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Safo-Kantanka NK, Quartey J, Kwakye SK. Physiotherapy students' rating on lecturers' and supervisors' clinical education attributes. Hong Kong Physiother J 2024; 44:79-90. [PMID: 38510158 PMCID: PMC10949104 DOI: 10.1142/s1013702524500045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/30/2023] [Indexed: 03/22/2024] Open
Abstract
Background Clinical education is considered a vital aspect of education of health science students. Attributes of clinical educators play a crucial role in determining the outcome of clinical teaching and learning. A good clinical educator ensures that students get maximum benefits of the clinical learning experience. Objective To determine the ratings of physiotherapy students on clinical education attributes of lecturers and clinical supervisors. Methods The study was conducted with 81 clinical physiotherapy students from two universities in Ghana. Two copies of McGill clinical teachers' evaluation (CTE) tool were used to obtain students' ratings on their clinical supervisors' and lecturers' clinical education attributes. Independent t-test was used to compare the means of students' level of study and ratings regarding the clinical education attributes of clinical supervisors and lecturers. Results Students had a high rating on their clinical education attributes of supervisors and lecturers with a mean score of (121 . 22 ± 18 . 12 ) and (122 . 11 ± 16 . 71 ), respectively. Rating on clinical education attributes of supervisors (p = 0 . 111 ) and lecturers (p = 0 . 124 ) did not differ significantly between the different levels of study. Conclusion Clinical physiotherapy students rated the clinical education attributes of their lecturers and supervisors high.
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Affiliation(s)
| | - Jonathan Quartey
- Department of Physiotherapy, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Awang S, Alias N, DeWitt D, Jamaludin KA, Abdul Rahman MN. Design of a Clinical Practice Guideline in Nurse-Led Ventilator-Weaning for Nursing Training. Front Public Health 2021; 9:726647. [PMID: 34869147 PMCID: PMC8632817 DOI: 10.3389/fpubh.2021.726647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
Cardiothoracic intensive care unit (CICU) nurses have shared the role and responsibility for ventilator-weaning to expedite decision-making in patient care. However, the actions taken are based on individual's unstructured training experience as there is no clinical practice guideline (CPG) for nurses in Malaysia. Hence, this study aims to design a CPG for the process of weaning from mechanical ventilation (MV) for a structured nursing training in a CICU at the National Heart Institute (Institut Jantung Negara, IJN) Malaysia. The Fuzzy Delphi Method (FDM) was employed to seek consensus among a panel of 30 experts in cardiac clinical practice on the guidelines. First, five experts were interviewed and their responses were transcribed and analyzed to develop the items for a FDM questionnaire. The questionnaire, comprising of 73 items, was distributed to the panel and their responses were analyzed for consensus on the design of the CPG. The findings suggested that the requirements expected for the nurses include: (a) the ability to interpret arterial blood gases, (b) knowledge and skills on the basics of mechanical ventilation, and (c) having a minimum 1-year working experience in the ICU. On the other hand, the CPG should mainly focus on developing an ability to identify criteria of patient eligible for weaning from MV. The learning content should focus on: (a) developing the understanding and reasoning for weaning and extubating and (b) technique/algorithm for extubating and weaning. Also, the experts agreed that the log book/competency book should be used for evaluation of the program. The CPG for structured nursing training at IJN in the context of the study is important for developing the professionalism of CICU nurses in IJN and could be used for training nurses in other CICUs, so that decision for ventilator-weaning from postcardiac surgery could be expedited.
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Affiliation(s)
- Sakinah Awang
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlidah Alias
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Dorothy DeWitt
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azhar Jamaludin
- Faculty of Education, Centre of Education Leadership and Policy, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Mohd Nazri Abdul Rahman
- Department of Curriculum and Instructional Technology, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
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Egerod I, Kaldan G, Nordentoft S, Larsen A, Herling SF, Thomsen T, Endacott R. Skills, competencies, and policies for advanced practice critical care nursing in Europe: A scoping review. Nurse Educ Pract 2021; 54:103142. [PMID: 34265667 DOI: 10.1016/j.nepr.2021.103142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Management of critically ill patients is changing due a rise in population age, comorbidity and complexity. To accommodate these changes, the demand is increasing for advanced practice nurses. More knowledge is needed regarding the role of advanced practice critical care nurses in European countries. The aim of the study was to review the literature describing skills and competencies required for advanced practice critical care nursing in Europe and to investigate related policy. REVIEW METHOD We performed a scoping review including papers published in 1992-2019 targeting policy and the intersection of advanced practice nursing (level of practice), critical care nursing (specialty area) and Europe (geographical origin). DESIGN AND DATA SOURCES Main sources of evidence were PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, SweMed+, Scopus, ERIC and Social Sciences Citation Index. We also searched grey literature, webpages, reference lists and performed hand-search. RESULTS The search identified 11,478 papers/references of which 42 were included. Four levels of practice were identified with unclear boundaries: professional nurse, specialized nurse, advanced practice nurse and advanced critical care practitioner (nurse or other). Most skills and competencies described in the literature were generic to advanced practice and only few were area specific to critical care. Advanced practice critical care nurses were often unable to fulfil their role because education, supportive policy and legislation were lacking. CONCLUSIONS This scoping review informs the policy makers and the INACTIC study of existing advanced practice in critical care nursing in Europe. The advanced role in critical care nursing is characterized by inconsistency regarding policy, education, titles, roles, scope of practice, skills and competencies. Levels of practice and areas of specialization need to be clarified. Most skills and competencies identified were generic for advanced practice nursing and many were generic for any profession. Task-shifting from physician to nurse needs to be more clearly defined and patient outcomes described. Given the scarcity of papers in our target area, we believe it might be too early to conduct a systematic review at this time.
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Affiliation(s)
- Ingrid Egerod
- Department of Intensive Care, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Gudrun Kaldan
- Department of Neurology, Copenhagen University Hospital Rigshospitalet Glostrup, Denmark.
| | - Sara Nordentoft
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Anders Larsen
- The University Hospitals Centre for Health Research, UCSF, Copenhagen University Hospital Rigshospitalet, Copenhagen Denmark.
| | | | - Thordis Thomsen
- Herlev Acute, Critical and Emergency Care Science Unit (Herlev-ACES), Copenhagen University Hospital Herlev-Gentofte, Denmark.
| | - Ruth Endacott
- School of Nursing and Midwifery, Plymouth University, UK.
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Jabbour M, Newton AS, Johnson D, Curran JA. Defining barriers and enablers for clinical pathway implementation in complex clinical settings. Implement Sci 2018; 13:139. [PMID: 30419942 PMCID: PMC6233585 DOI: 10.1186/s13012-018-0832-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While clinical pathways have the potential to improve patient outcomes and reduce healthcare costs, their true impact has been limited by variable implementation strategies and suboptimal research designs. This paper explores a comprehensive set of factors perceived by emergency department staff and administrative leads to influence clinical pathway implementation within the complex and dynamic environments of community emergency department settings. METHODS This descriptive, qualitative study involved emergency health professionals and administrators of 15 community hospitals across Ontario, Canada. As part of our larger cluster randomized controlled trial, each site was in the preparation phase to implement one of two clinical pathways: pediatric asthma or pediatric vomiting and diarrhea. Data were collected from three sources: (i) a mediated group discussion with site champions during the project launch meeting; (ii) a semi-structured site visit of each emergency department; and (iii) key informant interviews with an administrative lead from each hospital. The Theoretical Domains Framework (TDF) was used to guide the interviews and thematically analyze the data. Domains within each major theme were then mapped onto the COM-B model-capability, opportunity, and motivation-of the Behaviour Change Wheel. RESULTS Seven discrete themes and 58 subthemes were identified that comprised a set of barriers and enablers relevant to the planned clinical pathway implementation. Within two themes, three distinct levels of impact emerged, namely (i) the individual health professional, (ii) the emergency department team, and (iii) the broader hospital context. The TDF domains occurring most frequently were Memory, Attention and Decision Processes, Environmental Context and Resources, Behavioural Regulation, and Reinforcement. Mapping these barriers and enablers onto the COM-B model provided an organized perspective on how these issues may be interacting. Several factors were viewed as both negative and positive across different perspectives. Two of the seven themes were limited to one component, while four involved all three components of the COM-B model. CONCLUSIONS Using a theory-based approach ensured systematic and comprehensive identification of relevant barriers and enablers to clinical pathway implementation in ED settings. The COM-B system of the Behaviour Change Wheel provided a useful perspective on how these factors might interact to effect change. TRIAL REGISTRATION ClinicalTrials.gov, NCT01815710 .
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Affiliation(s)
- Mona Jabbour
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Room W1415, Ottawa, ON, K1H 8L1, Canada.
- University of Ottawa, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Amanda S Newton
- Department of Pediatrics, Division of General Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Johnson
- Departments of Pediatrics and Emergency Medicine, University of Calgary, Calgary, AB, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada
- Department of Emergency Medicine, IWK Health Centre, Halifax, NS, Canada
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An Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions. Child Adolesc Psychiatr Clin N Am 2018; 27:413-425. [PMID: 29933791 DOI: 10.1016/j.chc.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children and youth presenting to the emergency department with mental health concerns present a challenge for clinicians and system capacity. Addressing a significant system gap and sparse strategies in the literature, representative leaders from hospital and community agencies developed a novel pathway to guide efficient and doable risk assessment and ensure timely transition to appropriate community mental health services. This article describes and reflects on our innovative Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions that bridges traditional barriers between hospital and community settings to address mental health needs for this population.
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Jabbour M, Reid S, Irwin D, Losier A, Holmgren E, Albrecht D, Rohde K, Moreau K. Clinical pathway-based pediatric emergency outreach program: implementation and preliminary evaluation. Can J Hosp Pharm 2014; 67:240-5. [PMID: 24970945 DOI: 10.4212/cjhp.v67i3.1362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Mona Jabbour
- MD, MEd, FRCPC, is with the Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ontario
| | - Sarah Reid
- MD, FRCPC, is with the Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ontario
| | - Danica Irwin
- BScPhm, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Andrea Losier
- MD, FRCPC, is with the Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, Ontario
| | - Eleanor Holmgren
- RN, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Dennise Albrecht
- BA, MHA, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Kristina Rohde
- MA, CE, is with the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Katherine Moreau
- PhD, is with the University of Ottawa and the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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7
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Jabbour M, Curran J, Scott SD, Guttman A, Rotter T, Ducharme FM, Lougheed MD, McNaughton-Filion ML, Newton A, Shafir M, Paprica A, Klassen T, Taljaard M, Grimshaw J, Johnson DW. Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial. Implement Sci 2013; 8:55. [PMID: 23692634 PMCID: PMC3674906 DOI: 10.1186/1748-5908-8-55] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/15/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. DESIGN/METHODS We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. DISCUSSION This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. TRIAL REGISTRATION ClinicalTrials.gov: NCT01815710.
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Affiliation(s)
- Mona Jabbour
- Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Canada
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Janet Curran
- IWK Health Centre, Halifax, Canada, School of Nursing, Dalhousie University, Halifax, Canada
| | | | - Astrid Guttman
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, University of Montreal, Montreal, Canada
- Research Centre, CHU Sainte-Justine, Montreal, Canada
| | - M Diane Lougheed
- Departments of Medicine (Respirology), Biomedical and Molecular Sciences (Physiology) and Community Health and Epidemiology, Queen’s University, Kingston, Canada
- ICES-Queen’s University, Kingston, Canada
| | - M Louise McNaughton-Filion
- University of Ottawa, Ottawa, Canada
- Montfort Hospital, Ottawa, Canada
- Champlain Local Health Integrated Network, Ottawa, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Mark Shafir
- Department of Emergency Medicine, Cambridge Memorial Hospital, Cambridge, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Alison Paprica
- Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Terry Klassen
- Faculty of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Institute of Child Health, Winnipeg, Canada
| | - Monica Taljaard
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - David W Johnson
- Division of Emergency Medicine, Alberta Children’s Hospital, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
- Department of Pediatrics, Physiology and Pharmacology, University of Calgary, Calgary, Canada
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8
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Lee ASD, Cohen SL, Anderson JR, Chanmugam A, Bienstock JL. The effect of gynecologic algorithm pathways on emergency department visit times. J Emerg Med 2012; 44:217-24. [PMID: 22555055 DOI: 10.1016/j.jemermed.2012.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 08/24/2011] [Accepted: 02/15/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of multidisciplinary algorithmic pathways is one strategy to improve efficiency and quality of care in Emergency Departments (EDs). To this end, in the fall of 2005, we implemented algorithmic pathways for evaluation of ED patients with common gynecologic complaints. OBJECTIVES The goals of this initiative were to improve length of stay as a marker for operational efficiency and to reduce health care disparities by ensuring consistent management regimens for all patients. METHODS A retrospective observational comparison study was performed through a review of consults in the year preceding and the year after implementation of the pathways. The length of stay was calculated based on time of initial triage until discharge. The length of stay from both groups was compared using an unpaired Student's t-test analysis. RESULTS There was an 85-min decrease in the mean visit time between the pre-intervention group (108 patients, 610 min, SD 345.4) and the post-intervention group (105 patients, 525 min, SD 251.5), p=0.04. CONCLUSIONS Algorithmic pathways had a positive impact on patient care as measured by the average amount of time our patients spent in the ED. Gynecologic care in the ED was standardized, and length of stay for patients with gynecologic complaints decreased. The implementation of algorithms resulted in more consistent care with earlier initiation of pertinent studies, while facilitating more rapid critical decision-making by providers from both departments. Further analysis is required to examine cost-effectiveness as well as patient safety and provider satisfaction issues.
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Affiliation(s)
- Amy S D Lee
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
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Implementing quality initiatives using a bundled approach. Intensive Crit Care Nurs 2011; 27:117-20. [PMID: 21511476 DOI: 10.1016/j.iccn.2011.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/29/2011] [Indexed: 12/16/2022]
Abstract
Critical care has been criticised for its inconsistency in implementing and evaluating evidence based practice both at national and international level. A review of the critical care literature by Berenholtz et al. (2002) identified interventions that might help prevent morbidity or mortality in the intensive care unit; from this four elements were developed into the initial ventilator care bundle. The aim of this bundle was to improve the quality of care for mechanically ventilated patients by improving compliance with relevant evidence based practice; implementation of this or an adapted cluster of interventions has been shown consistently to reduce the incidence of ventilator-associated pneumonias across countries. There are now numerous care bundles and the bundle approach to quality improvement has been proven to be effective across a number of problems, international boundaries and in a wide variety of ICU's. The bundle approach recognises that core clinical interventions, are not always consistently applied across all appropriate patients, the range of interventions within a bundle tackles the problem from a variety of different angles. Other strengths include its adaptability to the wide variety of environments and working practices of intensive care units across the world. The bundle and the method of implementation can be adapted to suit individual teams and units; however, this can also be a weakness of this approach as it limits comparability across centres. The bundle approach to quality improvement requires significant multidisciplinary engagement and resources to be effective.
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White V, Currey J, Botti M. Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning: a systematic review of literature. Worldviews Evid Based Nurs 2011; 8:51-9. [PMID: 20819199 DOI: 10.1111/j.1741-6787.2010.00198.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care. METHOD A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review. RESULTS Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation. CONCLUSION Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.
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Offord RJ. Caring for critically ill children within an adult environment--an educational strategy. Nurs Crit Care 2011; 15:300-7. [PMID: 21040261 DOI: 10.1111/j.1478-5153.2010.00411.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Within the author's workplace, a predominantly adult general Intensive Care Unit (ICU), a small number of critically ill children are admitted each year. This causes difficulties for adult nurses because they are required to utilize specialist paediatric knowledge and skills that are practised on an infrequent basis only. This can lead them to experience feelings of stress, anxiety and a lack of confidence when caring for this distinct patient group. To address these issues, an education strategy was planned and implemented, which required staff members to attend a study day, organize a one day clinical placement and achieve a personal learning objective pertaining to paediatrics. This involved collaboration between key stakeholders, links to the lead paediatric centre, incorporation of local organizational strategy and the use of effective change management skills. Written candidate evaluation and low-level quantitative data demonstrate an increase in knowledge and confidence amongst nurses following the study day. Whilst the study day forms part of a more global educational concept, and not a 'stand alone' initiative, the full benefits of the encompassing programme are yet to be fully established. The author recommends the implementation of a similar programme within other acute care areas that occasionally admit critically ill children.
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Affiliation(s)
- Rebecca J Offord
- Department of Critical Care, Gloucestershire Royal Hospital, Gloucester, UK.
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Bosse G, Schmidbauer W, Spies CD, Sörensen M, Francis RCE, Bubser F, Krebs M, Kerner T. Adherence to Guideline-Based Standard Operating Procedures in Pre-Hospital Emergency Patients with Chronic Obstructive Pulmonary Disease. J Int Med Res 2011; 39:267-76. [DOI: 10.1177/147323001103900129] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated improvements in pre-hospital care for patients with acute exacerbated chronic obstructive pulmonary disease (aeCOPD) achieved by using a standard operating procedure (SOP). An SOP for pre-hospital treatment of patients with aeCOPD was designed based on valid national guidelines. A total of 1000 Emergency Medical Service patient care reports were analysed prospectively: 500 before and 500 after introduction of the SOP. Overall guideline adherence was 34.6% before and 53.8% after introduction of the SOP; this increase was not statistically significant. After SOP introduction, the administration of β2-mimetics by inhalative, intravenous and subcutaneous routes increased significantly. The level of knowledge of the national guidelines was rated at 67% by emergency physicians during self-assessment, but was only 33% when physicians were asked specific questions during interview. Introducing the SOP for patients with aeCOPD did not significantly improve adherence to valid national guidelines, but did help to improve specific elements of therapy.
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Affiliation(s)
- G Bosse
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - W Schmidbauer
- Department of Emergency Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - CD Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - M Sörensen
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - RCE Francis
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - F Bubser
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - M Krebs
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - T Kerner
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Asklepios Klinik Harburg, Hamburg, Germany
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13
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Tsianakas V, Calnan M, Atkin K, Dormandy E, Marteau TM. Offering antenatal sickle cell and thalassaemia screening to pregnant women in primary care: a qualitative study of GPs' experiences. Br J Gen Pract 2010; 60:822-8. [PMID: 21062549 PMCID: PMC2965967 DOI: 10.3399/bjgp10x532602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 03/30/2010] [Accepted: 05/20/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Timely antenatal sickle cell and thalassaemia (SC&T) screening for all women in primary care facilitates informed decision making, but little is known about its implementation. AIM To assess the feasibility of offering antenatal SC&T screening in primary care at the time of pregnancy confirmation. DESIGN OF STUDY Cross-sectional investigation of GPs' beliefs and perceived practices. METHOD Informal face-to-face interviews with 34 GPs. SETTING Seventeen inner-city general practices that offered antenatal SC&T screening as part of a trial. RESULTS GPs identified both barriers and facilitators. Organisational barriers included inflexible appointment systems and lack of interpreters for women whose first language was not English. Professional barriers included concerns about raising possible adverse outcomes in the first antenatal visit. Perceived patient barriers included women's lack of awareness of SC&T. Hence, GPs presented the test to women as routine, rather than as a choice. Organisational facilitators included simple and flexible systems for offering screening in primary care, practice cohesion, and training. Professional facilitators included positive attitudes to screening for SC&T. Perceived patient facilitators included women's desire for healthy children. CONCLUSION GPs reported barriers, as well as facilitators, to successful implementation but the extent to which screening could be regarded as offering 'informed choice' remained fundamental when making sense of these barriers and facilitators.
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Oh EG. Research activities and perceptions of barriers to research utilization among critical care nurses in Korea. Intensive Crit Care Nurs 2008; 24:314-22. [PMID: 18243707 DOI: 10.1016/j.iccn.2007.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 12/01/2007] [Accepted: 12/12/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research utilization is vital to promote evidence-based practice in the critical care area, where nursing practice continues to grow in complexity and nurses have greater responsibility and accountability for patient care. However, information about research activities and barriers to research utilization of critical care nurses is limited. AIMS This study aimed to describe research activities, to identify barriers to research utilization for practice and to examine factors related to research barriers among critical care nurses. METHODS Data from 63 critical care nurses were analyzed from a national study examining research utilization of clinical nurses working in university affiliated and educational hospitals in Korea. FINDINGS Research activities were relatively low. A lack of guidance for clinical implication and insufficient time to implement new ideas in the clinical area were identified as the highest-ranking barriers to use of research in this group. Perceptions of barriers to research utilization were significantly higher in those staff nurses with lesser clinical experience. The critical care nurses in this study shared a strong sense of valuing the contribution of research, but also shared perceptions on barriers for administrative aspects. Organizational support is crucial for critical care nurses to achieve evidence-based practice.
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Affiliation(s)
- Eui Geum Oh
- College of Nursing, Nursing Policy Research Institute, Yonsei University, 134 Shinchon-Dong, Seodaemun-Gu, Seoul 120-752, Republic of Korea.
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15
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Wallin L, Profetto-McGrath J, Levers MJ. Implementing nursing practice guidelines: a complex undertaking. J Wound Ostomy Continence Nurs 2007; 32:294-300; discussion 300-1. [PMID: 16234720 DOI: 10.1097/00152192-200509000-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical practice guidelines have been proposed to significantly reduce the gap between available scientific evidence and clinical practice. Evidence-based guidelines are also being produced at an ever-increasing pace. However, guidelines do not implement themselves, and the research to support implementation does not provide straightforward answers. What works in one setting does not necessarily work in another. In short, guideline implementation and change of practice is complex and messy. The purpose of this article is to discuss the implementation of clinical practice guidelines using the Promoting Action on Research Implementation in Health Services framework. More specifically, 3 key components are highlighted: (1) the evidence base for guideline recommendations, (2) the clinical context where guidelines are to be implemented, and (3) the nature of facilitation needed to ensure a successful change process. An overview of the literature in the field is provided, and the authors' experiences are shared, and a few recommendations are tentatively provided.
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Affiliation(s)
- Lars Wallin
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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16
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The level of knowledge of respiratory physiology articulated by intensive care nurses to provide rationale for their clinical decision-making. Intensive Crit Care Nurs 2007; 23:145-55. [PMID: 17419057 DOI: 10.1016/j.iccn.2006.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 11/08/2006] [Accepted: 11/15/2006] [Indexed: 12/01/2022]
Abstract
The combination of intensive care knowledge, and the ability to articulate analytical decision-making processes to the interdisciplinary team, enhances the clinical credibility of the intensive care unit (ICU) nurse. The objective of this paper is to outline a study firstly, assessing ICU nurses' ability in articulating respiratory physiology to provide rationale for their clinical decision-making and secondly, the barriers that limit the articulation of this knowledge. Using an evaluation methodology, multiple methods were employed to collect data from 27 ICU nurses who had completed an ICU education programme and were working in one of two tertiary ICUs in New Zealand. Quantitative analysis showed that nurses articulated a low to medium level of knowledge of respiratory physiology. Thematic analysis identified the barriers limiting this use of respiratory physiology as being inadequate coverage of concepts in some ICU programmes; limited discussion of concepts in clinical practice; lack of clinical support; lack of individual professional responsibility; nurses' high reliance on intuitive knowledge; lack of collaborative practice; availability of medical expertise; and the limitations of clinical guidelines and protocols. These issues need to be addressed if nurses' articulation of respiratory physiology to provide rationale for their clinical decision-making is to be improved.
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17
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Bosse G, Breuer JP, Spies C. The resistance to changing guidelines – what are the challenges and how to meet them. Best Pract Res Clin Anaesthesiol 2006; 20:379-95. [PMID: 17080691 DOI: 10.1016/j.bpa.2006.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Bridging the gap between scientific evidence and its practical application is of the utmost importance in improving the quality of care and increasing patient safety. Guidelines based on evidenced-based medicine (EBM) have led to improved performances and better outcomes. However, even though scientific data are available, resistance to adopting evidence-based guidelines is still enormous. Significant barriers hinder the introduction of best medical practice into the daily clinical routine. The barriers to implementing change are complex, multifunctional, and influenced on many levels by various interests both inside and outside the health-care system. Political, organizational, financial, cultural and scientific interests are regarded as being as important as the perception of patients and health workers. Strategies need to be planned which take account of the multidimensional character of quality of care and incorporate it at the various levels. The conclusion, therefore, is that we need to combine methods and tools to tailor our interventions to the patient's needs.
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Affiliation(s)
- Götz Bosse
- Department of Anaesthesiology, Charité Campus Mitte and Charité Campus Virchow-Klinikum, Charité-University Medicine Berlin, Schumannstrasse 20/21, 10089 Berlin, Germany
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18
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Currey J, Botti M. The influence of patient complexity and nurses' experience on haemodynamic decision-making following cardiac surgery. Intensive Crit Care Nurs 2006; 22:194-205. [PMID: 16563767 DOI: 10.1016/j.iccn.2005.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 04/15/2005] [Accepted: 06/13/2005] [Indexed: 11/30/2022]
Abstract
Critical care nurses' haemodynamic decision-making in the immediate postoperative cardiac surgical context is complex. To optimise patient outcomes, nurses of varying levels of experience are required to make complex decisions rapidly and accurately. In a dynamic clinical context such as critical care, the quality of such decision-making is likely to vary considerably. The aim of this study was to describe variability of nurses' haemodynamic decision-making in the 2-hour period after cardiac surgery as a function of interplay between decision complexity, nurses' levels of experience, and the support provided. A descriptive study based on naturalistic decision-making was used. Data were collected using continuous non-participant observation of clinical practice for a 2-hour period and follow-up interview. Purposive sampling was used to recruit 38 nurses for inclusion in the study. The quality of nurses' decision-making was influenced by interplay between the complexity of patients' haemodynamic presentations, nurses' levels of cardiac surgical intensive care experience, and the form of decision support provided by nursing colleagues. Two factors specifically influenced decision-making quality: nurses' utilisation of evidence for practice and the experience levels of both nurses and their colleagues. The findings have implications for staff resourcing decisions and postoperative patient management, and may be used to inform nurses' professional development and education.
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Affiliation(s)
- Judy Currey
- Alfred/Deakin Nursing Research Centre, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia.
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19
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Benbenishty J, DeKeyser Ganz F, Adam S. Differences in European critical care nursing practice: a pilot study. Intensive Crit Care Nurs 2005; 21:172-8. [PMID: 15907669 DOI: 10.1016/j.iccn.2004.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to determine if there are differences in nursing practice between critical care units across Europe, if these practices are related to the perceived level of incorporation of evidence into nursing practice and/or to regional differences. Nurses attending the nursing session of the bi-annual conference of the European Society of Intensive Care Medicine were asked to fill out a two page questionnaire which addressed five areas of practice: physical care, pain management, monitoring, weaning and ethical issues. Some differences were found between regions although there were no differences in the perception of whether these protocols were evidence-based.
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MESH Headings
- Attitude of Health Personnel
- Bed Rest/nursing
- Catheterization, Swan-Ganz/nursing
- Clinical Competence
- Critical Care/ethics
- Critical Care/organization & administration
- Critical Care/psychology
- Cross-Cultural Comparison
- Cultural Characteristics
- Decision Making, Organizational
- Europe
- Evidence-Based Medicine/education
- Evidence-Based Medicine/ethics
- Evidence-Based Medicine/organization & administration
- Health Knowledge, Attitudes, Practice
- Humans
- Monitoring, Physiologic/nursing
- Nurse's Role/psychology
- Nursing Methodology Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Organizational Culture
- Pain/nursing
- Pilot Projects
- Professional Autonomy
- Restraint, Physical
- Specialties, Nursing/education
- Specialties, Nursing/ethics
- Specialties, Nursing/organization & administration
- Surveys and Questionnaires
- Truth Disclosure
- Ventilator Weaning/nursing
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20
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Hardcastle JE. The meaning of effective education for critical care nursing practice: a thematic analysis. Aust Crit Care 2004; 17:114, 116-8, 120-2. [PMID: 15493859 DOI: 10.1016/s1036-7314(04)80013-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Continuing education and practice development are integral components of specialist nursing practice in environments such as intensive and critical care. Previous studies have examined the 'effectiveness' of various approaches to teaching and learning in critical care, yet few have considered how effective education affects the relationship between education and practice development. Using thematic analysis, this study explored the phenomenon of effective education (for critical care nursing practice) by asking: What does effective education for critical care nursing practice mean to nurses currently practising in the specialty? Eighty eight critical care nurses from the South Island of New Zealand provided written descriptions of what effective education for critical care nursing practice meant to them. Descriptive statements were analysed to reveal constituents, themes and essences of meaning. Four core themes of personal quality, practice quality, the learning process and learning needs emerged. Appropriateness or relevance for individual learning needs is further identified as an essential theme within the meaning of effective education for critical care nursing practice. Shared experiences of the phenomenon are made explicit and discussed with reference to education and practice development in the specialty. The study results lend support to education that focuses on individual learning needs, and identifies work based learning as a potential strategy for learning and practice development in critical care nursing.
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Affiliation(s)
- Jane E Hardcastle
- Graduate Studies in Nursing, School of Nursing Christchurch Polytechnic Institute of Technology, Christchurch, New Zealand
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21
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Vance DL. Effect of a treatment interference protocol on clinical decision making for restraint use in the intensive care unit: a pilot study. AACN CLINICAL ISSUES 2003; 14:82-91. [PMID: 12574706 DOI: 10.1097/00044067-200302000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The literature is replete with articles describing restraint reduction strategies used in long-term care settings, geriatric specialty units, and medical/surgical units in the acute care setting. The feasibility, effectiveness, and appropriateness of such strategies cannot be capriciously applied to the intensive care setting. This article provides an overview of the implementation and outcomes of a pilot study using an algorithmic approach that is clinically appropriate and justifiable for restraint use in the intensive care environment. It provides the critical care nurse with a standardized method for decision analysis when managing patients at risk for treatment interference.
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Affiliation(s)
- Diana L Vance
- Summa Health System Hospitals, Akron, Ohio 44309-2090, USA.
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22
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Abstract
A critical care nursing course was designed to enhance knowledge attainment for RNs new to critical care, and to prepare seasoned critical care nurses for specialty certification. The convenience sample of nurses (N = 57) was either enrolled in the 16-session course (n = 27) or assigned to a control group (n = 30). A repeated measures design allowed data collection at three time points: precourse, course completion, and 6 months after course completion. Mean scores on the Basic Knowledge Assessment Tool were significantly higher for course participants at the time of course completion, and scores continued to remain high 6 months later, demonstrating important retention of critical care knowledge.
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Affiliation(s)
- Christine Wynd
- University of Akron, College of Nursing, Ohio 44325-3701, USA
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