Safe Patient Care Research Articles

The Effect of Perceptions of Evidence-Based Practice on Endotracheal Cuff Pressure Management in Critical Care Nurses: A Correlational Cross-Sectional Multicentre Study.

This correlational cross-sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence-based practice leadership and work environment. A correlational cross-sectional multicentre study design. This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence-Based Practice Leadership Scale and Evidence-Based Practice Work Environment Scale. Descriptive statistics, chi-square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study. The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence-based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence-Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence-Based Practice Leadership Scale and the cuff pressure management. Adherence by nurses to current evidence-based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence-based practice. Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure. Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies. No patient or public contribution.

From books to the bedside: post-graduation impact of 'Week On the Wards' on medical education

BackgroundThe transition between preclinical and clinical years during medical school has been shown to be challenging. Cooper Medical School of Rowan University (CMSRU) implements one required two-week-long shadowing program for first and one one-week-long shadowing program for second-year medical students called Week On the Wards (WOW). The goal of this study is to ascertain whether students who completed the WOW curriculum found it beneficial over the long-term. Specifically, we want to evaluate alumni’s impression of the program’s influence on career, specialty choice, professional development, personal development, and confidence.MethodsTo evaluate our program, we developed, validated, and distributed a survey via email in the autumn of 2023. Our population included alumni from the classes of 2019–2022, irrespective of race and gender. After following steps for survey development, it was validated via focus group using qualitative methods. The survey consisted of 19 questions answerable on a 5-point Likert scale, a “Yes/No/Unsure/Maybe” section, and an optional open-ended response question. Descriptive analysis was done to report the percent responses.ResultsThe survey was emailed to 353 alumni, with 72 completed responses returned. Majority of respondents agreed or strongly agreed that the WOW program showcased the importance of teamwork in medicine (80.6%), helped them learn to apply medical knowledge (77.8%), influenced their decision regarding which residency/specialty they chose (72.2%), provided an example of how teamwork in medicine is necessary for patient safety and effective care (66.6%), and increased their confidence in their networking skills (66.6%). Alumni nearly unanimously agreed that the WOW program was a useful part of their medical school education (93.1%) and that it should be continued for future classes (94.4%).ConclusionOur results highlight the sustained importance of early preclinical exposure to clinical environments in students’ future career decisions, in their understanding of the clinical applications of learned preclinical topics, and the importance of teamwork in medicine.

Check, Please! Supervisor-Learner Dyads Using "Checking" for Clinical Support During Indirect Supervision.

Indirect supervision is essential for granting autonomy to learners. Sometimes referred to as leaving the learner "unsupervised," there is growing recognition that learners and supervisors engage in clinical support through ongoing interactions, albeit at a distance. To understand how the complementary activities of asking for and providing clinical support at a distance come together as indirect supervision by identifying the natural language used between learners and supervisors. A collective case study of 15 attending physician-senior medical resident dyads from 2018 to 2023. Each case consisted of 2 full days of ethnographic observation of the resident on an internal medicine clinical teaching unit in one of three metropolitan hospitals; 2 end of day interviews with each dyad member; and a third interview with the attending after the 2-week rotation. Fifteen internal medicine residents (PGY-2 and PGY-3) who were scheduled to work for the first time with 15 attending physicians. Data collection was iterative with deductive and inductive analysis to identify patterns of communication. The language of "checking," such as checkpoints, checking on, and checking in, was central to communications within dyads. Indirect supervision included attendings using scheduled checkpoints and backstage oversight activities to check on the senior resident's patient care while expecting residents to access their support, as needed, by checking-in with them. Residents checked in with their attending to relay patient information updates, ask questions, and hint at needing their plans doublechecked; these communications had similar formats making them difficult to distinguish but functioned to preserve resident independence while accessing clinical support. Indirect supervision creates clinical support through ongoing communication between learners and supervisors at a distance. It is a collaborative process for mutual reassurance that safe patient care is being provided and that support is available when needed.

Contextual Factors Influencing Intensive Care Patients' Discharge Processes: A Multicentre Prospective Observational Study.

To compare contextual factors influencing discharge practices in three intensive care units (ICUs). A prospective observational study. Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites. Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B. We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process. Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs. The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients' discharge processes were observed, and consumer representatives were involved in the study design.

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. PRR1-10.2196/58030.

Handover of intensive care patients

An effective patient handover is a core element of high-quality patient care. Communication during patient handover in the intensive care unit is particularly challenging due to the clinical complexity and rapid changes in patient trajectories, complex interdisciplinary and interprofessional interfaces, linguistic barriers, situational and structural disruptive factors, personnel stress factors as well as the communication and error culture of the teams. In addition to avoiding disruptive factors and creating optimal communication conditions and human resources, the use of standardized and structured handovers with the help of protocols and checklists, as recommended in the literature, plays a decisive role as part of a bundle of measures for effective and safe patient care.

Acute Care Nurses' Partnership With Patients to Recognise and Respond to Changes in Patients' Clinical States: AQualitative Study.

To explore and describe acute care nurses' partnership with patients to recognise and respond to changes in patients' clinical states. Acute care nurses' decisions to partner with patients to recognise deterioration in clinical states and to respond by activating a rapid response system improves patient outcomes. Acutely unwell patients can also experience clinical changes that include improvement and deterioration that does not trigger rapid response system activation over the course of hospitalisation from illness and treatment. How acute care nurses partner with patients in response to improvement and deterioration not triggering a rapid response system is not well-understood. An exploratory, descriptive study underpinned by Tanner's Clinical Judgement Model. Using purposive and quota sampling, 20 nurses with direct patient care responsibilities on one medical and one surgical ward in a large Australian hospital were recruited. Nonparticipant observations followed by semistructured interviews were conducted between January and May of 2021. Nurse-patient interactions were observed for 4 h, and verbally described and recorded. Semistructured interviews were recorded and explored nurses' reasoning behind decisions observed. Reflexive thematic analysis was used to analyse the data. Three themes were identified from the data: nurses checking in for changes; nurses forming judgements; and nurses partnering with patients to respond. Acute care nurses promoted subjective assessment based on patients' safety risks. Patients' participation in response to changes was prioritised based on acute care nurses' judgement of safety. Patients receive significant safety benefits when acute care nurses partner with patients in response to their experience of improvement and deterioration during acute illness. Further research should evaluate the sensitivity of subjective cues in patient assessment. Partnership with patients in assessment and management of improvement and deterioration improves the quality and safety of patient care. Assessment frameworks should equally prioritise the use of objective and subjective cues. Nursing education should promote the safety benefits of patient partnerships in responding to patient changes. Equator checklist COREQ. Data collected included description of patients' interactions with study participants.

Paper-and-Pencil vs. Electronic Patient Records: Analyzing Time Efficiency, Personnel Requirements, and Usability Impacts on Healthcare Administration.

Background: This study investigates the impact of transitioning from paper and pencil (P&P) methods to electronic patient records (EPR) on workflow and usability in surgical ward rounds. Methods: Surgical ward rounds were audited by two independent observers to evaluate the effects of transitioning from P&P to EPR. Key observations included the number of medical personnel and five critical workflow aspects before and after EPR implementation. Additionally, usability was assessed using the System Usability Scale (SUS) and the Post-Study System Usability Questionnaire (PSSUQ). Results: A total of 192 P&P and 160 EPR observations were analyzed. Physicians experienced increased administrative workload with EPR, while nurses adapted more easily. Ward teams typically consisted of two physicians and three or four nurses. Usability scores rated the system as "Not Acceptable" across all professional groups. Conclusions: The EPR system introduced usability challenges, particularly for physicians, despite potential benefits like improved data access. Usability flaws hindered system acceptance, highlighting the need for better workflow integration. Addressing these issues could improve efficiency and reduce administrative strain. As artificial intelligence becomes more integrated into clinical practice, healthcare professionals must critically assess AI-driven tools to ensure safe and effective patient care.

The Predictors of Patient Safety Culture in Hospital Setting: A Systematic Review.

Patient safety (PS) is a global public health concern. It is estimated that 10% of patients experience preventable harm while hospitalized. Patient safety culture (PSC) has been recognized as essential to improving PS, drawing inspiration from other high-risk industries. In PS research, however, PSC poses conceptual challenges, with inconsistent terminology, a lack of definitions, and limited use of substantiating theory. Despite these challenges, PSC remains widely used in PS research and practice, as it is seen as a potential gateway to understanding sociotechnical complex aspects of the healthcare system and improving safe patient treatment and care. This review explores the concept of PSC in a hospital setting. How PSC is used as an outcome, thus exploring the theoretical position underpinning PSC, which predictors impact PSC, and how these predictors are related to PSC. Using a search of 3 electronic databases, 23 studies that met the inclusion criteria were selected for review. The review identified 81 predictors of PSC. Study population, unit of analysis and method varied widely. PSC as an outcome was assessed based on one of 4 surveys. Thus, the underpinning position of the PSC construct is dominated by an organizational/managerial approach. The large number of predictors explored and the range in outcome measures, units of analysis, and methods make it hard to establish any causal relationship. We argue that studies closer to actual practices in the messy conditions of clinical practice are needed.

Characteristics, Impact, and Trends of Healthcare Simulation in Latin America and the Caribbean: A Bibliometric Analysis.

This study highlights the growing significance of healthcare simulation in enhancing the quality and safety of patient care across Latin America and the Caribbean, by analyzing bibliometric trends and the impact of publications on simulation-based clinical training between 2012 and 2022. Leveraging the Scopus database and VOSviewer software for thesaurus interaction analysis, the research identified 610 documents, accumulating 4681 citations, thereby indicating a burgeoning interest in this field with notable publication spikes in 2017 and 2020. Brazil and the United States emerged as leading contributors, with a primary focus on "simulation training," "clinical competence," "medical education," and "education." The study observed an uptick in international collaboration, mirroring the increase in document count and citations. This bibliometric review underscores the emphasis on evaluating technical skills and clinical practices as prevailing areas of interest, highlighting Brazil's significant academic contributions, and suggesting a promising future for the implementation of clinical simulation in the region. The study advocates for continued scholarly output to align with global advancements in medical simulation, aiming to optimize patient outcomes.

Enhancing Thoracic Surgery with AI: A Review of Current Practices and Emerging Trends.

Artificial intelligence (AI) is increasingly becoming integral to medical practice, potentially enhancing outcomes in thoracic surgery. AI-driven models have shown significant accuracy in diagnosing non-small-cell lung cancer (NSCLC), predicting lymph node metastasis, and aiding in the efficient extraction of electronic medical record (EMR) data. Moreover, AI applications in robotic-assisted thoracic surgery (RATS) and perioperative management reveal the potential to improve surgical precision, patient safety, and overall care efficiency. Despite these advancements, challenges such as data privacy, biases, and ethical concerns remain. This manuscript explores AI applications, particularly machine learning (ML) and natural language processing (NLP), in thoracic surgery, emphasizing their role in diagnosis and perioperative management. It also provides a comprehensive overview of the current state, benefits, and limitations of AI in thoracic surgery, highlighting future directions in the field.

Discharge communication during transitions from emergency care to home.

The healthcare system in Canada is overwhelmed and requires reform. Good discharge communication is a cornerstone of patient safety and quality care. In the Emergency Department (ED), good discharge communications means that patients leave with a clear understanding of their health condition, and the steps they need to take to continue their recovery at home. The fragmented nature of communication in the ED coupled with long wait times and high noise levels pose significant risks to the continuity of information exchange. Additional communication barriers arise for many patients due to a lack of control, language differences, low health literacy, and feelings of fear and uncertainty. Multiple interventions have been evaluated to improve ED discharge communication, but further work is needed to engage all end users in a theory-based approach. Addressing challenges related to successful discharge communication requires a multifaceted approach that includes improving institutional policies, adopting innovative co-designed interventions, and leveraging technology.

Nanotechnology in Drug Delivery: An Overview of Developing the Blood Brain Barrier.

The close connection between the brain microvascular endothelial cells (BMECs) that are enclosed within this barrier is the result of an intracellular junction, which is responsible for the constricted connection. The regulation and control of drug delivery systems both require nanoparticles, which are extremely small particles made up of a variety of materials, including polymers, metals, and other chemicals. Nanoparticles are a crucial component of the regulation and control of drug delivery systems. There is a possibility that nanomaterials composed of inorganic chemicals, such as gold nanoparticles, could be utilized in the treatment of neurodegenerative illnesses like Parkinson's disease. In addition to this, they are used as nano-carriers for the aim of distributing drugs to the region of the brain that is being targeted. There are a number of advantages that are easily apparent when compared to other methods of administering drugs for neurological diseases. The current review demonstrates both the advantages and disadvantages of utilizing a wide variety of nanomaterials for brain delivery, as well as the potential impact that this will have in the future on the safety and effectiveness of patient care.

AI-supported decision-making in obstetrics - a feasibility study on the medical accuracy and reliability of ChatGPT

The aim of this study is to investigate the feasibility of artificial intelligence in the interpretation and application of medical guidelines to support clinical decision-making in obstetrics. ChatGPT was provided with guidelines on specific obstetric issues. Using several clinical scenarios as examples, the AI was then evaluated for its ability to make accurate diagnoses and appropriate clinical decisions. The results varied, with ChatGPT providing predominantly correct answers in some fictional scenarios but performing inadequately in others. Despite ChatGPT's ability to grasp complex medical information, the study revealed limitations in the precision and reliability of its interpretations and recommendations. These discrepancies highlight the need for careful review by healthcare professionals and underscore the importance of clear, unambiguous guideline recommendations. Furthermore, continuous technical development is required to harness artificial intelligence as a supportive tool in clinical practice. Overall, while the use of AI in medicine shows promise, its current suitability primarily lies in controlled scientific settings due to potential error susceptibility and interpretation weaknesses, aiming to safeguard the safety and accuracy of patient care.

Eighteen-year trends in the rates of intra-operative cardiac arrest and associated mortality at a public university hospital in Brazil.

Intra-operative cardiac arrest is a rare but life-threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. A secondary aim was to identify associated risk factors. We conducted a retrospective observational study using data collected from 1 January 2005 to 31 December 2022. Factors associated with cardiac arrest and mortality were identified using multivariable logistic regression analysis. Among the 154,178 cases, the overall rates of intra-operative cardiac arrest (n = 297) and associated 30-day mortality (n = 248) were 19.3 (95%CI (16.6-21.9)) and 16.1 (95% CI 13.9-18.3) per 10,000 anaesthetics, respectively. These decreased over time (2005-2010 vs. 2017-2022) from 26.3 (95%CI 21.0-31.6) to 15.4 (95%CI 12.0-18.7) per 10,000 anaesthetics, and from 23.4 (95%CI 18.8-28.1) to 13.7 (95%CI 10.8-16.7) per 10,000 anaesthetics, respectively. Factors associated with intra-operative cardiac arrest included children aged < 1 year (adjusted OR (95%CI) 3.51 (1.87-6.57)); ASA physical status 3-5 (adjusted OR (95%CI) 13.85 (8.86-21.65)); emergency surgery (adjusted OR (95%CI) 10.06 (7.85-12.89)); general anaesthesia (adjusted OR (95%CI) 8.79 (4.60-19.64)); surgical procedure involving multiple specialities (adjusted OR (95%CI) 9.13 (4.24-19.64)); cardiac surgery (adjusted OR (95%CI) 7.69 (5.05-11.71)); vascular surgery (adjusted OR (95%CI) 6.21 (4.05-9.51)); and gastrointestinal surgery (adjusted OR (95%CI) 2.98 (1.91-4.65)). We have shown an important reduction in intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. Identification of relative risk factors associated with intra-operative cardiac arrest can be used to improve the safety and quality of patient care, especially in a resource-limited setting.

Communicating blood test results in primary care: a mixed methods systematic review.

Background Test result communication is important for patient-centred care, patient safety and primary care workload. Evidence is needed to ensure that test results are communicated safely and efficiently to patients in primary care. Aim To summarize existing evidence for blood test result communication between primary care providers and their patients and carers. Design and setting Mixed-methods systematic review Methods Medline, Embase, PsycINFO (Ovid); CINAHL (ESCOHost); and the Cochrane Library were searched from 2013 to September 2023. Primary studies of any design that provided information on the communication of blood test results by primary care staff to adult patients and carers were eligible for inclusion. Results There were 71 included studies, including 10 experimental studies and no randomized controlled trials. Study quality was mostly poor and risk of bias was high, partly due to a lack of reported information. Patients want more information about their blood test results, particularly in terms of 'what next', and prefer results to be provided quickly. Electronic methods such as online access or text messages were generally well accepted but not by everyone, and not for all results. Clinicians' opinions were mixed as to whether more information and direct release of test results to patients without clinician input was beneficial or could cause problems, such as increased workload. Conclusions We have identified a range of evidence on patient and clinician preferences, barriers and facilitators to test communication, which is particularly important in the current NHS context of a move towards patient online access.

Fall Risk Management by Nurses in the Inpatient Wards of Aceh Government Regional General Hospital, Indonesia

A patient fall is an incident that commonly occurs with or without injury. Not only does it potentially cause injury, but these incidents can also prolong the length of stay and increase the treatment cost. Nurses play an essential role in assessing and preventing the risk of falls in patients through appropriate education and preventive measures by Standard Operating Procedures (SOP). Effective implementation of SOPs can reduce the frequency and impact of fall incidents and improve the safety and quality of patient care. This case study aimed to expound on fall risk management in the Aceh Government Regional General Hospital wards. A quantitative case study type with a cross-sectional study was designed. The sample consisted of 28 nurses, and the data collection tool used an observation sheet to examine the implementation of fall risk management following the hospital SOP. Data analysis used descriptive statistical tests; the data was then presented as a frequency distribution table. The results show that 67.9% of nurses implemented fall risk management, and 32.1% did not implement it. It was essential to increase nurses’ compliance with the SOP for managing fall risk by monitoring and evaluating periodically and in stages by the first-line manager in the Aceh Government Regional General Hospital wards. It is also recommended that nurses routinely assess the risk of falling in patients, educate patients and their families about it, and participate in ongoing training to improve patient safety in hospitals to achieve better quality healthcare.

OPTIMUM DESIGN OF INTENSIVE CARE UNIT- AN EVIDENCE- BASED HEALING ENVIRONMENT

Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU canbe conceptualised into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including itsinfrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated equipments, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room,) and the universal support services (infection prevention, finishings &amp; and flooring, staff communications, signage &amp; wayfinding, security and fire &amp; safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. Synchronisation of the universal support services in the ICU with the hospital’s existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.

Comparative analysis of Physician Assistant/Associate National Certifying Examination (PANCE) performance trends: pre and during COVID-19 era

BackgroundCOVID-19 significantly impacted physician assistant/associate (PA) education programs. Most programs transitioned didactic and clinical education from in-person to remote, and clinical training opportunities diminished. Graduates of accredited PA programs take the Physician Assistant National Certifying Examination (PANCE), a five-hour exam with 300 multiple-choice questions, and must attain or exceed the scaled passing score of 350 (range: 200–800). We examined first-time examinees’ trends in PANCE scores and passing rates three years prior to the pandemic and three years during.MethodsWe analyzed data (N = 59,459) from the National Commission on Certification of Physician Assistants. The two primary outcomes were PANCE scores and pass rates. The main exposure was the timeframe: three years pre-pandemic (2017–2019) and three years during the pandemic (2020–2022). The 2017–2018 scores were equated to the new passing standard implemented in 2019. Covariates included age, gender, years the PA program has been accredited, program region, and rural-urban setting. Analyses consisted of descriptive, bivariate, and multivariate statistics.ResultsThe mean PANCE score and pass rate during the six-year study period were 463 and 93%, respectively. In unadjusted analyses comparing each year individually, mean PANCE score was highest in 2020 and lowest in 2022 than in all other years except for 2017. When comparing each pandemic year to the pooled three pre-pandemic years and adjusting for test-taker and PA program covariates, examinees scored significantly higher in 2020; there was no difference in 2021, and they scored lower in 2022. When controlling for covariates, examinees had 1.24 higher odds of failing in 2022 compared to the pooled pre-pandemic period.ConclusionFindings suggest that PANCE scores and pass rates were impacted during the third year of the pandemic. PANCE assesses if examinees have the essential clinical knowledge to enter the PA profession. It is crucial to determine whether the pandemic affected PANCE scores and pass rates to ensure PAs provide safe and high-quality patient care.

What do nurses think about telenursing? A descriptive Italian study

Introduction: Telenursing is a new nursing approach to improve continuity, quality and safety of care and patient outcomes. This study aims to describe the viewpoint of Italian nurses on their knowledge, attitudes, and barriers to telenursing.Materials and methods: This descriptive study following the STROBE guidelines was conducted in August 2022 through a web survey. A non-validated questionnaire and convenience snowball sampling were used. Descriptive statistical analysis was performed.Results: 323 nurses were included in the study. 75% of nurses were female, prevalently employed in hospitals (81%). Digital devices were present in 76% of healthcare facilities, but 82% of the sample had never carried out telenursing interventions. The academic training of 75% of nurses does not include telenursing education, and 93% of the sample would be interested in training on the topic, considering their previous knowledge insufficient (54%). Surveyed nurses believe telenursing could improve communication in the care team, patient safety (70%), and quality of care (45%). In nurses' opinion, patients' main barriers would be low digital literacy, use complexity and lack of resources. In addition to sharing the same barriers as patients, nurses need more skilled and exclusively assigned staff and better interconnection between the resources used.Conclusion: In Italian nurses’ opinion, telenursing should improve the quality and safety of care and team communication. The main barriers described by the present study (lack of knowledge, resources, integration, and complexity of the tools used) suggest the need for multi-level interventions and studies to increase its use between nurses and patients.