Clinical Agencies Research Articles

Overcoming Barriers to Healthcare Reform: A Call to Action.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.

The sustainability of a community-based learning collaborative to improve the use of trauma-informed evidence-based practices

PurposeMost youth who experience trauma do not receive evidence-based trauma intervention. Efforts to increase use oftrauma-informed evidence-based practices (EBPs) have identified the learning collaborative (LC) as an effective training and implementation model, yet few studies have evaluated sustainability outcomes. This study examined the sustainability of a community-based LC (CBLC) by describing provider, agency, and community-level use of trauma-informed EBPs, an average of 5.3 years after the training. Methods106 participants from 20 agencies completed a follow-up survey after a CBLC training. Participants were trained in Trauma-Focused Cognitive-Behavior Therapy (TF-CBT; clinical track), in Evidence-Based Treatment Planning (EBTP; broker/case manager track), or in strategies to support TF-CBT and EBTP implementation (senior leader track). Clinical and broker track participants reported on their current employment and EBP use within the past three months. Senior leaders for all 20 agencies provided information about the use of trauma-informed EBPs at their agencies. ResultsAt the provider-level, only 36.5 % of the clinical track continued to use TF-CBT and 28.1 % of the broker track continued to use EBTP. Provider promotion to supervisory and leadership positions supported EBP sustainability. Agency-level outcomes indicated that 89 % of clinical agencies and 60% of broker agencies continued to use TF-CBT and EBTP. Although retention of providers within agencies was low, LC trained clinicians and brokers spread to twenty-four new agencies in the community providing psychotherapy and/or case management services to youth. ConclusionsFindings suggest the CBLC model resulted in some sustained community-level changes as agencies continued to use the trauma-informed EBPs and trained providers spread to other agencies within the local community. Provider promotions also increased representation of CBLC trainees in leadership positions. Results suggest that measuring sustainability as a multi-level implementation outcome can lead to a better understanding of implementation success.

Building Confidence, Diminishing Stress: A Clinical Incivility Management Initiative for Nursing Students.

The aim of this study was to evaluate the effectiveness of an interactive program designed to reduce nursing students' perceived stress and improve self-efficacy and readiness to professionally address incivility during clinical practice. Incivility in clinical settings adversely impacts learners, educators, institutions, and healthcare systems, undermining safety and the teaching-learning process. Despite its increasing global prevalence, effective interventions remain largely unexplored. Our mixed-methods study, conducted from March to April 2024, involved senior baccalaureate pre-licensure nursing students (N = 35) from a California State University. The three-week, one-hour-per-week, interactive clinical incivility management program was developed through an extensive literature review. Pre- and post-intervention differences were assessed using a 10 min self-administered online survey that included the Uncivil Behavior in Clinical Nursing Education (UBCNE; 12 items), Perceived Stress Scale (PSS; 10 items), General Self-Efficacy Scale (GSE; 10 items), and a sample characteristics questionnaire (11 items). A one-hour face-to-face focus group (n = 11) then provided qualitative data on personal experiences of clinical incivility. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Colaizzi's method. Clinical incivility prevalence was 71.4% (n = 25 out of 35). No statistically significant differences were found in UBCNE, PSS, and GSE scores between pre- and post-intervention. However, professional responses to clinical incivility significantly improved after the intervention (t = -12.907, p < 0.001). Four themes emerged from the qualitative data: (a) uncivil behaviors or language from nurses, (b) emotional discouragement and low self-confidence, (c) resource and personnel shortages at clinical sites for education, and (d) the necessity for interventions to manage clinical incivility. Nursing schools and clinical agencies should collaborate to establish monitoring systems, enhance communication, and implement evidence-based policies and interactive interventions to prevent and manage clinical incivility experienced by nursing students from clinical sites.

Moonshot. Long shot. Or sure shot. What needs to happen to realize the full potential of AI in the fertility sector?

Quality healthcare requires two critical components: patients' best interests and best decisions to achieve that goal. The first goal is the lodestar, unchanged and unchanging over time. The second component is a more dynamic and rapidly changing paradigm in healthcare. Clinical decision-making has transitioned from an opinion-based paradigm to an evidence-based and data-driven process. A realization that technology and artificial intelligence can bring value adds a third component to the decision process. And the fertility sector is not exempt. The debate about AI is front and centre in reproductive technologies. Launching the transition from a conventional provider-driven decision paradigm to a software-enhanced system requires a roadmap to enable effective and safe implementation. A key nodal point in the ascending arc of AI in the fertility sector is how and when to bring these innovations into the ART routine to improve workflow, outcomes, and bottom-line performance. The evolution of AI in other segments of clinical care would suggest that caution is needed as widespread adoption is urged from several fronts. But the lure and magnitude for the change that these tech tools hold for fertility care remain deeply engaging. Exploring factors that could enhance thoughtful implementation and progress towards a tipping point (or perhaps not) should be at the forefront of any 'next steps' strategy. The objective of this Opinion is to discuss four critical areas (among many) considered essential to successful uptake of any new technology. These four areas include value proposition, innovative disruption, clinical agency, and responsible computing.

Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

BackgroundUnderstanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.MethodsA qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.ResultsDuring their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.ConclusionsThis qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

ChromEDA: Chromosome classification by ensemble framework based domain adaptation.

The precise identification of chromosomal abnormalities based on microscopy images in clinics heavily relies on manual analysis by karyotype experts, which is expensive and labor-intensive. Therefore, there is an urgent need for automatic classification technologies. However, current deep learning-based methods require a large amount of annotated data to achieve satisfactory performance. Additionally, there are domain shifts between datasets obtained from different instruments and clinical agencies, which hinders the utilization of existing public data resources. To overcome these challenges, we propose a novel ensemble learning framework called ChromEDA. This method incorporates soft pseudo-label learning, adversarial learning, and angle classification learning strategies to mitigate the domain shift. To evaluate its performance, we conducted cross-domain classification experiments using both public and private datasets. The results demonstrate that ChromEDA effectively addresses the domain shift issue and outperforms existing methods in cross-domain chromosome classification tasks. RESEARCH HIGHLIGHTS: The research transferred an unsupervised cross-domain algorithm into the chromosome microscopic image processing area, which can support fast and efficient deployment in equipment such as microscopies. To our knowledge, it is the first domain adaption application in chromosome image analysis. The research designed an ensemble learning framework-based chromosome classification model to alleviate the domain shift between different domains. It is a combination of soft pseudo-label learning, adversarial learning, and self-supervised angle recognition, which can significantly reduce the annotation requirements for chromosomal image processing. The results find that for chromosomes sharing the same centromere position category, banding information may contribute more to within-group classification. Thus, banding pattern information is encouraged to be considered for more precise classification of chromosomes.

Undergraduate Nursing Student Reflections on Academic Service Learning Experiences – A Qualitative Study

The provision of nursing care has shifted toward integrated primary care (provision of community health services by an interprofessional team), requiring that nurse educators take steps to ensure students have opportunities to learn and practice the leadership and professional skills required to function as members and leaders of interdisciplinary teams. We developed the Transforming RN Roles in Community Based Integrated Primary Care (TRIP) program for undergraduate nursing students to facilitate this learning. During clinical immersion, students participated in academic service learning (ASL) activities consisting of a minimum of 25 h of clinical agency service each semester. This descriptive qualitative design captures recurring themes in the ASL reflections of eight nursing students participating in the inaugural TRIP cohort. Three themes were identified (1) “Embracing the Nursing Profession” (2) “Utilizing the Professional Skills of Nursing” and (3) “I Am A Nurse”. We urge our faculty colleagues to consider incorporating ASL experiences into their undergraduate activities. We believe the effort to initiate, develop and sustain these partnerships will pay handsome dividends in terms skill and confidence enhancements for our undergraduate nursing students.

Diabetes Educational Intervention for Nurse Practitioner Students Within a Family Practice Clinic

Diabetes mellitus (DM) prevalence is rising. Nurse practitioner (NP) students must enter practice ready to implement current treatment guidelines in practice. This quality improvement project aimed to increase NP students’ knowledge and confidence for managing patients with DM by implementing an educational intervention. The intervention entailed 6 educational sessions led by a preceptor during morning huddles in a primary care clinic. Outcomes were measured by comparing pre- and postintervention survey item means. NP students’ knowledge and confidence increased across multiple DM management topics. Novel educational interventions delivered in clinical agencies by precepting providers may help increase NP students’ practice readiness.

Quantification of institutional and professional impact of a professional advancement program for advanced practice registered nurses and physician assistants.

Professional advancement programs, also known as career or clinical ladders, have proliferated for advanced practice registered nurses (APRNs) and physician assistants (PAs) and recognize clinical and/or professional contributions within clinical agencies. Although the literature is rich in describing the benefits of these programs on job satisfaction and staff retention, there is a dearth of literature on the effect of these programs on clinical practice, institutions, and the respective professions. This article quantifies the impact on the institution and profession of APRNs and PAs who have been promoted through an institution's career ladder.

Contribution of nursing students to clinical settings: A multi center cross sectional study.

To describe the contribution of nursing students to clinical settings based on the perceptions of nurse preceptors and to examine whether certain characteristics of nurses' professional activity are associated with a positive perception of nursing students. Most clinical agencies receive many nursing students each year, who acquire clinical competencies under the guidance of a registered nurse preceptor. However, there is limited evidence of the contributions made by nursing students during clinical placements. A multi-center cross-sectional study was carried out between June and December 2019. A convenience sample of Registered Nurses (n=927) was recruited from four public hospitals in Spain. The Nursing Student Contributions to Clinical Settings' questionnaire was used. In addition, sociodemographic, work and teaching activity variables were collected. Multivariable logistic regression was used to determine the variables associated with positive student contributions. The nursing student contributions were deemed favorable by 70.7% of the nurse preceptors, mainly because the nursing students are future professionals who know the center, support the development of the nurses' teaching role and constitute a link between the health center and the university. Certain professional characteristics of the Registered Nurses were significantly associated with a positive perception of the contributions of nursing students: having daily coffee breaks (Odds ratio: 2.60; 95% Confidence interval:1.27-5.32), high levels of professional satisfaction (Odds ratio: 2.13; 95% Confidence interval:1.21-3.75) and work in medical-surgical units (Odds ratio: 1.62; 95% Confidence interval: 1.08-2.41). In contrast, nurses with greater work experience (≥ 30 years) (Odds ratio: 0.48; 95% Confidence interval: 0.27-0.85) and who worked at units where 10 or more students perform clinical practice (Odds ratio: 0.57; 95% Confidence interval: 0.36-0.90) were associated with a lower probability of positive perceptions. In Spain, the contributions made by nursing students to clinical settings are favorable, both for the nursing profession and for healthcare institutions. Their contributions are influenced by the professional characteristics of the Registered Nurses, as well as the environment and the teaching activity within the units.

Strategies for recruiting the dependent children of patients with a life-limiting illness as research participants

Background: The voices of children and adolescents have historically been substituted by the perspective of adults. There is growing recognition that children (<18 years old) are able to participate in research and appreciate the opportunity to participate in studies. Aim: To share the strategies employed by two research teams from USA and UK, who have successfully recruited children living with parental life-limiting illness as research participants. Findings: The researchers overcame common challenges when negotiating ethics committees by anticipating the IRB/REC concerns, providing the committees with detailed applications including distress protocols, and offering resources to their ethics committee to learn about conducting research with this population. The researchers navigated recruitment and gatekeeping by clinicians and parents by partnering with clinical agencies and nurturing relationships with practitioners who are supportive of the research, offering to present the findings of the study with continuing education credits, and developing children’s, adolescents’ and parents’ project advisory groups to support recruitment, data collection and analysis. Conclusions: Simple strategies can be used to overcome barriers to recruitment, providing opportunities for children to be research participants and for their unique perspectives to be heard in palliative care research.

Evaluation of a Virtual Recreational Therapy Fieldwork and Clinical Supervision Program: Implications during the Pandemic and Beyond

Fieldwork and clinical supervision are vital to the growth and development of students during their Recreational Therapy (RT) education. However, restrictions on in-person instruction and suspended access to clinical agencies during the COVID-19 pandemic challenged educators to find new ways to provide these experiences. This retrospective program evaluation describes a virtual RT fieldwork and clinical supervision program, and assesses its effectiveness. Undergraduate students (n = 17) and RT clinical supervisors (n = 17) matched into dyads met virtually for one hour weekly over the course of 10 weeks. Data from separate student and clinical supervisor surveys were analyzed using frequency counts and thematic review. Findings suggest both students and clinical supervisors found value in this virtual fieldwork and clinical supervision program. Suggestions for program improvement/development as well as implications for RT education are discussed with emphasis placed on ways technology can expand opportunities for RT fieldwork and clinical supervision.

Journey to a new era: An innovative academic-practice partnership.

Successful academic-clinical partnerships are mutually beneficial for academic nursing and clinical organizations, supporting the long-term success of nursing programs while simultaneously improving patient outcomes. Advocated by the American Association of Colleges of Nursing in their 2016 report, Advancing Healthcare Transformation: New Era for Academic Nursing, this position paper provides six actions for transforming academic nursing. However, developing sustainable academic-practice models has proven challenging despite this roadmap, as research has not substantiated their benefits. This article describes an innovative academic-practice model that transitioned advanced practice registered nurses practicing at Le Bonheur Children's Hospital to full-time faculty, with a continued primary clinical practice role, in the College of Nursing at the University of Tennessee Health Science Center. We present the origin, development, and implementation of this academic-practice partnership model, offering recommendations for its replication by other universities and clinical agencies on this journey. Creating a sustainable model requires a shared vision, buy-in at all levels, frequent and transparent communication, planning that considers the individual policies of the partnering agencies, and persistence despite leadership changes. Two years into the partnership and remaining intact despite critical leadership changes within the clinical agency, the next phase of the relationship will permit us to document the model's impact on academic and clinical outcomes.

\u2018You just really have to assert yourself:\u2019 social work, nursing, and rehabilitation counseling student experiences of providing integrated behavioral health services before and after the immediate start of COVID-19

BackgroundEducators who train healthcare students to provide behavioral health services in primary care settings frequently encounter challenges as they work to ensure that students acquire the knowledge and skills to effectively function on interprofessional practice teams. This has become increasingly important during COVID-19, as interprofessional collaborative practice is needed more than ever to address the interrelated health, mental health, and social structural issues linked to the pandemic.MethodsWe used qualitative focus groups to understand the experiences of 6 interprofessional teams (comprised of graduate social work, nursing, and rehabilitation counseling students; n = 19) providing behavioral health services in primary care settings before and after the immediate start of COVID-19. To triangulate data and enrich findings, one focus group with students’ faculty supervisors was also conducted; n = 5). Data were analyzed using thematic analysis.ResultsFour themes highlighted student participants’ need to assert themselves at the beginning of their educational experience, to communicate and learn from one another to develop positive team dynamics, to contend with role confusion and missed opportunities for collaboration, and to manage the emotional impact of COVID-19 on learning.ConclusionFindings indicate that educators should work with clinical faculty and agency supervisors to orient students to ensure they have role clarity within the agency. Graduate students providing behavioral health services should also learn to work collaboratively within their scopes of practice to serve patients virtually, especially in preparation for public health emergencies.

Self-Efficacy, Grit and Perceptions of Rural Employment: What Changes Occur After Graduation?

Purpose: General self-efficacy, occupational self-efficacy, and grit have a correlation with academic and practical success amongst nursing students. The role of these same characteristics during the first 18-24 months following the transition from student to nurse is poorly understood. In addition, when a nursing graduate begins to consider a career in a rural area is also remains unclear. This study sought to understand the change, if any, in general self-efficacy, occupational self-efficacy, grit, and rural employment importance that occurred during this transition period. Sample: Nurses after graduating from a three-year Bachelor of Nursing degree (n=28). Method: A follow-up study of a larger longitudinal mixed-methods cohort design used a survey to examine general self-efficacy, occupational self-efficacy, grit, and rural employment importance among novice nurses. Participants had agreed when completing the initial study as students to participate in a follow-up study 18-24-months after graduating. Findings: Occupational self-efficacy increased as the cohort transitioned from student to professional nurse, while grit was remarkably lower between final year students and novice nurses. No change in earlier measures of general self-efficacy or importance placed on rural careers were detected. Conclusions: Following graduation, new clinicians are focused on building professional identity and the development of foundational skills for practice. Clinical agencies have an opportunity to shift the balance between autonomy and support in order to harness these key characteristics in an effort to improve the longevity and progression of nursing graduates within the nursing profession. Keywords: nurses, students, novice, grit, self-efficacy, community apgarDOI: https://doi.org/10.14574/ojrnhc.v21i2.680

Cybersecurity and the New Age of Ransomware Attacks

One of the most concerning health care information technology headlines is the growing number of cyber security challenges faced by clinical agencies. Cyber security threats and attacks can take many shapes and forms, but the most pernicious and aggressive are those that result in a complete shut-down of one or more vital technology systems or the rendering of health care data to be inaccessible. The intense dependency on technology in health care for everything from billing to intravenous drip rates has elevated concerns about these attacks and increased the risk for direct harm to patients.

The New ISO/IEC Standard for Automated ECG Interpretation

Updates to industry consensus standards for ECG equipment is a work-in-progress by the ISO/IEC Joint Work Group 22. This work will result in an overhaul of existing industry standards that apply to ECG electromedical equipment and will result in a new single international industry, namely 80601-2-86. The new standard will be entitled “80601, Part 2-86: Particular requirements for the basic safety and essential performance of electrocardiographs, including diagnostic equipment, monitoring equipment, ambulatory equipment, electrodes, cables, and leadwires”. This paper will provide a high-level overview of the work in progress and, in particular, will describe the impact it will have on requirements and testing methods for computerized ECG interpretation algorithms. The conclusion of this work is that manufacturers should continue working with clinical ECG experts to make clinically meaningful improvements to automated ECG interpretation, and the clinical validation of ECG analysis algorithms should be disclosed to guide appropriate clinical use. More cooperation is needed between industry, clinical ECG experts and regulatory agencies to develop new data sets that can be made available for use by industry standards for algorithm performance evaluation.

Commentary: Defining self-harm: how inconsistencies in language persist - a commentary/reflection on Ward and Curran (2021).

Self-harm definition is an important focus of academic research and clinical practice. The precise definition of self-harm has been contested for decades, and current terminology varies across, and sometimes within, countries. This commentary has been written to highlight the problematic use of the term 'deliberate' self-harm (i.e. DSH) and to clarify the terminology currently recommended by clinical agencies in the United Kingdom. Comparisons will be made to other definitions in the field, such as non-suicidal self-injury (NSSI), with the aim of contributing to the worldwide discussion about how we conceptualise, discuss and treat suicidal and non-suicidal behaviours. The commentary concludes by highlighting the findings of Ward and Curran (2021). It is suggested that undiagnosed ADHD may be a potential driver for self-harm, particularly among girls, further highlighting the ongoing challenges in identifying and predicting which youth are at risk for self-harm and suicidal behaviours. Central to this challenge has been the long-standing confusion around the best way to define self-harm.

Role of Race, Ethnicity, and Immigration in Perceived Stress and Depressive Symptomatology Trends During Pregnancy.

Our goal was to examine the role of race, ethnicity, and immigration status on prenatal perceived stress and depressive symptomatology trends across pregnancy in a low-income, minority population of pregnant women in urban Los Angeles. Longitudinal data on 442 Hispanic and Black women were analyzed using mixed effects models with a random intercept for participant were employed to evaluate predictors of higher perceived stress levels and probable depression across pregnancy. Compared to U.S. born Hispanic women, Black women had higher perceived stress (β 2.24; 95% CI 0.41,4.07) and higher odds of probable depression (OR 2.38; 95% CI 0.95,5.95) while Hispanic immigrants with greater than 20years of residency in the U.S. had higher odds of probable depression (OR 2.93; 95% CI 1.10,7.79). Maternal mental health among Hispanic immigrants with longer U.S. residency and Black race warrants increased attention from public health and clinical agencies.

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic.

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.