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Jennifer Lyon, Linda Butson Michele Tennant*, Kathy Moeller, Kathryn Summey Gretchen Kuntz Health Science Center Libraries *and UF Genetics Institute University of Florida Gainesville & Jacksonville http://library.health.ufl.edu Oct 8, 2011
Goals 1. Use interviews, focus groups, and survey data to describe and fully understand the emotional, intellectual, and practical experience of the librarian within the clinical context. 2. I dentify challenges and barriers that inhibit success of the librarian in the clinical context based on the collected experiential data 3. R ecommend and begin the development of educational interventions that will assist librarians in overcoming the challenges and barriers identified in Goal Two.
Methods Semi structured focus groups and individual interviews Online survey including open ended questions Qualitative data analysis using thematic coding to identify core theoretical concepts Leverage the themes for the development of educational interventions
Qualitative Research Techniques Action (Participatory) Research The researcher is the subject of his/her own research Phenomenology The descriptive study of how individuals experience a phenomenon Grounded Theory Develop theories based on (grounded in) data gathered without preconception
Background Similar studies have been done with other health care professions Nursing students Beck (1993) identified 6 themes: pervading anxiety, feeling abandoned, encountering reality shock, envisioning self as incompetent, doubting choices, and uplifting consequences. Pagana (1988) reports stresses and threats experienced in the first clinical encounter Medical students Pitkala & Mantyranta (2004) & Nevalainen et al. (2010 ) report that the first patient examination i s an "anxiety provoking and confusing incident" and students feel helpless dealing with serious illness and death. Karnieli Miller et al. (2010) report that medical students' professionalism narratives provided a "window" on medical curriculum
Focus Groups and Interviews Focus Groups 5 UF Health Science Center Librarians participated in a 2 hr semi structured focus group 6 Medical Librarians participated in 2 focus groups at the MLA 2011 conference Interviews 1 interview with an experienced clinical librarian was conducted via Skype
Demographics Years of medical librarianship: 1.5 to >30 yrs Years of clinical librarianship: >1 to 15 yr Specialization areas: internal medicine, emergency medicine, MICU/CICU, pediatrics, psychology, nursing education Types of rounds: Bedside, morning reports, case conference, tumor boards, grand rounds, magnet status preparation
Some Common Themes Disturbed by cases: sights, smells, odors Pre librarianship clinical experience important Need to understand clinical team R oles, hierarchy, clinical culture & workflow Fast paced environment Need for medical knowledge, especially language Limited preparation and training available Mentorship valued and needed; advocates also vital observation, self directed) Positives Helping patients as well as doctors Being told that you are valuable (positive feedback)
I walked on pins and needles for a while, not wanting to do anything to disclose my ignorance.
Online Survey Conducted March 23, 2011 July 29, 2011 167 Responded; 124 Completed Survey Question development based on themes identified in First Focus Group in an iterative, grounded theory process Includes Checkbox and Open Questions UF IRB Approved
Online Survey Demographics How long have you been a medical librarian? Answer Options Response Percent Response Count One year or less 6.4% 10 More than 1 year, but less than 2 years 4.5% 7 More than 2 years, but less than 5 years 16.6% 26 More than 5 years, but less than 10 years 14.0% 22 More than 10 years 58.6% 92 answered question 157 skipped question 10 How long have you been rounding? Answer Options Response Percent Response Count I haven't done any rounding 21.5% 32 One year or less 10.1% 15 More than 1 year, but less than 2 years 10.1% 15 More than 2 years, but less than 5 years 19.5% 29 More than 5 years, but less than 10 years 22.8% 34 More than 10 years 16.1% 24 answered question 149 skipped question 18 Do you work in... Answer Options Response Percent Response Count A non teaching hospital 12.2% 14 A teaching hospital 43.5% 50 An academic medical center 36.5% 42 Other location 7.8% 9 answered question 115 skipped question 52 How often do you attend rounds? Answer Options Response Percent Response Count Daily 15.6% 17 Once per week 31.2% 34 Twice per week 22.9% 25 Biweekly 5.5% 6 Monthly 3.7% 4 Other rounding schedule 21.1% 23 answered question 109 skipped question 58
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% Odors Seeing wounds/rashes/injuries Blood/bodily fluids Death of a patient Code/Crisis Situation Disruptive/violent/delirious patient Prisoners as patients (police presence) Abused patients (child abuse, elderly abuse) Particular disease types (cancer, trauma, burns) Particular patient types (children, disabled, elderly) Other fears Do any of the following disturb you? (Check all that apply)
Have you experienced an ethically difficult situation while you were on clinical rounds? Answer Options Response Percent Response Count Yes 26.1% 24 No 73.9% 68 answered question 92 skipped question 75 Was ethics or patient safety training required before you began rounding? Answer Options Response Percent Response Count Yes 42.4% 39 No 57.6% 53 answered question 92 skipped question 75 Did you do HIPAA training? Answer Options Response Percent Response Count Yes 71.4% 65 No 28.6% 26 answered question 91 skipped question 76 What did that ethically difficult situation deal with? (Check all that apply) Answer Options Response Percent Response Count Medication error 16.7% 4 Practice error 25.0% 6 Lack of professionalism 33.3% 8 Patient privacy issues 37.5% 9 Patient safety issues 25.0% 6 Other ethical issue 33.3% 8 answered question 24 skipped question 143 Other Ethical Issues: Conflict over treatment Clinical teams talking about other clinical teams that I round with Communication difficulties and raw emotion from the care giver to physician and back. Very little empathy on both accounts. Staff getting HPV How and when should retrieved information be shared among physicians without violating patron's privacy? Decision that was contradicted by practice guidelines Unwillingness of the family to respect the patient's advanced directives There were couple of times when I witnessed evidence of abuse and was surprised the care team did not address it.
Online Survey: Describe 1 st Experience Very intimidating, scary Fast pace Problems with terminology, slang, imaging Wear comfy shoes on your feet long time! Weight of laptops Fear of exposure to infection/illness Felt out of place; lack of confidence Emotions dealing with death & grief Feeling good when you get something right
Online Survey: Memorable Experiences Positives Being able to anticipate their need & identify the unspoken questions Seeing doctors share emotion with patients/families Being Personally being able to help a patient Able to provide real time assistance Negatives Dealing with an ethical dilemma Dealing with physician/team disagreements Dealing with a code being called Dealing with terminal illness, death and grief Realizing patient/family )
Online Survey: Training Needs Mentoring More internships; Certification Program Medical Knowledge Clinical Context Hierarchy & roles; culture & politics How different units function, differences between medical disciplines Instruction skills, esp. Rapid searching and evaluation Quick use resources, resource knowledge Multiple day courses Practicum style training (case based scenario learning)
Direct mentoring is key. The first experience was scary, even though everyone was nice. It was like they spoke a different language!
Continuing Research Individual interviews continuing Focus Groups at 2011 SCMLA conference Friday, October 7, 5:30 6:30pm Saturday, October 8, 4 5pm Focus Groups to be held at MAC conference
Thank you! Contact me at: email@example.com 4 5pm in my hotel room S ee me for more info!