Clinical Practice Environment Research Articles

Implications of Large Language Models for Quality and Efficiency of Neurologic Care: Emerging Issues in Neurology.

Large language models (LLMs) are advanced artificial intelligence (AI) systems that excel in recognizing and generating human-like language, possibly serving as valuable tools for neurology-related information tasks. Although LLMs have shown remarkable potential in various areas, their performance in the dynamic environment of daily clinical practice remains uncertain. This article outlines multiple limitations and challenges of using LLMs in clinical settings that need to be addressed, including limited clinical reasoning, variable reliability and accuracy, reproducibility bias, self-serving bias, sponsorship bias, and potential for exacerbating health care disparities. These challenges are further compounded by practical business considerations and infrastructure requirements, including associated costs. To overcome these hurdles and harness the potential of LLMs effectively, this article includes considerations for health care organizations, researchers, and neurologists contemplating the use of LLMs in clinical practice. It is essential for health care organizations to cultivate a culture that welcomes AI solutions and aligns them seamlessly with health care operations. Clear objectives and business plans should guide the selection of AI solutions, ensuring they meet organizational needs and budget considerations. Engaging both clinical and nonclinical stakeholders can help secure necessary resources, foster trust, and ensure the long-term sustainability of AI implementations. Testing, validation, training, and ongoing monitoring are pivotal for successful integration. For neurologists, safeguarding patient data privacy is paramount. Seeking guidance from institutional information technology resources for informed, compliant decisions, and remaining vigilant against biases in LLM outputs are essential practices in responsible and unbiased utilization of AI tools. In research, obtaining institutional review board approval is crucial when dealing with patient data, even if deidentified, to ensure ethical use. Compliance with established guidelines like SPIRIT-AI, MI-CLAIM, and CONSORT-AI is necessary to maintain consistency and mitigate biases in AI research. In summary, the integration of LLMs into clinical neurology offers immense promise while presenting formidable challenges. Awareness of these considerations is vital for harnessing the potential of AI in neurologic care effectively and enhancing patient care quality and safety. The article serves as a guide for health care organizations, researchers, and neurologists navigating this transformative landscape.

Feelings and thoughts of midwifery students during their first birth suite placement: A qualitative study.

This descriptive qualitative study aimed to understand the feelings and thoughts experienced by 4th year midwifery students during the first birth they attended during clinical practice. Focus group interviews were conducted with 22 final year midwifery students in Istanbul, Türkiye December 2020. The transcribed data were analyzed by the descriptive qualitative analysis method. The students experienced not only negative feelings such as fear, torment, anxiety but also positive feelings such as hope, excitement, and curiosity during the first birth practice. The situations that caused negative feelings and thoughts were not only the feelings of the students but also the conditions that negatively affected the care provided to the patient in the clinic. The clinical practice environment affects the feelings and thoughts of midwifery students about the birth process. For this reason, improving the clinical practice environment and supporting students throughout the education process may contribute to the development of positive feelings and thoughts when attending as a student for their first birth suite placement.

Participation Experience in Simulation Training Using Holographic Standardized Patients

To develop simulation practice education content and improve the quality of practice education by identifying nursing students' perception types regarding simulation practice education experiences using Holographic Standardized Patients (HSP) and analyzing and describing the characteristics of each type of nursing students' perception. This study is a qualitative study that applied phenomenological methods to explore the essential meaning of nursing students' perceptions of nursing students' simulation training using HSP. It was conducted after obtaining approval from the institutional ethics committee, and the data collection period was from October 24, 2022 to September 31, 2023. The interview was conducted as an in-depth interview. The participants were third-year nursing students at a university who received training implemented through simulation using HSP. Among the 14 students who voluntarily agreed to participate in the study after receiving an explanation of the contents of the study, they were the dropouts. The subjects were 10 people excluding. As a result of this study, 81 meaning compositions, 20 topic collections, and 4 categories were derived: 'interesting classes', 'expectations that overcome obstacles', 'models for future classes', and 'strengthening practical skills'. Korean nursing students have already become accustomed to digital culture for a long time, and it has been confirmed that this form of converged technology-based simulation education no longer poses a technical problem to students. If various simulation-based education is developed in the future, it is believed that it will lead to integrated development of nursing education and simulation education beyond the limited clinical practice environment.

Self-assessment of the characteristics of nurses' work environment and psychometric analysis of the Slovene-language version of the Practice Environment Scale of the Nursing Work Index (PES-NWI)

Introduction: Measures to improve nurses' work environments include ensuring adequate staffing levels, recognising the importance of nursing work, involving nurses in decision-making processes, and improving interprofessional communication. The aim of this study was to analyse the job characteristics reported by nurses and their association with the dimensions of clinical practice environments in hospitals.Methods: A cross-sectional explorative research design was employed. The Slovene-language version of the Practice Environment Scale of the Nursing Work Index (PES-NWI(SI)) and data on nurses' job characteristics were used. A total of 1,010 nurses (403 general care nurses and 605 healthcare assistants) from ten Slovenian general hospitals participated in the study. Permission to conduct the research was granted by the Commission of the Republic of Slovenia for Medical Ethics.Results: The mean score of the PES-NWI(SI) was low (2.64), and the scale reliability was 0.937. The original theoretical five-factor structure was confirmed. The regression model explained the five factors in 26–47% of cases. The explanatory variables included opportunities for advancement, educational opportunities, professional status, satisfaction with current job and work environment, independence at work, and study leave.Discussion and conclusion: The study revealed managers' inadequate ability to ensure sufficient staffing, insufficient involvement of both respondents and managers in hospital affairs, and the lack of promotion opportunities. Creating an optimal work environment for nurses is an important task for managers and leaders. National healthcare policy must consider nurses as equal healthcare professionals and nursing as both a professional and scientific discipline.

Impact of Work Environment on Job Satisfaction among Interventional Radiologists in Japan: A Cross-sectional Study.

This study aims to measure job satisfaction among interventional radiology physicians in Japan and analyze the factors affecting job satisfaction. A web-based survey was conducted among the members of the Japanese Society of Interventional Radiology between October and December 2021. Participants were questioned regarding their job satisfaction, workplace, work status, and demographic information. Principal component analysis was applied to 15 reasons related to job satisfaction, and the factors affecting job satisfaction were analyzed. Valid responses were obtained from 901 (31.9%) of the 2,824 interventional radiology physicians invited to participate. Job satisfaction was reported as "very satisfied" in 79 (8.8%), "moderately satisfied" in 426 (47.3%), "neither satisfied nor dissatisfied" in 230 (25.5%), "moderately dissatisfied" in 133 (14.8%), and "very dissatisfied" in 33 (3.7%) respondents. Thus, there were 505 (56.0%) satisfied physicians. Three principal components were extracted from the reasons for job satisfaction. Job satisfaction tended to be higher among those who reported performing a higher number of interventional radiology procedures and was positively associated with a higher rate of work time dedicated to interventional radiology and the first principal component (the environment of clinical practice, research, and interventional radiology education). The third principal component (salary and work environment) and the absence of an "IkuBoss" [a boss who takes initiative in creating a work environment supportive of the work-life balance of colleagues] were associated with lower job satisfaction. More than half the participants reported high job satisfaction. Job satisfaction of interventional radiology physicians in Japan was positively associated with a favorable clinical, research, and educational environment and negatively associated with the absence of an "IkuBoss," noninterventional radiology work, overtime work, and salary.

Physical Realism of Simulation Training for Health Care in Low- and Middle-Income Countries-A Systematic Review.

This systematic review was conducted, according to PRISMA standards, to examine the impact of the level of physical realism of simulation training on clinical, educational, and procedural outcomes in low- and middle-income countries (LMICs) as defined by the World Bank. A search from January 1, 2011 to January 24, 2023 identified 2311 studies that met the inclusion criteria including 9 randomized (n = 627) and 2 case-controlled studies (n = 159). Due to the high risk of bias and inconsistency, the certainty of evidence was very low, and heterogeneity prevented any metaanalysis. We observed limited evidence for desirable effects in participant satisfaction and confidence, but no significant difference in skills acquisition and performance in the clinical practice environment. When considering the equivocal evidence and cost implications, we recommend the use of lower physical realism simulation training in LMIC settings. It is important to standardize outcomes and conduct more studies in lower income settings.

Conflict Management in Healthcare Leadership; A Narrative Review

Conflict resolution is not merely a skill but an essential leadership competency for healthcare professionals. Unaddressed conflicts can have detrimental consequences on patient care, team morale, and organizational productivity. This article delves into the significance of conflict management in healthcare, exploring its multifaceted impact and highlighting the role of leadership in fostering a conflict-resilient work culture. Understanding the root causes of conflicts, such as resource constraints, communication challenges, and differences in personal and professional characteristics, is crucial for developing effective prevention strategies. Healthcare leaders need to adopt proactive approaches to conflict management, emphasizing open communication, mutual respect, and collaborative problem-solving. The article explores various conflict management models, providing healthcare leaders with a toolkit for effective conflict resolution. It highlights the role of emotional intelligence and ethical leadership behaviors in conflict mitigation and discusses the need for a dynamic conflict management framework and its implications in the healthcare environment. It also outlines the need for self-assessment of conflict management skills, essential conflict management strategies and effective leadership tactics to resolve a range of conflict management challenges. It concludes by emphasizing the importance of early intervention and effective handling of conflicts by professional communication. The findings in this article provide a practical roadmap for developing conflict management competencies in healthcare leaders. Importantly, they unravel the nuances of potential conflict management approaches, warranted to establish a conflict-resilient culture in the clinical practice environment.

The influence of clinical practice experience and environment on dental hygiene professionalism in dental hygiene students

Objectives: The purpose of this study was to analyze the clinical practice experience and environment of dental hygiene students, and to determine how these factors relate to their dental hygiene professionalism. The aim was to provide data necessary to improve the clinical practice environment and promote professionalism in dental hygiene. Methods: A survey was conducted in August 2023 among dental hygiene students from five randomly selected universities in the metropolitan area. Data analysis methods included t-test, ANOVA, Pearson’s correlation coefficients, and stepwise multiple regression. Results: The main influencing factors of dental hygiene professionalism were the quality of instruction in the clinical practice, opportunities for learning, preparedness for students, and satisfaction with the practice institution (p<0.05). There was a significant positive correlation between the clinical practice environment and all sub-items of dental hygiene professionalism (p<0.05). Conclusions: The results of this study emphasize that the choice of practice institution is very important to enhance dental hygiene professionalism, and close collaboration between universities and practice institutions is highlighted to improve the quality of clinical practice guidance and opportunities for participation.

The undue influence of genetic information on senior medical students’ treatment decisions

BackgroundKnowledge of the genetic basis of health conditions can influence how the public perceives their own and others’ health. When there are known genetic associations for such conditions, genetic essentialist biases facilitate deterministic thinking and an over-emphasis of genetic causality. This study investigates the role that genetic essentialist biases play in medical decision-making.MethodsSenior postgraduate medical students (N = 102) read a scenario in which a patient presents with gastroenterological symptoms. Half of the students were told that the patient tested positive for HLADQ2 – a gene implicated in, but not deterministic of, coeliac disease. The other half received no genetic information. Students were assessed on their recommendations for investigation and management using a multiple-choice questionnaire. Twenty-two of these students participated in a qualitative follow-up which used focus groups and semi-structured interviews to explore the reasoning behind students’ responses.ResultsManagement recommendations differed between the two groups, with those receiving genetic information more likely to recommend a gluten free diet. Recommendations for further investigation did not differ significantly between groups. Interviews suggested that these findings arose despite the students’ good understanding of the common non-deterministic nature of genes, such as HLADQ2.ConclusionDifferences in management recommendations suggest that the inclusion of genetic information unduly biased students towards a premature diagnosis of a serious health condition, coeliac disease. Follow-up interviews introduced the possibility that observed manipulation-based differences may have been based on anticipated expectations of examiners, rather than perceived future clinical practice. Based on the present results it is unclear whether intentional exam-taking strategies fully account for medical students’ decisions, or if they contribute in addition to the activation of genetic essentialist biases. Further research in clinical settings may ascertain whether genetic essentialist biases would truly influence medical student and doctors within their clinical practice environment.

The Relationship Between On-Site Clinical Practice, Nursing Professional Value, and Nursing Clinical Self-Efficacy During COVID-19: A Cross-Sectional Study.

During COVID-19, nursing students experienced variations in on-site clinical practice, such as a combination of on-site and non-face-to-face clinical practice. Although on-site clinical practice is critical for increasing nurses' clinical self-efficacy and developing professional nursing values, there is a lack of knowledge that reflects the current clinical practice environment. To examine the relationship between on-site clinical practice, nursing professional values, and nursing clinical self-efficacy during the COVID-19 pandemic. This study is a cross-sectional correlational study design. Demographic characteristics, on-site clinical practice, nursing professional values, and nursing clinical self-efficacy were assessed using an online survey from October 3, 2022, to November 6, 2022. Data were analyzed using descriptive statistics, ANOVA, t-test, Pearson's correlation coefficient, and multiple regression. Of the 86 participants, 18 (20.9%) were male and 68 (79.1%) were female. The duration of the participants' average participation in on-site clinical practice was 39.67 days (61.04%). Nursing professional values significantly influenced clinical self-efficacy (β=0.379, p<0.001). However, on-site clinical practice was not significantly related to clinical self-efficacy (β=0.051, p=0.611). In terms of nursing clinical self-efficacy, measuring blood glucose had the highest score. On the other hand, establishing and maintaining intravenous catheters had the lowest scores. Nursing students' professional values were significantly associated with nursing clinical self-efficacy; however, the extent of involvement in on-site clinical practice during the pandemic did not have a significant impact on nursing clinical self-efficacy. Given that this study focused on a single university, it is imperative to replicate this research using diverse samples in the future. In addition, there is a need to establish a range of teaching and learning approaches for clinical practice, including simulation, online learning, and the use of state-of-the-art technology for faculty-student feedback strategies, in anticipation of the need for alternative practices.

Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients.

Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases. Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores. After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23). As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.

Immersive VR (Virtual Reality) Simulator for Vein Blood Sampling

Vein blood sampling is a method of mass blood sampling that involves drawing blood from a vein for blood type discrimination, confirmation of various physiological indicators, disease diagnosis, etc.; it is the most commonly used blood sampling method. An important aspect of vein blood sampling is the search for the exact location of the vein for insertion of the syringe to draw blood. This is influenced by obesity as well as skin and blood vessel conditions in the patient and the experience of the clinical technologist, nurse, and resident who performs the blood sampling. Frequent practice is required to effectively perform blood sampling techniques. However, due to the many limitations of the practice room or laboratory, there is a problem of using only a limited environment and model for clinical practice. As a result, many medical educational institutions have situations in which only fragmentary clinical practices are performed, and it is difficult to practice many blood sampling skills, so they do not provide enough experience to understand the actual skill field. In this paper, we propose a virtual-reality-based vein blood sampling simulator that allows the practice of blood sampling techniques without limitation. The proposed vein blood sampling simulator can operate a 3D model related to vein blood sampling using an HMD controller and a haptic device in a virtual space for vein blood sampling practice by wearing an HMD (head-mounted display). Vein blood sampling can also be practiced through interaction with the patient 3D model. In addition, the effectiveness of a simulator developed for dental students was verified, and as a result of the verification, the potential of the proposed vein blood sampling simulator was confirmed.

Professional commitment and related factors among nursing undergraduates: A latent profile analysis

ObjectiveTo identify different subgroups of nursing professional commitment among nursing undergraduates and to analyze the related factors of the different subgroups. MethodsA cross-sectional study using the professional commitment scale with 430 nursing undergraduates was conducted. Latent profile analysis was used to explore the nursing students' professional commitment subgroups and using multivariate logistic regression to analyze the related factors of nursing professional commitment. ResultsThe overall mean score for professional commitment in nursing was (75.07 ± 14.715). There were three different subgroups of professional commitment characteristics, namely the “high professional commitment group” (20.465 %), the “medium professional commitment group” (66.279 %), and the “low professional commitment group” (13.256 %). Dissatisfaction with clinical placement (OR = 3.556, p = 0.008) and self-enrollment (OR = 0.186, p = 0.002) were significantly related factors for low-level and medium-level nursing commitment groups. Students' origin in western China (OR = 1.869, p = 0.042) significantly influenced the medium-level specialty commitment group. ConclusionsMost nursing undergraduates have been categorized in the “medium professional commitment group”. Students who were dissatisfied with their clinical experience and chose the nursing profession involuntarily were the main factors for low-level and medium-level nursing professional commitment. The clinical practice environment should be further improved to enhance the clinical experience satisfaction of nursing undergraduates; at the same time, the professional value cultivation of students whose choice of nursing profession was not made by themselves should be strengthened to improve the level of professional commitment of nursing undergraduates.

Genetics and genomics knowledge and competency of Chinese nurses based on the theory of diffusion of innovation: A descriptive cross-sectional study

BackgroundNurses are responsible for providing genetics and genomics health care services, including disease risk assessment, medical referrals, and advocating for communities and individuals who probably benefit from genomics and genetics services. ObjectiveThis study aimed to investigate Chinese nurses' understanding and previous training in genomics and genetics. Additionally, we aimed to understand the degree to which Chinese nurses use genomics and genetics knowledge in their daily practice and to assess the learning needs regarding genomics and genetics. MethodThis study utilized the design of a descriptive cross-sectional study. From January 18 to March 15, 2022, 406 registered nurses from the Shandong province of China working in clinical institutions and with good English proficiency were recruited as study subjects. Nurses' demographic data and data related to genetic knowledge and competency were collected using the Genetics and Genomics Nursing Practice Survey (GGNPS) questionnaire. Kruskal Wallis and Mann-Whitney-U tests were utilized to investigate the descriptive statistics and non-normally distributed data. ResultsThere are 406 nurses from Shandong Province, China participated in the study. Among them, BSN degrees accounted for 83.7%. Female nurses accounted for 96.8%, and 40% are clinical nurses. Among such nurses, 65.5% reported that genetics was involved in their nursing courses, and 56.2% planned to study more knowledge associated with genetics. The mean knowledge score was 7.35 (out of 12). Nurses' gender, primary role, genomics education, and experience caring for patients with common diseases influenced nurses' scores on genetic and genomics knowledge. ConclusionThe genomics knowledge and competency of Chinese nurses need to be further improved. Incorporating genomics into the standard nursing curriculum can effectively reduce the knowledge gap. Simultaneously, it is also necessary to improve the attention of senior nurses and nursing managers to genomics nursing and improve the clinical practice environment.

Navigating the acute to post-acute transition with patients: a first characterization of medical student knowledge gaps in rehabilitation and post-acute care

Purpose Clinical rehabilitation and post-acute care (PAC) learning experiences are not uniformly required within medical school core curricula in the United States or internationally. This study aims to characterize what medical students might know/need to know to support patients in the transition from acute hospitalization to post-acute rehabilitation settings. Materials/Methods The medical student cohort completing required clinical rotations in a United States quaternary care hospital system was provided a voluntary survey prompting reflection on experiences discharging patients to rehabilitation/PAC and related learning needs. Data were analyzed using descriptive statistics and qualitative grounded theory. Results Response rate was 72% (39/54). All respondents reported at least one gap in rehabilitation/PAC knowledge, falling into 8 themes: daily experience of rehabilitation/PAC; determination of eligibility/screening processes; distinctions among levels of rehabilitation/PAC; insurance coverage/equity; rehabilitation/PAC clinical practice environment; post-rehabilitation/PAC discharge support; medical capabilities within PAC settings; developing rehabilitation goals. Conclusions Despite caring for patients discharged to post-acute rehabilitation settings, medical students lack essential knowledge about the process of rehabilitation and recovery, including patient eligibility for and service availability across PAC settings. Explicit rehabilitation/PAC education for medical students could enhance their ability to counsel and advocate for patients with disability and rehabilitation needs through care transitions. Implications for rehabilitation Medical students lack knowledge about rehabilitation and post-acute care that is important for helping patients navigate the acute to post-acute transition. Dedicated rehabilitation/post-acute care education could prepare trainees for counseling and advocating for patients during care transitions. Knowledge gaps identified in this study could inform development of curricular interventions to address medical student learning needs.

Ultrasound Elastography in Children.

Ultrasound elastography is a novel ultrasound technique, being extensively researched in children in the last decade. It measures tissue elasticity with the observation of tissue response after an external stimulus. From research to clinical practice, ultrasound elastography has evolved significantly in liver fibrosis evaluation in children; however, several other applications of the technique are available in both clinical practice and research environments. Practically, in children any organ can be assessed, including the brain in early ages, along with muscle and connective tissue elasticity evaluation, spleen, kidney, skin, lymphatic tissue, etc. The elastography method, age, body mass index and technical points should be considered when performing ultrasound elastography. This review highlights its vast potential as a diagnostic tool in the pediatric population, where ultrasound is a dominant imaging tool; however, the indications and exam protocol for its clinical use in several fields in pediatrics have yet to be elucidated.

The implementation and evaluation of a mentoring program for Bachelor of Midwifery students in the clinical practice environment

AimTo describe the implementation and evaluation of a midwife/midwifery student-mentoring program in one Local Health District in Sydney NSW Australia. BackgroundEvidence suggests well designed and supported midwife/midwifery student mentorship programs can make a difference to the clinical placement experiences and attrition rates of midwifery students. DesignIn the evaluation of the mentoring program, we used surveys, focus groups and individual interviews. MethodsEighty-six participants, including midwife mentors, midwifery students, non-mentor midwives and midwifery managers participated in the evaluation. Quantitative data were analysed using descriptive statistics and qualitative data, content analysis. ResultsThe mentoring program increased midwives’ mentoring skills and was beneficial to their professional growth and leadership skills. Students reported positive outcomes including someone to talk to, emotional support and a sense of belonging. Mentoring programs require structure, mentor training, organisational support and transparency. ConclusionThe mentoring program provided benefits to both midwifery mentors and students and demonstrated the value of a structured and supported mentoring program for midwifery students.

Using Evidence-Based Practice in the Transition to Telepractice: Case Study of a Complexity-Based Speech Sound Intervention

Purpose: Speech-language pathologists (SLPs) are tasked with integrating the principles of evidence-based practice (EBP) to provide effective and efficient assessment and intervention services that best support clients and their families. As new research, technologies, and perspectives emerge, SLPs are required to adapt their clinical practices to meet these changes while maintaining high-quality evidence-based services. Through an illustrative case study, we aim to demonstrate the process of applying EBP principles—including research evidence, client and family perspectives, and clinical expertise—to a complexity-based speech sound intervention delivered via telepractice. Conclusions: Results of the case study suggest that utilizing the principles of EBP to transition an evidence-based complexity intervention to telepractice was successful. Additionally, the EBP framework provided opportunities for reflection and continued adaptation throughout the intervention. The process of applying an EBP framework to a quickly evolving clinical practice environment provides SLPs with essential tools that ensure their services meet the needs of the clients they serve.

Nursing students' experiences of safety threats and coping processes during clinical practice: A qualitative study

BackgroundNursing students are exposed to various safety incidents during clinical practice. Frequent safety incidents cause stress, undermining their will to continue studying. Therefore, more effort is needed to analyse the scope of training safety threats perceived by nursing students and their coping processes to improve the clinical practice environment. ObjectivesThis study aimed to explore nursing students' safety threat experiences and coping processes during clinical practice using focus group interviews. DesignA qualitative study. SettingsFour nursing departments located in the G and J cities in South Korea. ParticipantsSixteen third- and fourth-year nursing students with more than six weeks of clinical practice experience. Participants who had experienced safety-threatening incidents during their clinical practice were selected. The inclusion criteria were indirect experiences of safety-threatening incidents and exposure to incivility or physical violence from patients or caregivers. Students with no prior experience of safety incidents were excluded from this study. MethodsData were collected through focus group interviews conducted between 9 December and 28, 2021. ResultsThe five main data categories extracted were safety threat cognition, action-reaction, coping process, reinforcement experience, and reinforcing conditions, and thirteen subcategories were extracted. Nursing students experienced a growing sense of responsibility for their own and patients' safety through exposure to safety-threatening situations and coping processes in clinical practice. Ultimately, they reached the stage of the core category: “seeking to protect own and patients' safety while performing the dual role.” ConclusionsThis study delivers basic data on the safety threat situations experienced by nursing students during clinical practice and their coping processes. It can be used in developing clinical practice safety education programs for nursing students.

Slack resources and individual performance of clinicians: the mediating role of job satisfaction and empirical evidence from public hospitals in Beijing, China

BackgroundClinicians in Chinese public hospitals face a complex and severe clinical practice environment, and the individual performance of clinicians is key to improving the output of the healthcare industry. This study aims to explore the mechanism of slack resources in improving individual performance of clinicians and the role of job satisfaction in this process, while the study framework is based on the widely applied Job-Demands Resources theory.MethodsBased on the study framework composed of slack resources, individual performance, and job satisfaction, hypotheses have been put forward, and questionnaires have been distributed to representative clinicians in tertiary public hospitals. Finally, 318 valid data collected from clinicians have been obtained. To verify the hypotheses, multiple linear regression models have been established to explore the relationship between variables, and the three-stage regression models have been used to verify the presence of mediating role.ResultsAll four hypotheses proposed in this study have been proved to be held. Clinicians' job satisfaction has played a mediating role in the impact of slack resources and its three dimensions on individual performance. Among them, there has been a complete mediating role for staff slack, while time and space dimensions have played a partial mediating role in the impact of slack resources on individual performance.ConclusionsIn public hospitals in environments where behavior is subject to significant government interference, it is necessary and feasible to retain appropriate slack resources to improve individual performance. From the perspective of resources management in hospitals, it is necessary for public hospitals to implement a strategy of reserving an appropriate portion of time, staff and space in order to have the conditions to improve clinicians' satisfaction. The existence of slack resources in public hospitals can improve the job satisfaction of clinicians, and then improve the individual performance through the process.