Clinical Care Experience Research Articles

Medical University of South Carolina College of Medicine.

Medical University of South Carolina College of Medicine.

The Brody School of Medicine at East Carolina University.

The Brody School of Medicine at East Carolina University.

Western University Schulich School of Medicine & Dentistry.

Western University Schulich School of Medicine & Dentistry.

Value-Based Care: An Executive Briefing

In today’s challenging health care environment, the paradigm shift from volume to value requires nurse leaders to develop enhanced skills to transform health care in 2020. Key drivers for success include: igniting innovation and change; embracing data and analytics; and launching new care delivery models that soar beyond organizational boundaries. Value-based care is here to stay, and nursing must be the catalyst for change. Equipped with new skills and the knowledge of CMS Pay for Performance programs, nurse leaders will design the future health care landscape.

Workplace Ostracism in Nurses and Its Determining Factors.

This study attempted to identify workplace ostracism in nurses and its determining factors. Ostracism, which is a form of mistreatment in the nursing workplace, is neglected in the nursing profession although it can affect the quality of healthcare services. The present study was a descriptive correlational study. Nurses in healthcare centers (n = 340) that had at least 12 months of clinical care experience were selected through proportionate stratified random sampling for the period from 2018 to 2019. The study instruments were a modified questionnaire based on the workplace ostracism scale and a questionnaire that assessed personal-social factors. To analyze the data, descriptive and inferential statistics were used. Participants' average ostracism score was 9.03 ± 36.63, and there were statistically significant relationships between ostracism and employment status, university of education, a record of getting an incentive, nurses' current physical disorders, and feelings of colleagues' envy and managers' discrimination. Applying some approaches to educate nurses about interpersonal relationships and clearly communicating mutual expectations between the staff and nursing management could help solve this problem. The study results will serve to guide legislators and managers in developing interventions to create supportive and safe work environments, both for nurses and patients.

Meeting the need for Primary Care and Academic Pediatric Clinical Experiences: An innovative academic practice partnership

Background A primary care practice within a large academic pediatric center identified the need to expand access to after-hours care for the underserved pediatric population in the community. The clinic serves approximately 14,000 pediatric patients aged 0-18 years with over 30,000 visits annually. Over 85% of the clinic patients have public health insurance. State wide, approximately 16% of children live in poverty and 46% are on Medicaid. The minority population is 43% statewide and 77% in counties surrounding the clinic. The partnering academic institution identified the need for additional clinical education experiences for pediatric nurse practitioner (PNP) students. Nationally, academic …

Meeting the need for Primary Care and Academic Pediatric Clinical Experiences: An innovative academic practice partnership

Meeting the need for Primary Care and Academic Pediatric Clinical Experiences: An innovative academic practice partnership

Collaborating With Rural Practice Partners to Provide a Primary Care Experience for Prelicensure Nursing Students.

Prelicensure nursing education has generally emphasized acute care; however, as primary care changes in the United States, academia must transform. The national call for transforming primary care requires innovation in the education of prelicensure nursing students. To ensure future RNs can function in the primary care setting and assume enhanced roles within the interprofessional team, prelicensure nursing students need to be exposed to primary care. A key barrier to providing this essential education is the lack of partnerships with primary care facilities. The purpose of this project was to collaborate with rural practice partners to provide a primary care clinical experience for prelicensure nursing students. Collaboration between academic-practice partners to develop a clinical experience for prelicensure nursing students allowed exposure to the role of RNs in rural primary care. By sharing the process for planning the clinical experience, other interested academic institutions may replicate similar opportunities.

The Acute Care Confidence Survey: Examination of the Psychometric Properties and Predictors of Performance Among Students in a Large Inpatient Hospital System

Introduction. The Acute Care Confidence Survey (ACCS) was created as a measure of student self-efficacy for acute care clinical education experiences (CEEs). Initial measures of validity and reliability have been established; however, further psychometric testing is warranted to facilitate academic and clinical adaptation. This study aimed to further investigate the psychometric properties of the ACCS on a population of physical therapist students from diverse educational backgrounds. The study aims were to examine 1) the test–retest reliability of the ACCS, 2) the relationship between the ACCS and student demographic variables including previous acute care exposure, and 3) the relationship between ACCS scores and clinical performance. Methods. A total of 66 students completing their acute care CEE in a large hospital system were recruited. Sixty students from 14 different Doctor of Physical Therapy programs had complete data sets and were used for the final analysis. On the first day of their CEE, the students completed the ACCS along with a demographic questionnaire including items about academic preparation. Students completed the ACCS a second time within 1 week to determine the test–retest reliability. The midterm Clinical Performance Instrument (CPI) scores were used to measure the CEE performance. Descriptive statistics characterized the sample. A Pearson correlation coefficient was used to determine the test–retest reliability. The associations between ACCS scores and demographic characteristics and CPI scores were computed using Chi squared tests, t tests, and correlation coefficients. Results. The test–retest reliability of the ACCS was 0.83 (P < .0001). The correlation between total ACCS score and midterm CPI score was 0.32 (P < .01); low to moderate correlations were found between the mobility, instruct, and judgment subscales of the ACCS and midterm CPI scores (r = 0.26, 0.30, 0.44, respectively, P < .05). There were low but significant associations between ACCS scores and the number of previous CEEs (first, middle, and terminal; r = 0.33; P < .01), number of weeks of completed full-time CEEs (r = 0.37; P < .003), and number of acute care exposure hours (r = 0.28, P = .02). Having taken a didactic course specifically dedicated to acute care significantly impacted the judgment subscale of the ACCS (P = .005). Discussion. Previous exposure to the acute care setting and CEE experiences, regardless of setting, had a positive impact on the ACCS scores. The low to moderate correlations reported between the ACCS and student performance measured by the CPI indicate that self-efficacy alone may not be sufficient to predict the student performance. Conclusion. These data indicate that the ACCS is a reliable measure of student preparedness. Further examination on the utility of the ACCS is warranted.

Development and testing for a national survey: The Canadian Abortion Provider Survey (CAPS)

Objectives To create a questionnaire able to explore changes in abortion services, workforce, and clinical practices compared to our 2012 Canadian survey, particularly in relationship to the 2017 introduction of mifepristone medical abortion and updated SOGC clinical guidelines. We aimed to create a cross-sectional online survey capturing demographics, clinical care and provider experiences among healthcare professionals providing abortion care either independently or in collaborative care agreements. Methods After completing a literature search, we held expert working-group meetings to revise the 2012 survey instrument. We convened expert focus groups across Canada engaging clinicians and researchers from many sectors, and subsequently piloted the survey instrument. Results We held 7 expert working groups of 5–10 participants each. Input from participants including family physicians, obstetricians & gynaecologists, maternal–fetal–medicine specialists, midwives, nurses, and researchers ensured relevant and concise questions. Due to the complexity of some of the identified topics, such as interdisciplinary collaboration and differences between provinces, some of the survey sections underwent an iterative process of meetings and revisions until we reached consensus on constructs to include. The resulting instrument underwent pilot testing among additional experts representing the study population. We confirmed content validity, clarity of language and usability of the survey instrument. Conclusions The new national survey instrument is the product of a rigorous revision and testing process. We plan to implement the survey in 2020 to assess practice factors and their relationship to recent SOGC guidelines. To create a questionnaire able to explore changes in abortion services, workforce, and clinical practices compared to our 2012 Canadian survey, particularly in relationship to the 2017 introduction of mifepristone medical abortion and updated SOGC clinical guidelines. We aimed to create a cross-sectional online survey capturing demographics, clinical care and provider experiences among healthcare professionals providing abortion care either independently or in collaborative care agreements. After completing a literature search, we held expert working-group meetings to revise the 2012 survey instrument. We convened expert focus groups across Canada engaging clinicians and researchers from many sectors, and subsequently piloted the survey instrument. We held 7 expert working groups of 5–10 participants each. Input from participants including family physicians, obstetricians & gynaecologists, maternal–fetal–medicine specialists, midwives, nurses, and researchers ensured relevant and concise questions. Due to the complexity of some of the identified topics, such as interdisciplinary collaboration and differences between provinces, some of the survey sections underwent an iterative process of meetings and revisions until we reached consensus on constructs to include. The resulting instrument underwent pilot testing among additional experts representing the study population. We confirmed content validity, clarity of language and usability of the survey instrument. The new national survey instrument is the product of a rigorous revision and testing process. We plan to implement the survey in 2020 to assess practice factors and their relationship to recent SOGC guidelines.

Registered nurse education in primary care: Barriers and resolutions.

American health care is facing unprecedented challenges due to population aging, chronic disease prevalence, and financial restructuring. The Affordable Care Act (ACA) is transforming the primary care landscape from a reactive, episodic, fee-for-service system to a proactive, preventive, value-based system. A proactive, preventive, and value-based primary care model requires Registered Nurses (RNs) prepared to lead integrated, team-based, coordinated, and proactively managed care. The Health Resources and Service Administration (HRSA) forecasted an inadequate supply of RNs prepared to meet future primary care demands and highlighted the lack of education as a key problem. The primary care RN workforce shortage requires immediate attention by academic, political, and research stakeholders. HRSA has responded with academic funding to increase primary care RN education. This article describes key barriers and resolutions one HRSA-funded academic institution experienced while implementing a primary care RN education program, along with research implications for the future of primary care nursing. This article describes the project's stakeholder, faculty, and student engagement methods. This article also describes the clinic RN preceptor development program, and depicts the Primary Care RN Education Program Student Clinical Experience Preceptorship Model. Nursing education must align with transforming healthcare models while anticipating potential barriers and resolutions to enhancing curriculum with primary care nursing education and clinical experiences. This article provides insight for other academic institutions interested in developing primary care curriculum and academic-clinic partnership models to foster community-based primary care clinical experiences.

Palliative Care Training for Consultation-Liaison Psychiatry Fellows: A National Survey Project

Provision of palliative care is part of the standard of care for patients with serious, life-limiting medical illnesses. Patients in the palliative care setting have high rates of psychiatric co-morbidity. However, integration of mental health care into palliative care remains a significant gap. With appropriate training, consultation-liaison (C-L) psychiatrists are well-positioned to improve integration of mental health into palliative care. To understand current palliative care training practices for C-L psychiatry fellows in the United States. We invited all U.S. C-L psychiatry fellowship program directors to participate in a 17-item online structured survey aimed at understanding palliative care training in their fellowship programs. 37/61 (61%) of C-L psychiatry fellowship program directors responded to the survey. Eighty-six percent of programs provide some palliative care didactics, but the topics covered vary widely. Programs are closely split between offering a required, elective, or no clinical palliative care experiences. Only about half (45%) of programs identify formal opportunities for interaction between palliative care and C-L psychiatry fellows. Program directors identified topics such as goals-of-care discussions, systems issues in end-of-life care, and pain management as important for fellows to learn. Barriers to teaching these topics included time, lack of teaching faculty, and disciplinary siloes. Although C-L psychiatry fellowship program directors identify a number of key teaching topics in palliative care for C-L psychiatry fellows, there are wide discrepancies in the depth and content of existing palliative care didactic and clinical experiences in C-L psychiatry fellowships.

Student Interest in a Primary Care of Underserved Populations Course.

Medical students often lack curricular offerings specific to the care of underserved populations. We surveyed first- and second-year students to inform the development of a 4-week course on the skills necessary to care and advocate for underserved populations within a primary care context. This study assessed students' interest in the potential course, interest in primary care (PC) and underserved care (UC), and factors that would make the course more or less interesting to students. The authors designed and offered a survey examining UC, PC, and course interest to all first- and second-year students at one institution. Open-ended free-text survey responses were qualitatively analyzed using content analysis. Response rate was 72% (271/374). Most responding students (90%; 198/220) were very to somewhat interested in UC; 60% (132/220) were very to somewhat interested in PC; and 79% (173/220) were very to somewhat interested in the described course. Very interested students were more likely to endorse interest in learning about community advocacy, having a faculty mentor, clinical care experience, and loan repayment than those with low course interest (P<.001). Analysis of open-ended responses revealed an emphasis on advocacy and career feasibility, resulting in the inclusion of these topics in the final course curriculum. This manuscript outlines potential areas of engagement for students demonstrating low or high interest in a Caring for Underserved Patients course. Our study may inform educators seeking to develop similar curricular interventions, particularly those who aim to recruit students to PC or UC careers.

Nurse’s Perception of Barriers to Research Utilization in Hospitals; Comparative Descriptive Study

Background: Although the number of studies on research utilization is steadily growing, but still there is a strong need to identify the main causes that inhibit the use of research findings in the clinical setting. Aim of the Study: To assess nurse’s perception of barriers to research utilization in Saudi Arabia and Palestine Hospitals. This study focuses on medical and surgical nurses in private hospitals. Method: A convenient sample of 156 medical nurses, from 6 general private hospitals, 3 from north Palestine and 3 from Riyadh City (KSA). Results: Out of 180 nurses employed from private hospitals, a total of 156 questionnaires were returned (response rate 86.67%). Results in a final sample size for analysis of 156. The demographic characteristics, age, gender, hospital, role on health care team, clinical experience, marital status, education degree, and current certified in a special area of respondents are shown in Table 1. Their mean age was 29.41, about half of them below 6-year clinical experience 77 (49.4%). Although around 90 (57.7%) of the participants from Palestine hospitals and 66 (42.3%) from Saudi Arabia hospitals, almost half of them their education (diploma) 85 (54.5%). In addition, 114 (73.1%) were female, 85 (54.5%) have current certified in a special area, and 140 (89.7%) respondents worked as staff nurses. Regarding perceptions of barriers to research utilization, the results of the barriers show in the total scale a mean of 3.15 out of 5 f (SD = 0.55; 95% CI 3.05 to 3.23). The subscales of setting and research were the highest one (mean = 3.22, SD = (0.63), and the lowest one is “nurse” (mean = 2.95, SD = 0.75). Conclusions: The main barriers of research utilization in practice for nurse are nurses themselves, the setting in the hospitals and research in its process and findings.

Collaborative governance in the Quebec Cancer Network: a realist evaluation of emerging mechanisms of institutionalization, multi-level governance, and value creation using a longitudinal multiple case study design

BackgroundPeople living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems.National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the “missing link” for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system.Methods/designThe study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.

Development and Evaluation of a Simulation-Based Acute Care Course in a Physical Therapist Education Program

Introduction. Delivery of acute care content in physical therapist (PT) education programs varies greatly. A new course included a series of 6 progressively complex, high fidelity, immersive acute care simulation-based learning experiences (SBLEs) using standardized patients. The primary purpose of this study was to examine the students' perceived value of the SBLEs in relationship to their acute care clinical experiences (CEs). Self-efficacy and clinical performance were also measured to further evaluate course outcomes. Participants. Students completing acute care CEs were recruited from 3 consecutive cohorts of a Doctor of Physical Therapy (DPT) program. The control group completed the curriculum before implementing the new course. The experimental groups participated in the first and second years of the course, respectively. Methods. A total of 60 students across the 3 cohorts completed the study. Experimental groups completed the course before their acute care CE. Focus groups were conducted to explore student perspectives with both experimental groups on completion of their respective CEs. Self-efficacy was assessed using the Acute Care Confidence Survey before the course, after course completion, and midterm of the CE. Clinical performance was evaluated using the PT Clinical Performance Instrument rating scale at both midterm and final of the CE. Results. Qualitative analysis revealed 2 main themes: (1) SBLEs foster self-efficacy in application of the 3 domains of learning and (2) students develop a wider perspective of the dynamic professional roles of the acute care PT. Self-efficacy significantly increased, and there was an upward trend, although no significant difference, in clinical performance for students who completed the course. Conclusions. Student performance in the acute care setting was positively influenced by a series of SBLEs. A simulation-based acute care course can be effectively incorporated into a DPT curriculum to foster student's professional identity in multiple domains.

Supremacy of Auditory Versus Visual Input in Somatic Empathy and Perceived Pain Level

BackgroundPrevious studies support the role of both auditory and visual stimuli in the evocation of empathy, but no research to date has explored the relative effectiveness of each on any type of empathy. AimsThe present study compared how auditory and visual presentation influence somatic empathic arousal and perceived pain level. DesignExposure to auditory and/or visual information about an individual in pain was manipulated between groups of participants. MethodsStudents (N = 125) in several classes were randomly assigned in groups to one of three conditions—audio-only, video-only, or audio-video—each portraying an elderly man suffering from a painful kidney stone. Participants indicated his perceived pain and level of danger and relevant physical sensations and completed an empathy status scale. ResultsConsistent with the hypothesis, the results indicated that participants who were presented with an auditory stimulus (audio-only and audio-video conditions) estimated higher and more accurate pain and danger level for the patient compared with those in the visual-only group. Participants in the audio groups also reported experiencing physical sensations, whereas the visual-only group had no such report. ConclusionsThe study found that auditory information is more impactful in eliciting perceptions of pain in others compared with visual information. Experiences of clinical empathy and patient care may be improved by focusing on patients’ auditory pain communications.

A Framework for the Development of Healthcare Provider Education Programs on Human Trafficking Part Two: Survivors

ABSTRACT Background Previous work indicates that clinicians are seeing patients while they are being trafficked and these patients often have negative healthcare experiences. Survivor-recommended solutions are essential to training healthcare provider (HCPs) to better care for this patient population. Objective This investigation explored what content survivors of human trafficking (HT) recommend be included in HCP trainings on HT. Additionally, this study described the experiences of trafficking survivors who accessed healthcare to provide context to their recommendations. Methods A two-round mixed-methods Delphi was deployed to identify what topics trafficking survivors deemed important for inclusion in HCP educational programs. Survivors were recruited via purposive and snowball sampling, and received a $25 Amazon.com gift card for participation. Data was analyzed qualitatively using thematic analysis and quantitatively using the Individual Content Validity Index (ICVI) with a predetermined cut-off of 0.78. Results In phase one, 38 of 51 survivors approached participated; in phase two, 30 of the 38 participated. Participants shared multiple negative clinical care experiences, including inappropriate physical exams, breach of confidentiality, and frank HCP disbelief at patient disclosures. Based on their experiences, participants recommended the following content be included in HCP education: acceptable approaches to physical and psychosocial exams, appropriate patient referral methods, safe discharge planning techniques, and strategies that minimized barriers to effective recognition, intervention and referral for victims. Conclusions Human trafficking survivors are experts on their lived experiences and have valuable insights into content that is important for inclusion in HCPs’ training on the issue. Survivor participants emphasized measurable and immeasurable content as crucial components of a comprehensive educational program for healthcare providers.

Advocacy: Writing Effective Op-Ed Pieces

Child and adolescent psychiatrists have extensive experience in direct clinical care and working within health systems. This leads to an expertise that can inform and improve mental health care delivery. Yet physician voices aren’t necessarily sought after or readily heard when making legislative and policy decisions. Writing informative and effective op-eds can amplify your voice, but it requires many elements beyond expertise. An effective op-ed must be engaging enough to be read by a diverse group of readers, informative enough to allow readers to grasp the issues, and should avoid divisive language that could introduce barriers to problem solving.

Dementia Care Education for Nursing Students.

A theoretical foundation and clinical experience are necessary to prepare nursing students for the care requirements of people with dementia. A quasi-experimental design was used to examine the impact of Dementia Care Bootcamp (DCB) and clinical experience on students' dementia knowledge and attitudes, self-confidence for dementia care, and empathy, compared with students who received only the DCB. All students received a 10-hour DCB; half also received a clinical experience and completed a journal assignment. The DCB had a positive and significant effect on students' dementia attitudes, knowledge, and dementia care confidence and no effect on empathy. There was no significant difference between students who participated in the clinical experience and those who did not on any of the outcome measures. Although the DCB improved student outcomes, one clinical day was insufficient to further improve students' knowledge, attitudes, self-confidence, or empathy. Several reasons for the findings are discussed. [J Nurs Educ. 2019;58(3):136-143.].