Performance‐based assessment during clinical placement: Cross‐sectional investigation of a training workshop for practice educators

Performance‐based assessment evaluates a health professional student's performance as they integrate their knowledge and skills into clinical practice. Performance‐based assessment grades, however, are reported to be highly variable due to the complexity of decision‐making in the clinical environment. The aim of this study was to evaluate the impact of a training workshop based on frame‐of‐reference principles on grading of student performance by physiotherapy practice educators. This was a prospective cross‐sectional study which used a single group pre‐test, post‐test design. Fifty‐three practice educators rated two video vignettes depicting a poor and very good student performance, using a subsection of a physiotherapy performance‐based assessment tool before and after training. Overall, results showed that participants amended their scores on approximately half of all scoring occasions following training, with the majority decreasing the scores awarded. This impacted positively on scoring for the poor performance video, bringing scores more in line with the true score. This study provides evidence of the benefit of a training workshop to influence decision‐making in performance‐based assessment as part of a wider education program for practice educators.     

Effectiveness of a first‐aid intervention program applied by undergraduate nursing students to preparatory school children

Childhood injuries constitute a major public health problem worldwide. First aid is an effective life‐preservation tool at work, school, home, and in public locations. In this study, the effectiveness of a first‐aid program delivered by undergraduate nursing students to preparatory school children was examined. This quasi‐experimental study was carried out on 100 school children in governmental preparatory schools in Egypt. The researchers designed a program for first‐aid training, and this was implemented by trained nursing students. The evaluation involved immediate post‐test and follow‐up assessment after two months. The results showed generally low levels of satisfactory knowledge and inadequate situational practice among the school students before the intervention. Statistically‐significant improvements were shown at the post‐ and follow‐up tests. Multivariate regression analysis identified the intervention and the type of school as the independent predictors of the change in students' knowledge score, while the intervention and the knowledge score were the predictors of the practice score. The study concluded that a first‐aid training program delivered by nursing students to preparatory school children is effective in improving their knowledge and practice.     

助产士分层培训实践研究

目的：探讨提高助产士整体素质的有效培训方式。方法：依据助产士核心能力标准和助产士层级进行分级培训,并根据各级助产士的知识和技能培训目标制定理论、技能和个案管理考核内容。结果：实施助产士分层培训后,助产士核心能力考核成绩为（91．0±3．8）分,与培训前的（78．8±4．7）分相比,差异有统计学意义（t=-9．37,P〈0．01）;初产妇会阴侧切率、宫颈裂伤率、产后出血率与培训前相比,差异有统计学意义（P〈0．05）。结论：助产士分层培训可有效提高其基础理论与专科知识、专科技能、应急处理与抢救能力、教学与培训能力及综合管理能力,可有效提高产科护理质量。     

A before and after study assessing the impact of a new model for recognizing and responding to early signs of deterioration in an acute hospital

Aim. To evaluate the impact of a new model for the detection and management of deteriorating patients on knowledge and confidence of nursing staff in an acute hospital. Background. International evidence shows that clinical deterioration is not always recognized or acted on by nurses. The use of physiological track and trigger scoring systems accompanied by a graded response strategy has been recommended to monitor all adult patients in acute UK hospitals. However, little is known about the impact of these new systems in practice. Design. A single centre, mixed methods before‐and‐after study. Methods. A mixed methods before‐and‐after study, set in a district general hospital in England, in 2009, including a survey (n = 213) and qualitative interviews (n = 15) with nursing staff. The questionnaire examined knowledge and confidence in recognition and management of deteriorating patients 6 weeks before and after an intervention which included training, new observation charts and a new track and trigger system. Interviews further explored participants’ perspectives. Comparisons were made between registered and unregistered nurses. Results. Following the intervention, knowledge, and confidence to recognize and manage deteriorating patients increased; the number of concerns were reduced. Scores were higher for registered than unregistered nurses before and after the intervention. Interviews confirmed these findings and provided detail on how nurses felt the new system had improved practice. Conclusion. The new model had a positive impact on the self‐assessed knowledge and confidence of registered and unregistered nurses. Similar initiatives should take into account the clinical context and tailor training packages accordingly.     

Does ultrasound examination when the cervix is unfavorable improve the prediction of failed labor induction?

OBJECTIVE: To compare the Bishop score, ultrasound cervical parameters and fetal fibronectin assessment for predicting failed labor induction when the cervix is unfavorable. METHOD: A prospective observational study was performed in 106 consecutive pregnant women with a Bishop score < or =5 undergoing labor induction. Assessment of fetal fibronectin and ultrasound measurement of cervical length, cervical wedging and cervical lip areas were performed. The relationship between these parameters and failure of labor induction was determined. RESULTS: Failure of labor induction was defined as failure to reach a cervical dilatation of > or =5 cm, and it occurred in 16 patients (15.1%). Induction failure was associated with low Bishop scores before (P = 0.004) and 6 h after the start of induction (P = 0.007), increased clinical cervical length (P = 0.02) and increased ultrasound anterior cervical lip area (P = 0.04). The logistic regression model identified the Bishop score before induction (odds ratio = 2.25; 95% CI, 1.30-3.91; P = 0.003) and the clinical cervical length (odds ratio = 3.95; 95% CI, 1.3-11.7; P = 0.01) as being independent predictors of failed induction. To predict an induction failure, the best Bishop score cut-off value was 4, with a sensitivity of 87.5%, a specificity of 45.6%, a likelihood ratio of 1.58, a positive predictive value of 22.2% and a negative predictive value of 95.4%. CONCLUSION: Compared with the Bishop score, cervical length by ultrasound is not a better predictor for the outcome of labor induction in an unfavorable cervix. Nevertheless, the Bishop score appears to be of poor predictive value for failed induction of labor.     

297名助产士共情能力调查分析

目的 调查助产士共情能力现状并分析助产士共情能力的影响因素。方法 本研究采用滚雪球抽样的方法,通过问卷星进行网络调查。在2019年3—5月将自行设计的一般情况调查问卷和杰弗逊共情量表中文版制成问卷星电子调查问卷,发放到中华助产士专科培训微信群,并请求群成员将问卷转发至自己所在医院的产房助产士群,对全国25个省市80余家医院的297名助产士进行了调查。结果 助产士共情能力总分为（113.90±13.13）分,得分率均值为81.36%,各维度得分率均值由高到低依次为观点采择维度（82.36%）,情感护理维度（80.64%）,换位思考维度（79.67%）。参加过共情相关培训的助产士共情能力高于未参加培训者,对工作满意度高的助产士共情能力高于对工作不满意者和持一般态度者（P<0.05）。结论 助产士共情能力处于中等偏上水平,观点采择维度得分最高,换位思考维度得分最低,提示管理者可着重在换位思考角度加强对助产士共情能力的培训,同时采取多种措施提高助产士的工作满意度,以提高其共情能力。     

ICU nurses' knowledge of, and attitudes towards, the APACHE II scoring system

Aims and objectives. This study was undertaken to determine whether intensive care unit nurses possess adequate knowledge to implement the Acute Physiological and Chronic Health Evaluation (APACHE) II scoring system and to understand nurses’ attitudes towards this scoring system. Design. A questionnaire, which contained 20 multiple‐choice questions to test knowledge of the scoring system and 27 statements with a five‐points Likert type scale to assess attitude, was developed by researchers for this study. Methods. The participants consisted of 102 intensive care unit nurses working in adult, emergency, or coronary intensive care units in a large teaching hospital (Veterans General Hospital) in Taiwan, where the APACHE II scoring system is used routinely by nurses. Results. On the knowledge section of the questionnaire, 76% of the questions were answered correctly. However, more than 50% of the nurses were uncertain about how to score a patient's chronic history status, only 44.1% of the nurses knew that APACHE II total scores range from 0 to 71, and only 37.3% understood that the value for bicarbonate in venous samples could replace the arterial pH value. The results of the attitude questionnaire revealed that nurses believed APACHE II was useful mainly for statistical purposes by the administration rather than for patient care, but acknowledged that the scores could provide a reference for more aggressive treatment. Conclusions. The questionnaire answers indicated that greater knowledge concerning the APACHE II is needed. Relevance to clinical practice. Information and training concerning the proper use and purpose of APACHE II needs to be provided, especially for those intensive care unit nurses using this evaluation tool to score patients’ conditions routinely.     

基于核心胜任力的助产方向专科护士培训实践

目的探讨基于核心胜任力的助产方向专科护士培训效果。方法以2019年参加助产方向专科培训的39名学员为研究对象,以助产士核心胜任力为框架,从孕前保健、孕期保健、分娩保健、产后保健、新生儿保健、公共卫生保健对其进行理论(7周)与技能(9周)的培训,培训前后评价学员的理论知识、临床技能及助产士核心胜任力。结果培训后学员的理论成绩与临床技能成绩均较培训前提高(P<0.05),学员的助产士核心胜任力由(3.79±0.47)分提升至(4.16±0.43)分,差异有统计学意义(P<0.05)。结论基于核心胜任力的助产方向专科护士培训可有效提升助产士核心胜任力。     

Transvaginal sonography of the uterine cervix prior to labor induction.

OBJECTIVES: To compare the Bishop score and transvaginal sonographic measurement of cervical length for predicting the mode of delivery following medically indicated induction of labor in term patients. METHODS: The study was conducted prospectively in 179 women who required medically indicated induction of labor. Inclusion criteria were singleton pregnancy, gestational age > 37 weeks of amenorrhea, cephalic presentation and intact fetal membranes. Cervical length was measured upon arrival in the labor room but was not considered when choosing the induction procedure. Two receiver-operating characteristic curves were plotted to calculate the best threshold value for the Bishop score and for cervical length for predicting the risk of Cesarean section. RESULTS: Fifty-three women (29.6%) had a Cesarean section. The Bishop score was not predictive of the delivery mode, although Cesarean section for failure to progress was more frequent when the Bishop score was < or = 5. Among the women with a Bishop score > 5, the cervical length was not predictive of the induction outcome. However, among the women with a Bishop score < or = 5, a cervical length < 26 mm was associated with a lower Cesarean section rate (20.6 vs. 42.9%; P = 0.006). Furthermore, the interval between the beginning of cervical ripening and delivery was shorter in the case of a short cervix (11.01 +/- 6.7 vs. 18.55 +/- 7.07 h; P < 10(-5)). CONCLUSION: The length of the uterine cervix, measured by transvaginal sonography, is a better predictor of the risk of Cesarean section than the Bishop score after induction of labor for medical reasons. In women with an unfavorable Bishop score, a cervical length of < 26 mm is associated with a lower risk of Cesarean section and a shorter duration of labor.     

Midwives' view of the importance of genetics and their confidence with genetic activities in clinical practice: implications for the delivery of genetics education

Aims and objectives. The aim of the study was to ascertain the level of importance midwives attach to integrating genetics into midwifery care and to compare that with their self‐reported level of confidence in incorporating genetics into their clinical practice. Background. Previous work has shown that many midwives feel ill‐prepared for the increased integration of genetics into clinical practice and often only limited genetics education provision is in place. With the application of genetics to midwifery practice increasing, it is important that midwives develop their knowledge and skills to meet this growing clinical role. This study was therefore developed to ascertain the attitudes and educational needs of midwives by exploring genetic issues likely to arise in clinical practice and the confidence individuals felt in dealing with them. Design. A survey questionnaire with open and closed questions. Methods. All midwives working in four National Health Service trusts (n = 817) were invited to self‐complete the validated questionnaire anonymously. Data were collected on demographics and preferred continued professional development options for future educational programme development. Likert scales were used to rate the importance of genetic activities and midwives’ confidence to perform them based on the genetic activities which were first listed and then presented embedded within specific clinical scenarios. Results. The response rate was 51% (n = 416). The majority of midwives felt that genetics was important but many did not feel confident about integrating it into their clinical practice. Across all scenarios >60% of midwives were not confident on any risk identification or risk communication activities. The majority of midwives were receptive to genetics education particularly if delivered from a clinical rather than a psychosocial or scientific perspective. Conclusion. This study demonstrates the need for midwives’ pre‐ and postregistration education to include clinically relevant genetics. The evidence presented here can inform the design, development and delivery of future educational initiatives. What this study adds. This study was the first to identify the educational needs of midwives related to integrating genetics into midwifery clinical practice. It provides evidence of key topics to be included in educational programmes: referring to specialist genetics services, genetic testing, risk and communicating genetic information. It shows the type and format of course preferred by clinically based midwives: interactive workshops and lectures using clinical patient‐based case examples will attract midwives to participate and will be better received by their managers. Relevance to clinical practice. Midwives view genetics as important in their clinical practice. However, they have little confidence in their ability to integrate genetic activities in their current clinical practice. Midwives are receptive to additional genetics education and training. Antenatal and community‐based midwives could be targeted initially. Organizers must be responsive to work patterns in planning education sessions, and encourage and support champions from previous courses and specialist areas to promote genetics education in maternity units.     

改良牛舌模型在高年资助产士培训中的应用

目的:探讨改良牛舌模型在高年资助产士培训中的应用效果。方法:采取便利抽样法,2018年8月—2019年8月选取上海市第一妇婴保健院东院、西院、南院3个院区及其他省市前来培训的高年资助产士140名为研究对象。对其进行理论知识和操作培训,采用改良牛舌模型进行操作培训。比较培训前后助产士的理论和技能考核成绩及其对培训的满意度...     

医院陪护人员手卫生知识掌握现状及影响因素分析

目的了解医院陪护人员手卫生知识掌握现状,探讨主要影响因素,为提高手卫生认知水平提供依据。方法采用分层随机抽样方法,对621名医院陪护人员进行手卫生知识问卷调查,用单因素方差分析、独立样本t检验、多重线性回归进行统计学处理。结果陪护人员手卫生知识得分(22.0±6.1)分,最高分33分(满分),最低分8分,得分率66.7%,其中便后进行手卫生得分率最高,为95.9%,穿脱隔离衣后进行手卫生得分率最低,为34.6%。影响手卫生知识得分的因素为科室、教育程度、是否接受过培训、有无洗手示意图。结论医院陪护人员手卫生知识得分率不高,存在多方面的影响因素,科室应提供完善的手卫生设施,有针对性加强对医院陪护人员手卫生知识培训,增强手卫生意识,提高知晓率。     

Methods for cervical ripening and induction of labor

Induction of labor is common in obstetric practice. According to the most current studies, the rate varies from 9.5 to 33.7 percent of all pregnancies annually. In the absence of a ripe or favorable cervix, a successful vaginal birth is less likely. Therefore, cervical ripening or preparedness for induction should be assessed before a regimen is selected. Assessment is accomplished by calculating a Bishop score. When the Bishop score is less than 6, it is recommended that a cervical ripening agent be used before labor induction. Nonpharmacologic approaches to cervical ripening and labor induction have included herbal compounds, castor oil, hot baths, enemas, sexual intercourse, breast stimulation, acupuncture, acupressure, transcutaneous nerve stimulation, and mechanical and surgical modalities. Of these nonpharmacologic methods, only the mechanical and surgical methods have proven efficacy for cervical ripening or induction of labor. Pharmacologic agents available for cervical ripening and labor induction include prostaglandins, misoprostol, mifepristone, and relaxin. When the Bishop score is favorable, the preferred pharmacologic agent is oxytocin.     

手术室护士无瘤技术知识、信念、行为的调查与分析

目的调查手术室护士无瘤技术知识、信念、行为情况,为无瘤技术培训提供依据。方法应用自行设计的无瘤技术知识、信念、行为问卷,对江苏省6所医院的258名手术室护士进行调查。结果手术室护士的无瘤技术知识得分为(7.20±1.85)分,得分指标为72.00%;信念得分为(35.58±5.03)分,得分指标为71.16%;行为得分为(44.11±8.02)分,得分指标为63.08%。结论目前手术室护士缺乏无瘤技术相关知识,操作不规范,对无瘤技术的职责定位不高,需加强手术室护士的无瘤知识培训,以改善其无瘤技术行为。     

Exploring knowledge work and leadership in online midwifery communication

Aim. This paper reports a study to answer the following question: if given a user‐friendly online system, that enabled communication across the practice community, would midwives function as knowledge workers? Background. Globally, the demand for quality‐led and innovative service delivery requires that nurses and midwives shift from being ‘information workers’, or passive receivers of managerial and organizational decisions, to become ‘knowledge workers’ who are able to create, lead and communicate service innovation and practice development. New communication technologies may offer a means for healthcare professionals to interact as knowledge workers and develop supportive communities of practice. Methods. An online discussion forum was implemented as a low‐cost technological intervention, deploying existing hardware and a standard hospital intranet. The evaluation of the forum was constructed as case‐study organizational research. The totality of online communication, both traffic and content, was analysed over a 3‐month period (193 messages downloaded 2003/2004), and 15 in‐depth interviews were undertaken with forum users. Findings. Given simple, facilitative, innovative technology, supported by a positive working culture and guided by effective leadership, midwives could function as ‘knowledge workers’, critically reflecting upon their practice and translating knowledge into action designed to achieve change in practice. Participation occurred across all staff grades, and midwives were predominantly supportive and facilitative towards the contributions made by colleagues. Conclusion. Midwives may be well placed to exemplify the ‘ideal’ characteristics of the knowledge worker being demanded of modern healthcare professionals. The deployment of online interactive technologies as part of strategic vision to enhance knowledge work among healthcare professionals should be given attention within health systems.     

中西医结合医院临床医护人员加速康复外科理念知信行现状调查

目的了解临床医护人员加速康复外科(ERAS)理念知信行现状,为开展ERAS规范化培训提供参考。方法采用问卷调查法对137名临床医护人员进行调查。结果调查结果显示,医护人员态度维度总分高于知识维度和行为维度,知识维度得分最低。不同职称医护人员知识维度得分比较,差异有统计学意义(P<0.05),护士知识维度得分低于医生,差异有统计学意义(P<0.05)。结论医院应重视ERAS相关知识的培训,制定适合临床医护人员的规范化培训计划。     

华东地区助产士对适度保护会阴分娩技术应用倾向及影响因素分析

的 调查华东地区助产士对于适度保护会阴分娩技术的临床选择及其相关影响因素，为规范适度保护会阴分娩技术的临床应用提供科学依据，以期进一步完善助产教育与培训体系。 方法 采用微信填写方式，应用自编调查表对华东地区5个省市共78家医院分娩室的1884名在职助产士进行横断面调查。 结果 71%的助产士在临床操作中会优先选择适度会阴保护；logistic回归分析显示，医院属性、助产工作年限、适度保护会阴分娩技术操作培训是影响助产士选择适度会阴保护分娩技术的影响因素；助产士对于适度保护会阴分娩技术的临床应用与推广持积极态度，对其教育培训和社会推广的需求很高。结论 华东地区助产士在临床工作中会优先选择适度保护会阴分娩技术，为规范这一技术的临床实践提供参考意见。后续应进一步完善助产教育体系建设和助产培训机制以满足助产士的相关需求。     

Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor.

BACKGROUND: Induction of labor is carried out in approximately 20% of pregnancies. However, approximately 20% of women having induction of labor end up having a Cesarean delivery. The traditional method of predicting whether an induced labor will result in successful vaginal delivery is based on the preinduction "favorability" of the cervix as assessed by the Bishop score. However, this assessment is subjective and several studies have shown a poor predictive value for the outcome of induction. OBJECTIVES: To examine the relationship between preinduction sonographically measured cervical length and the Bishop score and to compare the two measurements in the prediction of successful vaginal delivery within 24 h of induction. METHODS: In this multicenter study, preinduction cervical assessment was undertaken in 240 women with singleton pregnancies at 37-42 weeks of gestation. The Bishop score was assessed by digital examination and the cervical length was measured by transvaginal sonography. RESULTS: Multiple regression analysis demonstrated that cervical length, Bishop score and parity provided independent contribution in the prediction of the likelihood of delivering vaginally within 24 h. Further examination of the different components of the Bishop score showed that only cervical length provided a significant contribution in the prediction of the likelihood of vaginal delivery within 24 h. In the receiver operating characteristic curves, the best cut-off point for the prediction of successful induction was 28 mm for cervical length and 3 for the Bishop score. However, cervical length appears to be a better predictor than the Bishop score, with a sensitivity of 0.87 and a specificity of 0.71 compared to 0.58 and 0.77, respectively. Similarly, the Kaplan-Meier survival curves indicate that better discriminatory results in the prediction of vaginal delivery within 24 h are achieved using cervical length rather than the Bishop score. CONCLUSION: Transvaginal sonographic measurement of cervical length provides a useful prediction of the likelihood of vaginal delivery within 24 h of induction.     

The effect of a peer-mentoring strategy on student nurse stress reduction in clinical practice

LI H‐C., WANG L. S., LIN Y‐H. & LEE I. (2011) The effect of a peer‐mentoring strategy on student nurse stress reduction in clinical practice. International Nursing Review 58 , 203–210 Background: That nursing students suffer high levels of stress during clinical practice is a common topic in nursing education, but there are some effective strategies for dealing with it. Purpose: The purpose of this study is to examine the effects that a peer mentoring program has on student nurses' stress levels during clinical practice. Methods: A quasi‐experimental design was conducted. Forty‐nine junior level nursing students (n = 17 in the experimental group; n = 32 in the control group) were enrolled in the same medical‐surgical nursing class. Mentors were recruited from students who had received medical‐surgical experience before entering university. A 6‐point perceived Stress Scale for the nursing students' questionnaire was used to evaluate the stress level. Results: Stress from ‘lack of professional knowledge and skills’ was the highest score before clinical practice in the experimental (3.78) and control (3.57) group, and also was the highest score after clinical practice in the control group (3.44). Stress from ‘assignments and workload’ was the highest score after clinical practice in experimental group (3.25). Wilcoxon matched paired signed ranks test revealed that there are no significant differences in stress scores between the two groups. Conclusions/Implications for practice: Study findings reveal that there are various advantages and disadvantages to implementing peer mentoring programs. The clinical teacher needs to provide suitable support and encouragement to the mentor and mentee students during this program. These results might provide information that can be used in improving clinical internship experience for the students.     

Transvaginal sonographic measurement of cervical length vs. Bishop score in labor induction at term: tolerability and prediction of Cesarean delivery.

OBJECTIVES: To compare transvaginal sonography for cervical length measurement and digital examination for Bishop score assessment in women undergoing labor induction at term, to assess their tolerability (in terms of pain) and ability to predict need for Cesarean delivery. METHODS: A prospective study was performed on 249 women admitted for labor induction. Cervical length was measured using transvaginal ultrasound examination. A 10-point visual analog scale (VAS) for procedure-related pain was obtained. Bishop score was determined just before labor induction and another pain score was obtained. Delivery outcome was recorded. Analyses were by t-test, Fisher's exact test, receiver-operating characteristics (ROC) curves and multivariate logistic regression. RESULTS: Transvaginal sonography was significantly less painful than digital examination for Bishop score assessment (mean difference in VAS score 3.46; P<0.001). Analyses of the ROC curves for cervical length and Bishop score indicated that both were predictors of Cesarean delivery (area under the curve 0.611 vs. 0.607; P=0.012 vs. P=0.015, respectively) with optimal cut-offs for predicting Cesarean delivery of >20 mm for cervical length and Bishop score20 mm (AOR 3.4; 95% CI, 1.4-8.1; P=0.006) were independent predictors of Cesarean delivery. CONCLUSIONS: Transvaginal sonography for cervical length measurement is better tolerated than digital examination for Bishop score assessment. Both cervical length and Bishop score are useful predictors of the need for Cesarean delivery following labor induction. A cervical length>20 mm at labor induction at term is an independent predictor of Cesarean delivery.