Patient Assessment Skills Research Articles

Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective.

Introduction Rural hospitals, particularly those in geographically isolated regions like Shimane Prefecture, Japan, face significant healthcare delivery challenges. These include limited resources, an aging population, and a scarcity of healthcare professionals. Advanced practice nurses (APNs) have emerged as pivotal in addressing these gaps, offering specialized patient assessment, diagnosis, and management skills. This study aimed to evaluate the demand for APNs in rural community hospitals, focusing on the specific educational needs and clinical competencies required to improve healthcare outcomes in these settings. Method Employing a mixed-methods approach, this research combined qualitative insights from stakeholder interviews with quantitative data analysis of electronic health records (EHRs) at Unnan City Hospital. This sequential exploratory design aimed to capture comprehensive educational needs and outcomes, integrating the depth of qualitative data with the breadth of quantitative evidence to tailor a curriculum for APNs in rural healthcare contexts. Results The study revealed a critical demand for APNs skilled in managing common medical issues in rural settings, such as infections, circulatory failures, and respiratory problems. Stakeholder interviews highlighted the necessity for a curriculum that enhances clinical competencies and emphasizes soft skills like communication and leadership. An analysis of EHRs identified 21 specific diseases across six categories, underlining the importance of targeted education on these prevalent conditions. Conclusion The findings underscore the urgent need for specialized education programs for APNs in rural hospitals to address these communities' unique healthcare challenges. Developing a curriculum that focuses on clinical and soft skills essential for rural healthcare delivery can significantly enhance the quality of care. This study advocates for implementing such tailored educational programs to empower APNs, thereby contributing to healthcare equity and improving patient outcomes in rural settings.

Automated rapid response system activation-Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed-methods study.

To explore general ward nurses' attitudes and perceptions towards recognising and responding to clinical deterioration in a hospital with automated rapid response system activation. There is growing interest in deploying automated clinical deterioration notification systems to reduce delayed or failed recognition and response to clinical deterioration of ward patients. However, little is known about its impact on ward nurses' perspectives and work patterns. A mixed-methods study. Online survey of 168 registered nurses and individual interviews with 10 registered nurses in one acute hospital in Singapore. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. Many nurses (38.1%) rarely performed patient assessments or observations other than vital signs assessment to assess for early signs of clinical deterioration. About 30% were worried about being criticised for calling the primary team doctors. Four themes emerged from the qualitative analysis: automated rapid response system activation as a safety net, being more cautious with vital signs monitoring, the NEWS2 alone is inadequate, and ward nurses as the 'middleman' between the intensive care unit outreach nurse and primary team doctors. Although nurses value the automated rapid response system activation as a safety net to minimise delays in accessing urgent critical care resources, it does not address the sociocultural barriers inherent in escalation of care. Although the automated system led nurses to be more cautious with vital signs monitoring, it does not encourage them to perform comprehensive patient assessments to detect early signs of deterioration. Nurse education on assessing for clinical deterioration should focus on the use of broader patient assessment skills other than vital signs. Sociocultural barriers to escalation of care remain a key issue that needs to be addressed by hospital management. No patients, service users, care-givers or members of the public were involved in the study.

Evaluation and Management of Developmental Dysplasia of Hip (DDH) in Children - Our Experience

Introduction: DDH is the most common congenital anomaly of the musculoskeletal system in newborns. The disease ranges from a simple flattening of the acetabular cavity to the complete dislocation of the femoral head. Most developed countries report an incidence of 1.5 to 20 cases of DDH per 1000 births, depending in part on the methods of screening used. It includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. Aim of the Study: The aim of this study was to evaluate the management of the Developmental Dysplasia of Hip (DDH) in children. Methods: This retrospective study was conducted in the Department of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh during the period from January2018 to December 2021. Result: In total 54 neonates completed the study. In our study we found majority (53.70%) of children were aged less than 4 months old. Followed by 25.93% & 20.37% were aged 1-2 months & 3-4 months respectively. Majority of neonates were girls (61.11%) compared to boys (38.89%). The highest risk factors of DDH was breech presentation (19%).We found that majority of neonates (70.37%) had dysplasia on left side and 7.41% had dysplasia on right side respectively. The prevalence of bilateral condition was 12(22.22%). Conclusion: DDH a common congenital anomaly that can be successfully treated non-operatively if detected early. For older individuals with dislocated or unstable hips, surgery is necessary. Surgery's function in treating acetabular dysplasia in children is changing and largely determined by symptoms. Expanding therapy choices for DDH and improved anatomical patient assessment skills among doctors will result in the proper intervention at the right time.

Analysis of shared cognitive tasks in the application of non-invasive ventilation to patients with COPD exacerbation

ABSTRACT Interprofessional teamwork plays a key role in the uptake of evidence-based interventions, such as noninvasive ventilation (NIV) for patients with exacerbated Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify the shared cognitive tasks in interprofessional teams using NIV for patients with COPD exacerbation. We used a cognitive task analysis approach (CTA) to engage nurses, rapid response team members, respiratory therapists, and physicians involved in the use of NIV to treat patients with COPD exacerbation. Clinicians participated in a semi-structured interview (n = 21) that elicited cognitions needed to treat COPD exacerbation. Three shared cognitive tasks were identified: Complete a thorough assessment, Formulate a care plan, and Continuously monitor patient status. Findings attest to the importance of having access to up-to-date information and expertise necessary to make accurate clinical inferences for patient assessment. Shared understanding of the formulated care plan among all members of the care team was important to its execution. Continuous monitoring was crucial; however, this cognitive task relied on patient assessment skills and ongoing collaboration within the clinical care team. Application of NIV for patients with COPD exacerbation may require enhancing collaboration through nontechnical skills and interprofessional training.

What patient assessment skills do pharmacist independent prescribers require to prescribe immunomodulators in myeloma?

To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing immunomodulators in myeloma across National Health Service Scotland. This was a two-phase study which used nominal group technique to gain local consensus followed by a two-round eDelphi questionnaire to gain national consensus across all cancer networks. This project was conducted across the three cancer networks within NHS Scotland: South East Scotland Cancer Network; West of Scotland Cancer Network and North Cancer Alliance. Participants were invited from each cancer network (South East Scotland Cancer Network, West of Scotland Cancer Network and North Cancer Alliance) and included haematology consultants, haematology specialist registrars, haematology advanced nurse practitioners and haematology pharmacists. There were five participants in the nominal group technique. Twenty-two out of 31 patient assessment skills gained local consensus, seven patient assessment skills did not gain consensus and two patient assessment skills were deemed irrelevant. There were 12 and 14 participants in round one and two of the eDelphi questionnaire, respectively. Twenty-nine patient assessment skills were included in the first-round questionnaire and 21 gained consensus. The remaining eight patient assessment skills were included in round two where seven did not achieve consensus and one achieved disagreement consensus. This research outlines 21 patient assessment skills required for pharmacist independent prescribers to prescribe immunomodulators for myeloma patients according to haematology specialists in Scotland. Discussion on patient assessment skills without consensus showed that the pharmacist independent prescribers would have a shared responsibility with the consultant. This work should inform the development of a competency framework to allow training of pharmacist independent prescribers in Scotland. Some patient assessment skills could be transferrable for pharmacist independent prescribers prescribing systemic anti-cancer therapy for other haematological malignancies.

The defining characteristics of newly graduated nurses – A Delphi study

Despite processes designed to ensure that graduates of accredited nursing programs possess the necessary skills and knowledge to enter the workforce, a gap remains between graduate capabilities and industry expectations of work-readiness. This study aims to identify the defining characteristics of work-ready graduate nurses from the perspective of a purposive sample of new graduates, employers and academics utilising a three-round Delphi design and to compare the findings. In Round One participants provided free-text descriptors of graduate attributes, core knowledge and skills. In Rounds Two and Three participants prioritised categorised results from Round One and added free-text responses. Data from these rounds were not aggregated. In Round One, 14 academics, 20 clinicians and 12 graduates provided responses. In Round Two we received 10, 12 and 5 responses respectively and in Round Three 9, 8 and 4 responses respectively. The final round identified 19 characteristics and attributes, 10 knowledge areas and 11 skills for work-ready graduate nurses. This study identified that graduates should be safe practitioners, with professional behaviours, an understanding of anatomy and physiology, pathophysiology of disease, and medication safety, with good patient assessment and communication skills. Time management and prioritisation skills that graduates expect of themselves, develop with consolidation of practice.

Use of patient assessment skills in advanced pharmacy practice experiences

IntroductionPharmacy programs are required to teach patient assessment (PA) skills. However, pharmacist workforce survey data indicates that limited opportunities exist for students to practice PA skills in real-world settings. The study objectives were to (1) assess how often PA skills are utilized by fourth-year pharmacy (P4) students on advanced pharmacy practice experiences (APPEs), (2) determine perceived competence in performing PA skills, and (3) examine relationships between grade-point average or post-graduation plans and the number of skills performed and between skill use frequency and self-reported competency. MethodsP4 students completed a questionnaire assessing 13 PA skills. Respondents performing a skill indicated frequency of use and rated their competence using a 5-point scale. Descriptive and bivariate statistics were reported. ResultsThe response rate was 81%. Measuring blood pressure (BP) (76%) and evaluating metered-dose inhaler (MDI) technique (74%) were most commonly performed. Peak-flow meter evaluation (6%) and lymph node examination (2%) were least commonly performed. Measuring BP and evaluating MDI technique had the highest competency ratings (4.6 + 0.7 for both). Lung (3.4 + 0.7) and heart (2.8 + 1) auscultation had the lowest competency ratings. Positive correlations were found between the frequency of skill use and self-reported competence for assessing MDI technique, peripheral pulses, and peripheral edema. No other findings were significant. ConclusionsP4 students reported high perceived competency for PA skills performed frequently during APPEs. Preceptor education, requiring skill use, and encouraging students to proactively identify situations to use skills could increase opportunities for use of PA skills.

Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study

BackgroundBlunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care.AimTo identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation.Methods1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis.2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains.3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria.ResultsOne hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators (TDF domains) were: understanding evidence-informed patient care and understanding risk factors (Knowledge); patient assessment skills and blunt chest injury management skills (Physical skills); identification with professional role (Professional role and identity); belief of consequences of care bundle (Belief about consequences); provision of training and protocol design (Environmental context and resources); and social supports (Social influences). Barriers were: not understanding the term ‘care bundle’ (Knowledge); lacking regional analgesia skills (Physical skills); not remembering to follow protocol (Memory, attention, and decision processes); negative emotions relating to new protocols (Emotions); equipment and protocol access (Environmental context and resources). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions.ConclusionsMultiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implementation strategies developed through this process have been included in a plan for implementation in the emergency departments of two hospitals. Evaluation of the implementation is underway.

What patient assessment skills are required by pharmacists prescribing systemic anti-cancer therapy? A consensus study.

In the UK, pharmacist independent prescribers can prescribe for any condition within their clinical competence including systemic anti-cancer therapy. Competency frameworks have been developed but contain little detail on the patient assessment skills pharmacist independent prescribers require to prescribe systemic anti-cancer therapy with concern in the literature over current training on these skills. To gain consensus on the patient assessment skills required by pharmacist independent prescribers prescribing systemic anti-cancer therapy for genitourinary cancer (prostate and renal) and lung cancer across National Health Service Scotland. Two phases were performed to generate patient assessment skill consensus. Initially, the Nominal Group Technique was performed within a local cancer network by discussion and participant ranking within genitourinary and lung cancer multi-disciplinary teams. Where consensus was achieved, patient assessment skills were carried forward to try to achieve national (National Health Service Scotland) consensus using a two-round Delphi questionnaire. Of the 27 patient assessment skills, consensus was gained for 21 and 23 patient assessment skills in the genitourinary and lung Nominal Group Technique groups, respectively. Within the genitourinary and lung national groups, 13/21 and 18/23 patient assessment skills were agreed as required for a pharmacist independent prescriber to prescribe systemic anti-cancer therapy in genitourinary and lung cancer, respectively. Eight common patient assessment skills were identified as core skills. Reasons for not reaching consensus included pharmacist independent prescriber competence, knowledge, skills and the roles and responsibilities of pharmacist independent prescribers within the multi-disciplinary team. We identified the core and specific patient assessment skills required to prescribe systemic anti-cancer therapy within two tumour groups. Further work is necessary to develop patient assessment skill competency frameworks, training and assessment methods and to redefine the roles of pharmacist independent prescribers within the multi-disciplinary team.

Improving Simulation Debriefing in Paramedic Education: The Paramedic Debrief Model

Introduction Simulation training is widely used in paramedic education. Quality of debriefing is central to optimising learning from educator-facilitated simulation training. There is considerable variation in the provision of simulation debriefs by paramedic educators, often leading to a varied perception of the quality of debrief by both students and tutors. There are currently no standardised debrief tools specific to paramedic practice. The purpose of this study was to provide a rationale and theoretical framework for the development of a paramedic specific model for simulation debrief, the Paramedic Debrief Model (PDM), that reflects the key elements of optimal debrief practice, feedback and reflective learning principles and that is aligned to a construct of paramedic competencies. Methods A systematic literature review was conducted that focussed on two areas: best practice, principles and models for simulation debrief and constructs for paramedic competencies. Emergent theme analysis was used to identify key components of effective simulation debrief and a construct of paramedic competencies that could be incorporated into the debriefing tool. Results It was identified that an optimal simulation debrief transitions sequentially through the elements of reaction, recollection, reflection, analysis and application. The construct of paramedic competencies best aligned with paramedic education consist of eight elements: communication, resource utilisation, ethics, situational awareness, decision making, patient assessment, history gathering and procedural skills. These themes were combined to create the PDM. Conclusion The study identified the key elements of an optimal simulation debrief and incorporated a construct of paramedic competencies to create the PDM. The PDM offers an evidence-based, structured approach to paramedic simulation debriefing and has potential to be utilised as an optimal strategy for facilitating simulation debriefs in paramedic education.

A qualitative exploration of current paramedic cardiac auscultation practices

This exploratory study addresses the current paucity of knowledge available in UK paramedic practice in relation to cardiac auscultation. There is a recognised lack of data surrounding the efficacy, safety and relevance of patient assessment skills in the pre-hospital setting in general, and cardiac auscultation specifically. This study provides information about current paramedic practice, and provides a basis for further research in this area. An online survey was distributed using convenience and snowball sampling, receiving 328 responses within a 31-day period. The results show that many paramedics rarely, or indeed never, undertake cardiac auscultation and that many lack confidence in recognising normal and abnormal heart sounds. There is also a divided opinion among respondents who provided free-text answers, with some feeling that the skill of cardiac auscultation is vital in pre-hospital care and others firmly disagreeing. This research lays the groundwork for further developments in training, education and continuing professional development for paramedics.

The Importance of Quality in Ventilation-Perfusion Imaging.

As the health care environment continues to change and morph into a system focusing on increased quality and evidence-based outcomes, nuclear medicine technologists must be reminded that they play a critical role in achieving high-quality, interpretable images used to drive patient care, treatment, and best possible outcomes. A survey performed by the Quality Committee of the Society of Nuclear Medicine and Molecular Imaging Technologist Section demonstrated that a clear knowledge gap exists among technologists regarding their understanding of quality, how it is measured, and how it should be achieved by all practicing technologists regardless of role and education level. Understanding of these areas within health care, in conjunction with the growing emphasis on evidence-based outcomes, quality measures, and patient satisfaction, will ultimately elevate the role of nuclear medicine technologists today and into the future. The nuclear medicine role now requires technologists to demonstrate patient assessment skills, practice safety procedures with regard to staff and patients, provide patient education and instruction, and provide physicians with information to assist with the interpretation and outcome of the study. In addition, the technologist must be able to evaluate images by performing technical analysis, knowing the demonstrated anatomy and pathophysiology, and assessing overall quality. Technologists must also be able to triage and understand the disease processes being evaluated and how nuclear medicine diagnostic studies may drive care and treatment. Therefore, it is imperative that nuclear medicine technologists understand their role in the achievement of a high-quality, interpretable study by applying quality principles and understanding and using imaging techniques beyond just basic protocols for every type of disease or system being imaged. This article focuses on quality considerations related to ventilation-perfusion imaging. It provides insight on appropriate imaging techniques and protocols, true imaging variants and tracer distributions versus artifacts that may result in a lower-quality or misinterpreted study, and the use of SPECT and SPECT/CT as an alternative providing a high-quality, interpretable study with better diagnostic accuracy and fewer nondiagnostic procedures than historical planar imaging.

Undertaking an accurate and comprehensive assessment of the acutely ill adult.

Accurate assessment of the acutely ill adult who has recently been admitted to hospital, or an inpatient whose condition begins to deteriorate, is becoming a required skill for nurses as people live longer and with a variety of complex conditions, and as nursing skills continue to evolve and develop. This article emphasises the importance of undertaking an accurate and comprehensive patient assessment to ensure that management strategies are implemented in a timely manner. The article also considers the importance of the National Early Warning Score (NEWS), which is a 'track-and-trigger' tool designed to identify patients who are at risk of deterioration. The presentation of shock is considered and how this can be identified using the NEWS. The patient assessment skills required by nurses are discussed and the main signs of patient deterioration, regardless of cause, are outlined. The article also examines the ABCDE (airway, breathing, circulation, disability and exposure) approach to assessment.

Patient assessment skills currently taught in pharmacy curricula

BackgroundAccreditation standards and guidelines discuss the inclusion of patient assessment in pharmacy education; however, there is no detail on specific skills that should be included in the curriculum. ObjectiveThis study describes patient assessment items currently taught in pharmacy school curricula across the United States. MethodsAn online questionnaire was distributed to 128 schools of pharmacy. Totally, 80 patient assessment items were compiled from a course textbook and faculty experience. Participants indicated which items were taught in didactic portions of the curricula. ResultsRespondents stated anywhere from 5 to 78 of the skills were taught at their institution, with manual blood pressure and heart rate measurement performed at every institution. In addition, at least 75% of schools stated the following items were taught: breath sounds auscultation, heart sounds auscultation, monofilament testing, pain assessment, palpatory pressure measurement, peak flow meter use, peripheral edema inspection or palpation, point-of-care testing, respiratory rate measurement, and temperature measurement. ConclusionWhile a variety of patient assessment items exist, there is some consistency with regard to what items are taught in pharmacy curricula. These study results identified areas of consistency, and may help establish best practices for patient assessment items within pharmacy curricula.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

Improving Escalation of Care: A Double-blinded Randomized Controlled Trial.

This study aimed to determine whether an intervention could improve the escalation of care skills of junior surgeons. Escalation of care involves the recognition, communication, and response to patient deterioration until a satisfactory outcome has been achieved. Although failure to escalate care can lead to increased morbidity and mortality, there is no formal training in how to perform this vital process safely. This randomized controlled trial recruited postgraduate year (PGY)-1 and PGY-2 surgeons to participate in 2 scenarios involving simulated patients requiring escalation of care. A control group performed both scenarios before receiving the intervention; the intervention group received the educational intervention before their second scenario. Scenarios were video recorded and rated by 2 independent, blinded assessors using validated scales to measure patient assessment, communication, management and nontechnical skills of participants, and the number of medical errors they detected. A total of 33 PGY-1 and PGY-2 surgeons, all with equivalent skill at baseline, participated. Postintervention, the intervention group demonstrated significantly better patient assessment (P < 0.001), communication (P < 0.001), and nontechnical skills (P < 0.001). They also detected more medical errors (P < 0.05). Teaching junior surgeons a systematic approach to escalation of care improved multiple core skills required to maintain patient safety and avoid preventable harm.

More than Just Chasing INRs: Patient-Centred Care in an Anticoagulation Clinic.

INTRODUCTION The Canadian Society of Hospital Pharmacy’s 2015 initiative, targeting excellence in pharmacy practice, sets forth a vision for pharmacists to practice to their full scope and to optimize patients’ medication-related outcomes by providing patientcentred care.1 Patient-centred care “is a professional obligation to take responsibility for, and provide care targeted to, the individual patient’s needs”.2 Fundamental elements of patientcentred care encompass respecting individual patients, appreciating their care goals and values, delivering education, enabling patients to participate in treatment decisions, and providing continuity of care.3 Within the Anticoagulation Clinic at the University of Alberta Hospital, the team’s seemingly narrow focus of anticoagulation management often evolves into care issues that go beyond simply “chasing” a specific laboratory value. The purpose of this paper is to model the delivery of patient-centred care through the lens of a specialty anticoagulation clinic, where assessment of the international normalized ratio (INR) is often used as an opportunity to discover, investigate, and treat the whole patient, not just his or her lab values. Established in 2001 with pilot project funding, the Anti coagulation Clinic is directed and staffed by 3.1 full-time equivalent clinical pharmacists, along with secretarial support, and as of spring of 2015 was managing about 750 patients. The clinic receives referrals from across Alberta for patients requiring anticoagulation therapy. Since its inception, the acceptance criteria have changed to target a more complex patient population, thus ensuring optimal resource use.4 Specifically, patients accepted are those with high thromboembolic risk, high risk for major hemorrhage, complex comorbidities, or medications that affect anticoagulation control. This higher-risk patient population requires that pharmacists collaborate with other practitioners across the health care continuum and use their additional prescribing authority to proactively change warfarin dosing and anticoagulant therapy to ensure safe and effective care delivery. Despite practising in a very specialized setting, pharmacists in the Anticoagulation Clinic use comprehensive patient assessment and investigational skills to manage these complex cases, often making interventions in areas not directly related to anticoagulation therapy. This paper presents several case vignettes to describe the scope of pharmacists’ practice at the Anticoagulation Clinic.* In particular, we reflect on the evolution of skill sets that now extend beyond the narrow, misperceived goal of simply “chasing an INR between 2.0 and 3.0”, in alignment with the provision of patient-centred care.

Work-related musculoskeletal disorders among Indian Physiotherapists

be gained. The document Clinical Education Guidelines for Canadian University Programs provides national guidelines for the expected clinical experience during physical therapy programs; unless the profile of student experience in the clinical setting is known, it is difficult to ensure that students have met these requirements. Methods: A PDSA (plan-do-study-act) model was utilized to introduce an electronic clinical log into the curriculum. The Planning phase included vendor selection and development of the software application. The “Do” phase included a pilot test; analysis of results from the pilot formed the “Study” phase which was followed by an initial “Act” phase consisting of modifications based on the results. Since full implementation, the PDSA cycle continues to be utilized to develop system enhancements and modifications based on feedback and user experience. Results:Design and redesign of the system required close and ongoing collaboration between educational institution, system vendor and end users (students). Data collected has included student experience with specific patient diagnoses, assessment and treatment skills utilized, level of independent practice, and a profile of clinical experience in the core areas of practice (such as cardiorespiratory). This information has been utilized by the educational program to encourage students to identify their individual learning gaps and needs, as well as to ensure congruence of individual and collective student experiencewith the clinical education guidelines. Unanticipated uses of the tool emerged including as a personal marketing strategy for students during job interviews and as a guide for developing student clinical learning objectives by clinical supervisors. Conclusion(s): The PDSA cycle provided an effective model for the development and implementation of a clinical logging tool for physical therapy students. Work is currently underway to explore the utility of the system for practicing physical therapists as part of a professional practice portfolio and as a tool to ensure continuing competence. Close collaboration between the vendor, institution and end users formed a key part of the success of the project. Implications: Use of the PDSA cycle can be an effective tool in guiding the process of development of development and implementation of an electronic clinical logging tool to ensure quality in the breadth and depth of clinical learning experiences during a physical therapy program.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

Should emergency medicine registrars focus on seeing patients and leave the teaching of medical students to others? No.

Patient Assessment Skills Pertinent to Practicing Pharmacists

Objectives: To describe pharmacists’ opinions regarding which patient assessment skills are necessary to understand and/or perform to provide optimal patient care in pharmacy practice.&#x0D; Methods: An online questionnaire was distributed to pharmacists licensed in North Carolina (n=14,167), as identified by the Board of Pharmacy. The 80 patient assessment items in the questionnaire were derived from a course text book and faculty experience. Participants indicated whether they “need to understand and be able to perform”, “need to understand only”, or “not need to understand or be able to perform” each item in their current practice setting. Descriptive statistics were used to describe background demographics and perceived need for each item. Post-hoc chi-square analyses were performed to determine differences in need based on practice setting and Pharm.D. degree completion.&#x0D; Results: Of 1036 responses received, 770 were used in data analysis; incomplete questionnaires and non-practicing pharmacist responses were excluded. Fifty-nine percent of respondents held a Pharm.D. degree. Participants identified their practice site(s) as inpatient (29%), outpatient (16%), community/retail (50%), long term care (5%), and other (8%). The top five patient assessment items respondents identified as important to understand and perform included automatic blood pressure measurement (63%), point of care testing (57%), manual blood pressure measurement (53%), heart rate measurement (52%), and peak flow meter use (47%). Post-hoc analyses showed a significant difference among those with a Pharm.D. versus those without for the response “need to understand and be able to perform” for 20 patient assessment items; a significant difference was also noted among practice settings for 29 items.&#x0D; Conclusions: The top items pharmacists identified they need to both understand and perform could be applied in various practice settings. The study results may guide which patient assessment items should be included in pharmacy education and training.&#x0D; &#x0D; Type: Original Research