Structured training in assessment increases confidence amongst basic life support instructors

AimAssessment skills are often neglected in resuscitation training and it has been shown that the ERC BLS/AED instructor course may be insufficient to prepare candidates for an assessment role. We have introduced an Assessment Training Programme (ATP) to improve assessors’ decision making. In this article we present our ATP and an observational study of candidates’ confidence levels upon completing both an ERC BLS/AED instructor course and our ATP.MethodsForty-seven candidates undertook the ERC instructor course and 20 qualified ERC BLS/AED instructors undertook the ATP. Pre- and post-course questionnaires were completed. Confidence was assessed on ten-point Visual Analogue Scales (VAS).ResultsOverall confidence on the ERC BLS/AED instructor course rose from 5.9 (SD 1.8) to 8.7 (SD 1.4) (P < 0.001). A more modest improvement was witnessed on the ATP, rising from 8.2 (SD 1.4) to 9.6 (SD 0.5) (P < 0.001). Upon completion of their respective courses, assessors (mean 9.6, SD 0.5) were significantly more confident at assessing than instructors (mean 8.7, SD 0.5) (P < 0.001). Confidence in assessing individual algorithm components was similar on both courses. On the post-course questionnaire those on the ATP remained significantly more confident at assessing borderline candidates compared to instructors (P < 0.001), with no difference for clear pass (P = 0.067) or clear fail (P = 0.060) candidates.ConclusionThe ATP raises the confidence of assessing BLS/AED candidates to a level above that of the ERC instructor course alone. We advocate that resuscitation organisations consider integrating an ATP into their existing training structure.     

Peer education for BLS-training in schools? Results of a randomized-controlled,noninferiority trial

BackgroundThe rate of bystanders who provide cardiopulmonary resuscitation (CPR) is low in Germany. To increase the bystander CPR rates of lay-rescuers in Germany, the national “einlebenretten” (“save one life”) campaign was initiated, and the introduction of CPR-training for all seventh-grade students was recommended. To meet the requirement of offering effective and low-cost mass-training to lay-rescuers, we adopted peer education for the basic life support (BLS) training of the students.MethodsWe used an experimental, prospective, randomized, controlled, and open-label noninferiority trial to test whether the hands-on BLS training of the students that was provided by peers was inferior to the training by professional instructors using a predefined noninferiority margin of 5%. The students from eight different schools were trained in one 45 min practice session to perform BLS based on the educational framework provided by “einlebenretten”. The students were randomly assigned to be trained either by peer-instructors (students in the same school who had been instructed in advance) or by professional instructors. In a structured practical assessment, the eight essential skills of BLS were tested and the examination was scored as either pass or fail.ResultsThe study included 1087 students 14–18 years of age. The performance in the assessment was similar between the two groups: 40.3% (n = 471) of the students in the peer-led group and 41.0% (n = 466) in the professional-led group passed the examination.ConclusionThe students who were trained by peer-instructors showed comparable skills in BLS to the students who were trained by professional instructors. The sample size was too small to demonstrate the noninferiority of the peer-led training.     

Effectiveness of simplified 15-min refresher BLS training program: A randomized controlled trial

ObjectivesTo evaluate the long-term effectiveness of 15-min refresher basic life support (BLS) training following 45-min chest compression-only BLS training.MethodsAfter the 45-min chest compression-only BLS training, the participants were randomly assigned to either the refresher BLS training group, which received a 15-min refresher training 6 months after the initial training (refresher training group), or to the control group, which did not receive refresher training. Participants’ resuscitation skills were evaluated by a 2-min case-based scenario test 1 year after the initial training. The primary outcome measure was the number of appropriate chest compressions during a 2-min test period.Results140 participants were enrolled and 112 of them completed this study. The number of appropriate chest compressions performed during the 2-min test period was significantly greater in the refresher training group (68.9 ± 72.3) than in the control group (36.3 ± 50.8, p = 0.009). Time without chest compressions was significantly shorter in the refresher training group (16.1 ± 2.1 s versus 26.9 ± 3.7 s, p < 0.001). There were no significant differences in time to chest compression (29.6 ± 16.7 s versus 34.4 ± 17.8 s, p = 0.172) and AED use between the groups.ConclusionsA short-time refresher BLS training program 6 months after the initial training can help trainees retain chest compression skills for up to 1 year. Repeated BLS training, even if very short, would be adopted to keep acquired CPR quality optimal (UMIN-CTR UMIN 000004101).     

Reduced hands-off-time and time to first shock in CPR according to the ERC Guidelines 2005

Background and aimChest compressions and early defibrillation are crucial in cardiopulmonary resuscitation (CPR). The Guidelines 2005 brought major changes to the basic life support and automated external defibrillator (BLS–AED) algorithm. We compared the European Resuscitation Council's Guidelines 2000 (group ‘00) and 2005 (group ‘05) on hands-off-time (HOT) and time to first shock (TTFS) in an experimental model.MethodsIn a randomised, cross-over design, volunteers were assessed in performing BLS–AED over a period of 5 min on a manikin in a simulated ventricular fibrillation cardiac arrest situation. Ten minutes of standardised teaching and 10 min of training including corrective feedback were allocated for each of the guidelines before evaluation. HOT was chosen as the primary and TTFS as the secondary outcome parameter.ResultsForty participants were enrolled; one participant dropped out after group allocation. During the 5-min evaluation period of adult BLS–AED, HOT was significantly (p < 0.001) longer in group ‘00 [273 ± 3 s (mean ± standard error)] than in group ‘05 (188 ± 3 s). The TTFS was significantly (p < 0.001) longer in group ‘00 (91 ± 3 s) than in group ‘05 (71 ± 3 s).ConclusionIn this manikin setting, HOT and TTFS improved with BLS–AED performed according to Guidelines 2005.     

Effects of two retraining strategies on nursing students’ acquisition and retention of BLS/AED skills: A cluster randomised trial

AimTo determine and compare the effects of two different retraining strategies on nursing students’ acquisition and retention of BLS/AED skills.MethodsNursing students (N = 177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter^® software and a self-efficacy scale were used to assess students’ overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time.ResultsThere was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-values < 0.05). However, at post-test, significantly more students in the SDG achieved overall BLS/AED competency when compared to IDG. In terms of retention at 3 months, success rates of students within the IDG deteriorated significantly for all variables except ≥70% of chest compressions with correct hand position (p-value = 0.12). Conversely, the proportion of students who achieved competency within the SDG only decreased significantly in ‘mean no flow-time≤5s’ (p-value = 0.02). Furthermore, differences between groups’ success rates at retention-test also proved to be significantly different for all variables measured (all p-values < 0.05).ConclusionThis study demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy.     

Hospital employees improve basic life support skills and confidence with a personal resuscitation manikin and a 24-min video instruction

IntroductionThe use of a personal resuscitation manikin with video instruction is reportedly as effective as traditional instructor-led courses in teaching lay people basic life support (BLS). We applied this method to an entire hospital staff to determine its effect on their practical and self-judged BLS skills.MethodsAll 5382 employees at Stavanger University Hospital were asked to learn or refresh their BLS skills with the personal resuscitation manikin and video instruction. Prior to and nine months after training, all employees were asked to rate their BLS skills on a scale from one to five. Additionally, randomly chosen study subjects were tested for BLS skills pre-training and six months post-training during 2 min of resuscitation on a manikin.ResultsIn total, 5118 employees took part in the BLS training program. The number of correct chest compressions increased significantly from 60 (5–102) to 119 (75–150) in the pre- vs. post-training periods, respectively, P < 0.01, but the number of correct MTM ventilations did not change. Self-reported BLS skills increased from 3.1 (±1.0) pre-training to 3.8 (±0.8) post-training, P = 0.031.ConclusionAfter distributing a personal resuscitation manikin with video instruction to an entire hospital staff, the median number of correctly performed chest compressions doubled and self-confidence in BLS skills improved significantly. This is a simple and less time-consuming method than instructor-led courses in preparing hospital employees in the basic handling of cardiac arrest.     

A novel assay system for myeloperoxidase activity in whole saliva

ObjectivesThe application of a novel assay system for the direct measurement of MPO (myeloperoxidase) activity in whole saliva.Design and methodsThe assay system employs a novel sensitive substrate from 3,3′-diaminobenzidine (DAB) and guaiacol in the presence of dapsone (4,4′-diaminodiphenylsulfone) to determine MPO activity in whole saliva using an original “sandwich” test-disk (DEAE-cellulose paper and cellulose chromatography paper). The saliva (0.1 mL) was directly applied to the sandwich test-disk, and then 0.1 mL of the substrate solution containing 1 mM dapsone in 0.3 M Tris–HCl buffer (pH 7.5) was added. After incubation for 30 min at room temperature, absorbance on the test-disk was measured at 460 nm with an optical analyzer.ResultsThe assay system was shown to distinguish MPO from salivary peroxidase in whole mixed saliva and was sensitive, easy and cheap. The assays revealed that MPO activity in whole saliva from subjects with periodontal disease was significantly higher than in saliva from healthy subjects. There was also a significant positive correlation between MPO activity and the probing depth of subgingival pockets (r = 0.736, p < 0.001).ConclusionsThese results indicate that this novel assay system for measurement of MPO is a useful technique for predicting the progression of periodontal disease.     

A novel approach to life support training using “action-linked phrases”

BackgroundObservations of cardiopulmonary arrests (CPAs) reveal concerning patterns when clinicians identify a problem, (e.g. loss of pulse) but do not immediately initiate appropriate therapy (e.g. compressions) resulting in delays in life saving therapy.MethodsWe hypothesized that when individuals utilized specific, short, easy-to-state action phrases stating an observation followed by an associated intervention, there would be a higher likelihood that appropriate action would immediately occur. Phase I: A retrospective analysis of residents in simulated CPAs measured what proportion verbalized “There's no pulse”, statements and/or actions that followed and whether “Action-Linked Phrases” were associated with faster initiation of compressions. Phase II: Two prospective, quasi-experimental studies evaluated if teaching three Action-Linked Phrases for Basic Life Support (BLS) courses or six Action-Linked Phrases for Advanced Cardiovascular Life Support (ACLS) courses was associated with increased use of these phrases.ResultsPhase I: 62% (42/68) of residents verbalized “there's no pulse” during initial assessment of a pulseless patient, and only 16/42 (38%) followed that by stating “start compressions”. Residents verbalizing this Action-Linked Phrase started compressions sooner than others: (30 s [IQR:19–42] vs. 150 [IQR:51-242], p < 0.001). Phase II: In BLS courses, the three Action-Linked Phrases were used more frequently in the intervention group: (226/270 [84%] vs. 14/195 [7%]; p < 0.001). In ACLS courses, the six Action-Linked Phrases were uttered more often in the intervention group: (43% [157/368] vs. 23% [46/201], p < 0.001).ConclusionsAction-Linked Phrases innately used by residents in simulated CPAs were associated with faster initiation of compressions. Action-Linked Phrases were verbalized more frequently if taught as part of a regular BLS or ACLS course. This simple, easy to teach, and easy to implement technique holds promise for impacting cardiac arrest teams’ performance of key actions.     

Perception of CPR quality: Influence of CPR feedback,Just-in-Time CPR training and provider role

AimMany healthcare providers rely on visual perception to guide cardiopulmonary resuscitation (CPR), but little is known about the accuracy of provider perceptions of CPR quality. We aimed to describe the difference between perceived versus measured CPR quality, and to determine the impact of provider role, real-time visual CPR feedback and Just-in-Time (JIT) CPR training on provider perceptions.MethodsWe conducted secondary analyses of data collected from a prospective, multicenter, randomized trial of 324 healthcare providers who participated in a simulated cardiac arrest scenario between July 2012 and April 2014. Participants were randomized to one of four permutations of: JIT CPR training and real-time visual CPR feedback. We calculated the difference between perceived and measured quality of CPR and reported the proportion of subjects accurately estimating the quality of CPR within each study arm.ResultsParticipants overestimated achieving adequate chest compression depth (mean difference range: 16.1–60.6%) and rate (range: 0.2–51%), and underestimated chest compression fraction (0.2–2.9%) across all arms. Compared to no intervention, the use of real-time feedback and JIT CPR training (alone or in combination) improved perception of depth (p < 0.001). Accurate estimation of CPR quality was poor for chest compression depth (0–13%), rate (5–46%) and chest compression fraction (60–63%). Perception of depth is more accurate in CPR providers versus team leaders (27.8% vs. 7.4%; p = 0.043) when using real-time feedback.ConclusionHealthcare providers’ visual perception of CPR quality is poor. Perceptions of CPR depth are improved by using real-time visual feedback and with prior JIT CPR training.     

Engaging a whole community in resuscitation

BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42,000, area 588 km²) none survived an OHCA in 2001–2003. Therefore, we designed a multifaceted community-based approach aiming at strengthening each link in the chain of survival.The purpose of this study was to evaluate the effect of implementation of the intervention on bystander basic life support (BLS) rates and survival to hospital discharge after OHCA.MethodsLaypersons completed 24-min DVD-based-self-instruction BLS courses in schools and workplaces or 4-h BLS/automated external defibrillator (AED) courses. The local television station had broadcasts about resuscitation. The ambulance personnel were trained and the staff at the island hospital completed BLS courses or more advanced courses.ResultsDuring 2 years 9226 people (22% of the population) completed the short course and 2453 (6% of the population) completed the 4-h course. The number of AEDs increased from 3 to 147. The bystander BLS rate for OHCAs with a presumed cardiac aetiology (N = 96, incidence 114/100,000 person-years) was 47% [95% CI 30–50] and for witnessed OHCAs (N = 35) it increased significantly from 22% (2004) to 74% [95% CI 58–86]. The AEDs were deployed in 9 cases. Survival to discharge for all-rhythms OHCA was 5.4% [95% CI 2–12], and for witnessed ventricular fibrillation (N = 17) 18% [95% CI 5–42].ConclusionStrengthening all links in the chain of survival was associated with significant increases in bystander BLS rates and survival after OHCA on a rural island.     

New models to support the professional education of health visitors: A qualitative study of the role of space and place in creating ‘community of learning hubs’

BackgroundIn response to a policy-driven workforce expansion in England new models of preparing health visitors for practice have been implemented. ‘Community of Learning hubs’ (COLHs) are one such model, involving different possible approaches to student support in clinical practice placements (for example, ‘long arm mentoring’ or ‘action learning set’ sessions). Such models present opportunities for studying the possible effects of spatiality on the learning experiences of students and newly qualified health visitors, and on team relationships more broadly.ObjectivesTo explore a ‘community of learning hub’ model in health visitor education and reflect on the role of space and place in the learning experience and professional identity development of student health visitors.DesignQualitative research conducted during first year of implementation.SettingsThree ‘community of learning hub’ projects based in two NHS community Trusts in London during the period 2013–2015.ParticipantsManagers and leads (n = 7), practice teachers and mentors (n = 6) and newly qualified and student health visitors (n = 16).MethodsSemi-structured, audio-recorded interviews analysed thematically.ResultsParticipants had differing views as to what constituted a ‘hub’ in their projects. Two themes emerged around the spaces that shape the learning experience of student and newly qualified health visitors. Firstly, a generalised need for a ‘quiet place’ which allows pause for reflection but also for sharing experiences and relieving common anxieties. Secondly, the role of physical arrangements in open-plan spaces to promote access to support from more experienced practitioners.ConclusionsAttention to spatiality can shed light on important aspects of teaching and learning practices, and on the professional identities these practices shape and support. New configurations of time and space as part of educational initiatives can surface new insights into existing practices and learning models.     

Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

PurposeAssessment of prognosis after out-of-hospital cardiac arrest (OHCA) is challenging. Cerebral computed tomography (cCT) scans are widely available, but the use in prognostication of comatose OHCA-patients is unclear. We evaluated the prognostic value of cCT in a clinical cohort of OHCA-patients.MethodA total of 1120 consecutive OHCA-patients with cardiac aetiology and successful or on-going resuscitation at hospital arrival were included (2002–2011). Utstein-criteria for registration of pre-hospital data and review of patient-charts for post-resuscitation care including cCT results were used. The primary endpoint was 30-day mortality analysed by log-rank and multivariate Cox-regression analyses.ResultsA cCT scan was performed in 341(30%) of the clinical OHCA-cohort, and an early CT (<24 h) was performed in 188 patients. The early CT was found ‘normal’ in 163(89%) and with reduced discrimination in 7(4%) of patients, which was independently associated with higher 30-day mortality compared with OHCA-patients with an early cCT (HR_adjusted = 3.5 (95%CI: 1.0–11.5), p = 0.04). A late CT (≥24 h) was performed in 153 patients in a median of 3 days (IQR: 2–5) and was ‘normal’ in 89(60%), ‘cerebral bleeding’ in 4(3%), ‘new cerebral infarction’ in 10(7%), and ‘reduced discrimination between white and grey matter and/or oedema’ in 45(30%) patients. ‘Reduced discrimination and/or oedema’ by late cCT was independently associated with higher 30-day mortality compared to patients with a normal late CT (HR_adjusted = 2.6 (95%CI: 1.4–4.8, p = 0.002).ConclusionOur observations suggest that a cCT may be useful as part of the neurological prognostication in patients with OHCA. ‘Reduced discrimination between white and grey matter and/or oedema’ on cCT was independently associated with a poor prognosis.     

Experience with prognostic disclosure of families of Japanese patients with cancer

ContextPrognosis is difficult to discuss with patients who have advanced cancer and their families.ObjectivesThis study aimed to explore the experiences of families of patients with cancer in Japan in receiving prognostic disclosure, explore family perception of the way the prognosis was communicated, and investigate relevant factors of family-perceived need for improvement.MethodsA multicenter questionnaire survey was conducted with 666 bereaved family members of patients with cancer who were admitted to palliative care units in Japan.ResultsIn total, 86.3% of the families received prognostic disclosure. The overall evaluation revealed that 60.1% of the participants felt that the method of prognostic disclosure needed some, considerable, or much improvement. The parameter with the highest value explaining the necessity for improvement was the family perception that the amount of information provided by the physician was insufficient (beta = 0.39, P < 0.001). Furthermore, the family perception that they had lost hope and that health care providers failed to facilitate preparation for the patient’s death had significant direct effects on the necessity for improvement (beta = 0.21, P < 0.001; and beta = 0.18, P < 0.001, respectively). The feelings for the necessity for improvement also were affected significantly by seven communication strategies (i.e., not saying “I can do nothing for the patient any longer,” pacing explanation with the state of the patient’s and family’s preparation, saying “We will respect the patient’s wishes,” making an effort to understand the family’s distress, being knowledgeable about the most advanced treatments, assuring continuing responsibility as the physician for medical care, and respecting the family’s values).ConclusionThis model suggests that strategies for care providers to improve family perception about prognostic disclosure should include 1) providing as much prognostic information as families want; 2) supporting families’ hopes by keeping up with up-to-date treatments and by assuring the continuing responsibility for medical care; 3) facilitating the preparation for the patient’s death by providing information in consideration of the family’s preparations and values; 4) stressing what they can do instead of saying that nothing can be done for the patient; and 5) assuring the family that they will respect the patient’s wishes.     

An investigation of thrust,depth and the impedance cardiogram as measures of cardiopulmonary resuscitation efficacy in a porcine model of cardiac arrest

ObjectiveOptimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO₂ (ETCO₂).MethodsTwo experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0–60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0–5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO₂ were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model.ResultsIn experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r = 0.69–0.77) and thrust (r = 0.66–0.82). A moderate correlation was observed between compression depth and thrust (r = 0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r = 0.89, r = 0.79) and ETCO₂ (r = 0.85, r = 0.64).ConclusionIn this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO₂ suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance.     

The learner as co-creator: A new peer review and self-assessment feedback form created by student nurses

BackgroundEngagement with peer review and self-assessment is not always regarded by student nurses as an activity that results in a positive learning experience. Literature indicates that withdrawal from the learning process becomes attractive to individuals affected by a negative experience of peer review. Literature also provides examples of student nurses' feeling ‘torn to shreds’ during the process of peer review, resulting in loss of confidence and self-esteem. An influencing factor in such situations appears to be the absence of specific learner-driven criteria against which student nurses can assess peer and self-performance. The idea was thus ignited, that creation and utilisation of a learner-driven feedback form might potentially prevent, or at least minimise, the possibility of negative peer review experience.ContextSet within the context of a pre-registration nursing programme, within a Higher Education institution, student nurses (n = 25), created a peer review/self-assessment feedback form. Its potential cross-discipline, global applicability is reasonably speculated.MethodsPurposive sampling, followed by Stratified Random sampling, maximised participant variation. Data collection took place on 34 occasions, utilising focus group discussions using Nominal Group Technique, a practical task which was video recorded for mediating artefact purposes, and individual interviews. Analysis was concept and theme driven.FindingsThe study found that participants desired a new feedback form that specifically asks the evaluator to judge human qualities, such as ‘compassion’ and ‘kindness’, in addition to the skills and knowledge criteria that any peer review or self-assessment form used currently had incorporated.ConclusionProviding the participants with the opportunity to develop criteria, against which performance could be measured, with emphasis being afforded to student inclusivity and resultant shift in power balance from the educator to the learner, embraces the idea of teaching and learning in the 21st Century.     

Nurses’ knowledge and perception of delirium screening and assessment in the intensive care unit: Long-term effectiveness of an education-based knowledge translation intervention

ObjectivesTo determine the impact of education on nurses’ knowledge of delirium, knowledge and perception of a validated screening tool, and delirium screening in the ICU.MethodsA quasi-experimental single group pretest-post-test design.SettingA 16 bed ICU in a Canadian urban tertiary care centre.Main outcome measuresNursing knowledge and perception were measured at baseline, 3-month and 18-month periods. Delirium screening was then assessed over 24-months.ResultsDuring the study period, 197 surveys were returned; 84 at baseline, 53 at 3-months post education, and 60 at the final assessment period 18-months post intervention. The significant improvements in mean knowledge scores at 3-months post intervention (7.2, SD 1.3) were not maintained at 18-months (5.3, SD 1.1). Screening tool perception scores remained unchanged. Improvements in the perception of utility were significant at both time periods (p = 0.03, 0.02 respectively). Physician value significantly improved at 18-months (p = 0.01). Delirium screening frequency improved after education (p < 0.001) demonstrating a positive correlation over time (p < 0.01).ConclusionMultifaceted education is effective in improving delirium knowledge and screening; however, without sustained effort, progress is transient. Education improved perceived tool utility and over time utility perception and physician value improved.     

Expert patient illness narratives as a teaching methodology: A mixed method study of student nurses satisfaction

ObjectiveTo evaluate nursing students' satisfaction with Expert Patient Illness Narratives as a teaching and learning methodology based on patient involvement.Methods and DesignMixed methods were used in this study: online survey with quantitative and qualitative items designed by researchers.Settings and ParticipantsSixty-four nursing students of the Universitat Autònoma de Barcelona, attending a Medical Anthropology elective course.ResultsWomen more frequently considered that the new learning methodology was useful in developing the competency “to reason to reason the presence of the triad Health-Illness-Care in all the groups, societies and historical moments” (p-value = 0.02) and in that it was consolidated as a learning outcome (p-value = 0.022). On the other hand, men considered that this methodology facilitated the development of critical thinking (p = 0.01) and the ability to identify normalized or deviant care situations (p = 0.007). Students recognized the value of Expert Patient Illness Narratives in their nursing training as a way to acquire new nursing skills and broaden previously acquired knowledge. This educational innovation improved nursing skills and provided a different and richer perspective of humanization of care.ConclusionsThe results of the present study demonstrate that nursing students found Expert Patient Illness Narratives satisfactory as a learning and teaching methodology, and reported improvement in different areas of their training and also the integration of new knowledge, meaning, theory applicability, as well las critical and reflective thinking. Involvement of patients as storytellers also provides a new humanizing perspective of care. Nonetheless, further studies of Expert Patient Illness Narratives are needed in order to improve its benefits as a teaching and learning methodology.