Going Paperless? Issues in Converting a Surgical Assessment Tool to an Electronic Version

Construct: The competence of a trainee to perform a surgical procedure was assessed using an electronic tool. Background: “Going paperless” in healthcare has received significant attention over the past decades given the numerous potential benefits of converting to electronic health records. Not surprisingly, medical educators have also considered the potential benefits of electronic assessments for their trainees. What literature exists on the transition from paper-based to electronic-based assessments suggests a positive outcome. In contrast, work done examining the transition to and implementation of electronic health records has noted that hospitals who have implemented these systems have not gone paperless despite the benefits of doing so. Approach: This study sought to transition a paper-based assessment tool, the Ottawa Surgical Competency Operating Room Evaluation (which has strong evidence for validity) to an electronic version, in three surgical specialties (Orthopedic Surgery, Urology, General Surgery). However, as the project progressed, it became necessary to change the focus of the study to explore the issues of transitioning to a paperless assessment tool as we identified an extremely low participation rate. Results: Over the first 3 months 440 assessment cases were logged. However, only a small portion of these cases were assessed using the electronic tool (Orthopedic Surgery = 16%, Urology = 5%, General Surgery = 0%). Participants identified several barriers in using the electronic assessment tool such as increased time compared to the paper version and technological issues related to the log-in procedure. Conclusions: Essentially, users want the tool to be as convenient as paper. This is consistent with research on electronic health records implementation but different from previous work in medical education. Thus, we believe our study highlights an important finding. Transitioning from a paper-based assessment tool to an electronic one is not necessarily a neutral process. Consideration of potential barriers and finding solutions to these barriers will be necessary in order to realize the many benefits of electronic assessments.     

食管癌病人术前营养状况的初步测评

目的了解食管癌病人术前营养状况,分析相关因素,为改善病人术前营养状况提供依据。方法采用人体测量、生化检查、微型营养评定(mini-nutritional assessment,MNA)以及主观全面评定法(subjective global as-sessment,SGA)对65例食管癌病人进行测评。结果本组病人的营养不良检出率为4.6%~61.5%。部分病人存在营养过剩。营养不良程度与进食状况、梗阻程度有关。结论应当采用综合性营养评价指标测评病人的营养状况,并结合进食状况、梗阻程度采取相应措施,改善病人的术前营养状况。     

Teaching spirituality to nurse practitioner students: the importance of the interconnection of mind, body, and spirit

PURPOSE: To describe the author's experience in locating and implementing a spiritual assessment tool in teaching a first semester clinical nurse practitioner (NP) course. DATA SOURCES: Selected articles and responses of NP students to the use of the tool. CONCLUSIONS: A spiritual assessment is an important component of a comprehensive health assessment. The use of a formal structured protocol provides a framework for beginning students to become comfortable with sprirituality and spiritual assessments and to begin to recognize spiritual distress in clients. IMPLICATIONS FOR PRACTICE: The protocol used in the course is very extensive and might not be practical in a busy practice setting. An alternative, 4-point assessment is provided.     

临床护士身体评估技能的应用状况与调查分析

目的 了解临床护士身体评估技术的应用现状,为提高身体评估质量提供可靠依据.方法 采用自行设计的身体评估能力调查问卷,对国内6省市医院的护理人员进行问卷调查,回收有效问卷1115份.结果 在171个身体评估项目中4.0%为经常使用的评估项目,19.3%较常使用,76.7%偶尔才会用到;身体评估技术的应用频率与主观需求、地域、文化程度、医院级别呈正相关,与职称、年龄、工作时间呈负相关.结论 区域、医院级别和学历是导致评估技术发展不平衡的主要因素,专科医院和专科病房的身体评估及技术亟待规范.

Abstract：

Objective To understand the application status of physical assessment in clinical nurses. Methods Using self-designed physical assessment skills questionnaire to investigate nurses in six provinces of China, 1115 questionnaires were valid. Results There were 171 items in this questionnaire,4.0% of them were used regularly, 19.3% used frequently, 76.7% used occasionally. The result of Spearman correlation showed that there was positive correlation between the frequency of physical assessment skills and the subjective needs of nurses, regional, educational background, hospital level. There was also negative correlation with title, age and seniority. Conclusions The main factors lead to imbalance development of physical assessment skills are regional, hospital-level and education background; the assessment skills of specialist hospitals and wards need to be standardized immediately.     

标准化病人在康复评定学教学中的应用

目的:评价在康复评定学教学中采用标准化病人(SP)教学法的教学效果。方法:选择康复治疗专业二年级本科生为研究对象,2006级学生67人采用传统教学法(传统组),2007级学生(SP组)60例采用SP的教学法。课程结束后运用DREEM量表及考试成绩评价教学效果。结果:SP组学生DREEM量表的总分及各下位量表评分均明显高于传统组(P<0.05,0.01),且SP组学生应用知识解决问题的得分和操作考试得分显著高于传统组(P<0.01)。结论:SP教学法适用于本科康复治疗专业学生的康复评定学教学,值得推广应用。     

STRENGTH & FUNCTIONAL ASSESSMENT OF HEALTHY HIGH SCHOOL FOOTBALL PLAYERS: ANALYSIS OF SKILLED AND NON‐SKILLED POSITIONS

Background/Purpose

Identifying an athlete''s functional capacity is an important consideration in determining when to allow an athlete to return to competition following injury. Establishing normative data for lower extremity functional assessment is valuable for comparison when making decisions regarding the high school athlete returning to play after injury. Therefore, the purpose of this study was to compare functional performance and strength between American high school football players of both skilled and non‐skilled positions.

Methods

Forty‐nine high school football players (30 skilled; 19 non‐skilled) completed a single‐session of testing consisting of a Figure of 8 test (F‐8), single‐leg vertical jump (SLVJ), single‐leg broad jump (SLBJ), and isokinetic knee strength assessment. Pearson correlation coefficients were used to determine the relationships between the results of functional testing and isokinetic strength measures. Paired t‐tests were used to determine the differences in functional performance and isokinetic muscle strength between skilled and non‐skilled athletes.

Results

Knee extension peak torque/body weight (BW) was moderately correlated (p < .01) with SLBJ (r = .54‐.61), SLVJ (r = .39‐.48), and F‐8 run times (r = ‐.50) for all athletes. Similar relationships were observed between knee flexion peak torque/BW and SLBJ (r = .48‐.49), SLVJ (r = .28‐.46), and the F‐8 run times (r = .41‐.52) for all subjects. No differences were observed between groups when examining raw peak torque values for knee flexion and extension (p > .05), however, skilled players did demonstrate greater peak torque/BW ratios (p < .05) for both knee extension and knee flexion at 60 and 240 degrees/sec. Skilled players also displayed faster F‐8 times (9.4 sec ± .3; p < .01) and greater SLBJ (p < .05) on both the dominant (81.0 in ± 9.3) and non‐dominant (83.0 in ± 7.6) limbs (p < .01) when compared to non‐skilled players.

Conclusions

Overall, skilled football players displayed greater peak torque/BW ratios and functional performance when compared to non‐skilled players. Furthermore, isokinetic peak torque/BW appears to be related to functional performance. This relationship is affected by position, with skilled players showing a stronger association. Limb dominance did not influence these functional and strength metrics. It is recommended that clinicians and coaches consider the positional differences in strength and functional performance when managing patients and athletes.

Level of Evidence

4 – Cross‐sectional Case Series     

Effects of Ecological and Standardized Vocational Assessments on Office of Vocational Rehabilitation Counselors' Perceptions Regarding Individuals with Developmental Disabilities

The purpose of this study was to examine the effects of an ecological and a standardized vocational assessment on Office of Vocational Rehabilitation (OVR) counselors' perceptions of individuals with developmental disabilities. One hundred and forty-one OVR counselors with experience in making funding decisions were randomly assigned to read either an ecological or a standardized vocational assessment report on an individual with developmental disabilities. Each group (ecological or standardized) then responded to 3 items on a questionnaire regarding job coach funding approval, time required for training, and employment outcome for the individual with disabilities. No statistically significant differences were found between groups with respect to job coach funding decisions. In contrast, significant differences between the 2 groups indicated that OVR counselors in the ecological assessment group perceived the individual with disabilities to need less training time, and to be more likely to remain on the job after job coaching was terminated than those in the standardized assessment group. Implications in terms of OVR funding decisions and directions for research are presented.     

Use of Giger and Davidhizar's Transcultural Assessment Model by Health Professions

Nursing science is increasingly gaining recognition. Witness the growing use by other disciplines of nursing's models and ideas. One example is the adoption of the Giger and Davidhizar Model of Transcultural Assessment by non-nursing disciplines to understand and address the needs of a pluralistic multicultural society. Below the authors describe a model to understand culturally diverse clients and show how health professions are using it to provide culturally competent care.     

Too much knowledge for a nurse? Use of physical assessment by final‐semester nursing students

There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.     

Comparison of peer assessment and faculty assessment in an interprofessional simulation-based team training program

Challenges related to limited clinical sites and shortage of clinical instructors may reduce the quality of clinical experiences, leading to increased demand for the establishment of simulation-based training programs in the curricula of educational institutions. However, simulation-based training programs in health education place great demands on faculty resources. It is interesting, therefore, to investigate peers contributions in formal assessment, and how this compares to faculty assessment. This paper report the results from the comparison of direct observation by peer observers who had received short rater training, and post-hoc video-based assessment by trained facilitators. An observation form with six learning outcomes was used to rate team performance. Altogether 262 postgraduate nursing students, bachelor of nursing students and medical students participated, organized into 44 interprofessional teams. A total of 84 peers and two facilitators rated team performance. The sum score of all six learning outcomes showed that facilitators were more lenient than peer observers (p = .014). The inter-rater reliability varied considerably when comparing scores from peer observers from the three different professions with those of the facilitators. The results indicate that peer assessment may support, but not replace, faculty assessment.     

What should we assess in practice?

Aim  This article reports on a PhD study and follow up work undertaken to review and develop a tool for assessment of practice.
Background  The assessment of practice in nursing and midwifery education and, other health professions has been the source of concern, criticism and research for a number of years with the conclusion that it might not be possible to develop an assessment tool that could encompass all aspects of professional practice.
Methods  A qualitative evaluation study was undertaken using the naturalistic method of inquiry. A combination of tools was used in order to collect the data and enable progressive focusing and cross checking of the findings. These included documentary analysis, a questionnaire and focus group and individual interviews. The data was collected from documents analysis, focus group interviews, individual interviews and questionnaires.
Results  The results showed that the assessment tool in use at the time did not encompass all criteria assessors used and six areas were identified as those to include in any future tool.
Conclusion  The six areas identified by subjects as those to include in any assessment tool were further developed with specific statements so that they could be used within a tool.
Implications for nursing management and education  Within the changing nature of health care there is a need to review whether the tool used for assessing pre-registration education of nursing and midwifery students practice is 'fit for purpose'.     

A critique of ‘at risk’ pressure sore assessment tools

• ? This paper critiques pressure sore risk assessment tools. No attempt is made to describe individual tools in detail as this literature is available elsewhere.
• ? The economic case for risk assessment is presented along with the criteria for an effective risk assessment instrument.
• ? Reliability and validity studies are reviewed in relation to three risk assessment tools: Norton, Waterlow and Braden.
• ? Finally a number of issues related to threshold scores, research design and the need to view pressure sores as a clinical problem rather than a nursing problem are discussed.

     

疼痛的评定

本文简要介绍了各种疼痛的评定方法 ,主要包括 :痛阈的测定、疼痛的客体评定、疼痛的主体评定、疼痛的间接评定。痛阈的测定主要应用的刺激因子有 :压力、热、电、冰水和激光 ,测定的内容为疼痛感觉阈和疼痛耐受阈。疼痛的客体评定是由医务人员进行的。疼痛的主体评定是患者本人的自我评定 ,主要用视觉模拟尺、疼痛分级法和疼痛问卷法。疼痛的间接评定是根据非自主性的生理功能的变化来评定疼痛的程度。本文介绍的方法多为量化标准 ,可用于疼痛的研究和疗效的评定