Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care : A cross-sectional survey

Journal article

Osman, Abdi D., Howell, Jocelyn, Smithies, Lisa, Wilson, Damian, Lam, Louisa Lok Yi, Moran, Juli, Jones, Daryl and Taylor, David M.. (2021). Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care : A cross-sectional survey. Australasian Emergency Care. 25(3), pp. 235-240. https://doi.org/10.1016/j.auec.2021.12.002

Publication dates
Authors	Osman, Abdi D., Howell, Jocelyn, Smithies, Lisa, Wilson, Damian, Lam, Louisa Lok Yi, Moran, Juli, Jones, Daryl and Taylor, David M.
Abstract	Background: Emergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well understood. Methods: A cross-sectional survey using purposive sampling was undertaken at a tertiary hospital’s Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation. Results: One hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = <0.01). Conclusions: Staff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: - professional practice, practice at the study site.
Keywords	Advance care directives; Goals of care; Advance care planning; Emergency department; Emergency treatment
Year	01 Jan 2021
Journal	Australasian Emergency Care
Journal citation	25 (3), pp. 235-240
Publisher	Elsevier Australia
ISSN	2588-994X
Digital Object Identifier (DOI)	https://doi.org/10.1016/j.auec.2021.12.002
Web address (URL)	https://www.sciencedirect.com/science/article/pii/S2588994X21000841
Open access	Published as non-open access
Research or scholarly	Research
Page range	235-240
Publisher's version	License All rights reserved File Access Level Controlled
Output status	Published
Print	22 Aug 2022
Publication process dates
Accepted	06 Dec 2021
Deposited	10 Jun 2024
Additional information	Copyright © 2021 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved.
Place of publication	Australia

Permalink -

https://acuresearchbank.acu.edu.au/item/909y4/assessment-of-emergency-department-staff-awareness-access-and-utilisation-of-advance-care-directives-and-goals-of-care-a-cross-sectional-survey

Restricted files

Publisher's version

(1 files)

17
total views
0
total downloads
0
views this month
0
downloads this month

These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

An Anglosphere comparison of paramedicine regulatory frameworks and the influence on curricula : A descriptive comparative review

Weber, Anthony, Devenish, Anthony and Lam, Louisa Lok Yi. (2024). An Anglosphere comparison of paramedicine regulatory frameworks and the influence on curricula : A descriptive comparative review. Paramedicine. pp. 1-11. https://doi.org/10.1177/27536386241249177

What are the facilitators and barriers experienced by sessional academics during the process of onboarding : A scoping review

Brouwer, Hendrika Jacoba, Griffiths, Semra, Jacob, Alycia, Ricks, Thomas Aaron, Schulz, Paula, Lavell, Sharni, Lam, Louisa and Jacob, Elisabeth. (2024). What are the facilitators and barriers experienced by sessional academics during the process of onboarding : A scoping review. Journal of Higher Education Policy and Management. pp. 1-18. https://doi.org/10.1080/1360080X.2024.2340987

Exploring the alignment between paramedicine's professional capabilities and competency frameworks for current and evolving scopes of practice : a literature review

Weber, Anthony, Devenish, Anthony and Lam, Louisa Lok Yi. (2024). Exploring the alignment between paramedicine's professional capabilities and competency frameworks for current and evolving scopes of practice : a literature review. BMC Medical Education. 24(1), pp. 1-11. https://doi.org/10.1186/s12909-023-04992-w

What are the facilitators and barriers experienced by sessional academics during the process of onboarding: a scoping review

Brouwer, H., Griffiths, S., Jacob, A., Ricks, T., Schulz, P., Lam, L. and Jacob, E.. (2024). What are the facilitators and barriers experienced by sessional academics during the process of onboarding: a scoping review. Journal of Higher Education Policy and Management. pp. 1-18. https://doi.org/10.1080/1360080X.2024.2340987

The impact of COVID-19 on stress and resilience in undergraduate nursing students : A scoping review

Smith, Graeme, Lam, Louisa Lok Yi, Poon, Sara, Griffiths, Semra, Cross, Wendy, Rahman, Aziz and Watson, Roger. (2023). The impact of COVID-19 on stress and resilience in undergraduate nursing students : A scoping review. Nurse Education in Practice. 72, pp. 1-10. https://doi.org/10.1016/j.nepr.2023.103785

Perinatal outcomes among Indian-born mothers in Australia

Barthasarathy, Kanmani and Lam, Louisa. (2023). Perinatal outcomes among Indian-born mothers in Australia. BMC Pregnancy and Childbirth. 23(1), p. Article 595. https://doi.org/10.1186/s12884-023-05897-8

Psychological distress, fear and coping strategies among hong kong people during the COVID-19 pandemic

Chair, Sek Ying, Chien, Wai Tong, Liu, Ting, Lam, Louisa, Cross, Wendy, Banik, Biswajit and Rahman, Muhammad Aziz. (2023). Psychological distress, fear and coping strategies among hong kong people during the COVID-19 pandemic. Current Psychology. 42(3), pp. 2538-2557. https://doi.org/10.1007/s12144-021-02338-7

“Resisting social identity threat and maintaining resilience” : A qualitative study of Chinese parents following the loss of an only child

Wang, Anni, Guo, Yufang, Cross, Wendy, Lam, Louisa, Plummer, Virginia, Zhang, Wen and Zhang, Jingping. (2022). “Resisting social identity threat and maintaining resilience” : A qualitative study of Chinese parents following the loss of an only child. Psychological Trauma: Theory, Research, Practice and Policy. pp. 1-9. https://doi.org/10.1037/tra0001262

Associations between perceived overqualification, organisational commitment and work passion of nurses : A multicentre cross-sectional study

Guo, Yu-Fang, Wang, Ying, Plummer, Virginia, Cross, Wendy, Lam, Louisa and Wang, Ke-fang. (2022). Associations between perceived overqualification, organisational commitment and work passion of nurses : A multicentre cross-sectional study. Journal of Nursing Management. 30(5), pp. 1273-1282. https://doi.org/10.1111/jonm.13610

Quality of life in cancer patients with different preferences for nurse spiritual therapeutics : The role of psychological capital

Guo, Yu-Fang, Wang, Ke-Fang, Cross, Wendy, Lam, Louisa, Plummer, Virginia and LI, Jing. (2022). Quality of life in cancer patients with different preferences for nurse spiritual therapeutics : The role of psychological capital. Journal of Advanced Nursing. 78(4), pp. 991-1000. https://doi.org/10.1111/jan.15023

Air pollution perception in ten countries during the COVID-19 pandemic

Lou, Baowen, Barbieri, Diego Maria, Passavanti, Marco, Hui, Cang, Gupta, Akshay, Hoff, Inge, Lessa, Daniela Antunes, Sikka, Gaurav, Chang, Kevin, Fang, Kevin, Lam, Louisa, Maharaj, Brij, Ghasemi, Navid, Qiao, Yaning, Adomako, Solomon, Foroutan Mirhosseini, Ali, Naik, Bhaven, Banerjee, Arunabha, Wang, Fusong, ... Agarwal, Nithin. (2022). Air pollution perception in ten countries during the COVID-19 pandemic. Ambio. 51(3), pp. 531-545. https://doi.org/10.1007/s13280-021-01574-2

Factors influencing the transition and retention of mental health nurses during the initial years of practice : Scoping review

Joseph, Bindu, Jacob, Sini, Lam, Louisa and Rahman, Muhammad Aziz. (2022). Factors influencing the transition and retention of mental health nurses during the initial years of practice : Scoping review. Journal of Nursing Management. 30(8), pp. 4274-4284. https://doi.org/10.1111/jonm.13882

Nurse leadership in promoting and supporting civility in health care settings : A scoping review

Ota, Marianne, Lam, Louisa, Gilbert, Julia and Hills, Danny. (2022). Nurse leadership in promoting and supporting civility in health care settings : A scoping review. Journal of Nursing Management. 30, pp. 4221-4233. https://doi.org/10.1111/jonm.13883

Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units : A multicentre survey

Guo, Yu-Fang, Fan, Jun-Ying, Lam, Louisa, Plummer, Virginia, Cross, Wendy, Ma, Yue-Zhen, Wang, Yu-Fen and Jia, Yan-Nan. (2022). Associations between perceived overqualification, transformational leadership and burnout in nurses from intensive care units : A multicentre survey. Journal of Nursing Management. 30(7), pp. 3330-3339. https://doi.org/10.1111/jonm.13774

Undergraduate health professional students’ team communication in simulated emergency settings : A scoping review

Bourke, Sharon L., Cooper, Simon, Lam, Louisa and McKenna, Lisa. (2021). Undergraduate health professional students’ team communication in simulated emergency settings : A scoping review. Clinical Simulation in Nursing. 60, pp. 42-63. https://doi.org/10.1016/j.ecns.2021.07.004

Chinese mental health professionals’ perceptions of shared decision-making regarding people diagnosed with schizophrenia : A qualitative study

Huang, Chongmei, Lam, Louisa, Zhong, Yaping, Plummer, Virginia and Cross, Wendy. (2021). Chinese mental health professionals’ perceptions of shared decision-making regarding people diagnosed with schizophrenia : A qualitative study. International Journal of Mental Health Nursing. 30(1), pp. 189-199. https://doi.org/10.1111/inm.12771_1

Association between psychological capital and spiritual care competencies of clinical nurses : A multicentre cross-sectional study

Guo, Yu-Fang, Cross, Wendy M., Lam, Louisa, Plummer, Virginia, Wang, Xin-Xin and Wang, Shuang-Shuang. (2021). Association between psychological capital and spiritual care competencies of clinical nurses : A multicentre cross-sectional study. Journal of Nursing Management. 29(6), pp. 1713-1722. https://doi.org/10.1111/jonm.13303

Feasibility of brief distress screening for family caregivers of adults diagnosed with schizophrenia in Changsha, Hunan, China

Guan, Ziyao, Cross, Wendy, Lam, Louisa, Wiley, James A., Sun, Mei, Bai, Xiaoling and Tang, Siyuan. (2021). Feasibility of brief distress screening for family caregivers of adults diagnosed with schizophrenia in Changsha, Hunan, China. Journal of Psychiatric and Mental Health Nursing. 28(2), pp. 174-185. https://doi.org/10.1111/jpm.12663

The way we do things around here. A qualitative study of the workplace aggression experiences of Victorian nurses, midwives and care personnel

Hills, Sharon, Crawford, Kimberley, Lam, Louisa and Hills, Danny. (2021). The way we do things around here. A qualitative study of the workplace aggression experiences of Victorian nurses, midwives and care personnel. Collegian. 28(1), pp. 18-26. https://doi.org/10.1016/j.colegn.2020.02.012

Severity of illness and distress in caregivers of patients with schizophrenia : Do internalized stigma and caregiving burden mediate the relationship?

Guan, Ziyao, Wang, Yuwei, Lam, Louisa, Cross, Wendy, Wiley, James A., Huang, Chongmei, Bai, Xiaoling, Sun, Mei and Tang, Siyuan. (2021). Severity of illness and distress in caregivers of patients with schizophrenia : Do internalized stigma and caregiving burden mediate the relationship? Journal of Advanced Nursing. 77(3), pp. 1258-1270. https://doi.org/10.1111/jan.14648

Influence of core competence on voice behavior of clinical nurses : A multicenter cross-sectional study

Guo, Yu-fang, Wang, Xin-Xin, Plummer, Virginia, Cross, Wendy, Lam, Louisa Lok Yi and Wang, Shuang-Shuang. (2021). Influence of core competence on voice behavior of clinical nurses : A multicenter cross-sectional study. Psychology Research and Behavior Management. 14, pp. 501-510. https://doi.org/10.2147/PRBM.S309565

Condom use consistency and associated factors among college student men who have sex with men from seven colleges in changsha city : A cross-sectional survey

Wang, Honghong, Yu, Simin, Cross, Wendy, Lam, Louisa, Banik, Biswajit and Zhang, Kaili. (2021). Condom use consistency and associated factors among college student men who have sex with men from seven colleges in changsha city : A cross-sectional survey. HIV/AIDS - Research and Palliative Care. 13, pp. 557-569. https://doi.org/10.2147/HIV.S305932

Impact of COVID-19 pandemic on mobility in ten countries and associated perceived risk for all transport modes

Barbieri, Diego Maria, Lou, Baowen, Passavanti, Marco, Hui, Cang, Hoff, Inge, Lessa, Daniela Antunes, Sikka, Gaurav, Chang, Kevin, Gupta, Akshay, Fang, Kevin, Banerjee, Arunabha, Maharaj, Brij, Lam, Louisa, Ghasemi, Navid, Naik, Bhaven, Wang, Fusong, Mirhosseini, Ali Foroutan, Naseri, Sahra, Liu, Zhuangzhuang, ... Rashidi, Taha Hossein. (2021). Impact of COVID-19 pandemic on mobility in ten countries and associated perceived risk for all transport modes. PLoS ONE. 16(2), p. Article e0245886. https://doi.org/10.1371/journal.pone.0245886

Feeling responsible : Family caregivers’ attitudes and experiences of shared decision-making regarding people diagnosed with schizophrenia : A qualitative study

Huang, Chongmei, Lam, Louisa Lok Yi, Plummer, Virginia and Cross, Wendy. (2021). Feeling responsible : Family caregivers’ attitudes and experiences of shared decision-making regarding people diagnosed with schizophrenia : A qualitative study. Patient Education and Counseling. 104(7), pp. 1553-1559. https://doi.org/10.1016/j.pec.2020.10.032

Willingness, preferred ways and potential barriers to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in China

Yu, Simin, Cross, Wendy, Lam, Louisa Lok Yi, Zhang, Kaili, Banik, Biswajit, Li, Xianhong and Wang, Honghong. (2021). Willingness, preferred ways and potential barriers to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in China. BMJ Open. 11(10), p. Article e053634. https://doi.org/10.1136/bmjopen-2021-053634

Cardiopulmonary resuscitation and endotracheal intubation decisions for adults with advance care directive and resuscitation plans in the emergency department

Osman, Abdi D., Rahman, Aziz, Lam, Louisa Lok Yi, Lin, Chien-Che, Yeoh, Michael, Judkins, Simon, Pratten, Neely, Moran, Juli and Jones, Daryl. (2020). Cardiopulmonary resuscitation and endotracheal intubation decisions for adults with advance care directive and resuscitation plans in the emergency department. Australasian Emergency Care. 23(4), pp. 247-251. https://doi.org/10.1016/j.auec.2020.05.003

Compassion satisfaction and compassion fatigue in Australian emergency nurses : A descriptive cross-sectional study

O'Callaghan, Erin L., Lam, Louisa, Cant, Robyn and Moss, Cheryle. (2020). Compassion satisfaction and compassion fatigue in Australian emergency nurses : A descriptive cross-sectional study. International Emergency Nursing. 48, p. Article 100785. https://doi.org/10.1016/j.ienj.2019.06.008

I am the person who knows myself best : Perception on shared decision-making among hospitalized people diagnosed with schizophrenia in China

Huang, Chongmei, Plummer, Virginia, Wang, Yun, Lam, Louisa and Cross, Wendy. (2020). I am the person who knows myself best : Perception on shared decision-making among hospitalized people diagnosed with schizophrenia in China. International Journal of Mental Health Nursing. 29(5), pp. 846-855. https://doi.org/10.1111/inm.12718

Impact of WeChat-based 'three good things' on turnover intention and coping style in burnout nurses

Guo, Yu-Fang, Plummer, Virginia, Cross, Wendy, Lam, Louisa and Zhang, Jing-Ping. (2020). Impact of WeChat-based 'three good things' on turnover intention and coping style in burnout nurses. Journal of Nursing Management. 28(7), pp. 1570-1577. https://doi.org/10.1111/jonm.13111

Non-pharmacological depression therapies for older Chinese adults : A systematic review & meta-analysis

Gill, Baljit Kaur, Cant, Robyn, Lam, Louisa, Cooper, Simon and Lou, Vivian Wei Qun. (2020). Non-pharmacological depression therapies for older Chinese adults : A systematic review & meta-analysis. Archives of Gerontology and Geriatrics. 88, p. Article 104037. https://doi.org/10.1016/j.archger.2020.104037

Perceptions of shared decision-making in severe mental illness : An integrative review

Huang, Chongmei, Plummer, Virginia, Lam, Louisa and Cross, Wendy. (2020). Perceptions of shared decision-making in severe mental illness : An integrative review. Journal of Psychiatric and Mental Health Nursing. 27(2), pp. 103-127. https://doi.org/10.1111/jpm.12558

Translation and psychometric testing of a decision-making scale

Huang, Chongmei, Plummer, Virginia, Lam, Louisa and Cross, Wendy. (2020). Translation and psychometric testing of a decision-making scale. Journal of Psychiatric and Mental Health Nursing. 27(5), pp. 533-542. https://doi.org/10.1111/jpm.12601

Shared decision-making in serious mental illness : A comparative study

Huang, Chongmei, Plummer, Virginia, Lam, Louisa and Cross, Wendy. (2020). Shared decision-making in serious mental illness : A comparative study. Patient Education and Counseling. 103(8), pp. 1637-1644. https://doi.org/10.1016/j.pec.2020.03.009

A WeChat-based “three good things” positive psychotherapy for the improvement of job performance and self-efficacy in nurses with burnout symptoms : A randomized controlled trial

Guo, Yu-Fang, Lam, Louisa, Plummer, Virginia, Cross, Wendy and Zhang, Jing-Ping. (2020). A WeChat-based “three good things” positive psychotherapy for the improvement of job performance and self-efficacy in nurses with burnout symptoms : A randomized controlled trial. Journal of Nursing Management. 28(3), pp. 480-487. https://doi.org/10.1111/jonm.12927

Hospital nurses' simulation-based education regarding patient safety : A scoping review

Cant, Robyn P., Cooper, Simon J. and Lam, Louisa L.. (2020). Hospital nurses' simulation-based education regarding patient safety : A scoping review. Clinical Simulation in Nursing. 44, pp. 19-34. https://doi.org/10.1016/j.ecns.2019.11.006

A study protocol of mobile phone app-based cognitive behaviour training for the prevention of postpartum depression among high-risk mothers

Sun, Mei, Tang, Siyuan, Chen, Jiarui, Li, Ying, Bai, Wenhui, Plummer, Virginia, Lam, Louisa, Qin, Chunxiang and Cross, Wendy M.. (2019). A study protocol of mobile phone app-based cognitive behaviour training for the prevention of postpartum depression among high-risk mothers. BMC Public Health. 19(1), p. Article 710. https://doi.org/10.1186/s12889-019-6941-8

The effects of resilience and turnover intention on nurses’ burnout : Findings from a comparative cross-sectional study

Guo, Yu-fang, Plummer, Virginia, Lam, Louisa, Wang, Yan, Cross, Wendy and Zhang, Jing-ping. (2019). The effects of resilience and turnover intention on nurses’ burnout : Findings from a comparative cross-sectional study. Journal of Clinical Nursing. 28(3-4), pp. 499-508. https://doi.org/10.1111/jocn.14637

The risk factors of antenatal depression : A cross-sectional survey

Chen, Jiarui, Cross, Wendy M., Plummer, Virginia, Lam, Louisa, Sun, Mei, Qin, Chunxiang and Tang, Siyuan. (2019). The risk factors of antenatal depression : A cross-sectional survey. Journal of Clinical Nursing. 28(19-20), pp. 3599-3609. https://doi.org/10.1111/jocn.14955

Using the theory of planned behaviour to predict nurse's intention to undertake dual practice in China : A multicentre survey

Bai, Xiaoling, Wang, Anni, Plummer, Virginia, Lam, Louisa, Cross, Wendy, Guan, Ziyao, Hu, Xin, Sun, Mei and Tang, Siyuan. (2019). Using the theory of planned behaviour to predict nurse's intention to undertake dual practice in China : A multicentre survey. Journal of Clinical Nursing. 28(11-12), pp. 2101-2110. https://doi.org/10.1111/jocn.14791

An evaluation of a positive psychological intervention to reduce burnout among nurses

Luo, Yuan-hui, Li, Hui, Plummer, Virginia, Cross, Wendy M., Lam, Louisa, Guo, Yu-fang, Yin, Yi-zhen and Zhang, Jing-ping. (2019). An evaluation of a positive psychological intervention to reduce burnout among nurses. Archives of Psychiatric Nursing. 33(6), pp. 186-191. https://doi.org/10.1016/j.apnu.2019.08.004

A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women

Chen, Jiarui, Cross, Wendy M., Plummer, Virginia, Lam, Louisa and Tang, Siyuan. (2019). A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women. Women and Birth. 32(6), pp. 487-492. https://doi.org/10.1016/j.wombi.2018.11.019

Newly qualified graduate nurses’ experiences of workplace incivility in Australian hospital settings

Mammen, Bindu, Hills, Danny J. and Lam, Louisa. (2018). Newly qualified graduate nurses’ experiences of workplace incivility in Australian hospital settings. Collegian. 25(6), pp. 591-599. https://doi.org/10.1016/j.colegn.2018.08.003

Burnout and its association with resilience in nurses : A cross-sectional study

Guo, Yu-fang, Luo, Yuan-hui, Lam, Louisa, Cross, Wendy, Plummer, Virginia and Zhang, Jing-ping. (2018). Burnout and its association with resilience in nurses : A cross-sectional study. Journal of Clinical Nursing. 27(1-2), pp. 441-449. https://doi.org/10.1111/jocn.13952

Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel

Hills, Danny, Lam, Louisa and Hills, Sharon. (2018). Workplace aggression experiences and responses of Victorian nurses, midwives and care personnel. Collegian. 25(6), pp. 575-582. https://doi.org/10.1016/j.colegn.2018.09.003

The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients : A systematic review

Nachiyunde, Brenda and Lam, Louisa. (2018). The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients : A systematic review. Annals of Cardiac Anaesthesia. 21(4), pp. 363-370. https://doi.org/10.4103/aca.ACA_186_17

Positive psychotherapy for depression and self-efficacy in undergraduate nursing students : A randomized, controlled trial

Guo, Yu-Fang, Zhang, Xia, Plummer, Virginia, Lam, Louisa, Cross, Wendy and Zhang, Jing-Ping. (2017). Positive psychotherapy for depression and self-efficacy in undergraduate nursing students : A randomized, controlled trial. International Journal of Mental Health Nursing. 26(4), pp. 375-383. https://doi.org/10.1111/inm.12255

Female nurses’ burnout symptoms : No association with the Hypothalamic-Pituitary-Thyroid (HPT) axis

Guo, Yufang, Lam, Louisa, Luo, Yuanhui, Plummer, Virginia, Cross, Wendy, Li, Hui, Yin, Yizhen and Zhang, Jingping. (2017). Female nurses’ burnout symptoms : No association with the Hypothalamic-Pituitary-Thyroid (HPT) axis. Psychoneuroendocrinology. 77, pp. 47-50. https://doi.org/10.1016/j.psyneuen.2016.11.020

Exploring resilience in Chinese nurses : A cross-sectional study

Guo, Yu-Fang, Cross, Wendy, Plummer, Virginia, Lam, Louisa, Luo, Yuan-Hui and Zhang, Jing-Ping. (2017). Exploring resilience in Chinese nurses : A cross-sectional study. Journal of Nursing Management. 25(3), pp. 223-230. https://doi.org/10.1111/jonm.12457