-based experiences.
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