Care Skills Research Articles

Effectiveness of a virtual patient simulation training on improving provider engagement in suicide safer care.

Health care providers have a critical opportunity to mitigate the public health problem of suicide. Virtual patient simulations (VPS) allow providers to learn and practice evidence-based suicide prevention practices in a realistic and risk-free environment. The purpose of this study was to test whether receiving VPS training increases the likelihood that providers will engage in effective suicide safer care practices. Behavioral health and non-behavioral health providers (N = 19) at a Federally Qualified Health Center who work with patients at risk for suicide received the VPS training on risk assessment, safety planning, and motivation to engage in treatment. Providers' electronic health records were compared 6months pre- and post-VPS training on their engagement in suicide safer care practices of screening, assessment, safety planning, and adding suicide ideation to the problem list. Most behavioral health providers were already engaging in evidence-based suicide prevention care prior to the VPS training. Findings demonstrated the VPS training may impact the likelihood that non-behavioral health providers engage in suicide safer care practices. VPS training in evidence-based suicide prevention practices can optimize and elevate all health care providers' skills in suicide care regardless of role and responsibility, demonstrating the potential to directly impact patient outcomes.

What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour.

Investigating the knowledge and attitude of nurses regarding hypoglycemia of diabetic patients hospitalized in Marjan Teaching Hospital in 2022

Introduction and purpose: Diabetes is the most common disease caused by carbohydrate metabolism disorder that causes damage to many organs including kidney, eyes and heart. Increasing the knowledge and attitude of nurses can reduce the chronic complications of the disease. Therefore, the present research was conducted with the aim of determining the knowledge and attitude of nurses regarding hypoglycemia of diabetic patients admitted to Marjan Teaching Hospital in the year. Research method: In this cross-sectional descriptive study, 172 nurses working in Marjan teaching hospital in Babylon city were selected by available purposive sampling method. Information was collected using three parts of questionnaire, including first part of demographic data, and tow part about knowledge assessment, and last part of questionnaire to assess nurses' attitudes regarding hypoglycemia in diabetic patients. Findings: results of the study showed that among 172 participating nurses, the majority were women (55.8%), with the largest number falling into the age group of 20-29 years. Regarding knowledge assessment, nurses scored an average of 57.47 out of a total possible score ranging from 41 to 70, indicating a moderate level of knowledge about hypoglycemia in diabetic patients. Specifically, nurses in this department scored an average of 59.86% of knowledge points related to hypoglycemia. The average score among nurses regarding hypoglycemia in diabetic patients was 17.41 out of a possible range of 9 to 24, suggesting a generally positive attitude towards managing hypoglycemic episodes in diabetic patients. Conclusion: The study highlights the importance of improving nurses' knowledge and attitudes regarding hypoglycemia in diabetic patients. While most nurses showed moderate knowledge levels, there's room for enhancement, especially in managing hypoglycemic episodes effectively. Although nurses generally displayed a positive attitude, continuous education could bolster their confidence and skills in diabetic care, potentially reducing chronic complications.

The implementation of clinical assessment by nurses in Switzerland: A cross-sectional study from the nursing perspective

The implementation of clinical assessment by nurses in Switzerland: A cross-sectional study from the nursing perspective Abstract: Background: Clinical assessment is a core competency of BSc and MSc prepared nurses in Switzerland. However, influencing factors of its implementation and the experience in the interprofessional team has been studied little so far. Objective: The aim of this study was to explore how often clinical assessment skills are used by BSc and MSc graduated nurses in Switzerland, to identify facilitating and hindering factors for implementation and to investigate the nurses experience of the implementation in the interprofessional team. Method: We used an exploratory, descriptive research design employing a cross-sectional study of the convenience sample of BScN and MScN graduates in Switzerland. 264 questionnaires were analysed quantitatively and 149 written statements as part of the survey qualitatively. Results: Respondents indicated that they routinely only use 18.9% of the 53 assessment skills they were trained in. The "respiratory system", "abdomen", "skin" and "mental status" were used most frequently. MScN graduates use respiratory assessments and BScN graduates use abdominal assessments more frequently. Lack of time and interruptions, lack of influence on patient care and specialty specific skills are hindering factors for the implementation. Better conditions at the institutional level and appreciation within the interprofessional team can make an encouraging contribution in future. Conclusion: This study illustrates, that the theory-practice transfer of clinical assessment in Switzerland needs to be further promoted.

An Analysis of Teaching Menstrual Care Skills Using Single-Subject Methodology: A Systematic Literature Review.

There is a paucity in research supporting procedures to teach skills needed during an individual's menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills. A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC's criteria to assess the rigor of each studies' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills. The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40years of research. One study met all criteria required to receive the WWC's highest rating. The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.

Nephrologists' perspectives and experiences with hospice among older adults with end-stage kidney disease.

Hospice care leads to improved patient and family outcomes. Hospice use among older adults with end-stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. Here, our aim was to explore barriers to timely receipt of high-quality hospice care for older adults with ESKD. Utilizing a qualitative study design, we conducted a secondary analysis focused on hospice, a theme that we identified in our larger overarching study that involved semi-structured interviews with 20 nephrologists in the United States focused on treatment decision-making in older adults with advanced chronic kidney disease. We analyzed the interview transcripts using emergent thematic analysis to develop an understanding of barriers to high-quality hospice. With a couple notable exceptions, nephrologists voiced general support for the concept of hospice, but few recalled patients of theirs who had received hospice. Nephrologists' interviews revealed two interrelated contributors to the lack of timely access to high-quality hospice care for seriously ill older adults with ESKD: (1) nephrologists view dialysis and hospice as mutually exclusive models of care; (2) nephrologists feel unsure who should manage hospice care for patients with ESKD. The first contributor was rooted in nephrologists' narrow vision of when to consider hospice (informed, in part, by policy barriers) and, in a couple of cases, strong discomfort with hospice. The second stemmed from nephrologists' belief that neither they nor hospice are adequately prepared to provide hospice care for ESKD. Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients.

Digital competence using the example of executives in residential care facilities in Germany-a comparison.

Change and progress through digitalisation is also becoming increasingly important in the field of professional care and the associated increasing demands on the skills of nursing staff. The European Union considers digital skills to be one of the eight key competences for lifelong learning. At present, few reliable statements can be made about the status of digital skills in professional nursing care in Germany. The aim of this study was to map the current status of digital competences of executives in full inpatient care facilities in Germany and to identify possible differences to reference values of academics. This survey is based on a Germany-wide cross-sectional survey in full inpatient care facilities (N = 8,727). The survey instrument Digital Competences Framework (DigComp 2.2) according to the European Union's reference framework was used as the basis for recording the digital competence characteristics. The statistical analysis was descriptive and inferential (t-test, two-sided, p < 0.05). Out of 15 items across five dimensions, significant differences for nine items can be determined. The competence levels of the participating managers from the full inpatient care facilities were lower compared to the reference sample. In order to be able to counter the skills discrepancy shown by the study in the future, it is of central importance to deepen knowledge and skills in the area of digitalisation in the care context.

Reducing ambulatory central line-associated bloodstream infections: A family-centered approach.

Ambulatory central line-associated bloodstream infections (CLABSIs) cause significant morbidity and mortality, especially in pediatric oncology. Few studies have had interventions directed toward caregivers managing central lines (CL) at home to reduce ambulatory CLABSI rates. We aimed to reduce and sustain our ambulatory CLABSI rate by 25% within 3years of the start of a quality improvement intervention. Plan-do-study-act cycles were implemented beginning April 2016. The main intervention was a family-centered CL care skill development curriculum for external CLs. Training began upon hospital CL insertion, followed by an ambulatory teach-back program to achieve home caregiver CL care independence. Other changes included: standardizing ambulatory nurse CL care practice (audits, a train the nurse trainer process, and workshops for independent home care agencies); developing aids for trainers and caregivers; providing supplies for clean surfaces; wide dissemination of the program; and minimizing opportunities of CLABSI (e.g., standardizing timing of CL removal). The outcome measure was the ambulatory CLABSI rate (excluding mucosal barrier injury laboratory-confirmed bloodstream infection), compared pre intervention (January 2015 to March 2016) to post intervention, including 2years of sustainability (April 2016 to June 2023), using statistical process control charts. We estimated the total number of CLABSI and associated healthcare charges prevented. The ambulatory CLABSI rate decreased by 52% from 0.25 to 0.12 per 1000 CL days post intervention, achieved within 27months; 117 CLABSI were prevented, with $4.2 million hospital charges and 702 hospital days avoided. Focusing efforts on home caregivers CL care may lead to reduction in pediatric oncology ambulatory CLABSI rates.

Decision-making process in seeking antenatal care: A cohort study in a poor urban and a typical rural area in Bangladesh.

Decision-making in choosing and using maternal health care among different care-seeking options is a complex process influenced by multilevel factors. Existing evidence on maternal health care-seeking behaviour stems primarily from cross-sectional studies with limited information. Therefore, we designed a cohort study to better understand the decision-making process in antenatal care (ANC) seeking. We conducted this mixed-methods study among pregnant women at <27 weeks of gestation in a poor urban area (n = 1320) and a typical rural area of Bangladesh (n = 1239) whom we followed up till eight weeks after delivery. In view of quantitative methods, we interviewed all enrolled women 5-6 times four weeks apart. For the qualitative approach, we conducted 70 case studies in the urban area and 46 in the rural area by interviewing the participants and their close family members. In the urban area, about one-third of the pregnant women (38.4%) sought ANC at non-governmental organisations, and nearly an equal proportion went to public facilities (36.6%). In both the situations, women preferred facilities with one-stop services at a reasonable cost. In contrast, the lack of readiness in public facilities of the rural area pushed women (77.8%) toward private facilities for ANC. The reputation of the facilities, availability of skilled care providers, diagnostic tests, and ultrasonography services therein were the key influencing factors in the participants' decisions to seek ANC services from specific facilities. The availability of one-stop services was a key factor for participants' choosing of a facility for ANC. For the urban setting, there is a need to establish large public facilities with one-stop service provision in different zones, along with supporting non-governmental organisations in poor areas. For the rural setting, there is an urgent need to strengthen ANC service provision in public facilities at the community- and the sub-district level to redirect women from the private to the public sector to ensure low cost, quality services.

Training for a mass casualty incident: Conception, development, and implementation of a crew-resource management course for forward surgical teams.

Since 2021, the predeployment training of French FSTs has included a simulation-based curriculum consisting of organizational and human factors. The purpose of this article is to describe the development of a crew-resource management (CRM) training course dedicated for the forward surgical teams (FSTs) of the French Military Health Service. The approach was based on three steps: (1) establishment of a conceptual framework of FSTs deployment; (2) development of an aircrew-like CRM training combining lectures, laboratory exercises, and situational training exercises to consider four fundamental "nontechnical" (cognitive and social) skills for effective and safe combat casualty care: (a) leadership, (b) decision-making, (c) coordination, and (d) situational awareness; (3) Implementation of teamwork evaluation tools. A multidisciplinary team designed a conceptual framework for FST preparedness, 24 French FSTs completed a high-quality training that takes into account both technical and nontechnical skills to maintain quality of combat care during mass-casualty incidents, FSTs' CRM skills were assessed using an audio/video recording of a simulated mass-casualty incident.

Analysis of the Chain-Mediated Effects of Narrative Care Skills and Evidence-Based Nursing Competencies between Clinical Nurse Core Competencies and Sense of Career Benefit

Background: To understand the current status of clinical nurses' narrative care skills and evidence-based nursing competence, and to explore their chain-mediated roles between nurses' core competence and sense of career benefit, so as to provide references for improving nurses' sense of career benefit and positively developing nursing teams. Methods: A general information questionnaire, narrative competence scale for healthcare professionals, evidence-based nursing competency scale, registered nurse core competency scale, and nurses' sense of career benefit questionnaire were used to survey 716 nurses, and the chain mediation model was constructed and tested. Results: The total evidence-based nursing competency score of clinical nurses was (65.53±9.17), which was at a moderate level. The total score of narrative care skills (113.57±18.52), the total score of nurses' core competence (179.15±33.37), and the total score of nurses' sense of career benefit (109.37±20.81) were in the middle level; narrative care skills and evidence-based nursing competence acted as chain mediators between nurses' core competence and their sense of career benefit, and the mediation effects were respectively 0.006, 0.014. Conclusion: Narrative care skills and evidence-based nursing competency were at intermediate level, and the chain mediating effect of narrative care skills and evidence-based nursing competency indirectly predicted nurses' sense of professional benefit. It is suggested that nursing leaders can carry out lectures and training courses to improve nurses' narrative care skills and evidence-based nursing competence, to promote nurses' sense of career identity and to create a good nurse-patient relationship, which will be conducive to the positive development of the nursing team in the modern healthcare environment.

Which neurocritical care skills support daily work in general critically ill patients?

Which neurocritical care skills support daily work in general critically ill patients?

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

Instrumen Discharge Planning Berbasis Patient Family Centered Care

This study aims to develop a discharge planning instrument through an inpatient family centered care approach, to improve service quality. The method used was systematic review, a systematic search through the Scopus, Science Direct, and Pub Med databases published between 2018-2023. The results showed that discharge planning based on patient family centered care helps prepare patients and families for home care, increase knowledge and skills, and collaborate with other health workers. The conclusion of this study is that discharge planning has an influence on the success of patient care after being at home. The implementation of discharge planning is important in preparing patients and families with education by nurses related to the disease and patient care so as to increase knowledge and skills for home care. Improved quality of service at home and patient and family satisfaction. Keywords: Discharge Planning, Instrument Development, PFCC, Hospitalization, Hospital.

Depletion through transnational social reproduction: guestworker migration and uneven development in the South Pacific

The recent expansion of regional guestworker migration schemes has altered the political economy of the South Pacific, creating a ‘permanent labour reserve’ (MacWilliam, 2022) for low-wage industries in rural Australia and New Zealand. Historical structures of uneven development, against which the ‘blackbirding’ of indentured Kanaka labourers took place more than a century prior, have again enabled a transnational labour (im)mobility regime in which Pasifika workers are rendered unfree and situated as a ‘fix’ for accumulation: limited to racialised and gendered labour practices, tied to employer-sponsors in remote locations, and without the rights afforded to other migrant workers. Taking the Pacific Australia Labour Mobility (PALM) scheme as the paradigmatic example of a resurgent guestworker model in the region, this article foregrounds overlooked processes of transnational social reproduction that emerge from the interplay of restrictive migration policies and exploitative Local Labour Control Regimes (LLCRs). Drawing on extensive in-depth interviews with migrant workers, their family members, and government staff from four participating Pacific Island Countries (PICs), it examines how the PALM scheme spatially and temporally reconfigures care practices, skills formation, and communal labour to progressively deplete (Rai et al, 2014) socially reproductive capacity within the South Pacific. The article concludes by suggesting that the strains the PALM scheme places on social reproduction within PICs is itself a fundamental driver of uneven development across the region.

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses’ perceptions

BackgroundNurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses’ perceptions of developmental care. ObjectiveTo determine perceptions and attitudes towards developmental care in a specialty neonatal setting. DesignCross-sectional study. SettingsTwo surgical neonatal intensive care units in Australia. ParticipantsRegistered nurses permanently employed at the study sites between May 2021 to April 2022. MethodsA modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses’ perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. ResultsOf 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3–8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1–6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1–6.2]. ConclusionsThe results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Early Impact: Integrating Core Palliative Care Skills into Medical Education

Early Impact: Integrating Core Palliative Care Skills into Medical Education

LGBTQ+ individuals are not explicitly represented in emergency medicine simulation curricula

Background Medical educational societies have emphasized the inclusion of marginalized populations, including the lesbian, gay, bisexual, transgender and queer (LGBTQ+) population, in educational curricula. Lack of inclusion can contribute to health inequality and mistreatment due to unconscious bias. Little didactic time is spent on the care of LGBTQ+ individuals in emergency medicine (EM) curricula. Simulation based medical education can be a helpful pedagogy in teaching cross-cultural care and communication skills. In this study, we sought to determine the representation of the LGBTQ+ population in EM simulation curricula. We also sought to determine if representations of the LGBTQ+ population depicted stigmatized behavior. Methods We reviewed 971 scenarios from six simulation case banks for LGBTQ+ representation. Frequency distributions were determined for major demographic variables. Chi-Squared or Fisher’s Exact Test, depending on the cell counts, were used to determine if relationships existed between LGBTQ+ representation and bank type, author type, and stigmatized behavior. Results Of the 971 scenarios reviewed, eight (0.82%) scenarios explicitly represented LGBTQ+ patients, 319 (32.85%) represented heterosexual patients, and the remaining 644 (66.32%) did not specify these patient characteristics. All cases representing LGBTQ+ patients were found in institutional case banks. Three of the eight cases depicted stigmatized behavior. Conclusions LGBTQ+ individuals are not typically explicitly represented in EM simulation curricula. LGBTQ+ individuals should be more explicitly represented to reduce stigma, allow EM trainees to practice using gender affirming language, address health conditions affecting the LGBTQ+ population, and address possible bias when treating LGBTQ+ patients.

Rhinoplasty for unilateral cleft lip deformity

Cleft nasal deformity is most common sequel after cleft lip and palate surgery. The severity of the nasal deformity is usually decided by initial cleft state, previous operation skill and postoperative care. Secondary cleft rhinoplasty for unilateral cleft patient requires both esthetic and functional results. Understanding the anatomic defect and growth potential after cleft operation help to perform favorable secondary rhinoplasty. Surgical methods for deformed cleft nose are diverse and each methods have pros and cons. Closed or open rhinoplasty with or without cartilage graft and piriform augmentation are the mainstay for cleft rhinoplasty. The purpose of this study was to describe current concepts in secondary rhinoplasty for unilateral cleft lip nasal deformity. Secondary rhinoplasty for cleft patients requires an understanding of the anatomic situation, and the use of cosmetic and functional rhinoplasty techniques for its successful management.

Advancing social work curriculum to challenge FASD-related stigma and promote strengths-based family engagement

ABSTRACT The need for professionals to become educated in fetal alcohol spectrum disorder (FASD) has emerged as a critical topic in child and family settings. FASD is sometimes described as being entirely preventable implying blame toward mothers and negative attitudes toward people with FASD. Without preservice education to address stigma associated with FASD, social workers are at risk of exacerbating deficit-based models of FASD care. Guided by an Australian study with health professionals who have skills in FASD assessment and care, this paper advances an agenda for social work curriculum capable of challenging FASD-related stigma to promote strengths-based family engagement.