Staff Confidence Research Articles

‘He knows he is safe; you are the safety net’. Key adult intervention with children with attachment difficulties: the TAs perspective

Children and young adults who are ‘looked after’ can present teachers and teaching assistants with a variety of day‐to‐day classroom challenges and a range of complex behaviours due to adverse childhood environments. This group of vulnerable young people have very complex social and emotional behaviours that require a considered approach of support and interventions. The types of interventions deployed in schools, however, may depend on staff knowledge, staff self‐confidence, and interpersonal skills to support the child's learning and complex behaviours. An example of an intervention is the key adult intervention programme, which is purported to develop staff knowledge and self‐confidence when working with looked after children. training in key adult intervention occurred at a special school, which had a high percentage of looked after children, situated in an East Midlands town. The purpose of the study was firstly to support the children through in‐depth knowledge development for supporting staff, and secondly to investigate staff confidence and understanding of the needs of looked after children. In addition, supporting factors of the key adult intervention and a discovery of any barriers to its implementation were sought. Using a mixed methods approach, data were collected from participating staff using questionnaires and focused conversations. Qualitative data were analysed using Cresswells six‐step process. Findings suggest that the key adult intervention is an effective means to support staff confidence and understanding and offer support for looked after children. Recommendations for future practice include increased training and support for teaching assistants, teachers and the school community as a whole. In addition, targeted professional and emotional support for the teaching assistants deployed, and increased communication between senior leaders and teaching assistants is crucial. The current research, therefore, adds to existing literature by providing an evaluation of the key adult intervention within a special school setting with evidence gathered from teaching assistants.

1234 IMPROVING HEART FAILURE MANAGEMENT WITHIN HOSPITAL AT HOME

Abstract Introduction Heart failure (HF) is a common problem managed in our West Lothian multi-disciplinary hospital at home (HaH) service, however significant variation in practice was noted with considerable resource implications. We aimed to standardise and improve this by developing a dedicated protocol. Methods We developed a protocol to guide the assessment and management of HF within HaH. We collected baseline (n=25) and follow-up data (n=10) after protocol introduction from patients referred to HaH with heart failure. Outcomes reviewed included anticipatory care planning (ACP) decisions, length of stay (LOS) and treatment strategy. We held staff education sessions and surveyed staff confidence regarding HF management. Results ACP discussion rates improved after protocol introduction, with decision rates improving for both escalation of care (28% to 80%) and resuscitation (44% to 60%). LOS reduced after protocol introduction (mean 6.3 days to 5.9 days). Titration of oral diuretics alone (71%) was associated with a shorter LOS (mean 5.4 days) compared to IV (29%, mean 8.1 days), with no difference in 28 day outcome. In those with HF with reduced ejection fraction, the rates of beta-blocker prescription increased (57% to 80%) however ACE-inhibitor prescription decreased (29% to 20%). Use of add-on therapy (e.g. thiazide diuretics) increased (12% to 30%) with a decrease in complication rates (12% to 0%). All staff found the protocol helpful with an improvement in confidence levels. Conclusions Through introducing a standardised protocol, we observed an improvement in anticipatory care discussion rates and a trend towards shorter LOS. Oral diuretic titration was less resource intensive without an adverse impact on outcome. Future plans include ongoing education and data collection, trialling a joint multi-disciplinary meeting with cardiology for discussion of complex patients and embedding a treatment strategy of oral diuretic titration with a ‘discharge with planned review' approach in appropriate patients.

Community engagement strengthens pig disease knowledge and passive surveillance in Timor-Leste.

Smallholder pig production in Timor-Leste is culturally and economically important for most households. However, regular and ongoing disease surveillance and pig husbandry training for farmers are limited. This article describes collaborative social and diagnostic research followed by a pilot community engagement program to improve farmer and technician knowledge, skills, and working relationships. There were three phases: (1) A qualitative study in 2020 to explore the experiences and knowledge of 133 pig farmers, 6 village leaders, and 16 district veterinary technicians on pig diseases and reporting, treatment methods, and access to information or assistance. (2) A pilot community engagement program in 3 villages in 2021 with the diagnostic investigation with samples analyzed from 27 dead pigs, and (3) Evaluation of community engagement and training outcomes. Results of the qualitative study revealed limited reporting of sick or dead pigs by farmers to veterinary technicians due to a lack of trust in the veterinary diagnostic system. Most technicians lacked experience with sampling or post-mortems so diagnostic training was undertaken for the pilot disease investigation. Evaluation results showed improved knowledge, motivation, and confidence of government staff and farmers. The credibility of veterinary technicians improved and gave them more confidence to work with communities. Farmers felt supported because all aspects of pig husbandry were addressed, and they were more willing to report dead or sick pigs. The project indicates that improved passive disease surveillance can be achieved by engaging communities in smallholder pig farming in Timor-Leste. Further research and testing of the approach in other districts and countries is recommended.

Implementing Trauma-Informed Care Through a Learning Collaborative: A Theory-Driven Analysis of Sustainability.

This study investigated the sustainability of a multi-agency 15-month Learning Collaborative (LC) for implementing trauma-informed care in 23 rural Pennsylvania counties. Provider agencies (N = 22) were assessed three years following completion of the LC. Sustained trauma-informed practices were assessed through criteria indicating organizational achievement as a trauma-informed care center. A theoretical model of clinical training was applied to determine the extent to which training- and skill-related factors were associated with sustained trauma-informed care. Three years after the LC, trauma symptom screening rates and staff training improvements were sustained, while staff confidence in delivering trauma-informed care worsened across time. Sustained trauma-informed care was associated with implementation milestone completion and third-party ratings of quality improvement skills during the LC. Building capacity for organizational change through training and skill development during active phases of implementation is important for sustained trauma informed care in behavioral health service.

Evaluating the impact of a family violence transformational change project in a major trauma hospital: A three-year follow-up comparison study of knowledge, confidence, and family violence response skills in clinical staff.

Family violence is a significant public health issue. Healthcare systems have an important role to play in recognising and responding to current family violence experiences in their patients. However, many healthcare workers and systems remain underprepared to fulfil this role. The current study evaluated the impact of a transformational change project in family violence clinical response at a major adult trauma hospital in Australia. Clinician self-rated knowledge, confidence, and family violence clinical skills were evaluated at three years post implementation of a family violence initiative at the Royal Melbourne Hospital, Melbourne. The three years post survey results (N = 526) were compared to baseline (N = 534) using Mann Whitney U and χ 2 analyses. Self-reported clinician family violence knowledge, confidence and patient screening were all significantly improved from baseline. Specific family violence skills, including knowledge of key indicators, enquiry with patients and disclosure response were also all significantly improved. The most common clinician identified barriers to working effectively in the area were similar to baseline and included the presence of a suspected perpetrator during the clinical interaction, clinicians perceiving patients would be reluctant to disclose, and time limitations. However, significantly fewer staff endorsed a lack of knowledge or supporting policies and procedures as a barrier. The findings indicate that investment in a transformational change project comprised of the establishment of response policies and clinical work-flow, broad-scale training, a clinical champions program, a secondary consultation service and links with partner organisations, was effective at improving clinician self-rated rated family violence skills, across the hospital. However, one quarter of clinicians still reported having not received any family violence training, and half endorsed having little or no confidence in their skills to identify and respond to patient family violence experiences. This indicates ongoing and sustained work is required to optimise clinician skills in responding to family violence.

Analyzing E-Commerce effectiveness of SMEs Using SERVQUAL Model

This paper attempts to aid the E-Commerce influence on SMEs using SERVQUAL methodology and five factors of reliability, assurance, tangibles, empathy, and responsiveness. In Saudi Arabia, according to the survey results, the e-commerce has enhanced the country's service and quality. Safe transactions processing, employee appearance, on-time delivery, attention to customer wants, record keeping, and confidence in staff are the top six areas of improvement following the implementation of e-commerce. Product display, staff help, equipment appearance, delivery time, customer waiting time, and customer care are the six factors listed at the bottom of the improvement after integrating e-commerce. E-commerce has a positive effect on confidence, which was previously at 20.31% and is now at 11.02%, even though several features are found to be in the top before and after the implementation of E-commerce. Prior to e-commerce, it is being noticed that service was more important in terms of customer happiness. Observing the improvement will be easier if the recommendation is implemented and measured again. In the future, we can investigate the performance of the top five E-Commerce platforms in greater depth.

Towards an Evidence-Based Model of Workplace Postvention.

This instrumental case study explored what suicide postvention might offer workplaces using the example of a large metropolitan funeral company. A mixed methods approach was utilized to examine staff experiences with suicide bereavement funerals and responses to a bespoke postvention training package. Staff found funerals due to suicide difficult in terms of communication, engagement and emotionality. These challenges were commonly characterized by increased tension and concern. In the absence of a postvention informed approach, staff had developed individual ways to negotiate the identified challenges of this work. The introduction of a staff-informed postvention training package delivered improvements in staff confidence with communication, understanding and management of the impact of suicide bereavement, and increased willingness to share information about postvention services with families and mourners. The findings indicated that benefits of the training could be extended through organizational governance and integration of supports. The findings are used to inform a model of workplace postvention together with a methodology incorporating staff experience and organizational context.

Behavioral Skills Training for Teaching Safety Skills to Mental Health Clinicians: Protocol for a Pragmatic Randomized Control Trial

Workplace violence is an increasingly significant topic, particularly for staff working in mental health settings. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, considers workplace safety a high priority and consequently has mandated staff safety training. For clinical staff, key components of this training are self-protection and team-control skills, which are a last resort when an individual is at an imminent risk of harm to self or others and other interventions are ineffective (eg, verbal de-escalation). For the past 20 years, CAMH's training-as-usual (TAU) has been based on a 3D approach (description, demonstration, and doing), but without any competency-based assessment. Recent staff reports indicate that the acquisition and retention of these skills may be problematic and that staff are not always confident in their ability to effectively address workplace violence. The current literature lacks studies that evaluate how staff are trained to acquire these physical skills and consequently provides no recommendations or best practice guidelines. To address these gaps described by the staff and in the literature, we have used an evidence-based approach from the field of applied behavior analysis known as behavioral skills training (BST), which requires trainees to actively execute targeted skills through instruction, modeling, practice, and feedback loop. As part of this method, competency checklists of skills are used with direct observation to determine successful mastery. Our objectives are to evaluate the effectiveness of BST versus TAU in terms of staff confidence; their competence in self-protection and team-control physical skills; their level of mastery (predefined as 80% competence) in these skills; and their confidence, competency, and mastery at 1 month posttraining. We are using a pragmatic randomized controlled trial design. New staff registering for their mandatory safety training are randomly assigned to sessions which are, in turn, randomly assigned to either the BST or TAU conditions. Attendees are informed and consented into the study at the beginning of training. Differences between those consenting and those not consenting in terms of role and department are tracked to flag potential biases. This study was internally funded and commenced in January 2021 after receiving ethics approval. As of May 2022, data collection is complete; half of the baseline, posttraining, and 1-month videotapes have been rated, and three-fourths of the interrater reliability checks have been completed. The analysis is expected to begin in late summer 2022 with results submitted for publication by fall 2022. The findings from this study are expected to contribute to both the medical education literature as well as to the field of applied behavioral analysis where randomized controlled trial designs are rare. More practically, the results are also expected to inform the continuing development of our institutional staff safety training program. DERR1-10.2196/39672.

Learning Design in the Time of COVID-19: The Digital Learning Design Unit Story

Learning designers became the “first responders” during the great onlining due to the Covid-19 pandemic. In this innovative practice article, we share the experiences of a team of digital learning designers created to support the university community’s pivot online. This project adopts a case study methodology. The case study of the Digital Learning Design Unit (DLDU) described in this article offers an examplar of learning design and the work of learning designers during the time of Covid-19. Findings from this case study indicate that a demand led professional learning approach can be very effective at encouraging staff engagement with learning design; a rapid learning design intervention can provide just in time support for colleagues during a time of crisis; time and digital competencies are essential to build staff competence and confidence with online pedagogy and learning design approaches. In this case study, the pandemic prompted a strategic approach to learning design for online, blended and hybrid education. This strategic approach began as a temporary proactive measure to keep teaching and learning going but has now been cemented into a permanent strategy for online blended and hybrid education at our institution which will continue in the post pandemic environment.

Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study.

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

An organisational approach to building research capacity among nurses, midwives and allied health professionals (NMAHPs) in clinical practice

Background: As nurses, midwives and allied health professionals deliver the majority of direct patient care, they are well placed to lead research and generate evidence to inform practice. Aims: To consider how best to implement the findings of The Whitehouse Report, to reflect on the development of a nursing, midwifery and allied health professions research and evaluation service at a UK NHS foundation trust, and to understand the mechanisms that contribute to change. Methods: Using the principles of change theory we developed four theories of change, underpinned by a logic model, to consider the sequence of events and the expected results. The impact of the new service on workforce capacity and capability and the mechanisms of change were considered retrospectively over a two-year period between 2019 and 2021. Surveys, interviews, field notes and data regarding a number of projects were collected and reviewed. Results: Research, quality improvement and service evaluation activity have increased across all nursing, midwifery and allied health professions at our hospital trust. Six underpinning core values and seven practical mechanisms to implement these values were identified as successful drivers of change for the service. Discussion: The intentional development of a network of teams, individuals and patients was fundamental to building capacity, capability and confidence among staff. Enablers to the increase in research activity included using role modeling, inspiration and perseverance to make visible the value of nurses, midwives and allied health professionals in leading research-based care. Preconceived ideas of who ‘should’ do research challenged the positive culture of critical inquiry for the benefit of patients, service improvements and celebration of existing work. Strategies to support research activities across the professions require vision, time, infrastructure and buy-in at micro, meso and macro levels, as well as a sustained effort from those directly involved. Conclusions: It would be beneficial to encourage bespoke approaches to help staff translate ideas into practice-based projects as part of capacity, capability and confidence building for research across the clinical workforce. Audit, quality improvement and evaluation activities can lead directly to an increase in research engagement, involvement and leadership among nurses, midwives and allied health professionals, as well as supporting recruitment and retention. Future research could explore whether this approach would be replicable and effective in other healthcare organisations or systems. Implications for practice: Shared values are essential to forge progress in research activities led by nurses, midwives and allied health professionals The use of audit, quality improvement and service evaluation approaches are effective in increasing research activity within organisations A number of approaches to growing the capacity, capability and confidence of staff should be considered within the organisational context. One approach does not fit all Research-active organisations have better outcomes for patients, whether or not the patients are part of a trial. Increasing the capacity and capability of staff means more research is likely to be undertaken through a nursing, midwifery and allied health professionals lens

Rapid cycle deliberate practice model: cardiac arrest simulation for ward-based staff

The Simulation Centre, in a largest district general hospital, provides a large portfolio of scenario-based courses, for all staffing groups, including the development of modified rapid cycle deliberate practice (RCDP) simulation. Modified RCDP is a model of simulation where learners repeat a scenario, with micro-debriefings, allowing for improvement upon each cycle, in a dynamic learning experience [1]. The centre developed a hybrid style of RCDP and simulation to create a model called Die, Debrief, and Develop, with a focus on the initial response during a cardiac arrest, based upon safety learning events and staff confidence during these emergency events. The aim of the sessions was to improve learner confidence, focusing on technical and non-technical skills in a safe learning environment. The simulation approach was delivered within the clinical environment, utilizing a manikin and equipment on the ward, including the cardiac arrest trolley. A clear pre-briefing was provided to ensure transparency around the expectations within the scenario, for example, the patient will be in cardiac arrest. Due to the repetitive nature of the simulation, there was also the freedom to fail [2]. Each cycle was 5 minutes and repeated 3 times, with a micro-debriefing between each cycle. The improvement between each cycle included patient assessment, ergonomics, human factors, critical thinking, communication, clinical skills and latent threats using elements of gamification. The micro-debriefing between each cycle allowed candidates to reflect on the experience to allow for improvement during each cycle. As well as learning personal safety in the pre-briefing, patients and relatives in the clinical area were informed that the session would be taking place. The feedback from learning following the simulation sessions included: ‘I enjoyed cardiac arrest practice it made much more sense and more relatable than talking through what you would do!’ ‘Was valuable learning and very relevant to our ward’ ‘Has helped me understand cardiac arrest’ ‘I feel empowered!’ ‘Now I know where things are on the crash trolley’ As a result of the RCDP model of training, this has been replicated in simulation sessions for Preceptorship and Internationally Educated Nurses. The outcome from this training has demonstrated the impact of RCDP in learner confidence and in technical and non-technical skills, that can be replicated in other forms of scenario-based training. 1. Peng CR, Schertzer, K. Rapid Cycle Deliberate Practice in Medical Simulation. Treasure Island, Florida: StatPearls Publishing; 2022. 2. Erickson A, Lundell J, Michela E, Pfleger PI. Gamification. In: Kimmons R, Caskurlu S (eds.) The Students’ Guide to Learning Design and Research. EdTech Books; 2020.

Using simulation to support a new theatre setup

Following the redevelopment of the day case theatre complex at Chorley District General Hospital it was identified that new ways of working were required, and changes to patient processes would need to be made. Some of these were normal, expected, adaptations to be made when moving to a new working environment, such as the location and storage of equipment. The Resuscitation and Simulation Team, led by the associate Clinical Lead for Simulation, modelled the theatre list for the first day using simulated patients and in line with the ASPiH standards [1]. This gave the theatre staff the opportunity to run through cases in real time and gauge when patients needed to be sent for, how long was needed for setting up, and at what time they could safely call for the next patient without causing unnecessary delays or having patients waiting in corridors. Each step in the process was followed by a debriefing so that the actions could be discussed and any changes made. The feedback was positive and team members found it extremely useful to simulate their upcoming lists. As expected, there were several patient flow related issues raised, mainly around timings and logistics ( Issues identified following simulation of a theatre list Simulation of normal business can be successfully used to improve patient safety and the confidence of clinical staff when developing new clinical areas. 1. Association for Simulated Practice in Healthcare. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education.

Evaluation of timeliness and models of transporting critically ill children for intensive care: the DEPICT mixed-methods study

Background Centralisation of paediatric intensive care has increased the need for specialist critical care transport teams to transfer sick children from general hospitals to tertiary centres. National audit data show variation in how quickly transport teams reach the patient’s bedside and in the models of care provided during transport; however, the impact of this variation on clinical outcomes and the experience of patients, families and clinicians is unknown. Objectives We aimed to understand if and how clinical outcomes and experience of children transported for intensive care are affected by timeliness of access to a transport team and different models of transport care. Methods We used a mixed-methods approach with a convergent triangulation study design. There were four study workstreams: a retrospective analysis of linked national clinical audit data (2014–16) (workstream A), a prospective questionnaire study to collect experience data from parents of transported children and qualitative analysis of interviews with patients, families and clinicians (workstream B), health economic evaluation of paediatric transport services (workstream C) and mathematical modelling evaluating the potential impact of alternative service configurations (workstream D). Results Transport data from over 9000 children were analysed in workstream A. Transport teams reached the patient bedside within 3 hours of accepting the referral in > 85% of transports, and there was no apparent association between time to bedside and 30-day mortality. Similarly, the grade of the transport team leader or stabilisation approach did not appear to affect mortality. Patient-related critical incidents were associated with higher mortality (adjusted odds ratio 3.07, 95% confidence interval 1.48 to 6.35). In workstream B, 2133 parents completed experience questionnaires pertaining to 2084 unique transports of 1998 children. Interviews were conducted with 30 parents and 48 staff. Regardless of the actual time to bedside, parent satisfaction was higher when parents were kept informed about the team’s arrival time and when their expectation matched the actual arrival time. Satisfaction was lower when parents were unsure who the team leader was or when they were not told who the team leader was. Staff confidence, rather than seniority, and the choice for parents to travel with their child in the ambulance were identified as key factors associated with a positive experience. The health economic evaluation found that team composition was variable between transport teams, but not significantly associated with cost and outcome measures. Modelling showed marginal benefit in changing current transport team locations, some benefit in reallocating existing teams and suggested where additional transport teams could be allocated in winter to cope with the expected surge in demand. Limitations Our analysis plans were limited by the impact of the pandemic. Unmeasured confounding may have affected workstream A findings. Conclusions There is no evidence that reducing the current 3-hour time-to-bedside target for transport teams will improve patient outcomes, although timeliness is an important consideration for parents and staff. Improving communication during transport and providing parents the choice to travel in the ambulance with their child are two key service changes to enhance patient/family experience. Future work More research is needed to develop suitable risk-adjustment tools for paediatric transport and to validate the short patient-related experience measure developed in this study. Trial registration This trial is registered as ClinicalTrials.gov NCT03520192. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 34. See the NIHR Journals Library website for further project information.

Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review.

To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.

Evaluating methods for the use and decontamination of needleless connectors: A qualitative inquiry.

Needleless connectors (NCs) are essential devices designed to provide safe, needle-free connection between venous access devices, syringes and infusions. There is a variety of designs, and associated decontamination products and practices; the resulting confusion can cause detrimental patient outcomes. This study aimed to explore nurses' attitudes, techniques, and practices around the use and decontamination of NCs in clinical practice. Qualitative inquiry was conducted with seven focus groups of 4-6 participants each in the cancer and surgical units of a large tertiary hospital in Australia between January and March 2019. Participants comprised nurses who had taken part in a recent clinical trial of NC decontamination. Focus group sessions were recorded, transcribed and synthesised using content analysis. Seven focus groups were conducted (total, N=30 participants), lasting 16-20min. Six major themes were identified surrounding needleless connector use and decontamination: 'safety and utility'; 'terminology and technological understanding'; 'clinical practice determinants'; 'decontamination procedures and influencers'; 'education and culture'; and 'research and innovation'. The participants articulated positive attitudes towards needleless connector use for needle-stick and infection prevention, however rationales for care and maintenance practices demonstrated limited understanding of guidelines (e.g., disinfection time) and specific NC function (e.g., positive, negative pressure). The findings indicated the need for targeted, standardised needleless connector education, to enhance staff confidence, improve consistency of care and ensure patient safety.

Physical activity knowledge and confidence of education staff in a special education setting

Children with intellectual disabilities (ID) are less likely to meet physical activity (PA) guidelines and have higher tendencies towards sedentary behaviors. Considering a large proportion of a child's day is spent at school, this setting provides a promising environment for increasing PA levels. Staff often significantly impact the success of PA within schools. Limited research has focused on PA knowledge and confidence of staff in a special education setting. In this study, staff from two Schools for Specific Purposes in Sydney, Australia, were invited to complete a questionnaire regarding their knowledge of child PA guidelines, and their confidence in delivering PA to children with ID. Questions were derived from the validated Schools Physical Activity & Nutrition Survey (SPANS). Descriptive analyses were completed on all variables. The questionnaire was completed by 55 of the 74 participants. Although 40.0% reported knowledge of Australian PA guidelines for children, only 20% correctly identified these guidelines. PA was perceived to be ‘extremely important’ (4.69/5) for children with ID, and staff reported ‘confidence’ (3.78/5) in delivering PA for children with ID. Only seven (12.7%) participants reported meeting the New South Wales Department of Education PA requirements (mean = 100 minutes per week). We conclude that despite confidence in delivery of PA and its perceived importance, staff within special education settings have little knowledge of child PA guidelines and are unlikely to meet current Department of Education requirements. We suggest a targeted intervention to improve staff knowledge of PA guidelines, which may enhance the delivery of PA for children with ID.

The effect of multicomponent approach in enhancing the level of confidence with evidence-based practice activities and promoting evidence-based practice culture among nurses in a clinical setting in the United Arab Emirates.

The aim of this work is to examine the effect of multicomponent interventions on enhancing the level of confidence of staff nurses with evidence-based practice in an acute care hospital in the United Arab Emirates. Evidence-based practice is one of the strategic pillars of nursing practice and a key to organizational success. To effectively implement and sustain evidence-based practice programmes in clinical sites, well-designed implementations can promote staff attitude, knowledge, skills, and confidence in translating research evidence into optimal patient care. Experienced and bachelor prepared nurse managers in collaboration with the clinical resource nurse undertook condensed staff training and interventions for the evidence-based practice programme, where 70 registered nurses participated. The intervention was conducted over a period of time extending from December 2019 until December 2020. The study design is quasi-experimental using the pre- and post-Self Efficacy Assessment tool to gauge the nurses' confidence in evidence-based practice. Also, SPSS software was used to explore the effect of the programme. Higher significant score on the evidence-based nursing practice self-efficacy scale postprogramme was noted (t= -7.667 and p value <.001). Participating in a well-structured evidence-based practice programme would positively enhance the nurse's confidence in the programme implementation and promote an evidence-based practice culture in clinical settings. Nurse managers must recognize their critical role in promoting evidence-based practice among nurses. A focused and well-designed intervention may assist in establishing a culture of evidence-based practice to ensure the best patient outcome.

Higher education and the new normal: implications for sustainable post covid-19 era in Nigerian tertiary institutions

This study assessed readiness of Nigerian Tertiary institutions towards adopting e-learning education as a new normal post COVID-19, identified e-learning packages available for use in the institutions before and during the COVID-19 Lockdown using the E-Learning Survey for Academic Staff and Students of Nigerian Tertiary Institutions (ELSASSoNTI). This research adopted an online survey using a quantitative method of data collection. A structured Google Form questionnaire was shared with academic staff and students of public and private tertiary institutions in Nigeria via different online platforms. Population comprised all academic staff and students of South-East Nigerian Tertiary Institutions. A sample size of 615 academic staff and students responded to the instrument. Data were analyzed using descriptive and inferential statistics. Results revealed that: tertiary institutions in Nigeria are to a larger extent not ready for the adoption of e-learning education approaches as teaching-learning alternative during emergencies. Majority of tertiary institutions except private universities did not adopt any e-learning platform for use before and during the COVID-19 lockdown. There is lack of basic resources, logistics, and inadequate capacity for the effective adoption and implementation of e-learning within Nigerian tertiary institutions. The study thus recommends, among other things; provision of facilities needed for smooth transition to the new normal, training programs to improve the confidence of academic staff and students in using e-learning platforms. These would improve their e-learning readiness, overcome the usual disruption of school activities during emergencies and ensure a sustainable post Covid-19 era in the higher education sector.

The acceptability and effectiveness of eHealth interventions to support assessment and decision-making for people with dementia living in care homes: A systematic review.

As dementia progresses, care needs increase leading many to require 24-h care in care homes. eHealth interventions have the potential to improve care processes of assessment and decision-making for people with dementia. However, little is known on the acceptability and effectiveness in care homes. To identify and explore the components, acceptability and effectiveness of eHealth interventions for people with dementia, families and staff to support assessment and decision-making in care homes. A mixed methods systematic review using narrative synthesis. Four databases were searched (Embase, PsycINFO, MEDLINE, and CINAHL) from 2000 to July 2021. Quality appraisal used validated assessment tools appropriate for the study design. Twenty-six studies met eligibility criteria. Study designs and interventions were heterogeneous. Overall quality was high to moderate. Interventions that promoted supportive, practical learning through integrated working and provided staff with language to communicate resident symptoms were favored by staff. We found evidence that indicated residents were willing to use video consultations; however, families preferred face-to-face consultations. Fifteen studies considered effectiveness. Use of eHealth interventions indicates an improvement in resident outcomes in appropriate prescribing and advance care planning. Staff knowledge, confidence, and wellbeing were also improved. Hospitalisations were reduced when a video consultation component was implemented. Care home staff require support to meet the often multiple and changing care needs of residents with dementia. eHealth interventions can improve outcomes for staff and residents and facilitate integrated working with external professionals to support assessment and management of care. Further work is required to understand acceptability for residents and their families and effectiveness on family outcomes, particularly in non-Western cultures and low-middle income countries. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254967, identifier: CRD42021254967.