Placement Team Research Articles

Impact of nurse education prior to and during COVID-19 on nursing students’ preparedness for clinical placement: a qualitative study

Introduction: Nursing students internationally entered challenging clinical placements during COVID-19. Lessons learnt could inform nurse education planning, particularly in preparation to implement future workforce plans.Aim: This study aimed to explore the impact of COVID-19 on nursing students undertaking clinical placements across the UK, particularly the extent to which nursing education prior to and during COVID-19 had prepared them for placements, and to distil key messages for future nursing education.Methods: A UK-wide qualitative study was conducted using audio or written placement diaries and post-placement telephone or online interviews with nursing students from all years of study and from adult, children, mental health and learning disability disciplines. Transcripts were analysed thematically using the Framework Approach. A pre-survey collected participants’ demographic information, details and expectations of their upcoming clinical placements, and how well prepared they felt. Ethical approval was gained.Results: Two hundred and sixteen nursing students from across the UK participated in the study. Five key themes were identified: ‘stepping up to the challenge and feeling the fear’, ‘new ways of learning’, ‘theory versus clinical practice’, ‘impact on clinical and academic partnerships’, and ‘concerns around demonstrating proficiency’.Discussion: Differing levels of preparedness of nursing students for clinical placement were reported. While many felt honoured to be a part of the nursing workforce during COVID-19, the rapidly changing clinical landscape led to unplanned changes to placements, lack of skills practice, uncertain practice supervision and distance learning which impacted on their confidence and perceived levels of competence leading to anxiety around demonstrating proficiency and achieving practice hours. Greater collaboration between universities, clinical placement teams, policy makers and regulators are key lessons post COVID19 to improve the support and preparedness of nursing students.

Misunderstanding Equality, Power, and Vulnerability: Elevating the Individual over Cohesion in Hierarchy as a Value

Abstract This article explores dominant ideas of value at play in a critical incident experienced by international mission candidates on a team placement, in an Anglican community of the United Kingdom. The ethnographic analysis will compare different perspectives on how misunderstanding cultural values and social relations as theological obligations can lead to suffering. Thus, the study shows how qualitative differences in cultural values and social relations determine contrary ways of understanding theological conceptualizations of equality as a Christian idea in contact zones of international mission communities. The analysis challenges two Christian assumptions: firstly, that extending equal value to people before God is universally understood in the same way, and secondly, that individual well-being is inherently superior to ensuring social cohesion, exemplified by Korean hierarchy. Although people realize hierarchy and individualism the world over, the nuances of meaning dominating their relations to other values determine why and how people experience suffering.

Insights from the pandemic: an autoethnography of nursing clinical placement teams

Background Designated placement staff, including academics, professional clinical support teams and stakeholder clinical teams, are responsible for organising students' clinical placements. Disciplines have reported sustained innovations in the way placement staff work following the pandemic. There are few published reports from nursing placement staff. Aim: Understand how challenges during the pandemic, may have led to disrupting the status quo for nursing placement staff. Design Nine academic, professional and industry nursing placement staff reflected on their daily work practices and team culture post the pandemic disruptions. The reflections were analysed using a descriptive thematic approach. Results Staff described “a double-edged sword” balancing fatigue from the dynamic situation increasing their workloads with wanting to seize opportunities to challenge the status quo. Three themes were identified. Conclusion Clinical placement staff shared reflections are useful for identifying workplace initiatives that may enhance nursing and other disciplinary placement staff team culture and ways of working.

The effect of introducing a nurse-practitioner-led peripherally inserted central venous catheter placement program on the utilization of central venous access device: A retrospective study in Japan.

Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated. To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs. Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications. Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; p < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; p < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; p < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; p = .90). This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.

Conceptualising responsibility and hostility within work-integrated learning placements for students with disabilities

The expectation for universities to support students’ employability through work-integrated learning placements demands investigation into how opportunities are inclusive to students from a diversity of backgrounds. In this paper, we explore the experiences of students with disabilities during work placements, drawing on qualitative data collected through six focus groups with students (n = 27). Analysed through the frame of stigma, the results show how students bear an unfair burden of responsibility in their placement experiences, as they shoulder consequential decisions to disclose and/or request accommodations to support their learning. In this study, work placement environments were often somewhat hostile, both in relation to their built environments but also through the bias and/or prejudice of others. The results shed light on the difficulties that students with disabilities face in their placements and underscore how educational equity is multi-layered, requiring scrutiny of the student life-course including access to opportunities in professional fields.

How academics can play a more influential role during a year-in-industry placement: A contemporary critique and call for action

Universities worldwide are tasked with producing employable graduates capable of operating in evolving, complex, and global labour markets. Research into the effectiveness of year-in-industry placements to facilitate such objectives often portrays the dominant actors as students, employers, managers, and (de)centralised placement teams. Framing this as our point of departure, we propose that academics can play a more influential role. Our essay discusses the challenges for academics of designing, delivering, and assessing a year-in-industry placement module. Next, we consider the opportunities for students to enhance their self-perceived employability. We conclude with a call for innovative thinking, knowledge sharing, and empirical research.

Construct Validation and Exploration of Student Satisfaction from Internships: Evidences from India

An internship experience is considered to be of paramount importance. It helps explore the link between academics and the world of work, as most of the students joining business schools in India have no or relatively very low work experience. The purpose of the present study was to validate and explore factors that affect the summer internship experience of business school students in India. In this study, the scale for measuring student satisfaction was validated based on four factors: (a) learning experiences during the internship, (b) the effectiveness of the pre-placement activities for the internship, (c) the support offered by the placement team and (d) the support offered by the employing organisation during the industrial internship in the Indian context. A survey was administered to 235 business students in Mumbai. In the context of the present study, the student internship scale was first validated keeping in mind Indian ethos using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Furthermore, structural equation modelling (SEM) using analysis of moment structure (AMOS) was used to test the model. Multigroup structural equation modelling (MSEM) was conducted to check the impact of gender on the overall scale. The study confirms that factors like student learning experiences, pre-placement activities, and assistance provided by the placement team and support from the employer organisation (EO) are important to understand a student’s overall perception on internship. This is the first study in India that can guide both educational institutions and EOs to enhance the internship experience of the management students.

Approach to advanced practice nursing student clinical during COVID-19.

Approach to advanced practice nursing student clinical during COVID-19.

Prehospital interventions and neurological outcomes in marathon-related sudden cardiac arrest using a rapid mobile automated external defibrillator system in Japan: a prospective observational study

ObjectiveTo describe neurological outcomes after sudden cardiac arrests (SCAs) in road and long-distance races using a rapid mobile automated external defibrillator system (RMAEDS) intervention.MethodsA total of 42 SCAs from 3...

Novel Multidisciplinary Vascular Access Team Helps to Improve ICU Workflow Amidst Covid-19 Pandemic.

The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country's shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic. Vascular surgeons, interventionalists, and anesthesiologists, were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement. While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April, 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%. The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.

POS-668 BARRIERS AND OPPORTUNITIES TO INCREASE PD INCIDENCE AND PREVALENCE: LESSONS FROM A EUROPEAN SURVEY

Peritoneal Dialysis (PD) remains underutilized despite the fact that outcomes have been demonstrated to be equal to hemodialysis (HD). Several barriers for PD growth have been identified, such as late referral, economic incentives, lack of training facilities or PD catheter placement issues. However, the potential interaction between all these mediators has not been explored, and they might be intertwined. The EuroPD™Future Leadership group* therefore performed a pan-European survey to identify potential barriers to growth of PD programs by exploring PD and home HD related practices and organizational aspects at centre level. In this abstract, we focus on the association between PD catheter placement policy, urgent (unplanned) start and education policy*EuroPD™FutureLeadership includes also Bechade C France; de Laforcade L France; Eden G Germany; Martin H,Germany; Steubl D,Germany; Wojtaszek E,Poland; Altabas K,Slovenia; Pajek J,Slovenia; Ros S,Spain; Vega A,Spain; Burkhalter F,Suisse; Allen J,UK; Corbett Richard,UK; Lambie M,UK An electronic survey was send to the contacts of EuroPD™ and to the members of regional societies of the members of the EuroPD Future Leadership initiative. In the survey, a virtual case vignette of a 48 year old woman not previously known to your unit who arrives at the emergency department with established end stage kidney disease was presented (late referral/unplanned start). We used chi-square tests and (ordinal) logistic regression to assess associations between modality choices for this case vignette and PD related practices, and also with % incident and prevalent patients on PD. We received 628 responses (317 academic, 243 non academic non private, 68 private; 67 with less than 50, 125 with 50-100, 243 with 100-220 and 193 with more than 200 patients). For the unplanned start case vignette, 32.6, 32.2 and 35.2% indicated they would start urgent PD, urgent HD or urgent HD with the plan to educate patient on PD at a later time respectively. Only 2 out of 3 respondents indicated that it was (very) likely this patient would receive education on PD in the unplanned setting. Urgent placement of a PD catheter (<48hours) was only possible in 32.4% of centres. In univariate analysis, choice for urgent start PD was associated with presence of a dedicated PD team, presence of a structured PD education program, the likelihood of an unplanned patient to receive education on PD, and having good relations with the PD access placement team, but not with centre size, %PD incidence or prevalence, financial issues, or the possibility to have a PD catheter placed within 48 hours. In a general linear mixed model, inclination to start PD in the case-vignette on unplanned start was only associated with presence of a dedicated PD team and the likelihood that the patient will receive education on homebased therapies. Percentage PD incidence and prevalence were only associated with presence of good education for both planned as for unplanned patients, and with a good relationship with the PD access team. Absence of a dedicated PD team seems to be the common denominator of already identified barriers to PD growth such as unplanned start and PD access placement issues. If we intend to grow PD programs, we will need to establish enthusiastic PD teams with good collaborations with dedicated PD catheter placement teams.

Sustainability of an IPCP program within a federally qualified health center including interprofessional student team placements

ABSTRACT In an effort to improve teamwork and collaborative care at a Federally Qualified Health Center (FQHC), the Midwest Interprofessional Practice, Education, and Research Center (MIPERC) collaborated on the implementation of an interprofessional collaborative practice (IPCP) program that included placement of multidisciplinary student teams. The MIPERC IPCP program supported staff, preceptor and student teams through interprofessional education and structured interprofessional activities for students, including daily huddles, interprofessional student team visits, and nurse triage phone calls. Results from the project’s first year were previously reported (Nagelkerk et al., 2017b). Ongoing effects of IPCP on staff morale, IPE knowledge and practice efficiency were measured. Study tools included demographic forms, pre/post module knowledge tests, focus groups and program evaluations. The mean number of clinic patient visits per hour per medical provider was calculated to evaluate practice efficiency. Students (n = 26) and staff (n = 30) demonstrated improvement (p ≤.05) in knowledge test scores for Patient Safety, Team Dynamics and Tips for Behavioral Changes. Providers increased the number of patients seen per hour. Program evaluations and focus group data from providers, staff, and students indicated IPCP programs can be sustainable with ongoing intentional team care strategies.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

Parity in Athletes Unlimited Softball

Athletes Unlimited developed an alternative scoring system for the sport of softball, designed to produce greater team parity and to highlight individual parity. By creating a scoring system that rewards individual contributions as well as team accomplishments, it is believed that players’ skill and athleticism is more fairly measured. Simulations also suggest that the rotating drafting order will result in greater team parity. Milestones are calculated for how many non-team points an individual must earn for any given week in order to overcome any deficits from unfortunate team placement.

What are the stressors and coping strategies adopted by undergraduate healthcare students during placement?

This paper aims to explore what the current stressors and coping strategies are in placements for students in undergraduate healthcare programmes.Pulido-Martos, Augusto-Landa and Lopez-Zafra (2012) suggest that stress levels among healthcare professionals are higher than other workers. Pryjmachuk, Easton and Littlewood (2009) found that approximately 25% of students withdrew from nursing courses due to emotional distress, difficulty in coping and placement. Literature highlights a lack of mentor support as a common stressor (Shivers, Hasson & Slater, 2017; Thomas & Westwood, 2016). However, the literature lacked any exploration into coping strategies. This research therefore focuses on the experiences of individuals from a variety of healthcare professions and explores the use of coping mechanisms.A qualitative approach was used in order to gain in-depth responses about personal thoughts and experiences (Denny & Weckesser, 2018). A focus group was carried out with participants attending university who were recruited via purposive sampling from a wider convenience sample (Liamputtong, 2011). The data was then analysed using thematic analysis (Clarke & Braun, 2017).The findings from this study demonstrate that several factors contribute to undergraduate healthcare student stress levels whilst on placement, affecting participants in different ways with some reporting thoughts of discontinuing the course. Five main themes were found in response to sources of stress: placement team, transport, academic factors, personal life and negative mood. Two common themes were found for coping strategies: socialising and distraction.Gaining students’ perspectives is valuable in understanding issues and beginning to resolve them. This study highlights factors that impact on healthcare students’ stress levels whilst on placement, that also contribute to negative moods such as feeling tired, demotivated and angry. This study demonstrates the benefits of using socialisation and distraction. While healthcare is and will likely remain a stressful career route due to the pressures of care (Pich, 2018), this study highlights areas for improvement.

Role of NATO Special Operations Combat Medics in Special Operations Surgical Teams.

Battlefield medicine is constantly evolving. Wound patterns, terrain, weapons, and medical evacuation change, so surgical capabilities must adapt. With the changing environment, we must evolve by adapting to offer the best practical care, closest to the frontline. The golden hour has never been a magical number, and the most successful care is provided by the most advanced practitioners as close to the point of injury as possible. The proper placement and access of surgical teams are a key factor in access to a casualty within minutes. NATO Special Operations combat medics (NSOCMs) are highly trained medical Operators who can work as a force multiplier, not only to the Special Operations elements in which they serve but also as members of a Special Operations surgical team (SOST), and these Soldiers can provide the essential skills necessary to best employ and support the surgical asset.

Evaluation of intensive pulse polio immunization in Solapur District

Background: Mass immunization campaigns are now an established fact for the eradication of poliomyelitis. Intensified pulse polio immunization (IPPI) campaigns using only a booth-based approach have not been sufficient to interrupt wild poliovirus transmission in different areas, where it is most persistent with low immunization coverage. Since 1995, PPI is conducted in India and IPPI was introduced in 1998. When we are progressing toward polio eradication and ever-increasing efforts are being done to administer polio drops to every eligible child, it has been observed subjectively that an element of fatigue is creeping in the health system and community. Aim and Objective: The objective of the study is to assess the operational aspects and knowledge of staff regarding PPI program. Material and Methods: Study design – A community-based cross-sectional study. Setting – Six taluks of Solapur district – Mangalwedha, Sangola, Barshi, Mohol, Pandharpur, and Madha. Study period – October 24–30, 2010, and November 21–27, 2010, i.e., 2 weeks. Sample studied – 174 booths, 359 parents, 1289 houses, and 3162 children under 5 years of age. Result: Out of 174 booths, 94.83% booths were easily accessible and IEC material displayed prominently on 85.06% booths.. Regarding source of information of IPPI, 38.16% parents got information from health workers followed by poster. Placement of teams at transit sites, teams were adequate at 80.77% sites, shifting timing appropriate at 88.46%, deployed member present at site in only 76.92% booths and supervisor cross checking the work of teams at only 50% booths. More than 85% of total booth workers were trained. On post booth day activity, in migrant's population 11.97% children were unimmunized whereas in settled population it was 2.32%. Percentage of unimmunized children in migratory population was more than settled population which is statistically highly significant. Conclusion: Special attention is required toward immunization of migratory populations, including slums with migration, nomads, sugar cane cutters, brick kiln workers, also construction site workers and also on transit sites including bus stand, railway stations, mela sites, and weekly bazaars. The role of local media and mass communication programs should be worked out and organized in a more systemic manner. Use of mass media must be done to motivate people for immunization. Supervisor work needs to improve. Community participation should be view as one of the key component for the success of the program. More voluntary agencies, persons, local leaders, and nongovernmental organizations should be motivated to come forward and work for this noble cause.

Pre-hurricane optimal placement model of repair teams to improve distribution network resilience

Predictive planning for restoration and emergency reaction before occurrence of hurricane is an effective action in reducing time and cost of electricity interruption and improving resilience in overhead distribution networks. Traditionally, approaches in load and system recovery are constructed based on reliability studies, with the consideration of equipment failure. However, widespread outages due to the extreme natural events with low probability and high destruction intensity have different properties in comparing the interruptions due to the failures in equipment. Therefore, this paper proposes a new method for restoration and emergency reaction planning. The purpose of this method is resilience improvement of distribution network against hurricane. In the proposed pre-hurricane repair team placement model (PHRTPM), using Monte Carlo simulation method and fragility curves, different failure samples of poles and conductors of medium voltage distribution network are generated according to the predicted speed of hurricane. Furthermore, the forward dynamic programming algorithm is used to determine the path of the repair teams. In this method, using a square grid topology, the optimum locations of utility teams are achieved. The objective function of problem considers the importance of loads and the cost of outages. In the numerical studies, the proposed model is implemented on a modified and real distribution network in Iran which consisted of 81 buses. The results are discussed and the sensitivity analysis is performed for various parameters.

P004: Simulation for emergency department quality improvement

Introduction: There have been an increasing number of studies published since 2011 investigating the benefits of in situ simulation as a quality improvement (QI) modality. We instituted an emergency department (ED) in situ simulation program at Kelowna General Hospital in 2015 with the aims of improving inter-professional collaboration, improving team communication, developing resident resuscitation leadership skills, educating ED professionals on resuscitation medical expertise, and identifying QI action items from each simulation session. Methods: We applied the SMART framework. Our specific, measureable, and attainable goal was to select two QI action items discovered from each simulation session. Realistic and timely follow-up on each action item was conducted by the nurse educator group who reported back to the local ED network, pharmacy, or manager depending on the action item. This ensured sustainability of our model. Results: A total of 65 individuals participated in 2015 at program inception. This increased to 213 individuals in 2017 with an average of 24 participants/session. Attendants included nurses (31%), ED physicians (20%), ED residents (18%), paramedics (10%), and medical students, respiratory therapists, pharmacists, and others (21%). Our QI action items were grouped as (1) team/communication, (2) equipment/resources, and (3) knowledge/tasks. Examples of each category were: (1) Inability to hear paramedic bedside reports resulting in reinforcement of one paramedic speaking while the team remains quiet, (2) Difficulty in looking up medication information in the resuscitation bay resulting in installation of an additional computer in the resuscitation bay, and (3) Uncertainty of local process for initiating extra corporeal membrane oxygenation (ECMO) in the ED resulting in review of team placement, patient transfer, and initiation of ECMO lines in the ED. Inter-professional team members have reported through electronic feedback on the value of these sessions, including improved inter agency cooperation and understanding. Conclusion: This quality improvement initiative used in situ simulation as a QI tool. We were able to identify latent safety threats, test new patient care protocols, find equipment issues, and foster teamwork in a sustainable way to improve the quality of care in our ED. We hope that this serves as encouragement to others who are initiating a similar program. Our main suggestions after reflection include: (1) Engage a multidisciplinary team in the development of an in situ simulation program, (2) Start with aims and objectives, (3) Foster attendance and buy in by making it convenient for people to attend, (4) Celebrate your successes through interdepartmental communication, and (5) Recruit individuals with expertise in simulation based education.

Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review.

Challenges for bedside placement of small-bore feeding tube (SBFT) include iatrogenic injury, multiple exposures to x-rays, and prolonged placement times. In 2011, the study facility began a feeding tube placement team (FTPT) using the CORTRAK system (CS) in the adult intensive care unit (ICU) and medical-surgical populations. In 2013, a protocol was implemented using the CS to determine final SBFT location. Serial retrospective reviews were done of patients with SBFT placement by the FTPT during July 2011-December 2012 and 2015. Measures included pulmonary deviation, tube location, placement agreement beyond chance for CS tracing and confirmation radiography (CR), x-ray frequency, and placement time intervals. A total of 6290 SBFT placements were completed for 4239 patients. First-attempt SBFT locations were 12.78% gastric, 13.39% first through fourth portion of duodenum, and 73.83% ligament of Treitz/jejunum, with zero placements in esophagus or lung. In 2015, staff avoided 68 lung placements by recognizing proximal pulmonary deviation. X-ray preprotocol vs protocol (mean [SD]: 1.02 [0.15] vs 0.26 [0.44]) resulted in 74% x-ray reduction and cost avoidance of $346,000. Time intervals (mean [SD]; N = 6290) were 14.90 (12.74) minutes for insertion, 46.04 (13.80) minutes for placement event, and 3.85 (2.23) hours for consult conclusion. Agreement for n = 1692 placements was 85.28%, with k score of 0.622 (95% confidence limit: 0.582, 0.661; P = .0005). Team management of SBFT placement using the CS optimizes patient safety, standardizes practice, and decreases cost. Using the CS to determine final SBFT location is a safe alternative to CR.