Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

AIMS

To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines.

BACKGROUND

Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control.

DESIGN

A descriptive cross-sectional design.

METHODS

A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting.

RESULTS

301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003).

CONCLUSIONS

Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis): The MANCTRA-1 international audit

BACKGROUND/OBJECTIVES

Reports about the implementation of recommendations from acute pancreatitis guidelines are scant. This study aimed to evaluate, on a patient-data basis, the contemporary practice patterns of management of biliary acute pancreatitis and to compare these practices with the recommendations by the most updated guidelines.

METHODS

All consecutive patients admitted to any of the 150 participating general surgery (GS), hepatopancreatobiliary surgery (HPB), internal medicine (IM) and gastroenterology (GA) departments with a diagnosis of biliary acute pancreatitis between 01/01/2019 and 31/12/2020 were included in the study. Categorical data were reported as percentages representing the proportion of all study patients or different and well-defined cohorts for each variable. Continuous data were expressed as mean and standard deviation. Differences between the compliance obtained in the four different subgroups were compared using the Mann-Whitney U, Student's t, ANOVA or Kruskal-Wallis tests for continuous data, and the Chi-square test or the Fisher's exact test for categorical data.

RESULTS

Complete data were available for 5275 patients. The most commonly discordant gaps between daily clinical practice and recommendations included the optimal timing for the index CT scan (6.1%, χ2 6.71, P = 0.081), use of prophylactic antibiotics (44.2%, χ2 221.05, P < 0.00001), early enteral feeding (33.2%, χ2 11.51, P = 0.009), and the implementation of early cholecystectomy strategies (29%, χ2 354.64, P < 0.00001), with wide variability based on the admitting speciality.

CONCLUSIONS

The results of this study showed an overall poor compliance with evidence-based guidelines in the management of ABP, with wide variability based on the admitting speciality. Study protocol registered in ClinicalTrials.Gov (ID Number NCT04747990).

Physical (in)activity, and its predictors, among Brazilian adolescents: a multilevel analysis

Background

Physical activity is a multifactorial trait, determined by both individual and environmental characteristics, it seems relevant to understand the determinants related to youth guidelines accomplishment. The present study aimed to verify the differences between the Brazilian federative units regarding to the prevalence of youth physical activity guidelines accomplishment and to investigate the determinants related to the inter-individual differences in this accomplishment.

Methods

Sample comes from the 2015 Brazilian National School Health Survey (PeNSE), comprising 99,570 adolescents (51,527 girls, 13-17y), enrolled in 3039 schools. Adolescents reported the time they spend in moderate-to-vigorous physical activity daily, and they were categorized as active or inactive, if the guidelines were achieved, or not, respectively, and multilevel statistical analyses were used, including both child and school-level variables. Multilevel Binomial model was computed in the SuperMix software.

Results

The majority of the adolescents did not comply with the physical activity guidelines daily, where Bahian children complied the least, while those from Amazonas, Tocantins, and Mato Grosso do Sul complied the most. Boys (OR: 2.305; 95%CI: 2.277-2.334), older adolescents (OR: 1.044; 95%CI: 1.036-1.051), and those who spent more time in active travelling to/from school (OR: 1.001; 95%CI: 1.001-1.001) complied more the physical activity guidelines. At the school level, adolescents from larger schools (OR: 0.957; 95%CI: 0.928-0.986) tended to comply less with the guidelines.

Conclusion

Significant differences between Brazilian federative units in youth daily physical activity guidelines compliance were observed, highlighting the role of individual but also environmental constraints in the Brazilian adolescents’ engagement in physical activity.

Compliance with evidence-based clinical guidelines in the management of acute biliary pancreatitis: the MANCTRA-1 study protocol

Despite existing evidence-based practice guidelines for the management of biliary acute pancreatitis (AP), the clinical compliance with recommendations is overall poor. Studies in this field have identified significant discrepancies between evidence-based recommendations and daily clinical practice. The most commonly reported gaps between clinical practice and AP guidelines include the indications for CT scan, need and timing of artificial nutritional support, indications for antibiotics, and surgical/endoscopic management of biliary AP. The MANCTRA-1 (coMpliAnce with evideNce-based cliniCal guidelines in the managemenT of acute biliaRy pancreAtitis) study is aiming to identify the areas for quality improvement that will require new implementation strategies. The study primary objective is to evaluate which items of the current AP guidelines are commonly disregarded and if they correlate with negative clinical outcomes according to the different clinical presentations of the disease. We attempt to summarize the main areas of sub-optimal care due to the lack of compliance with current guidelines to provide the basis for introducing a number of bundles in AP patients’ management to be implemented during the next years. The MANCTRA-1 study is an international multicenter, retrospective cohort study with the purpose to assess the outcomes of patients admitted to hospital with a diagnosis of biliary AP and the compliance of surgeons worldwide to the most up-to-dated international guidelines on biliary AP. ClinicalTrials.Gov ID Number: NCT04747990, Date: February 23, 2021. Protocol Version V2.2.