The critical need for nursing education to address the diagnostic process

Typology of solutions addressing diagnostic disparities: gaps and opportunities

OBJECTIVES

Diagnostic disparities are preventable differences in diagnostic errors or opportunities to achieve diagnostic excellence. There is a need to summarize solutions with explicit considerations for addressing diagnostic disparities. We aimed to describe potential solutions to diagnostic disparities, organize them into an action-oriented typology with illustrative examples, and characterize these solutions to identify gaps for their further development.

METHODS

During four human-centered design workshops composed of diverse expertise, participants ideated and clarified potential solutions to diagnostic disparities and were supported by environmental literature scan inputs. Nineteen individual semi-structured interviews with workshop participants validated identified solution examples and solution type characterizations, refining the typology.

RESULTS

Our typology organizes 21 various types of potential diagnostic disparities solutions into four primary expertise categories needed for implementation: healthcare systems' internal expertise, educator-, multidisciplinary patient safety researcher-, and health IT-expertise. We provide descriptions of potential solution types ideated as focused on disparities and compare those to existing examples. Six types were characterized as having diagnostic-disparity-focused examples, five as having diagnostic-focused examples, and 10 as only having general healthcare examples. Only three solution types had widespread implementation. Twelve had implementation on limited scope, and six were mostly hypothetical. We describe gaps that inform the progress needed for each of the suggested solution types to specifically address diagnostic disparities and be suitable for the implementation in routine practice.

CONCLUSIONS

Numerous opportunities exist to tailor existing solutions and promote their implementation. Likely enablers include new perspectives, more evidence, multidisciplinary collaborations, system redesign, meaningful patient engagement, and action-oriented coalitions.

Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone

Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.

Nursing Graduates' Preparedness for Practice: Substantiating the Call for Competency-Evaluated Nursing Education

Practice readiness continues to be a challenge in healthcare. This was especially evident during the COVID-19 pandemic. This focused descriptive-correlational study examined nurses' perceived preparedness for practice during the pandemic. One hundred and eighty-four registered nurses (RN) responded to Qualtrics survey questions addressing the competencies they perceived they had and the competencies they felt they needed that would have better prepared them to care for patients during the COVID-19 pandemic. The results demonstrated that although these nurses felt competent in certain areas, they perceived that they needed more education in those same areas to feel better prepared. Bivariate correlations and linear regression analysis indicated that institutional competency development, education, and work experience influenced perceived competency.

Strategies Used in Canadian Nursing Programs to Prepare Students for NCLEX-RN® Licensure Exam

Nursing educators need strategies for preparing students to be successful in the National Council Licensure Examination (NCLEX-RN^®). Understanding the educational practices used is an important step in informing curricular decisions and helping regulatory agencies evaluate nursing programs' efforts to prepare students for practice. This study described strategies used in Canadian nursing programs to prepare students for the NCLEX-RN^®. A cross-sectional descriptive national survey was completed by the program's director, chair, dean, or another faculty member involved in the program's NCLEX-RN^® preparatory strategies using the LimeSurvey platform. Most participating programs (n = 24; 85.7%) use one to three strategies to prepare students for the NCLEX-RN^®. Strategies include the requirement to purchase a commercial product, the administration of computer-based exams, NCLEX-RN^® preparation courses or workshops, and time dedicated to NCLEX-RN^® preparation in one or more courses. There is variation among Canadian nursing programs in how students are prepared for the NCLEX-RN^®. Some programs invest considerable effort in preparation activities, while others have limited ones.

Human centered design workshops as a meta-solution to diagnostic disparities

OBJECTIVES

Diagnostic errors - inaccurate or untimely diagnoses or failures to communicate diagnoses - are harmful and costly for patients and health systems. Diagnostic disparities occur when diagnostic errors are experienced at disproportionate rates by certain patient subgroups based, for example, on patients' age, sex/gender, or race/ethnicity. We aimed to develop and test the feasibility of a human centered design workshop series that engages diverse stakeholders to develop solutions for mitigating diagnostic disparities.

METHODS

We employed a series of human centered design workshops supplemented by semi-structured interviews and literature evidence scans. Co-creation sessions and rapid prototyping by patient, clinician, and researcher stakeholders were used to generate design challenges, solution concepts, and prototypes.

RESULTS

A series of four workshops attended by 25 unique participants was convened in 2019-2021. Workshops generated eight design challenges, envisioned 29 solutions, and formulated principles for developing solutions in an equitable, patient-centered manner. Workshops further resulted in the conceptualization of 37 solutions for addressing diagnostic disparities and prototypes for two of the solutions. Participants agreed that the workshop processes were replicable and could be implemented in other settings to allow stakeholders to generate context-specific solutions.

CONCLUSIONS

The incorporation of human centered design through a series of workshops promises to be a productive way of engaging patient-researcher stakeholders to mitigate and prevent further exacerbation of diagnostic disparities. Healthcare stakeholders can apply human centered design principles to guide thinking about improving diagnostic performance and to center diverse patients' needs and experiences when implementing quality and safety improvements.

Healthcare Professionals' Electroencephalography Competency: A Disconnect Between Self-Assessment and Objective Testing

ABSTRACT

BACKGROUND: The role of the healthcare professional (HCP) in performing high-quality electroencephalography (EEG) is critical to ensuring accurate results. This study analyzes HCPs' subjectively and objectively assessed EEG competence to provide information on their EEG competence and competence needs for the development of their education and training. METHODS: The study was a descriptive cross-sectional study. The target group of the study was HCPs working in the clinical neurophysiology departments of university hospitals in Finland. The research data were collected using the EEG Competence instrument created for this research. The instrument consisted of a self-assessment section and a knowledge test component. RESULTS: The participants (N = 65; response rate, 81%) consisted of 34 registered nurses and 31 laboratory technologists. In the self-assessment section, the highest mean score was in patient observation (mean, 4.6) and the lowest was in EEG theoretical knowledge (mean, 3.9). In the test section, most of the respondents (73.8%) answered all questions correctly (maximum, 6 points). There was a positive correlation between age, work experience, own satisfaction with EEG competence, and subjective self-assessment. Those familiar with EEG guidelines and who participated in training days assessed their competence as significantly better ( P < .05). Respondents who read EEG-related literature on their own identified artifacts better ( P = .005). CONCLUSIONS: Laboratory technologists' and registered nurses' subjectively and objectively assessed EEG competence was high. In the future, the EEG competence instrument should be developed further, and more research is needed to assess its psychometric properties to provide more information on HCPs' competence in the diagnostic process.

A call to action: next steps to advance diagnosis education in the health professions

OBJECTIVES

Improving diagnosis-related education in the health professions has great potential to improve the quality and safety of diagnosis in practice. Twelve key diagnostic competencies have been delineated through a previous initiative. The objective of this project was to identify the next steps necessary for these to be incorporated broadly in education and training across the health professions.

METHODS

We focused on medicine, nursing, and pharmacy as examples. A literature review was conducted to survey the state of diagnosis education in these fields, and a consensus group was convened to specify next steps, using formal approaches to rank suggestions.

RESULTS

The literature review confirmed initial but insufficient progress towards addressing diagnosis-related education. By consensus, we identified the next steps necessary to advance diagnosis education, and five required elements relevant to every profession: 1) Developing a shared, common language for diagnosis, 2) developing the necessary content, 3) developing assessment tools, 4) promoting faculty development, and 5) spreading awareness of the need to improve education in regard to diagnosis.

CONCLUSIONS

The primary stakeholders, representing education, certification, accreditation, and licensure, in each profession must now take action in their own areas to encourage, promote, and enable improved diagnosis, and move these recommendations forward.