Comparative analysis of two venipuncture learning methods on nursing students

Introduction

Venus cannulation is one of the main nursing actions. For the safety of patients and nurses, this skill is important to be performed in a proper and responsible way. Thus, the need for adequate education on this skill is essential.

Study objective

Comparison between the 4-stage (demonstration, deconstruction, comprehension, performance) learning method and the simplified 2-stage method (deconstruction, performance) on venous cannulation.

Methods

The study took place from November 2011 to March 2012. In total, 117 students of the Nursing Department of Technological Educational Institute of Athens were randomized into two education groups of the 2- (Group A) and 4- (Group B) stage method respectively. Students of both groups were assessed during training and 45 days later for skill retention. For the assessment of all students, a check list with the steps required to venous cannulation was used. The time to complete the process was also assessed.

Results

Group A included 54 students and Group B 50 students. During initial training, the average time to complete the process without any errors was lower for Group A compared to Group B (1.77 ± 0.12 min vs. 2.33 ± 0.13 min, p = 0.006). Regarding the appropriate steps for venous cannulation, Group A made fewer errors compared to Group B (0.95 ± 0.95 vs. 1.38 ± 1.10, p = 0.021). In addition, Group A omitted more steps than Group B (0.29 ± 0.06 vs. 0.11 ± 0.05, p = 0.042). During skill retention assessment, no significant difference was observed in the number of incorrect steps or in the number of omitted steps between groups.

Conclusion

According to our findings, the 4-stage method, is associated with less omitted steps, while the 2-stage method, is associated with less time required to complete the procedure and less errors during performance, at initial stages. However, skill retention does not seem to be associated with the type of the educational methodology.     

加强病区高危药品安全管理的实践与效果

目的 加强对病区高危药品的安全管理,确保患者用药安全.方法 2011年针对医院病区高危药品管理中存在的问题进行原因分析,通过建立安全管理组织、健全安全管理制度、规范使用流程、制订管理手册、组织培训与考核等一系列措施,加强病区高危药品的安全管理.结果 与2010年相比,2011年发生高危药品管理缺陷和用药安全隐患的事件明显下降,差异有统计学意义(x2=6.97,P＜0.05).护理人员对高危药品药学知识的掌握程度有显著提高.结论 加强病区高危药品的安全管理,能有效提高护理人员的安全用药能力,保障患者安全.     

对新护士进行高警讯药物知识专题培训的实践

目的研究如何通过培训提高新护士的高警讯药物知识及用药安全意识。方法对进院2年内的新护士进行专题培训20学时,并进行考核。结果新护士高警讯药物理论与操作技能考试成绩显著高于培训前（P〈0．01）,用药差错与护理缺陷明显减少。结论高警讯药物知识专题培训可提高护士的相关药物知识与临床用药安全管理质量。     

A national survey of nursing education and practice of newly licensed nurses

The Institute of Medicine recommended establishing evidence-based teaching methods and curricula in health professions' education to meet the needs of the changing healthcare system. In an attempt to provide evidence-based information for nursing education, this study was designed to identify educational elements that best prepare nurses for practice. The study employed a two-tiered survey process for collecting and combining data from programs of nursing education and the graduates of those programs. Administrators of 410 nursing programs responded to questions related to elements of education in their programs (response rate = 51%), whereas 7,497 RN (76.5%) and LPN (23.5%) graduates of respondent programs answered questions related to the adequacy of educational preparation for practice, difficulty with current client care assignments, and other professional and practice issues (response rate = 45.4%). The majority of the nurses reported that their education had adequately prepared them to perform many, but not all, essential areas of the nursing functions examined. Nearly 20% of the RNs and 18% of the LPNs reported having difficulty with client care assignments. Inadequate preparation of several nursing functions were identified as predictive of difficulty with patient care assignments. These areas include working effectively within the healthcare team, administering medications to groups of patients, analyzing multiple types of data when making client-related decisions, delegating tasks to others, and understanding the pathophysiology underlying a client's conditions. In addition, it was found that the graduates were more likely to feel adequately prepared when nursing programs taught them use of information technology and evidence-based practice; integrated pathophysiology and critical thinking throughout the curriculum; taught content related to the care of client populations as independent courses; and had a higher percentage of faculty teaching both didactic and clinical components of the curriculum. The findings of this study are significant in broadening our understanding of the relationships between educational elements and preparedness of new nurses for practice.     

Associations between state regulations,training length,perceived quality and job satisfaction among certified nursing assistants: Cross-sectional secondary data analysis

Background

In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training.

Objectives

This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants.

Design

Cross-sectional secondary data analysis.

Settings

This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training.

Participants

2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US.

Methods

State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics.

Results

Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p = 0.02) and were more satisfied with their jobs (OR = 1.51, 95% CI = 1.09–2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR = 1.91, 95% CI = 1.41–2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR = 1.36, 95% CI = 0.99–1.84).

Conclusions

Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover.     

低年资护士继续护理教育需求的质性研究

目的：探讨低年资护士对继续护理教育的实际需求,为低年资护士的继续教育提供依据。方法采用质性研究中的现象学研究方法,对15名低年资护士进行半结构式深入访谈,并用现象学分析法进行资料分析。结果通过阅读、编码、分析升华出低年资护士对继续护理教育需求的4个主题,即对继续教育的目的与重要性认识清晰、希望继续教育内容注重实用性、希望培训方法多元化、继续教育现状与期望有差距。结论应以低年资护士的需求为导向,以多元化的教学策略及健全的组织管理优化继续护理教育。     

多媒体+手机APP移动教学在低年资护士继续教育中的应用

目的探讨多媒体+手机APP移动教学在低年资护士继续教育中的应用效果。方法选择我院N0,N1,N2层级护士共234名作为研究对象,应用传统护理继续教育结合多媒体+护理助手软件学习方式对其进行继续教育,对比实施前后护士的学习态度、医院护理教学培训工作效率、护士及授课老师满意度。结果与实施前比较,实施后护士学习态度各项得分及出勤率明显更高(P<0.05),管理人员统计护士学分用时、理论考试阅卷用时、数据分析用时明显更短(P<0.05),护士及授课老师满意度得分明显更高(P<0.05)。结论多媒体+手机APP移动教学能有效改善低年资护士对继续教育的学习态度,提升教学工作效率和师生满意度。     

品管圈活动对提高二级医院护士继续教育参与成效的影响

目的 通过开展品管圈活动提高二级医院护士继续教育成效。方法 选择我区二级医院中的部分护士成立品管圈小组,确立“提高二级医院护士继续教育参与成效”的主题,对活动前继续教育成效较差的原因进行分析,通过树立正确观念;建立健全科学的管理制度;拓宽继续教育活动的形式和领域;完善考评体系等加强护理继续教育管理,并对活动前后护理人员对继续教育的认识程度、参与继续教育的出勤率、考试优秀率、培训课程质量等内容进行对比研究。结果 实施品管圈活动后,护理人员对护理继续教育的认知、参与情况以及考试优秀率、培训课程质量等都得到了大大的提高,差异均有统计学意义（P<0.05）。结论 开展品管圈活动能有效提高护士参加继续教育的效果,提高专业水平,激发护理人员参与继续教育的热情。     

社区护士继续教育现状调查分析

目的了解社区护士继续教育的现状。方法采用自设问卷形式,对北京市146名社区护士进行继续教育现状调查。结果社区护士获得继续教育学分的方式是参加医院组织继续教育项目(63.73%);社区护士参加继续教育的内容是社区护理知识(82.88%)和临床护理知识(82.19%);参加继续教育的主动性差;影响参加继续教育的主要原因是工作太忙(74.66%);社区护士希望每周进行短期培训(82.88%);社区护士急需人际沟通知识(69.86%)和护理基本技能(69.86%)的继续教育内容。结论鼓励学历教育,丰富社区护士继续教育形式,提高社区护士的整体素质,优化社区护理队伍,以满足社区护士的工作需要。     

Innovative solutions: pharmacy and nursing collaboration on a high-risk medication project.

Banner Good Samaritan Medical Center is a 650-bed tertiary care facility in the Southwestern United States. The pharmacy and nursing departments collaborated on a multifocal project to address the educational and operational needs of the facility regarding the new JCAHO Medication Management Review Standards for high-risk and high-alert medications. The project encompassed policy creation, nursing education, identification and evaluation of HRHA medications, and facility-wide distribution of information related to high-risk and high-alert medications.     

浙江省社区护士继续教育现状及需求调查分析

[摘要]目的调查浙江省社区护士继续教育现状及需求。方法采用便利抽样法,自设问卷对全省11个行政区共263名社区护士进行问卷调查,调查他们的一般情况、继续教育现状及需求。结果79．5％的社区护士通过短期培训班参加继续教育．93．5％的社区护士认为S-作繁忙影响他们参加继续教育。社区护士对继续教育内容需求排在前5位的是：社区急救处理、社区护理知识、社区护士职业安全防护、医学相关知识、社区护理安全隐患与防范。结论社区护士继续教育应根据护士的学习需求．采用更灵活的培训方式,让护士有更多机会参加相关教育。     

The Doctor of Nursing Practice: a national workforce perspective

In 2004, the American Association of Colleges of Nursing (AACN) adopted a position statement concerning the future of advanced practice nursing education. A target date of 2015 was articulated as the point by which master’s preparation for advanced practice nurses would be replaced by doctoral level education. Seismic shifts in the realities surrounding nursing education and practice have occurred since the proposal to require a Doctor of Nursing Practice (DNP) degree for entry into advanced practice nursing was proposed. Unprecedented economic challenges have resulted in significant budget downturns for all sectors, including higher education. The consequent cutbacks, furloughs, and restructuring in educational operations of all types have placed enormous demands on faculty, staff, and students across the country. In addition, the growing incidence and earlier onset of chronic disease, a rapidly aging population, health care reform agendas, a shortage of primary care practitioners, and projected severe shortages of nursing faculty have raised fundamental questions about the capacity of nursing education to produce the numbers of advanced practice nurses needed. This article addresses the changing realities and growing concerns associated with the future of advanced practice nursing. Recommendations to ensure continuing development of advanced nursing practice that serves the interests and needs of the public now and in the future are presented within the context of a national workforce perspective.     

Cultural competence of baccalaureate nursing faculty: are we up to the task?

Reported low levels of cultural competence among baccalaureate nursing students, as well as professional nurses, have raised questions about nursing faculty's readiness to prepare culturally competent graduates. This study examined cultural competence among faculty of baccalaureate nursing programs in Louisiana. Using a five-point Likert-type scale, the respondents were asked to express their level of agreement with statements addressing the components of cultural competence. The data analysis revealed the respondents' rating of their cultural awareness (4.14), desire (3.67) knowledge (3.65), skills (3.65), and encounters (3.56). Overall cultural competence was rated as 3.73. When the overall cultural competence index was regressed on the index of each subscale, the cultural knowledge index and the cultural encounter index significantly explained 87% of the variance in the model. These findings suggest that faculty should be encouraged to attend continuing education programs on cultural competence to improve their knowledge in this area. This continuing education, coupled with more local and/or international cross-cultural encounters should significantly improve the overall cultural competence of the respondents.     

Ensuring a knowledgeable and committed gerontological nursing workforce

There is a growing societal need for professional nurses who are knowledgeable and committed to working with older adults. In order to address this need, a small study that included self-evaluation and curriculum review was conducted by faculty at one Midwestern nursing program in the United States. A moderately positive attitude, moderately high knowledge, and moderate pursuit of knowledge of older adults were identified with the faculty in the presence of limited curricular content of gerontology. Implications for nursing education included continuing education for nursing faculty and program support in nursing curricula.     

Nurses' attitudes toward continuing formal education: a comparison by level of education and geography

The education of nurses has an influence on patient safety and outcomes, the nursing shortage, the faculty shortage, and nurses' attitudes and actions. This article reports on a dissertation study designed to examine the attitudes of nurses, initially registered with an associate degree or diploma in nursing, toward continuing formal education. Actively licensed registered nurses in the eastern and western United States (n=535) participated. The main finding of this study was that, although nurses held positive attitudes overall, attitudes ranked barely above neutral. The findings suggest that work needs to be done to improve nurses' attitudes toward continuing formal education and research needs to be undertaken to understand what would entice nurses back to school. Implications for nursing practice and education are discussed along with suggestions for future research.     

The benefits of a simplified method for CPR training of medical professionals: A randomized controlled study

Objectives

We developed and tested a training method for basic life support incorporating defibrillator feedback during simulated cardiac arrest (CA) to determine the impact on the quality and retention of CPR skills.

Methods

298 subjects were randomized into 3 groups. All groups received a 2 h training session followed by a simulated CA test scenario, immediately after training and at 3 months. Controls used a non-feedback defibrillator during training and testing. Group 1 was trained and tested with an audiovisual feedback defibrillator. During training, Group 1 reviewed quantitative CPR data from the defibrillator. Group 2 was trained as per Group 1, but was tested using the non-feedback defibrillator. The primary outcome was difference in compression depth between groups at initial testing. Secondary outcomes included differences in rate, depth at retesting, compression fraction, and self-assessment.

Results

Groups 1 and 2 had significantly deeper compressions than the controls (35.3 ± 7.6 mm, 43.7 ± 5.8 mm, 42.2 ± 6.6 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. controls; P = 0.001 for Group 2 vs. controls). At three months, CPR depth was maintained in all groups but remained significantly higher in Group 1 (39.1 ± 9.9 mm, 47.0 ± 7.4 mm, 42.2 ± 8.4 mm for controls, Groups 1 and 2, P = 0.001 for Group 1 vs. control). No significant differences were noted between groups in compression rate or fraction.

Conclusions

A simplified 2 h training method using audiovisual feedback combined with quantitative review of CPR performance improved CPR quality and retention of these skills.     

Chest compressions performed by ED staff: a randomized cross-over simulation study on the floor and on a stretcher

Background

Multiple factors may contribute to the observed survival variability following in-hospital cardiopulmonary resuscitation (CPR). While in-hospital CPR is most often performed on patients lying on a bed or stretcher, CPR training uses primarily manikins placed on the floor. We analyzed the quality of external chest compressions (ECC) in simulated cardiac arrest scenarios occurring both on a stretcher and on the floor.

Methods

Prospective cross-over simulation study enrolling ED nurses and nurse's aides as part of an annual evaluation. Simulated CPR was performed in the 2 rescuer-mode for 2 min, both kneeling on the floor, and standing beside a knee high stretcher. The order of position was randomized. ECC parameters were compared.

Results

ED nurses (n = 48) and nurse's aides (n = 26) performed 128 scenarios. Mean ECC depth was 32 ± 13 mm on the floor and 27 ± 11 mm on a stretcher (?: 5 mm, 95%CI [3-7], P < .001). Participants last trained within a year (n = 17) developed deeper ECCs than their colleagues (n = 47) in both positions (floor: 39 ± 12 mm vs stretcher: 34 ± 11 mm (p = 0.016) for those trained within the year, and floor: 29 ± 12 mm vs stretcher: 24 ± 10 mm (P < .001) for those trained over a year ago).

Conclusions

The quality of chest compressions performed by ED staff was below 2005 guideline standards, with decreased ECC depth during CPR on a stretcher. Annual refresher courses should be implemented in the ED, with a focus on obtaining required ECC depth while standing next to a stretcher.     

Basic life support trained nurses ventilate more efficiently with laryngeal mask supreme than with facemask or laryngeal tube suction-disposable—A prospective,randomized clinical trial

Objective

In some emergency situations resuscitation and ventilation may have to be performed by basic life support trained personnel, especially in rural areas where arrival of advanced life support teams can be delayed. The use of advanced airway devices such as endotracheal intubation has been deemphasized for basically-trained personnel, but it is unclear whether supraglottic airway devices are advisable over traditional mask-ventilation.

Methods

In this prospective, randomized clinical single-centre trial we compared airway management and ventilation performed by nurses using facemask, laryngeal mask Supreme (LMA-S) and laryngeal tube suction-disposable (LTS-D). Basic life support trained nurses (n = 20) received one-hour practical training with each device. ASA 1-2 patients scheduled for elective surgery were included (n = 150). After induction of anaesthesia and neuromuscular block nurses had two 90-second attempts to manage the airway and ventilate the patient with volume-controlled ventilation.

Results

Ventilation failed in 34% of patients with facemask, 2% with LMA-S and 22% with LTS-D (P < 0.001). In patients who could be ventilated successfully mean tidal volume was 240 ± 210 ml with facemask, 470 ± 120 ml with LMA-S and 470 ± 140 ml with LTS-D (P < 0.001). Leak pressure was lower with LMA-S (23.3 ± 10.8 cm H₂O, 95% CI 20.2–26.4) than with LTS-D (28.9 ± 13.9 cm·H₂O, 95% CI 24.4–33.4; P = 0.047).

Conclusions

After one hour of introductory training, nurses were able to use LMA-S more effectively than facemask and LTS-D. High ventilation failure rates with facemask and LTS-D may indicate that additional training is required to perform airway management adequately with these devices. High-level trials are needed to confirm these results in cardiac arrest patients.     

Current assessment of patient safety education

The purpose of this literature review was to examine current evidence on how student nurses and nursing faculty members perceived the integration of patient safety education in preregistration/undergraduate nursing training. Databases searched from January 2000 to April 2011 included CINAHL, PsycINFO, British Nursing Index, PubMed, AMED, Academic Science, Midline, Cochrane Library Database, Web of Knowledge, Ovid Nursing Database, Wiley Online Library and Science Direct. In total, 77 articles were initially found, although only 15 were included in the author's review. Of these, 5 papers were research-based articles that examined aspects of patient safety education in undergraduate/pre-registration nursing training, and 9 papers were literature review and discussion based, which provided insight into the experience, assessment, evaluation or implementation of patient safety education curriculum in nursing education. The author's literature review highlights the continuing lack of research on patient safety education in undergraduate/preregistration nursing training and, in particular, outlines areas in nursing education which need to be addressed to develop patient-safety-friendly nursing curricula.