Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration

AimThe aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care.MethodsA three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing.ResultsA prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW).ConclusionThe development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system.     

Recognizing, responding to and reporting patient deterioration: transferring simulation learning to patient care settings

Background

A simulation program was implemented in a pre-registration nursing curriculum for developing nursing students’ performances in assessing, managing and reporting in relation to patients with physiological deterioration.

Aim

To explore nursing students’ experiences of how a simulation programme has prepared them to transfer their performance to clinical practice, in their encounters with deteriorating patients in ward.

Method

A qualitative study using a critical incident technique was conducted. After they had undertaken a simulation program, fifteen undergraduate nursing students, who had encountered deteriorating patients in their clinical practicum in wards were interviewed using semi-structured questionnaires. Content analysis was used to analyse the data.

Results

Four main themes emerged describing key factors influencing the transfer of simulation learning to clinical practice; memory, involving simulation learning enhanced storage and retrieval of knowledge; mnemonics as transfer tools for performing systematic physical assessment and reporting a patient's deterioration to a doctor; recognizing similar situations, where students used experiences from similar simulation situation to identify problems and initiate nursing interventions for their patients; and finally, emotional responses, that have both negative and positive impacts on transferring their simulation learning. Two other main themes emerged regarding strategies to facilitate transfer; self-directed learning for promoting the retention of simulation learning; and, realism, where simulated patients could be used to provide real-life clinical experiences.

Conclusion

The findings provide an understanding of how a simulation program may impact on the nursing students’ performances in clinical practice, which is useful information for future improvement of programmes to optimize learning and transfer effective care to patient care settings.     

FIRST2ACT: educating nurses to identify patient deterioration - a theory-based model for best practice simulation education

Delayed assessment and mismanagement of patient deterioration is a substantial problem for which educational preparation can have an impact. This paper describes the development of the FIRST²ACT simulation model based on well-established theory and contemporary empirical evidence. The model combines evidence-based elements of assessment, simulation, self-review and expert feedback, and has been tested in undergraduate nurses, student midwives and post-registration nurses. Participant evaluations indicated a high degree of satisfaction and substantial self-rated increases in knowledge, confidence and competence. This evidence-based model should be considered for both undergraduate and post-registration education programs.     

Effectiveness of a simulation-based educational program in a pediatric cardiac intensive care unit

Optimal staff performance of resuscitation skills is best achieved through regular effective training. However, providing this teaching in a busy high-acuity pediatric cardiac intensive care unit (ICU) had become a challenge due to time and logistical constraints. A program to effectively and efficiently teach ICU nurses the skills necessary in patient resuscitation was developed using simulation training to better meet staff learning needs. Training via simulation provides an ideal learning environment with hands-on experience with the roles required in patient resuscitation. A simulation training program incorporating simulation training was developed for ICU nursing staff. All staff nurses in the ICU were required to attend over a year's time. The program involved mock resuscitation scenarios in which participants performed various resuscitation roles, followed by video review and group debriefing. All participants completed a survey prior to and immediately following participation in the training and again at 1 year. Data collected included self-report of knowledge, skill, and comfort related to patient resuscitation. Data revealed statistically significant improvement in scores pre and post training and at 1 year for self-reported knowledge, skills, and comfort related to resuscitation. Nursing staff reported that simulation training in resuscitation skills was helpful and positively impacted their knowledge, comfort, and skills. Feedback from nursing staff continues to be very positive, and performance of actual resuscitations on the unit has improved anecdotally.     

医学院校临床教师师资培训课程设置初步探索

目的调研临床教师的基本素质、基本技能、知识要求和与现状的差距。方法采用问卷和访谈的方式,调查139名教师的现状,内容包括自我评价和客观评价。结果在教学技巧和方法上有很大改善空间和培训需求。结论应该采取有效措施来提高临床教师的教学能力和授课技巧。     

Clinician and manager perceptions of factors leading to ward patient clinical deterioration

Background

Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown.

护理综合操作实践课程的构建与实践

针对学生在临床实习前临床综合应用能力不足,理论知识与实践技能缺乏有效融合的问题,我院在四年制护理本科课程中增设了护理综合操作实践小学期课程,旨在通过组合护理技能操作,依托模拟平台,进行互动式训练,提升学生的护理综合实践能力,同时促进教师护理操作实践教学方法改革,提高教学质量。     

Innovations in interprofessional learning and teaching: providing opportunities to embed patient safety within the pre-registration physiotherapy curriculum. A Pilot Study

Abstract

Background: Despite recognition of the need to embed patient safety within undergraduate healthcare education, there are limited examples of how this has been achieved within physiotherapy. The purpose of this regional initiative was to develop a course and teaching resources to support Higher Education Institutions in the United Kingdom (UK) when embedding the World Health Organization (WHO) multiprofessional patient safety curriculum into undergraduate healthcare education.

Objectives: In this pilot study, researchers assessed the impact of the interprofessional simulation-based education (IPSE) course on students’ perceptions of interprofessional learning and patient safety post-course, and explored the participants’ perceived application of knowledge and skills 3 months later.

Methods: A sequential mixed-methods evaluation was conducted, including pre- and post-course Readiness for Interprofessional Learning Scale (RIPLS) questionnaires and two course evaluation questionnaires featuring open and closed items (administered immediately post-course and 3 months later). Participants included undergraduate physiotherapy, medical, nursing, and pharmacy students.

Results: The IPSE course enabled students to develop an appreciation of each other’s professional roles and particularly their individual and collaborative practices that may positively impact upon patient safety. Post-course students reported being able to influence patient safety through an increased application of their ability to identify errors and influence their colleagues’ practices, thus impacting directly upon patient safety.

Conclusion: This paper provides an evaluation of an innovative method of providing interprofessional patient safety learning and teaching opportunities within undergraduate healthcare curricula.     

Effectiveness of intermediate-fidelity simulation training technology in undergraduate nursing education

AIM: The aim of this paper is to present the results of a study designed to determine the effect of scenario-based simulation training on nursing students' clinical skills and competence. BACKGROUND: Using full-scale, realistic, medical simulation for training healthcare professionals is becoming more and more common. Access to this technology is easier than ever before with the opening of several simulation centres throughout the world and the availability on the market of more sophisticated and affordable patient simulators. However, there is little scientific evidence proving that such technology is better than more traditional techniques in the education of, for example, undergraduate nursing students. METHODS: A pretest/post-test design was employed with volunteer undergraduate students (n = 99) from second year Diploma of Higher Education in Nursing programme in United Kingdom using a 15-station Objective Structured Clinical Examination. Students were randomly allocated to either a control or an experimental group. The experimental group, as well as following their normal curriculum, were exposed to simulation training. Subsequently, all students were re-tested and completed a questionnaire. The data were collected between 2001 and 2003. RESULTS: The control and experimental groups improved their performance on the second Objective Structured Clinical Examination. Mean test scores, respectively, increased by 7.18 and 14.18 percentage points. The difference between the means was statistically significant (P < 0.001). However, students' perceptions of stress and confidence, measured on a 5-point Likert scale, was very similar between groups at 2.9 (1, not stressful; 5, very stressful) and 3.5 (1, very confident; 5, not confident) for the control group, and 3.0 and 3.4 for the experimental group. CONCLUSIONS: Intermediate-fidelity simulation is a useful training technique. It enables small groups of students to practise in a safe and controlled environment how to react adequately in a critical patient care situation. This type of training is very valuable to equip students with a minimum of technical and non-technical skills before they use them in practice settings.     

高等中医院校本科护理学专业课程设置的调查分析

目的 调查我国高等中医院校本科护理学专业课程设置情况,分析可能影响课程设置的因素,为促进高等中医院校本科护理学专业课程体系改革提供依据.方法 收集我国19所高等中医院校本科护理学专业课程设置的相关资料,采用比较研究法获取其特征与不足,并分析可能的影响因素.结果 19所高等中医院校护理学专业所有课程(2815.8±432.9)学时,专业基础课程(787.4±211.8)学时,专业课程(717.0±189.8)学时,人文素养课程(238.7±73.8)学时,中医相关课程(289.9±130.9)学时.我国高等中医院校本科护理学专业的课程设置已初步形成体系,但存在着中医护理特色不够突出、人文素养课程比例偏小及课程类型构成欠佳等问题.影响课程设置的因素是多方面的,包括师资队伍、教材建设、市场需求及中医护理学科体系定位等.结论 我国高等中医院校本科护理学专业课程设置有待进一步完善.护理教育者应认识影响课程设置的因素,采取具有针对性的措施,构建科学、合理及可持续发展的课程体系.     

The diffusion of human patient simulation into an associate degree in nursing curriculum

The diffusion of human patient simulation (HPS) within a nursing curriculum is challenging. This article describes an exemplar that presents a 3-year process guided by the Diffusion of Innovations theory to plan, implement, and evaluate HPS in an associate degree in nursing program curriculum.Without funding for a major renovation or construction of new simulation laboratories, existing campus laboratories were converted into simulation laboratories including space dedicated to maternal–child simulation and a remediation simulation laboratory.     

Rethinking theory and practice: pre-registration student nurses experiences of simulation teaching and learning in the acquisition of clinical skills in preparation for practice

In the United Kingdom (UK) simulation learning has been recognised in the form of a regulatory agreement that may replace hours from clinical practice. This integration has become an embedded feature of the pre-registration nursing programme at a University in the North of England, along with strategic investment in staff and simulation suites developed to underpin this curriculum change albeit in the absence of sparse empirical evidence, hence the rationale for the study which was designed to explore the relationship between simulation, theory and practice. The study features a thematic analysis of evaluation questionnaires from pre-registration student nurses (n=>500) collected over a 2 year period which informed subsequent focus group interviews to explore the themes in more detail. Consistent data findings were the students' positive response to simulation as a learning approach facilitating the application of theory in a safe controlled environment. Students reported that they felt prepared for practice, recognising that simulated learning improved their humanistic and problem solving abilities as well as the development of psychomotor, technical skills, and overall confidence. The theory-practice gap is a recurring narrative in the nursing literature, the findings of this study recognises that simulation offers an opportunity to enact the integration of theory and practice illuminating this relationship in a controlled environment thus, reinforcing the theory-practice relationship for nursing students.     

护理专业课程设置中两种分科的认可度调查分析

目的:了解目前两种护理分科的认可度,找出生命周期课程设置存在的问题,为今后教材的编写提供依据,为护理专业课程设置的改革设置疑问,引导思考。方法:采用自行设计的问卷,调查人民卫生出版社相关课程的编者和我院首届国培班学员对两种护理分科的认知状态和倾向性。结果:67.1%的教师倾向于临床分科,32.9%的教师倾向于生命周期分科。结论:生命周期课程设置存在问题较多,改革阻力较大,但已经渐渐深入人心。     

The experience of faculty practice: developing and evaluating a newly established program

While the notion of faculty practice, that is clinical practice by an academic in a health service environment, is not new, Australian Universities have been slow in providing practice environments where academics' theoretical understanding is informed through the service environment. Although there is a plethora of published academic opinion on the benefits, there is a dearth of meaningful data describing the subjective experience of academics that participate in faculty practice. Developing an understanding of the issues academics experience, while on faculty practice, provides a vital opportunity for those seeking to adopt a faculty practice model in their institution. The paper describes the genesis of the faculty practice program and outlines both the benefits and challenges that were encountered during implementation. A program evaluation conducted by an independent consultant indicated that all faculty practice participants found the process to be empowering and revitalising, despite their initial apprehension. The personal and professional gains achieved while on faculty practice were considered to compensate for the additional workload involved. The immediate dividends of enhanced self-esteem, classroom practices and credibility with students for faculty practice participants were outcomes achieved.