Update on teaching in the long-term care setting

Since the advent of the teaching nursing home, made formal in the 1980s, long-term care has been used to teach geriatric medicine. Despite this, national surveys have indicated a need for more training during residency to facilitate the appropriate care for the frail long-term care patient population. In addition to medical knowledge, the long-term care site is appropriate for teaching the Accreditation Council of Graduate Medical Education's core competencies of "practice-based learning and improvement," "interpersonal and communication skills," and "systems-based practice." Program planners should emphasize opportunities for students to demonstrate their skill in one of these competencies.     

阶段性目标管理在新定科护士培训中的应用效果

目的  探讨阶段性目标管理在新定科护士培训中的应用效果。 方法  选择新定科的92名护士作为研究对象,在其临床实践教学中采用阶段性目标管理模式进行培训1年,并以沿用传统临床带教方法培训的92 名护士作为对照组。比较采用阶段性目标管理模式和传统临床带教方法培训后,新定科护士核心能力的差异。 结果  实施阶段性目标管理培训后,新定科护士在护理教学计划落实、理论考试成绩、对教学效果自我评价的满意度等方面明显好于对照组,差异均具有统计学意义(P＜0.01)。 结论  新定科护士培训运用阶段性目标管理模式,可明显提高护士的核心能力水平,同时临床教学质量和效率也得到显著提升。     

Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals

The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event.     

Core competencies for cardiac rehabilitation/secondary prevention professionals: 2010 update: position statement of the American Association of Cardiovascular and Pulmonary Rehabilitation

Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.     

National Survey of Clerkship Directors in Internal Medicine on the Competencies That Should Be Addressed in the Medicine Core Clerkship

PURPOSE: To prioritize competencies that should be addressed in the medicine core clerkship, assess factors influencing this prioritization, and estimate the percentage of clerkship time that should be devoted to inpatient versus outpatient care.METHODS: A national survey of the Clerkship Directors in Internal Medicine (CDIM) was used. Using explicit criteria, respondents assigned priority scores, on a 1 to 5 scale, to 17 general competencies and 60 disease-specific clinical competencies pertinent to care of adult patients in inpatient. ambulatory, intensive care, and emergency settings.RESULTS: Ninety-three (75%) of 124 CDIM members responded. The highest mean priority scores were assigned to 6 general competencies: case presentation skills (4.65), diagnostic decision-making (4.64), history and physical diagnosis (4.61), test interpretation (4.47), communication with patients (4.35), and therapeutic decision-making (4.12). Disease-specific clinical competency areas receiving the highest mean priority scores were: hypertension (4.57), coronary disease (4.53), diabetes mellitus (4.45), heart failure (4.42), pneumonia (4.39), chronic obstructive pulmonary disease (4.26), acid-base/electrolyte disorders (4.19), and acute chest pain (4.08). Priorities for general competencies were moderately correlated with importance to the practice of general internists (mean Spearman rho 0.49) and with importance to students pursuing careers outside internal medicine (mean Spearman rho 0.45), but only weakly correlated with the adequacy with which a competency was addressed in other parts of the curriculum. Respondents' mean recommended allocation of clerkship time was: 52% inpatient, 33% ambulatory care, 8% intensive care, and 7% emergency medicine. This time allocation did not differ by any characteristics of respondents.CONCLUSION: There is consensus among medicine clerkship directors that the medicine core clerkship should emphasize fundamental competencies and devote at least one third of the time to clinical competencies pertinent to ambulatory care.     

Better arthritis care: What training do community‐based health professionals need to improve their care of people with arthritis? A Delphi study

Objective

The aim of the present study was to identify the competencies that non‐specialist community‐based nurses and allied health professionals (AHPs) need to enable them to assess, care for and manage arthritis appropriately.

Methods

A Delphi survey with an expert panel of 43 rheumatology specialists and expert patients was used to identify the competencies needed by community‐based nurses and AHPs to enable them to improve their care of people with arthritis. The process was informed by feedback from focus groups with arthritis patients, community‐based nurses and AHPs.

Results

The core competencies in arthritis care needed by non‐specialist community‐based nurses and AHPs were identified. The key goals identified were to increase the understanding of arthritis and its impact on patients’ lives, and to increase the ability to help patients to self‐manage their condition and access support. Competencies included an understanding of the pathology underlying inflammatory and non‐inflammatory arthritis, the ability to distinguish between the two and the ability to recognize early warning signs, with an emphasis on osteoarthritis (OA), rheumatoid arthritis, gout and septic arthritis. Essential competencies included the ability to engage in shared decision making, goal setting and signposting, to provide patients with education and information and to make appropriate referrals.

Conclusions

Health professionals working in the community commonly encounter arthritis as a presenting problem or as a co‐morbidity. The quality of care provided to people with inflammatory arthritis and OA in the community is currently variable. The present study identified the core competencies that all community‐based nurses and AHPs should have in relation to OA and inflammatory arthritis.     

心血管内科患者护理中双心护理模式的应用价值研究

【】目的 研究双心护理模式用于心血管内科患者的护理中的临床效果。 方法 选取2014年6月-2015年6月在我院心内科接受治疗的心血管疾病患者共188例为研究对象,分别为常规组和双心组。常规组采用内血管内科的常规护理方式,双心组则采用身体护理和心理护理双心护理模式进行护理。比较两组护理后的生活质量、心理状况、住院时间、临床症状消失时间以及患者的护理满意度。 结果 双心组护理后的QOL评分、HAMA评分以及HAMD评分均高于常规组,双心组的住院时间和临床症状的消失时间均少于常规组,双心组的护理满意度(89.36%)高于常规组(72.34%),P<0.05,差异具有统计学意义。 结论 双心护理模式用于心血管内科患者的护理能够从一定程度上缓解甚至是消除患者的紧张、焦虑以及恐惧等不良情绪,有利于患者疾病的康复,提高患者的心理健康和生活质量,起到了很好的辅助治疗的作用。     

Core competencies for diabetes educators: A scoping review

AimsDiabetes educators (DEs) play a major role in diabetes education and management. The aims of this scoping review were to compile the currently identified core competencies for DEs and, to review the currently used criteria to assess DEs’ core competencies.MethodsA scoping review was conducted using the methodology of the Joanna Briggs Institute. Five databases (Ovid, CINAHL, Scopus, Web of Science and PubMed) were searched. Keywords as well as inclusion and exclusion criteria were identified as search strategies and study selection for this review.ResultsA total of (n = 22) publications comprising sixteen peer-reviewed studies and six professional-organisations (grey literature) were selected for review, as they listed the core competencies of DEs. The most common core competencies were related to knowledge and skills in diabetes self-management education, knowledge of pathophysiology and epidemiology, teaching skills, clinical skills and cultural competency. Evidently, an appropriate tool for assessing DEs’ competencies is currently unavailable.ConclusionsGiven the importance of diabetes education in the care of people living with diabetes, it is imperative that DEs possess competencies in diabetes education and management. The review also identified the need to develop a globally applicable core competency assessment tool for DEs.     

Exploring Skills-Based Competencies Through Geriatric Care Management Modules

As educational competencies in gerontology continue to evolve, skills-based competencies (from beginner to expert level) endure as the hallmarks of the field. This study explored the impact of exposure to “active learning” modules for the practice of professional geriatric care management (GCM) on beginning gerontology students and their ability to acquire core knowledge and more advanced skills related to assessment and counseling community-based older adults. Working with a group of “nontraditional” students, many having previous caregiving experience and working with older adults in direct care and allied health care roles, evaluation of these modules show that early exposure to “advanced” professional practice can be an effective approach for introducing higher-level competencies to beginning gerontology students.     

Toward a Core Curriculum for Interdisciplinary Geriatric Care

This paper describes a core curriculum for interdisciplinary geriatric care that was developed by the faculty of the Hunter/Mount Sinai Geriatric Education Center (GEC). The core curriculum encompasses the knowledge, attitudes and skills held in common by the nine health care disciplines that the GEC faculty represent. Each discipline can use the core as a unified base upon which to develop competencies unique to its own practice role and neccessary for implemntation of an interdisciplinary approach to geriatric care. The core curriculum is a first step in the development of basic, advanced and continuing education programs for interdisciplinary geriatric care.     

Core competencies of the European internist: A discussion paper

In an attempt to enhance the quality of internal medicine practice and to reform the education of internists across Europe, the European Board of Internal Medicine (formed by the European Federation of Internal Medicine and the European Union of Medical Specialists Section of Internal Medicine) has launched a project aimed at defining core competencies that are common to all internists. The compilation of six core competencies presented in this paper consists of patient care; medical knowledge; communication skills; professionalism, ethical, and legal issues; organizational planning and service management skills; and academic activities. These core competencies are the foundation required for the provision of high-quality medical care everywhere, regardless of the professional traditions and organization of health care in different countries. The authors hope this paper will stimulate constructive discussion and thoughtful debate, and that it will be followed by a collaborative effort to develop and endorse a European consensus.     

Arbeitsbelastungen in der Altenpflege reduzieren: Ein Trainingsprogramm für Mitarbeiter und Leitungskräfte

Caregivers of the residents in nursing homes are exposed to a high degree of physical and mental stress. The purpose of this study was to develop and to test the effects of skill training aimed at reducing occupational stress. The training consisting of 12 sessions of 90 minutes each was designed for nursing assistants and for care supervisors, respectively. Contents of the program are communicating with the demented, coping with job stress and cooperating with colleagues and subordinates, respectively. Eleven homes for the elderly and nursing homes were involved in the pilot study; 88 caregivers participated in the training, 34 of them were supervisors and 54 nursing assistants. The participants mainly appreciated the contents of the training. A controlled study design was applied to evaluate the training effects. 56 participants assessed their competencies, their job conditions and their health status at the beginning, at the end of the training as well as 12 weeks after the intervention had been finished. 56 persons completed the questionnaire receiving no training. Among the training participants, particularly the self-care skills improved. In addition, occupational stress could be reduced and the climate with the residents improved significantly, whereas the frequency of health problems did not change. Compared to the changes also observed in the control group, statistically significant effects were confined to the improvement of the climate with the residents. Care supervisors in general reported a higher benefit from the training than did nursing assistants. The results of the pilot study were used to adapt the training to the caregivers' needs.     

Effectiveness of a critical care nursing course: preparing students for practice in critical care

Experiences in critical care in an undergraduate program provide an opportunity for students to develop beginning knowledge and skills for practice in this setting, gain exposure to the role of the nurse in critical care, and acquire competencies essential for care of any acutely ill patient regardless of health problem and setting. The purposes of this study were to (1) examine the acquisition of basic critical care nursing knowledge after completion of an undergraduate course in critical care, (2) compare the differences in learning between students who completed only the theory component of the course and those who completed both theory and clinical practice in critical care, (3) examine learner perceptions toward critical care nursing, and (4) examine the impact of the course on selection by new graduates of critical care as their practice specialty. A quasi-experimental pretest-posttest design was used with two experimental groups: lecture only and lecture and clinical practice, and a randomized control group. Subjects were 85 senior nursing students in a baccalaureate program in a large metropolitan area in the Midwest. Data were collected by using a demographic data sheet, the Basic Knowledge Assessment Tool (BKAT), the Perceptions of Critical Care Nursing Questionnaire (PCCNQ), and follow-up interviews of graduates who completed the course. Both experimental groups demonstrated a statistically significant increase in learning from pretest and posttest, as measured by the BKAT. There were no significant differences in BKAT scores between the lecture and lecture-clinical practice groups. Mean scores on the BKAT at posttest for the experimental groups, who participated in the course, were significantly higher than the control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improving Geropsychology Competencies of Veterans Affairs Psychologists

Older adults are more likely to seek mental health care through integrated care settings such as primary care. Currently, there exists a significant shortage of mental health providers trained in geropsychology and integrated care competencies. To address this need within the Veterans Health Administration, a national workforce development program was extended to include psychologists, which is called the Geriatric Scholars Program-Psychology Track (GSP-P). The GSP-P has two overarching educational program aims: (1) to improve geropsychology competencies of practicing VA psychologists, particularly those working within integrated settings (e.g., primary care) and (2) enrich psychologists' abilities to enact change in their clinical settings. Ninety-eight VA clinicians participated in the GSP-P, which includes a multi-day in-person course, from 2014 to 2018. Participants completed measures assessing confidence and self-reported knowledge in geropsychology and integrated care competencies pre-course and 3-months post-completion. Two-weeks post-course participants responded to open-ended survey questions regarding their perceptions of the course and potential applications of learning. Significant improvements in confidence in and knowledge of geropsychology and integrated care competencies emerged from pre-course to 3-months post-completion. Qualitative findings demonstrated that participants valued the face-to-face, integrated multimodal educational program. Findings provided insights regarding clinicians' planned application of the knowledge acquired, such as modifying treatments for older patients. Specialized workforce programs such as the GSP-P have a significant, positive impact on the care of older Veterans.     

Health care workforce development in rural america: when geriatrics expertise is 100 miles away

The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics and gerontology and in quality improvement (QI) and support to implement a local QI project; in addition, elective options include webinars, audio conferences, clinical practica, and mentoring. The program is effective in improving core competencies in geriatrics and in improving clinical care for older Veterans who receive health care in rural clinics.     

Health Care Workforce Development in Rural America: When Geriatrics Expertise Is 100 Miles Away

The Geriatric Scholar Program (GSP) is a Department of Veterans Affairs' (VA) workforce development program to infuse geriatrics competencies in primary care. This multimodal educational program is targeted to primary care providers and ancillary staff who work in VA's rural clinics. GSP consists of didactic education and training in geriatrics and gerontology and in quality improvement (QI) and support to implement a local QI project; in addition, elective options include webinars, audio conferences, clinical practica, and mentoring. The program is effective in improving core competencies in geriatrics and in improving clinical care for older Veterans who receive health care in rural clinics.     

Workshop: Credentialing of Anticoagulation Providers: A Proposed Model

The winter 1997 survey of Anticoagulation Forum members identified a strong desire for an anticoagulation provider certification program. The Anticoagulation Provider Certification Working Group (APCWG) is a multidisciplinary committee formed (1) to develop the objectives and process required to achieve the competencies for anticoagulation therapy providers, (2) to propose a framework for a national certification process that validates achievement of anticoagulation therapy provider competencies, and (3) to create a reproducible educational framework for all clinicians involved with anticoagulation therapy. The APCWG assessed the need for credentialing the levels of mastery expected of anticoagulation providers, identified key elements of a certification program, assessed published anticoagulation provider competencies, studied elements of a successful regional credentialing program, proposed core anticoagulation domains of knowledge and associated competencies, and solicited and incorporated broad-based multidisciplinary feedback on such domains and competencies. As a result, the APCWG has developed a draft of five knowledge domains: physiology/pathophysiology of thromboembolic disorders, patient assessment and management, patient education, pharmacology of antithrombotic agents, and operational processes surrounding the coordinated care of an anticoagulated patient. These draft domains of knowledge and the accompanying list of detailed competencies were distributed to all attendees of the May 1997 Anticoagulation Forum Meeting for review and feedback. The plan is to incorporate comments and revise the documents, develop and pilot a certification process, and present the results of the pilot(s) to a national organization to serve as a foundation of a valid and accepted national certification process.     

Health care ethics consultation: nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation

Patients, families, and health care providers have a right to expect that ethics consultants can deal competently with the complex issues that they are asked to address. The Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation explored core competencies and related issues in ethics consultation. This position paper summarizes the content of the resulting Task Force Report, which included nine general conclusions: 1) U.S. societal context makes "ethics facilitation" an appropriate approach to ethics consultation; 2) ethics facilitation requires certain core competencies; 3) core competencies can be acquired in various ways; 4) individual consultants, teams, or committees should have the core competencies for ethics consultation; 5) consult services should have policies that address access, patient notification, documentation, and case review; 6) abuse of power and conflicts of interest must be avoided; 7) ethics consultation must have institutional support; 8) evaluation of process, outcomes, and competencies is needed; and 9) certification of individuals and accreditation of programs are rejected.     

Swedish nursing and medical students' high vaccination adherence during the influenza A (H1N1) pandemic 2009: insights for pandemic preparedness

The aim of this study was to analyze Swedish health science student decision-making regarding vaccination against pandemic influenza during a national mass vaccination campaign. A questionnaire was distributed to 430 students during the influenza A (H1N1) pandemic in 2009. The data from medical and nursing students were compared and a multiple logistic regression model was applied to identify items independently associated with the decision to be vaccinated. The overall survey response rate was 90%. More medical (93.2%) than nursing students (84.8%) reported that they had received the vaccine (p < 0.01). Only the perception that benefits can outweigh possible side effects was significantly (p < 0.001) associated with the decision to get vaccinated. We recommend that, during pandemics, health science universities focus vaccination information for students on objective risk communication. It should be taken into account that the pandemic information provided by authorities to the general public also affects health care students.     

Nurse preparation and organizational support for supervision of unlicensed assistive personnel in nursing homes: a qualitative exploration

PURPOSE: Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered nurse/licensed practical nurse staffing, and role expectations, are not well understood. The purpose of this paper is to describe the organizational, managerial, and nurse-level factors associated with the nurse's role as supervisor of UAP in nursing homes. DESIGN AND METHODS: An ethnographic approach to data collection included 31 interviews, 170 hr of observation, and organizational document review at three nursing homes. Analysis included micro-coding and content analysis. RESULTS: Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses' estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role. IMPLICATIONS: Delivery of high-quality nursing home care is a matter of national importance, and these findings offer a call to action for nursing home leaders in policy, academia, and ownership and management positions. Nurses must be equipped with competencies and skills that reflect the complex organizational environments in which they work. Additionally, nursing home administrators and managers must be equipped with the competencies and skills needed to effectively and efficiently organize and operationalize care delivery practices to support nurses' role enactment.