Clinical Practice Placements Research Articles

Individual placement and support (IPS): duration of employment support and equity of access and outcome in routine clinical practice.

To explore the duration of support, reach, effectiveness and equity in access to and outcome of individual placement and support (IPS) in routine clinical practice. A retrospective analysis of routine cross-sectional administrative data was performed for people using the IPS service (N = 539). A total of 46.2% gained or retained employment, or were supported in education. The median time to gaining employment was 132 days (4.3 months). Further, 84.7% did not require time-unlimited in-work support, and received in-work support for a median of 146 days (4.8 months). There was a significant overrepresentation of people from Black and minority ethnic communities accessing IPS, but no significant differences in outcomes by diagnosis, ethnicity, age or gender. Most people using IPS services do not appear to need time-unlimited in-work support. Community teams with integrated IPS employment specialists can be optimistic when addressing people's recovery goals of gaining and retaining employment.

Experiences of Undergraduate Nursing Students on Clinical Placement as a Formal Community of Practice

Background: Through their academic journey at their academic institutions and clinical practice placements, nursing students experience mutual engagement, joint enterprise, and a shared repertoire that marks a community of practice. As a result of this interaction and activity, students develop an interprofessional identity as they also become active members of this interprofessional community. Method: A descriptive qualitative approach was used to study the experience of 12 student nurses following clinical practice placements. Purposive sampling was adopted and the data from individual interviews was analysed using thematic analysis. Results: Five themes emerged, namely: Bridging the Theory-Practice Gap, Feeling Welcomed and Wanted, Belongness and Support, Chance of Being Selected and Need for Further Collaboration. Conclusion: Through practical placements and engagement with other healthcare professionals, the student’s ability to utilize interpersonal skills and professional skills are highly developed and by becoming part of a community of practice, they develop to become an essential asset in today’s health workforce.

Clinical practice competence and associated factors among undergraduate midwifery and nursing sciences students at Bahir Dar city, Northwest Ethiopia

Background: Competence describes actions that will be demonstrated or observed and assessed while competency refers to the skill itself. Following appropriate theoretical and practical training, clinical experience is required to achieve the highest level of clinical competence. It is estimated that many women and newborns die each year due to a lack of qualified health professional around the world. As a result, the purpose of this study was to determine the prevalence and factors influencing clinical competency in the study area. Methods: An Institutional-based cross-sectional study was conducted from 12 August to 12 September 2022, among 403 undergraduate health sciences students of Bahir Dar University. Participants were approached through simple random sampling technique. Data were collected using a pre-tested structured questionnaire through a face-to-face interview, and entered into Epidata version 3.1 and analyzed using SPSS version 22. The prevalence was reported using proportion with 95% CI and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio (AOR) with 95% CI. Statistical significance was declared at P value less than 0.05. Results: Overall, the prevalence of clinical practice competency was 36.5% [95% CI; 33.5, 39.1]. Students who were provided a logbook (AOR=5.40, 95% CI 2.91, 10.02), adequate clinical cases in the clinical practice placement (AOR=2.72, 95% CI 1.60, 4.60), preceptor show different procedures (AOR=2.50, 95% CI 1.33, 4.71), student’s confidence during conducting procedure (AOR=4.16, 95% CI 1.67, 10.35) and the suitability of the way of teaching to the learning styles of students during skills demonstration (AOR=2.10, 95% CI 1.00, 4.40) were factors statistically associated with clinical practice competence. Conclusions: According to this study, more than three out of every five participants were found to be clinically incompetent. Providing logbooks, adequate clinical cases, preceptors showing different procedures, students’ confidence, and suitability of the way of teaching to the learning styles of students were significantly associated with clinical practice competence. Implementing logbooks, selecting clinical sites, enhancing the confidence of students, preferred teaching/learning styles, and clinical preceptor support were important to improve the clinical competence of students.

Experiences of nursing students during their mental health clinical training at a general hospital in Namibia.

Clinical training is important because it constitutes more than half of the formal courses in nursing education. Accordingly, it is important for institutions of higher learning to continually explore the experiences of nursing students during their clinical placement. These experiences can be used to promote a positive clinical learning environment for students. However, the experiences of nursing students during their mental health clinical training in Namibia have not been extensively researched. The aim of this study was to explore and describe the experiences of nursing students during their mental health clinical training at a general hospital in Namibia. A qualitative, exploratory, descriptive and contextual research design was followed as the basis for conducting the study. A sample of 15 nursing students was conveniently selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The following three themes emerged: collating theory and mental health practice experiences, facing challenges in clinical placements, and recommendations to ensure effective learning about mental health. The use of a general hospital for clinical placements within an undergraduate nurse training course led to some concerns regarding the relevance and appropriateness of such experience within a nursing programme.Contribution:The findings have important implications for the training of undergraduate nursing students in general hospitals. It can be utilised to develop strategies to improve positive clinical practice placement and develop clinical skills for undergraduate nursing students in general hospitals.

Optimizing peritoneal dialysis catheter placement.

Long-term success of peritoneal dialysis as a kidney replacement therapy requires a well-functioning peritoneal dialysis catheter. With ongoing reductions in infectious complications, there is an increased emphasis on the impact of catheter-related and mechanical complications. There is currently a marked variation in the utilization of various types of catheters (double cuff vs single cuff, coiled tip vs straight tip), methods of catheter insertion (advanced laparoscopic, open surgical dissection, image guided percutaneous, blind percutaneous), timing of catheter insertion, location of catheter placement (pre-sternal v. abdominal) and peri-operative practices. Specialized approaches to catheter placement in clinical practice include use of extended catheters and embedded catheters. Marked variations in patient lifestyle preferences and comorbidities, specifically in high acuity patient populations (polycystic kidney disease, obesity, cirrhosis) necessitate individualized approaches to catheter placement and care. Current consensus guidelines recommend local procedural expertise, consideration of patient characteristics and appropriate resources to support catheter placement and long-term functioning. This review focuses on an overview of approaches to catheter placement with emphasis on a patient-centered approach.

Virtual Reflection Group Meetings as a Structured Active Learning Method to Enhance Perceived Competence in Critical Care: Focus Group Interviews With Advanced Practice Nursing Students

Advanced practice nurses (APNs) are in high demand in critical care units. In Norway, APNs are educated at the master's degree level and acquire the competence to ensure the independent, safe, and effective treatment of patients in constantly and rapidly changing health situations. APNs' competence embraces expert knowledge and skills to perform complex decision-making in the clinical context; therefore, it is essential that educational institutions in nursing facilitate learning activities that ensure and improve students' achievement of the required competence. In clinical practice studies of APN education, face-to-face reflection group (FFRG) meetings, held on campus with the participation of a nurse educator and advanced practice nursing students (APNSs), are a common learning activity to improve the competence of APNSs. Although FFRG meetings stimulate APNSs' development of required competencies, they may also result in unproductive academic discussions, reduce the time that APNSs spend in clinical practice, and make it impossible for nurse preceptors (NPs) to attend the meetings, which are all challenges that need to be addressed. This study aimed to address the challenges experienced in FFRG meetings by implementing virtual reflection group (VRG) meetings and to explore the experiences of APNSs, NPs, and nurse educators in VRG meetings as an active learning method supported by technology to stimulate students' development of the required competence to become APNs in critical care. This study adopted a qualitative explorative design with 2 focus group interviews and used inductive content analysis to explore the collected data. The main finding is that reflection group meetings supported by technology resulted in a better-structured active learning method. The VRG meeting design allowed APNSs to spend more time in clinical practice placements. The APNSs and NPs experienced that they participated actively and effectively in the meetings, which led to a perceived increase in competence. The APNSs also perceived an improved learning experience compared with their prior expectations. Users perceived that the implemented novel teaching design supported by technology, the VRG meeting, was a more effective method than FFRG meetings on campus to develop APNSs' required competence in critical care. The VRG was also perceived as an improved method to solve the challenges encountered in FFRG meetings. Specifically, the APNSs felt that they were prepared to undertake complex decision-making with a higher level of analytic cognition in a clinical context and to lead professional discussions in the ward. This developed teaching design can easily be adapted to diverse educational programs at various levels of professional education.

Capturing, the experiences of undergraduate student nurses undertaking a pre-registration nursing degree course using an adapted experience based co-design approach

BackgroundThe quality of student experience in higher education plays an increasingly important role in attracting and retaining pre-registration nurses. Identifying and understanding the students' experiences of their course is a necessary step in the move towards improving the student experience. Experience Based Co-design (EBCD) is successfully established as an effective process for improving patient experience in a health care setting. This study presents the use of EBCD outside of healthcare, specifically in a higher education setting. ObjectivesTo capture, explore and understand the experiences of students' undertaking a pre-registration (adult) nursing course, and co-design potential improvements for future experiences through the application of an EBCD approach. MethodsAn adapted EBCD approach was utilised for gaining insight into what shapes students' experience of the nursing course and to collaboratively produce priority recommendations for course improvement. Semi-structured interviews, emotional touchpoint mapping and co-design events were conducted with undergraduate nursing students (n = 22) and staff stakeholders in a pre-registration (adult) nursing course (n = 19). Findings were analysed using the ‘Six phases of thematic analysis’ (Braun & Clarke, 2006). ResultsStudents had varied experiences on the nursing course, both positive and negative, particularly with student support. Three priority recommendations for course improvement were identified from the findings including: facilitating and supporting student development of independent study skills, enhancing student support in the clinical practice placement environment and clarifying and enhancing the role of the academic advisor. ConclusionsFindings from this study highlight areas for improvement on a pre-registration nursing course that could impact future students' experience. Furthermore, this study appears to be the first documented as using EBCD in a higher education setting with the focus on students, that enabled students and staff stakeholders in the nursing course to co-design priority recommendations for course improvement.

Barriers to the use of ultrasound guidance in central venous catheter placement by emergency physicians in Saudi Arabia: a cross-sectional study

The use of ultrasound-guided central venous catheter (USG-CVC) placement is still low among emergency physicians in many countries, including Saudi Arabia, because of several inherent perceived barriers. We assessed the barriers to the use of USG-CVC placement in clinical practice among Saudis currently in training, residents and board-certified physicians and evaluated the association of these barriers with the demographic characteristics of EPs. We conducted a cross-sectional survey among all emergency physicians (EPs) practicing in Saudi Arabia who completed a residency program in emergency medicine (EM) or were board-certified emergency physicians from October to December 2018. The survey material was sent via SurveyMonkey through the Saudi Commission for Health Specialties to target EPs. Two hundred thirty-four EPs completed the survey (response rate: 66.9%), and 177 (75.6%) were males. EPs from nongovernment institutions tended to agree significantly more than EPs from government institutions with the perception that USG-CVC placement is a time-consuming process (17.9% vs. 20.3%, respectively, p = 0.022). Residents were 3.8 times more likely to perceive loss of their skill in using Ultrasound (US) for CVC placement Odds ratio (OR) = 3.806, 95% Confidence interval (CI) = 0.218–0.686, p < 0.001), 2 times more likely to believe that USG-CVC placement was not proven in randomized controlled trials (OR = 2.061, 95% CI = 0.010–0.460, p = 0.040), and 5.5 times more likely to believe that USG-CVC placement was not a cost-effective procedure (OR = 5.490, 95% CI = 0.411–0.870, p < 0.001) than board-certified EPs. Many EPs, particularly those in training, believe there are several barriers to using USG-CVC placement, including loss of skill, a lack of support of the procedure in randomized controlled trials and cost-effectiveness. This is true, although there is existing evidence and a consensus regarding the superiority of USG-CVC placement over the landmark technique. In comparison to the more experienced and well-trained board-certified EPs, residents’ confidence and skill in using USG-CVC placement may have been influenced by their training and experience.

Development of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement Instrument.

Instruments that measure clinical learning environments have lacked rigorous methodological approaches in their development and validity. Development research using a survey design approach was conducted for an instrument to evaluate the quality of nursing students' clinical practice placement. The development and validity of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement (SNEP) resulted in a 40-item instrument to evaluate nursing students' experience of their completed clinical practice placement. Adequate level of model fit was indicated (χ2[719] = 1909.47, p < .001) for the confirmatory factor analysis (χ2/df = 2.66, comparative fit index = 0.92, Tucker-Lewis Index = 0.92, and root-mean-square error of approximation = 0.07). Standardized factor loadings were high, ranging from 0.68 to 0.95. The SNEP was designed and validated incorporating the perspective of various nurse stakeholders and can be used in both research and clinical learning environments. [J Nurs Educ. 2022;61(10):559-569.].

Nursing students’ clinical placement experiences during the Covid-19 pandemic: A phenomenological study

AimThis study explored the clinical placement experiences of nursing students during the Covid-19 pandemic. BackgroundThe health emergency caused by Covid-19 required a rapid reorganisation of care settings. This reorganisation entailed revisiting the clinical placements settings and learning programs of Italian nursing faculties. Some Italian universities wanted to seize the health emergency as a learning opportunity enabling the nursing student to acquire additional knowledge and skills. DesignWe conducted a descriptive qualitative study employing a phenomenological approach. The study population was second and third-year nursing students. The students did their clinical placement in 5 Northern Italy hospitals, mainly in infectious diseases wards, intensive care and sub-intensive care units, emergency department, short-stay surgical units and internal medicine wards. In these departments, the inpatient wards were entirely converted into Covid-19 units. Ethical approval was obtained from the local ethics committee. MethodsSemi-structured, open-ended interviews were conducted in March-April 2021 and analysed following a phenomenological approach. ResultsTwenty-one nursing students in their 2nd and 3rd academic year participated. Their average age was 24 years. 81% were female and 19% were male. Three main themes were generated: (i) Learning which surpasses technicalities; (ii) Confronting dignity issues; (iii) Feeling treated as an equal in the workspace. Students had to learn how to lower their fear and self-manage the emotional burden to be a caring presence for the patients who were intensely suffering from the disease and isolation. Attending a clinical practice placement in Covid-19 wards led them to focus on human dignity issues: participants realised how dignity was questioned and how they could become patients’ advocates. Students also described that they felt part of the team, with their student role almost fading. ConclusionsThis study describes that the most unpredictable public health emergency, such as Covid-19, can provide learning opportunities in the practice environment for nursing students. Students described feeling useful and capitalising on new competencies. Designing educational activities for nursing students concerning pandemic emergencies may be strategic for dealing with similar situations in the future.

Healthcare educators’ experiences of challenging situations with their students during clinical practice: A qualitative study

During clinical practice, students become acquainted with the key work tasks associated with their professions. Students need more support from healthcare educators during clinical practice learning, particularly in challenging situations. This study aimed to describe healthcare educators’ experiences of challenging situations during clinical practice placements. A qualitative study design was used to collect data through interviews with ten healthcare educators from two higher education institutions. The data were analyzed with inductive content analysis. The SRQR reporting guidelines were used to improve the transparency of the study. Educator reactions commonly involved emotional, goal-oriented and pedagogical support towards their students. The interviewed educators felt that mentors – when facing a challenging situation during clinical practice – are tasked with creating an atmosphere that supports student learning. Students faced challenges that were related to self-evaluation, goal-oriented activities, and their attitudes towards feedback. The building of a safe clinical learning environment involves collaboration between students, their clinical mentors and educators.

Missed nursing care as experienced by undergraduate nursing students.

Background: In clinical settings where missed nursing care prevails, nursing students' instructions, supervision and the joint reflection on clinical practice with mentors are also affected and nursing students become involved in dealing with missed nursing care. To explore the experience of missed nursing care in clinical placements, its meaning for nursing students, and actions they considered or took. Qualitative study based on a content analysis of nursing students' written reports. Nursing students in three universities in Germany with experience of at least one clinical practice placement were invited to participate. Online, they answered three open questions concerning missed nursing care focusing on: (1) experiences of the phenomenon, (2) its meaning and (3) actions that had been considered or taken when dealing with missed nursing care. A content analysis was performed. The recruitment criteria were met by 69 nursing students. Four main themes and 20 sub-themes were identified. The reports covered all forms of missed nursing care. Becoming involved led to intrapersonal conflicts and, feelings of powerlessness but also to learning opportunities. It challenged professional and ethical standards. Students identified a broad spectrum of actions to answer the challenge. Dealing with missed nursing care creates opportunities and challenges for nursing students. To build up a well-trained and sustainable nursing workforce, learning environments for nursing students must reflect the challenges and counteract deficits.

French speech-language therapy students' interest in evidence-based practice: A survey.

Taking into account international studies interested in the development of evidence-based practice (EBP) in the speech and language therapy field, this survey investigated key issues with regard to students' perception of EBP. To determine how final-year students in France conceive EBP; to know if they feel competent in this area; to investigate any barriers to the use of EBP; and to assess their intention of using the EBP approach in their professional practice after graduating. Between January and April 2019, 182 advanced French students from 15 French speech-language university training centres (SLUTC) completed an online survey addressing these questions. The results show that 68.7% of students in the sample had a positive perception of the EBP. Between 54.9% and 73.6% of students felt rather competent to apply part of the approach, and 17% were sure to implement it in their own practice later on. Step 3 'Critically evaluating the evidence' was the most difficult. Regardless of the different EBP steps, the most important barrier for students who felt competent was the lack of practice; for students who did not feel competent, the major barriers were both the lack of theoretical knowledge and the lack of practice. A total of 61% of students reported not seeing EBP being practised by their clinical practice placements supervisors; 55% reported never having used their EBP knowledge during their clinical practice placements. The students interviewed had a positive perception of EBP. Nevertheless, these results demonstrate a need to improve the EBP curricula and to include EBP in clinical education, under the guidance of clinical practice placements supervisors. What is already known on the subject Despite the fact that EBP is widespread, previous studies have shown that it is not sufficiently used in the practice of speech and language therapists (SLT) and that young professionals tend to seek advice from experienced professionals rather than use EBP. Some students, despite their programme, do not feel competent enough to implement EBP. What this study adds to the existing knowledge French SLT students had a positive opinion of EBP despite barriers to implementation in their future professional practice, especially regarding the critical analysis of evidence. Moreover, the study reveals a need to practise EBP during clinical practice placements, and to create specific pedagogical framework for EBP. What are the potential or actual clinical implications of this work? The potential implication of this study is the use of the questionnaire to investigate the students' perception of EBP from a theoretical and a practical point of view, in collaboration with clinical practice placement supervisors, with the aim of promoting the task value and the self-efficacy as the two best factors to enhance students' motivation in favour of EBP.

Attracting Israeli nursing students to community nursing

BackgroundThe shift from inpatient care to community patient care has had an essential impact on the nursing profession. Despite the growing demand for community nurses in many countries, their number remains relatively low and many students do not perceive this field as an interesting career to pursue. In this review we aimed to understand if exposure of undergraduate nursing students to various nursing work settings during their studies affects their work setting choices after graduation.MethodsA literature search of papers relating to work setting preferences of nursing students in Israel and other countries was performed. Israel Ministry of Health, Nursing Administration documents and other related documents were also reviewed, with a focus on the nursing training program in Israel.FindingsWhile most first-year nursing students have limited knowledge regarding the profession, in later years, their preferences for post-graduation work settings are affected by their exposure to the various clinical fields through knowledge gained in courses together with clinical practice placements. In Israel, specific classroom courses in community nursing are allocated only 6% of the total time allocated to all classroom courses in nursing, and a single clinical placement in community nursing takes place during the third or fourth year of the nursing program, exposing students to a single aspect of community nursing during their nursing training. Studies in other countries have reported that students’ experience during clinical placement contributes to shaping students’ opinions of nurses’ roles within that field. Nursing students who had a primary healthcare placement showed greater intention for working in this setting after graduation.ConclusionsThe lack of exposure to the various aspects of community nursing during undergraduate studies contributes to a lack of motivation for entering this field. Therefore, a profound change is needed in nursing training programs’ curricula to prepare graduates to face future challenges in community nursing. Whilst both hospital and community nursing are equally important, nursing leaders and policy makers must be made aware of the various factors that contribute to new registered nurses’ preferences of hospital over community nursing and build strategies for directing nurses to work in the community in order to respond to the expected nurse shortage in this setting.

Final year M.Pharm. student views and performance in objective structured clinical examinations

Introduction: Objective structured clinical examinations (OSCEs) are widely used as a competency-based assessment of clinical skills within M.Pharm. programmes of many United Kingdom (UK) pharmacy schools. Aim: To evaluate the clinical performance of final year M.Pharm. students and elicit their views and experiences of the OSCE assessment. Methods: Students were divided into 11 groups and completed an OSCE exam, comprising 11 stations of seven minutes in length, following a four-day placement in clinical practice. Students were asked to complete an acceptability questionnaire, and their OSCE performance was correlated with their final degree classification and their Oriel rank position. Results: Overall, the OSCE assessment is acceptable from the students’ perspective. Differences were found between the students’ performances at the individual OSCE stations. Students performed best on patient consultation stations and least on clinical-problem solving stations. There was no correlation between students OSCE marks and their Oriel rank position. There was however a strong correlation between the students OSCE mark and their final degree classification (r=0.528, n=119, p=0.000). Conclusion: Final year pharmacy undergraduates perform poorly in activities which demand an element of clinical problem identification. Further research is required on how clinical problem solving skills can be developed amongst undergraduates and the specific role placements have in achieving this.

Clinical Practice Competence of Mettu University Nursing Students: A Cross-Sectional Study.

IntroductionClinical practice competence is the ability to effectively integrate cognitive, affective and psychomotor skills during the delivery of health care. It is the concern and the center of attention for the managers, professional associations, government, and society as a whole. Therefore, identifying the level of clinical practice competence of students and taking appropriate action is crucial. The aim of the present study was to investigate clinical practice competence of nursing students in Mettu University.MethodsA cross-sectional study was employed on 105 nursing students at Mettu University from February to April, 2019. Systematic random sampling technique was used to select study participants. Data were entered into EpiData manager version 4.2.2 and exported to statistical package for the social science (SPSS) version 20.0 and analyzed using descriptive statistics, bivariate and multivariate logistic regressions. The statistical significance was set at p<0.05.ResultsOut of the total participants involved, 102 participants returned the questionnaire making response rate of 97.1%. Majority 78 (76.5%) of participants were males with the mean age of 23.05 (SD = 1.11) years. The overall clinical practice competence of participants was 2.03 (SD = 0.54) which indicates clinical practice incompetence. Year of study [AOR 4.9; 95%, CI: 0.04, 16.53] and clinical practice placement [AOR: 2.7; 95% CI: 0.1, 14.86] were the identified associated factors of clinical practice competence at p<0.05.ConclusionClinical practice competence of nursing students was inadequate to provide quality, safe and satisfying nursing care. This could not meet patients holistic needs and may even bringfear, stress, anxiety and unnecessary errors by students at clinical sites. Nursing schools and teaching hospitals should collaborate to enhance the nursing students clinical practice competence.

Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches

Heavily T2-weighted MR myelography (HT2W-MRM) is emerging as an alternative approach for detection and follow up of CSF leaks. We aimed to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Fifty-nine consecutive patients suspected of having a CSF leak underwent HT2W-MRM. After excluding patients with subdural hematoma and poor image quality, 26 (10 men, 16 women; mean age 44.92 ± 12.6 years) patients were included in this study. Patients received EBP on the basis of HT2W-MRM assessments and clinical assessment. Imaging findings and clinical outcome were evaluated. CSF leak was identified in 21 patients (80.8%, 21/26) based HT2W-MRM. Most cases were graded on a confidence scale as CSF leak definitely (n = 13) or probably (n = 3) present. Successful clinical EBP treatment was achieved in 14 of 17 patients (82.4%) after first targeted EBP, and patient symptoms significantly improved after treatment (numerical rating score 6.4 before EBP, 1.3 after EBP, P < 0.001). HT2W-MRM based EBP are the rational and effective choices for CSF leak treatment in routine clinical practice.

PLATO: A practice education tool to support learning and professional development.

It is important that nursing students are adequately supported during their clinical practice placements in order to promote effective learning and reduce student attrition. Educators have an important role and this paper offers an interactive tool, 'PLATO', (The Practice Learning and Teaching Orientations Tool) to support them to meaningfully engage with learners in the practice setting. To enable such engagement, four personal orientations are presented, (role model, advocate, legitimiser and respecter) which enable educators to explore their role, across both local and wider contexts. PLATO recognises the multiple and varied influences on practice education and supports educators to develop their practice in a positive way.

Adapting and validating the Hospital Survey on Patient Safety Culture (HSOPS) for nursing students (HSOPS-NS): A new measure of Patient Safety Climate

BackgroundPatient Safety Culture and Patient Safety Climate (PSC) are different factors. PSC is the shared perception that is held within a hospital's area or unit at a specific moment in time. This measure is necessary for designing activities for promoting and improving safety. It must include the perception of all the agents involved, including future nurses throughout their patient safety education. ObjectivesThe aim was to adapt and validate a new version of the Hospital Survey on Patient Safety Culture (HSOPS), targeted specifically at nursing students. It provides a new comprehensive and more complete measure of PSC that contributes to improving patient safety. MethodsData were obtained from 654 undergraduate and postgraduate nursing students. PSC was tested using factor analyses and structural equation modeling. In order to facilitate the improvement of PSC, we examined differences in climate strength across different academic groups using the Rwg(j) and ICC measures of inter-rater agreement. ResultsFactor analyses confirmed a five-factor solution that explained between 52.45% and 54.75% of the variance. The model was found to have adequate fit χ2 (5) = 14.333, p = .014; CFI = 0.99; RMSEA = 0.05. Cronbach's alphas for PSC were between 0.74 and 0.77. “Teamwork within units” was the highest rated dimension, and “Staffing” the lowest rated. Medium-to-high scores were obtained for PSC. The median of Rwg (j) was high in the five dimensions of the PSC survey, supporting the idea of shared climate perceptions (0.81–0.96) among undergraduate and postgraduate nursing students. ConclusionsHSOPS-NS is a useful and versatile tool for measuring the level and strength of PSC. It screens knowledge regarding patient safety in clinical practice placements and compares nursing students' perceptions of the strength of PSC. Weaknesses perceived in relation to PSC help implement changes in patient safety learning.

Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement.

Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.