Practices and Barriers towards Physical Assessment among Nurses Working in Intensive Care Units: Multicenter Cross-Sectional Study

The effects of mentorship and educational videos on nursing students' physical examination skills: a clinical audit

BACKGROUND

Poor competence in clinical examination skills among nurses has been reported in practice, and there is a strong consensus that physical examination (PE) education must be improved. However, deficiencies cannot be resolved by theoretical training alone, and new training approaches are required to enable nursing students to perform PE accurately. This study aimed to determine and compare the effect of two new educational methods (mentorship and educational video methods) on the physical examination skills of Iranian nursing students.

METHODS

This study was a clinical audit with three group pretest posttest design. Eligible nursing students were recruited through the census method and assigned to three groups (mentorship, educational videos, and control group) using permuted block randomization. Students were taught PE skills in three vital systems through three approaches (mentors, educational videos, and routine educational methods). Data were collected using a two-part instrument consisting of a demographic information questionnaire and a 32-item checklist for assessing the students' skills in examining the respiratory system (10 items), cardiovascular system (13 items), and 12 cranial nerves (9 items). Data were analyzed using SPSS software version 16 and descriptive and analytical statistical tests.

RESULTS

At baseline, students in all groups scored less than half of the possible scores in all three systems, and the mean scores of the three groups were not statistically different (P > 0.05). After the intervention, the mean scores of students in the mentorship group increased significantly in all three systems (P < 0.001), whereas the mean scores of students in the educational video group and the control group did not change significantly (P > 0.05). Furthermore, after the intervention, the mean scores of the educational video group and the control group did not significantly differ in any of the three systems (P > 0.05). The ANCOVA showed that with posttest score as the covariate, PE skills in all three systems improved one week after the intervention in the mentor group compared to the control group and the educational video group. However, PE skills in all three systems did not improve one week after the intervention in the educational video group compared to the control group.

CONCLUSIONS

The mentorship method is more effective than the educational video and routine methods for teaching PE skills to nursing students. Nursing schools can use the mentor method in training nursing students, and it is recommended to revise the PE lesson unit in the nursing curriculum and exchange it from a purely theoretical-based unit to a mixture of theoretical and clinical-based training. Educational videos alone cannot improve nursing students' PE skills; thus, if educational videos are used to teach clinical skills, it is necessary to hold hands-on sessions to provide feedback to students and correct their mistakes.

A health systems approach to critical care delivery in low-resource settings: a narrative review

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to "ensure the timely and effective delivery of life-saving health care services to those in need". In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or "building blocks": (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings.

The effectiveness of education strategies for nurses to recognise and manage clinical deterioration: A systematic review

OBJECTIVES

To identify, critically appraise and synthesise evidence on the efficacy of education strategies for nurses to recognise and manage clinical deterioration, as well as provide recommendations for standardised educational programmes.

DESIGN

A systematic review of quantitative studies.

METHODS

Quantitative studies published in English between 1 January 2010 and 14 February 2022 were chosen from nine databases. Studies were included if they reported education strategies for nurses to recognise and manage clinical deterioration. The quality appraisal was performed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project. The data were extracted and the findings were integrated into a narrative synthesis.

RESULTS

Altogether, 37 studies published in 39 eligible papers were included in this review, encompassing 3632 nurses. Most education strategies were determined to be effective, and outcome measures can be divided into three types: nurse outcomes; system outcomes; and patient outcomes. The education strategies could be divided into simulation and non-simulation interventions, and six interventions were in-situ simulations. Retention of knowledge and skills during the follow-up after education was determined in nine studies, with the longest follow-up interval totalling 12 months.

CONCLUSIONS

Education strategies can improve nurses' ability and practice to recognise and manage clinical deterioration. Simulation combined with a structured prebrief and debrief design can be viewed as a routine simulation procedure. Regular in-situ education determined long-term efficacy in response to clinical deterioration, and future studies can use an education framework to guide regular education practice and focus more on nurses' practice and patient outcomes.

Physical examination in nursing related to work experience

Background: Poland and other European countries have incorporated the physical assessment of patients into nursing practice. Appropriate practical skills and awareness of physical assessment play an important role in early diagnosis, appropriate management, and mitigation of adverse consequences resulting from the deterioration of the patient's health. Aim of the study: The study aimed to evaluate the undertaking of physical examinations (PE) in professional practice by nurses with varying years of service. Material and methods: The study included a group of 171 registered nurses from Poland. Using the author's non-standardized questionnaire, the study examined the professional experience and usefulness of PE in the nursing profession. Results: Most nurses (56.3%) perform PE every day, regardless of seniority. The main reason for not performing PE was lack of time due to other nursing activities (32.7%) and insufficient staffing (29.9%). Some nurses also explained that it was due to the reluctance of medical personnel (24.1%). The most commonly used techniques in PE were inspection (44.1%) and palpation (32.8%). Most nurses (54.5%), regardless of seniority, felt satisfied with their PE performance. In the opinion of the respondents, 68.3% of patients approached PE undertaken by nurses with trust and appreciation, regardless of their seniority. Conclusions: Professional experience did not significantly affect the perception and performance of PE by nurses in professional practice. In the opinion of the respondents, trust and appreciation was the reaction most often declared by patients concerning nurses undertaking PE, which had no statistically significant relationship with the seniority of the nurse.

Current State of Critical Care Nursing Worldwide: Current Training, Roles, Barriers, and Facilitators

This review provides insights on the current state of roles and responsibilities, on-the-job training, barriers, and facilitators of critical care nursing (CCN) practice. Some of the established roles and training of CCN were providing care for acutely ill patients, delivering expert and specialist care, working as a part of a multidisciplinary team, monitoring, and initiating timely treatment, and providing psychosocial support and advanced system treatment, especially in high-income countries. In low-resource settings, critical care nurses work as health care assistants, technical or ancillary staff, and clinical educators; manage medications; care for mechanically ventilated patients; and provide care to deteriorating patients.

Nursing management of the critical thinking and care quality of ICU nurses: A cross-sectional study

AIM

To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency.

BACKGROUND

Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice.

METHODS

A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality.

RESULTS

After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care.

CONCLUSION

The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability.

IMPLICATIONS FOR NURSING MANAGEMENT

A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.