Clinical Hours Research Articles

Academic nursing administrators perceptions of replacing clinical hours with simulation

BackgroundNursing education has seen a shift towards simulation-based education (SBE) to meet the demands of a rapidly evolving healthcare landscape. Maryland's Clinical Simulation Resource Consortium (MCSRC) aimed to enhance SBE utilization; however, noted a decline in SBE usage post pandemic prompting an investigation into nurse administrators' perspectives on replacing clinical hours with SBE. MethodsThis descriptive quality improvement study was informed by Rogers' Diffusion of Innovation (DOI) Theory. Semi-structured interviews were conducted with four academic nurse administrators from various pre-licensure nursing programs in Maryland. The data collected were analyzed using thematic analysis. ResultsNurse administrators who value SBE as a safe learning space are integral when building and maintaining infrastructure to support simulation usage. Identified barriers related to faculty buy-in, workload, and inadequate human resources to deliver high-quality simulations can hinder sustained adoption of clinical simulation. ConclusionsThis study highlights the necessity of continuous faculty training in SBE and dedicated resources to support simulation infrastructure. Recommendations include sustained investment in faculty development, creating specialized roles for simulation champions, and fostering collaborations to strengthen simulation integration. The findings emphasize the pivotal role of nurse administrators in navigating challenges and maximizing SBE's potential to replace clinical hours in nursing education, urging ongoing support and strategic planning for successful integration.

Development of a mobile application to increase motivation, engagement & teaching activity of clinical faculty using gamification principles

Background: Clinician teachers (CT) have historically felt undervalued and underappreciated. One technology used to increase motivation is gamification: the process of inserting elements of game-playing into activities that are not usually associated with games. We developed a mobile application that rewards CTs using in-app gamification techniques to increase CTs motivation. This program was implemented specifically in a regional campus setting, Mississauga, Ontario. Methods: A cross-platform application that rewards physicians for their clinical teaching hours was created. This consisted of a star grading criteria where each physician was awarded depending on the number of hours completed. End-user perceptions of the application were evaluated using a survey with a Likert scale and open-ended questions. Survey results were collated with descriptive statistics and thematic analysis. Results: The TutorTracker application was developed implementing a live gamification algorithm. It allows physicians to view their hours completed, rewards obtained, and add additional hours. The majority of CTs agreed or strongly agreed that the application was user-friendly, easy to navigate and enjoyed the rewards provided. Major themes that emerged were regarding additional features and full integration of such an application for rewarding teaching efforts. Conclusions: Gamification principles have been implemented in a cross-platform application allowing CTs to be rewarded for their teaching. The next steps would be to formally quantify the effects and advantages of using the application to increase the motivation of tutors.

Paramedic educational programs maintain entry level competency throughout the COVID-19 pandemic.

The COVID-19 pandemic required unprecedented changes to emergency medical services (EMS) educational frameworks in the United States. It is unclear if pandemic-related changes impacted paramedic educational outcomes. We aimed to evaluate curricular and performance changes resulting from the initial COVID-19 pandemic on paramedic educational programs. We performed a retrospective cross-sectional evaluation of paramedic educational programs in 2019 and 2020 using the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions annual reports. These reports contain detailed program components and measures of program success. We included programs reporting at least one graduate in the study period. Descriptive statistics (proportions [%], median [interquartile range, IQR]) were calculated for paramedic program characteristics in 2019 and 2020, as well as pandemic specific curriculum changes. Wilcoxon rank-sum and Fisher's exact tests were used to evaluate differences in characteristics by year. The number of paramedic educational programs in our population decreased from 640 programs in 2019 to 612 in 2020, with a statistically significant decrease in clinical hours (2019: 219 [IQR 168‒272]; 2020: 200.5 [IQR 157‒261]). There was no difference in first or third-attempt certification examination success between years. Temporary shutdown was experienced in 34% of programs (duration: 3weeks [2‒7]) and 72% of required curricular changes. Curricular changes commonly included decreased in-person education (86%), traditional classroom lectures (78%), number of clinical sites (78%), and increased online didactic education (92%). Only 20% of programs decreased laboratory simulation or total training hours. During the pandemic, paramedic educational programs changed educational delivery with no observed differences on overall program performance. Identifying key curricular changes and best practices for implementation may be necessary to better optimize future educational delivery.

Neonatology Staffing Practices– An In-Depth Exploration of Leaders’ Perspectives

To describe neonatology leaders' perspectives on ideal staffing practices, including clinical work, non-clinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking. We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in four categories: clinical and non-clinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts. Leaders described their perspectives of ideal staffing practices. All clinical hours should count towards total clinical time and clinical full-time Equivalent (cFTE), and many non-clinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be <24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs. Neonatology leaders recognize current staffing challenges and the need to evolve towards more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.

Behavior of biometric parameters during clinical hours

Purpose: To evaluate and quantify variation of biometric parameters - axial length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW).Methods: A population-based retrospective cohort study was performed on patients who underwent a biometry test prior to cataract surgery using the IOL Master 700 (Carl Zeiss Meditec, Jena, Germany) between the years 2017-2021. Differences in these parameters were evaluated between scans executed at different times of the day.Results: 21,975 examinations of 8,611 patients were included. Mean age was 70.50±12.56 years. The mean time of the biometry exams was 10:52±1:23 AM. Measurements of AL, ACD, CCT and WTW were tested hourly and grouped between 7:00-9:00 AM and 12:00-03:00 PM.All the parameters showed a diurnal increase with a significance of p<0.001 (AL from 23.64±1.5 to 24.01±1.76mm; ACD from 3.29±0.67 to 3.35± 0.64mm; CCT from 0.52±0.04 to 0.53±0.04 µm and WTW from11.83±0.46 to 11.90±0.51mm). The most significant change was seen in AL.The difference between time groups remained significant in a generalized linear mixed model (P<0.001).Conclusions: There are fluctuations in AL, ACD, CCT, WTW measurements during office hours. These results raise questions about the significance of timing of the biometry exam and the effect on the ELP calculation.

Beyond Boundaries: Elevating Continuity of Care in Student-Run Free Clinics

We discuss the challenge of continuity of care in Student-Run Free Clinics (SRFCs) across the nation due to barriers of transportation, variation in care teams, communication, coordination, and improper utilization of resources. Discussion at the 2023 Society of Student-Run Free Clinic’s Annual Conference “Bridging the Gap” session with various medical schools and respective SRFCs allowed us to identify after-care teams as a common and effective modality to improve continuity of care. Patient-centered care is at the heart of SRFCs, and we strongly believe that communicating outside of clinic hours allows for effective longitudinal patient care. Such initiatives allow for improvements in health status via motivational interviewing, discussing medications, and addressing socioeconomic issues. Each clinic we consulted during this session had its individualized program focused on the same ideology. By instituting an after-care team, SRFCs can improve continuity of care while fulfilling the Triple Aim outlined by the Institute of Healthcare Improvement (IHI). Our perspective article emphasizes the importance of after-care teams to improve continuity of care and patient value in relation to the Triple Aim.

Clinical learning of nursing students during the COVID-19 pandemic in Limpopo province, South Africa.

The Nursing Education Programme was affected during the coronavirus disease 2019 (COVID-19) pandemic, resulting in nursing students being unable to participate in the clinical experiential learning required by the South African Nursing Council. The study seeks to explore and describe nursing students' experiences of clinical experiential learning during the COVID-19 pandemic. A qualitative, explorative and descriptive, research design was used in the study. A non-probability purposive sampling method was used, and 55 nursing students participated in the study. Data were collected through six focus group discussions, consisting of 8-12 nursing students in each group. Data were analysed following Tesch's open coding method. Three themes emerged from the study's findings: The impact of COVID-19 on the clinical experiential learning of nursing students, the effects of COVID-19 on the mental well-being of nursing students, and nursing students' experiences of support during the COVID-19 pandemic. Notably, 11 sub-themes emerged. The findings of this study reveal that the COVID-19 pandemic severely disrupted the Nursing Education Programme, highlighting the challenges of inadequate clinical hours, restricted clinical access and the significant psychological impact on students.Contribution:This study adds to the literature on students' experiences during clinical experiential learning in South Africa during the COVID-19 pandemic.

Delivering therapy over telephone in a humanitarian setting: a pilot randomized controlled trial of common elements treatment approach (CETA) with Syrian refugee children in Lebanon

BackgroundIn recent years, the number of forcibly displaced persons has risen worldwide, with approximately 40% being children and adolescents. Most of them are hosted in low- and middle-income countries (LMICs). Many individuals meet the criteria for mental health issues, which can also be exacerbated by a number of risk factors, including low socioeconomic status, displacement, and stressors linked to conflicts in their country or region of origin. However, the vast majority never receive treatment for their psychological problems due to multiple reasons, including a shortage of mental health professionals in LIMCs, transportation challenges in accessing clinics, and clinic hours conflicting with family commitments. In the current study we investigated whether individual psychotherapy delivered by trained lay counsellors over telephone to Syrian refugee children living in Lebanon is effective and overcomes barriers to treatment access.MethodsAfter adaptation of Common Elements Treatment Approach (CETA) to remote delivery over telephone (t-CETA), preliminary effectiveness of the treatment modality was assessed with a pilot single blind randomised controlled trial including a total sample of 20 refugee children with diagnosed mental health problems. Data was analysed applying a Bayesian approach.ResultsThere was a significant session-by-session decrease in self-reported mental health symptoms over the course of treatment. Independent assessments showed that t-CETA resulted in a greater reduction of symptoms than standard in-person treatment as usual. There was no difference between groups for impairment. Importantly, the majority of children allocated to t-CETA completed treatment whilst no children in the treatment as usual condition were able to do so.ConclusionThe study provides preliminary evidence that telephone-delivered psychotherapy in a humanitarian setting, delivered by lay counsellors under supervision, works and significantly increases access to treatment compared to traditional in-person treatment. However, findings remain to be replicated in larger trials.Trial RegistrationClinical Trials. gov ID: NCT03887312; registered 22nd March 2019.

Intraday Variations in Skin Water Parameters

Introduction: Three interrelated skin water assessments include stratum corneum hydration (SCH) via electrical measurements, skin water using tissue dielectric constant (TDC) measurements, and transepidermal water loss (TEWL). These are differentially used for skin physiology research, clinical assessments of dermatological conditions and to assess skin water in diabetes and lymphedema. Often volar forearm skin is used for assessments done at various times of day (TOD). The present goal was to assess the extent of intraday variability in SCH, TDC, and TEWL. Methods: Twelve medical students self-measured SCH, TDC, and TEWL on their forearm every 2 h from 08:00 to 24:00 h on 2 consecutive days. All participants were well trained and pre-certified in all procedures. Tests for parameter differences among TOD were via the nonparametric Friedman test. Results: No significant differences in SCH or TEWL were found among TOD over the 16-h interval for either day or combined. Contrastingly, TDC decreased slightly but significantly from morning through evening. There was no evidence of a diurnal pattern. Interestingly, a significant nonlinear relationship between TEWL and SCH was detected. Conclusion: Findings indicate only minor intraday variations with TOD trend except for TDC which decreases slightly from morning through evening. The clinical relevance relates to the confidence now gained associated with the parameter estimates when measured at different TOD during normal clinic hours or beyond. This should help in estimating the potential importance of small differences if measured at a different TOD. From a physiological viewpoint, the findings uncover and describe an interesting nonlinear relationship between TEWL and SCH which may serve to propel further investigations that might better characterize this process.

A Comprehensive Analysis of Wait Times in Ambulatory Obstetrics and Gynecology Clinic at a Tertiary Care Hospital in Pakistan.

Objective Wait times are an important determinant of patient satisfaction measured objectively and associated significantly with it. It is a measure of time taken from the arrival of patients to the registration desk of a facility to the time they access service. This study focuses on current patient pathways at the Obstetrics and Gynecology Outpatient (OBGYN) Ambulatory Clinic at Shalamar Hospital and assesses wait times by stratifying it at each step of the pathway. Methodology Data on consultation times was obtained from 105 patient processes over three months. We had in-depth discussions with the doctors, nurses, and paramedical staff to better comprehend the medical conditions, the terminologies, the structural hierarchy, and the functions of the department. Based on this the patient journey through the clinic was further dissected into operational steps including the check-in process, patient vitals screening, patient history, physical examination, medical hierarchy, referral for further testing or procedures, and lastly prescription generation. Results The average wait time for obstetrics and gynecology patients is 45.18±39.37 minutes. The average time the patients waited for the check-in process was 1.73±1.80 minutes, for the vitals screening was 3.08±10.07 minutes, for patient history and examination was 19.90±22.71 minutes, and for consultation within the medical hierarchy (SR and Consultants) patients waited 1.31±5.71 minutes. For those patients who had no other tests or procedures recommended, the prescription generation required a further 4.10±3.14 minutes. While those who had tests or procedures recommended waited 5.75±28.27 minutes for voucher generation for the specific test or procedure and 9.31±11.35 minutes for the test or procedure itself. Conclusion The obstetrics and gynecology clinic at Shalamar Hospital has average wait times comparable to others in the region of approximately 45 minutes. The longest wait during the visit is before patient history and examination approximately 20 minutes. To improve wait times, the clinic should implement staggered appointments, use a token system, manage queues better, follow clinic hours, and improve coordination between doctors. This will allow for improved patient experiences, faster patient turnovers, and increased patient inflow.

Physician EHR Time and Visit Volume Following Adoption of Team-Based Documentation Support

Physicians spend the plurality of active electronic health record (EHR) time on documentation. Excessive documentation limits time spent with patients and is associated with burnout. Organizations need effective strategies to reduce physician documentation burden; however, evidence on team-based documentation (eg, medical scribes) has been limited to small, single-institution studies lacking rigorous estimates of how documentation support changes EHR time and visit volume. To analyze how EHR documentation time and visit volume change following the adoption of team-based documentation approaches. This national longitudinal cohort study analyzed physician-week EHR metadata from September 2020 through April 2021. A 2-way fixed-effects difference-in-differences regression approach was used to analyze changes in the main outcomes after team-based documentation support adoption. Event study regression models were used to examine variation in changes over time and stratified models to analyze the moderating role of support intensity. The sample included US ambulatory physicians using the EHR. Data were analyzed between October 2022 and September 2023. Team-based documentation support, defined as new onset and consistent use of coauthored documentation with another clinical team member. The main outcomes included weekly visit volume, EHR documentation time, total EHR time, and EHR time outside clinic hours. Of 18 265 physicians, 1024 physicians adopted team-based documentation support, with 17 241 comparison physicians who did not adopt such support. The sample included 57.2% primary care physicians, 31.6% medical specialists, and 11.2% surgical specialists; 40.0% practiced in academic settings and 18.4% in outpatient safety-net settings. For adopter physicians, visit volume increased by 6.0% (2.5 visits/wk [95% CI, 1.9-3.0]; P < .001), and documentation time decreased by 9.1% (23.3 min/wk [95% CI, -30.3 to -16.2]; P < .001). Following a 20-week postadoption learning period, visits per week increased by 10.8% and documentation time decreased by 16.2%. Only high-intensity adopters (>40% of note text authored by others) realized reductions in documentation time, both for the full postadoption period (-53.9 min/wk [95% CI, -65.3 to -42.4]; 21.0% decrease; P < .001) and following the learning period (-72.2 min/wk; 28.1% decrease). Low adopters saw no meaningful change in EHR time but realized a similar increase in visit volume. In this national longitudinal cohort study, physicians who adopted team-based documentation experienced increased visit volume and reduced documentation and EHR time, especially after a learning period.

The impact of a clinical academic nurse researcher in critical care: A 1-year service review.

To outline the activity and impact from implementing a clinical academic nurse researcher in a multi-centre critical care unit. A prospective exploratory activity audit informed by the Plan, Do, Study, Act framework. Quantitative data on clinical academic activity, from 1 April 2023 to 31 March 2024, were collected in a Microsoft Excel © [2022, version 16.66.1] spreadsheet. Activity narratives were detailed in qualitative data and the impact categorized. A total of 1500 clinical academic activity hours were logged (accounting for annual leave entitlement and sickness). Of these, 973 h were directly categorized within clinical academic activity. Most frequently undertaken clinical academic activities were academic writing (17.6%), data collection/analysis (9.6%), grant and funding workup (6.8%), Intensive Care Unit service development (6.6%), clinical activity (5.2%) and local level capability and capacity (4.9%) and other supportive tasks such as administration, unscheduled meetings, critical planning time and peer support (38%). Improvements broadly mapped onto five healthcare improvement domains; organizational, process design, data optimization and utilization, evidenced-based practice, and patients/staff impact. Our data indicate system mechanisms afforded by the clinical academic role that have not been explored within the contemporary literature. A nursing clinical academic demonstrates impact across the broad organization whilst increasing the visibility of nursing work and the potential for system resilience. In conclusion, our service review underscores the transformative potential of clinical academics in shaping the future of healthcare. Utilizing their expertise and contributions paves the way for innovation, excellence and sustainability in patient care. This review has provided clarity about clinical academic activity of a nurse researcher during the first year. There is international impact of this work for both clinical academics who may be evaluating such roles and healthcare management developing similar roles locally. No Patient or Public Contribution.

Wellness and Stress Management Practices Among Healthcare Professionals and Health Professional Students.

Healthcare professionals experience stressors that begin during training and persist into their careers that adversely impact their well-being. This study aims to identify students' and professionals' stress levels, satisfaction with wellness domains, barriers to wellness, and stress management practices. This study was a cross-sectional self-reported survey study. The study included students (N = 242) and professionals (N = 237) from medicine, nursing, pharmacy, physical therapy, social work, and counseling/psychology. The Managing Health & Wellness in Health Professions Training and Practice survey was used to capture wellness practices and barriers among participants. Results: Students reported significantly higher perceived stress compared to professionals (P < 0.001). Total wellness is significantly higher among professionals compared to students (P < 0.001). A higher stress rate is significantly related to being female, having a lower wellness score, and facing more barriers (P < 0.001). Intellectual health is the most valuable wellness domain for providers (M = 3.71, SD = 0.9) and students (M = 3.43, SD = 0.85), followed by spiritual health for providers (M = 3.4, SD = 1.1), and work/learning environment for students (M = 3.33, SD = 0.93). Professionals and students are least satisfied with their physical and financial health. Barriers include fatigue, workload/productivity in clinical practice, work hours, and burnout. Healthcare professionals exhibit a variety of stress management practices, encounter barriers, and prioritize different wellness domains. Healthcare systems should incorporate self-care education into their curricula and implement systemic changes to foster a thriving healthcare workforce.

Potential US Health Care Savings Based on Clinician Views of Feasible Site-of-Care Shifts

Shifting care to alternative sites when clinically appropriate may be associated with reduced US health care spending, improved access, and, in some cases, improved care outcomes. To fill 2 main gaps in the current literature on site-of-care shifts: (1) understanding the clinician perspective on appropriateness of alternative care sites, given the central role they play in referrals and patient trust and (2) considering all potential sites where care could shift and calculating net savings potential. In this survey study, physicians (MDs and DOs), nurse practitioners, physician assistants, nurse anesthetists, radiology and imaging technicians, and psychologists were surveyed from September 17 to November 22, 2021, about potential shifts of care from the hospital setting to alternative sites. Participants were selected by the survey firm Intellisurvey to provide broad representation across all specialties of interest. A minimum of 34 clinicians responded to each question. Data were analyzed from April 2022 through October 2023. More than 5000 individual diagnostic and procedural codes were reviewed and sorted into 312 distinct care activities by an expert panel of physicians. Survey respondents were then provided with the 2019 claims-based distribution across sites of care for each care activity and were asked, "based on your clinical judgment, what portion of [care activity] could safely occur in each of the following sites of care, without compromising clinical outcomes?" Based on clinician-reported distributions, the total potential shift of volume from hospital-based settings to alternative sites and the associated net savings were estimated. Survey respondents included 1069 practicing clinicians (386 female [36.1%]; mean [SD] years since residency of physicians, 21.0 [9.7] years; mean [SD] age of nonphysicians, 45.3 [9.4] years) across specialties, all of whom practiced more than 20 clinical hours per week. There were 794 physicians (74.3%), and the remaining 275 respondents were midlevel professionals, such as physician assistants. Among 312 care activities surveyed, respondents indicated that 10.3 percentage points (95% CI, 10.0-10.5 percentage points) of commercial and 10.9 percentage points (95% CI, 10.7-11.1 percentage points) of Medicare volume currently taking place in hospital-based settings could shift to alternative sites with today's technology without compromising clinical outcomes. Across the entire US health care system, these shifts could be associated with a reduction in overall health care consumption spending ($3 562 339 000 000 000) by approximately $113.8 billion ($113 767 446 087 174 [3.2%]) to $147.7 billion ($147 661 672 284 263 [4.1%]) annually. In this study, a substantial net savings opportunity was estimated. However, realizing this potential will require ongoing alignment among organizations, clinicians, and policymakers to overcome barriers to these shifts.

The Impact of Low Workplace Support During Pregnancy on Surgeon Distress and Career Dissatisfaction.

To describe the impact of lack of workplace support (LOWS) for obstetric health on surgeon distress and career satisfaction. Although most pregnant surgeons desire clinical duty reductions to mitigate obstetric risk, few modify their schedules due to low workplace support. US surgeons with at least one live birth completed an electronic survey. LOWS during pregnancy was defined as (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest; (2) feeling unable to reduce clinical duties despite health concerns due to risk of financial penalties, requirement to make up missed call shifts, being perceived as "weak", burdening colleagues, or accommodations being denied by the workplace. Multivariate logistic regression determined the association between LOWS and burnout, low quality of life, plans to leave clinical practice or to reduce work hours, and likelihood of recommending a surgical career to one's child. Of 557 surgeons, the 360 (64.6%) who reported LOWS during pregnancy were more likely to report burnout (OR:2.57; 95%CI:1.60-4.13), low quality of life (OR:1.57; 95%CI:1.02-2.41), a desire to leave their practice (OR:2.74; 95%CI: 1.36-5.49), plans to reduce clinical hours in the next year (OR:4.25; 95%CI:1.82-9.90), and were less likely to recommend their career to their child (OR:0.44; 95%CI:0.28-0.70). LOWS for maternal-fetal health concerns is associated with burnout, low quality of life, and career dissatisfaction. The work environment is a modifiable factor requiring system-level interventions to limit clinical work during pregnancy and provide fair compensation for covering surgeons. Supporting surgeons during pregnancy is a short-term investment with long-term implications for improving longevity and diversity of the workforce.

Introduction to "The older analyst at work: The old man and the sea?"

This Analyst at Work section examines the work of an older psychoanalyst as he ages yet continues to work as a psychoanalyst. Eike Hinze describes his work with a disturbed young man. Decisions about starting an analysis and the struggles involved in 'reaching' this patient form part of the question of whether this is a 'quest', or another analysis, near the end of an analytic career.Of particular note is Dr. Hinze's explicit use of his own 'reverie'/ countertransference/ unconscious states to form interventions. The two discussants express their own understanding of how they might approach the problems posed. They both speak to the forms of intervening that differ from their own, and their clinical understanding of revealing one's own associations in the clinical hour. They also speak to how the process of aging might have influenced the clinical work itself.The possible shift in technique over the course of Dr. Hinze's clinical career is more difficult to assess: does it come from age, maturity, shifts in theory and technique, or an intense desire to make emotional contact within this particular patient and clinical setting? These are the "question marks" conveyed in their discussions, like the one in the title itself.

Innovating to meet AACN essentials in a bachelor of science in nursing program

Our large, two campus (one urban and one suburban) and two track (RN-BSN and Entry-level BSN) program has revised our BSN curriculum to reflect the new Level One American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (AACN, 2021). This article describes the work to revise the curriculum to meet the demands of contemporary nursing education with increased elective choices for Generation Z learners, professional role courses on wellness and resiliency, a course on palliative care and symptom management, increased clinical hours to include virtual simulation and more community and public health experiences, and increased innovative student experiences with our clinical partners. A revised clinical evaluation tool (CET) was also developed to evaluate students in competency-based education and to reflect our new program outcomes.

Incorporating Diversity, Equity, and Inclusion Within Community Health Nursing Simulation.

Undergraduate nursing institutions face difficulties providing learners with community and public health nursing clinical opportunities. An opportunity existed to improve a senior-level undergraduate community and public health nursing course by developing alternative clinical teaching-learning experiences that promote diversity, equity, and inclusion. Utilizing theory and evidence-based practice, a simulation emulating a community home health visitation allowed learners to function as members of a health care team who provide care for a family in their home setting. The results indicate that all learners met project objectives, and 88% of learners reported increased self-efficacy related to the project's topics after implementation. Learner reflections offered their perception of the experience. A community and public health nursing teaching-learning project provided learners with clinical hours by completing a simulation learning experience incorporating diversity, equity, and inclusion through exposure to patient inequities within the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study.

Hypertension is a global health challenge, especially in low-to-middle-income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed-method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020-July 2021). Quantitative data included socio-demographic characteristics and patient follow-up rates. Qualitative data comprised focus group discussions (FGD) and in-depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher-level healthcare facilities, leading to substantial loss of follow-up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient-centered interventions are crucial steps.

Accounting for taste: preferences mediate the relationship between documentation time and ambulatory physician burnout.

Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout. We combined EHR active use data capturing physicians' hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am. Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout. Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout. Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.