Placement Settings Research Articles

Practicing information literacy: Practicum students negotiating information practice in workplace settings

This study explores practicum students' experiences of information literacy (IL) in work placement settings and describes the various ways they experience IL while learning in these settings. Using phenomenography to conduct and analyze interviews with practicum students in health and community programs at an undergraduate university, this study finds that in practicum settings, learners understand and practice IL not only from their perspectives as students but also as employees and future professionals. This exploration of student IL experiences in learning contexts beyond the classroom presents insights that can inform and strengthen IL curriculum and pedagogy for students in professional programs.

E-portfolios and Entrustable Professional Activities to support competency-based education in dietetics.

The concept of Entrustable Professional Activities, recently pioneered in medical education, has emerged to support the implementation of competency-based education. Although competency-based frameworks are widely used in healthcare professional education to develop outcomes-based curricula, assessment of student competency in professional placement settings remains challenging. The novel concept of Entrustable Professional Activities together with established methods of competency assessment, namely e-portfolios and self-assessment, was implemented in the "[La Trobe University Dietetic program in 2015-2016. This study aimed to appraise the e-portfolio and evaluate the use of Entrustable Professional Activities to assess competence. A mixed-methods evaluation, using qualitative and quantitative surveys with follow-up structured consultations, was conducted with final year dietetics students and their supervisors. Dietetics students were comfortable with Entrustable Professional Activities and competency-based assessment, whereas supervisors preferred Entrustable Professional Activity based assessment. All stakeholders valued student self-assessment and the ongoing use of structured e-portfolios to develop and document competency. The use of structured e-portfolios, student self-assessment, and the emerging concept of Entrustable Professional Activities are useful tools to support dietetics student education in professional placement settings.

In Reply to the Letter to the Editor Regarding “Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures”

In Reply to the Letter to the Editor Regarding “Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures”

Letter to the Editor Regarding “Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures”

Letter to the Editor Regarding “Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures”

Words in action: Examining what clinical education placement documents contribute to thinking, acting and feeling like a health professional

Introduction: Clinical placements are critical for student learning and transition to practice. They help students integrate their knowledge and skills and support their development of professional identity—so they come to “think, act and feel” like a member of their profession. Students have reported that placements play a role in development of professional identity. Documents are frequently the first contact students have with the placement setting. However, there are few studies examining the impact of clinical placement documents on the development of allied health students’ professional identity. This study examines what clinical placement documents contribute to the development of professional identity through facilitating thinking, feeling and acting like a health professional.Methods: Thematic analysis of clinical education placement documents was conducted using a deductive framework based on review of literature considering how students can be supported to think, act and feel like a health professional.Results: Thirteen placement orientation documents were reviewed. Reference to factors that support “thinking” described learning opportunities to enable students to develop knowledge for practice. Reference to factors that support “acting” described graded learning that enables student contribution to service delivery and recognition as a health professional, and reference to factors that support “feeling” described workplace culture and practices supporting connectedness.Conclusions: This study identified that placement documents can contribute to allied health students thinking, acting and feeling like a health professional while on clinical placement. Academic staff and organisations reviewing clinical placement documents may wish to consider the implications identified in this study, which demonstrate how documents can include or exclude students in the workplace.

Pediatric Floating Elbow Injuries Are Not as Problematic as They Were Once Thought to Be: A Systematic Review

Pediatric ipsilateral supracondylar humerus and forearm fractures (floating elbow), are historically reported to have a high rate of complications, including pediatric acute compartment syndrome (PACS). As a result, treatment paradigms for these types of injuries differ in the urgency, extent of fixation, and type of immobilization than if each fracture were treated in isolation. We aimed to systematically review the literature on pediatric floating elbow injuries and assess the reported risk of PACS along with risk factors for poor outcomes. A systematic review was performed in November 2019 in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An exhaustive search of the PubMed and Embase databases was conducted for peer-reviewed literature between 1999 and 2019. Two reviewers filtered the results, looking for articles in English that reported >10 pediatric floating elbow cases. Primary outcomes were the rate and risk factors for developing PACS. Secondary outcomes included patient and injury characteristics, treatment strategies, other complications (eg, neurovascular injuries), and final outcomes. The initial search yielded a total of 150 studies. Following review, 11 studies were included, with 433 patients available for review. The mechanism of injury was a fall in 96% of cases. Closed reduction and percutaneous pinning was the most common treatment performed for both fractures. Only 8/433 patients (2%) developed PACS. The incidence of a pulseless limb at presentation was 4%, and all patients regained a pulse following reduction. Three cases of iatrogenic ulnar nerve injury were reported in the setting of medial pin placement. Good to excellent results were reported in 83% to 100% of patients, based on the modified Flynn criteria. Despite being limited to heterogenous and retrospective case series, the evidence reviewed in this study contradicts the current belief of a high risk of PACS or other complications in pediatric floating elbows. PACS is much more common with displaced fractures in the setting of delayed treatment. The rate of other complications is comparable to isolated supracondylar humerus fractures. Evidence supports treating these injuries in an urgent fashion in the setting of a displaced fracture, although fixation of both distal and proximal fractures is not supported by evidence. The outcomes of pediatric floating elbows are generally good and do not reflect the poor prognosis that adult floating elbows represent. Level IV-systematic review of level IV studies.

A Strategic and Significant Method for the Optimal Placement of Phasor Measurement Unit for Power System Network

Currently the new state of power system relies on a precise monitoring of electrical quantities such as voltage and current phasors. Occasionally, its operation gets disturbed because of the flicking in load and generation which may result in the interruption of power supply or may cause catastrophic failure. The advanced technology of phasor measurement unit (PMU) is introduced in the late 1990s to measure the behavior of power system more symmetrically, accurately, and precisely. However, the implementation of this device at every busbar in a grid station is not an easy task because of its expensive installation and manufacturing cost. As a result, an optimum placement of PMU is much needed in this case. Therefore, this paper proposes a new symmetry approach of multiple objectives for the optimum placement of PMU problem (OPPP) in order to minimize the installed number of PMUs and maximize the measurement redundancy of the network. To overcome the drawbacks of traditional techniques in the proposed work a reduction and exclusion of pure transit node technique is used in the placement set. In which only the strategic, significant, and the most desirable buses are selected without considering zero injection buses (ZIBs). The fundamental novelty of the proposed work considers most importantly the reduction technique of ZIBs from the optimum PMU locations, as far as the prior approaches concern almost every algorithm have taken ZIBs as their optimal placement sets. Furthermore, a PMUs channel limits and an alternative symmetry location for the PMUs placement are considered when there is an outage or PMUs failure may occur. The performance of the proposed method is verified on different IEEE-standard such as: IEEE-9, IEEE-14, IEEE-24, IEEE-30, IEEE-57, IEEE-118, and a New England-39 bus system. The success of the proposed work was compared with the existing techniques’ outcomes from the literature.

Symptomatic cerebral vasospasm in the setting of carmustine wafer placement for glioblastoma: A case presentation and review of literature

Background: Gliadel placement in glioblastoma resection, particularly with concurrent chemoradiation, has demonstrated an improvement in survival. There have been several reported adverse effects, some of which lend to significantly increased morbidity and mortality. With only two other cases described in literature, cerebral vasospasm secondary to carmustine-impregnated wafers is an extremely rare side effect.Case Description: We report the case of a 51-year-old female who presented with the left lower limb paresis 8 days after high-grade glioma resection provoked by carmustine wafer placement.Conclusion: We urge surgeons to reconsider placement of carmustine wafers in nations where the surgical resection cavity includes exposed large cerebral vasculature. We also propose the early identification of this devastating complication in the postoperative period by maintaining a high clinical suspicion and prompt utilization of computed tomography and digital subtraction angiography in the management and treatment of these patients accordingly.

Alternative mental health clinical placements: Knowledge transfer and benefits for nursing practice outside mental healthcare settings.

To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices. Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self-determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities. This study employed a phenomenological research design, involving individual semi-structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to. Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. "I definitely look at people with mental health conditions in a different light." At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change. Recovery Camp may have facilitated the transfer of knowledge that is more person-centred among nursing students, consequently impacting their current nursing practices. Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education.

Fourth year nursing students' perceptions of their educational preparation in medication management: An interpretative phenomenological study

BackgroundMedication safety is an integral aspect of patient safety. Nurses, as advocates of patient safety, actively consider medication safety in the course of their daily work. Hence, it is important to consider the educational preparation of nursing students in medication management, as future caregivers. There are inherent links between nurses' undergraduate educational preparation in medication management and patient safety. ObjectiveThis research study identifies fourth-year nursing students' perceptions of their educational preparation in medication management. DesignAn interpretative phenomenological methodological approach underpinned this research study. SettingThis study was conducted at a University in the West of Ireland. ParticipantsParticipants were final year students of three undergraduate nursing programmes, Bachelor of Science in Nursing (General), Bachelor of Science in Nursing (Intellectual Disability) and Bachelor of Science in Nursing (Mental Health). MethodsFourteen semi-structured, face-to-face interviews were conducted with students on a one-to-one basis. Data were analysed using thematic content analysis. ResultsThe voices and interpretations of the participants in this study were fundamental to understanding nursing students' perceptions of their preparation in medication management and provided the foundation for this research. These perceptions were captured in the format of four themes: developing an understanding, embedding knowledge in practice, engaging in practice and accepting professional responsibility. ConclusionsFindings point to the important role of the university and the clinical placement settings in nursing students' medication management education and the need for further collaboration and development across both settings. Teaching and learning strategies which promote the integration of theory and practice throughout the four years of the undergraduate degree programme should be encouraged, such as technology enhanced learning and simulation.

Preservice Teachers’ Perceptions of Inclusive Education: The Reality of Professional Experience Placements

AbstractDeveloping the knowledge and practical skills for implementing inclusive education is a legislative and policy imperative for contemporary graduate teachers. In this qualitative study, the authors investigated the experiences of 18 preservice teachers during their practical school placements in primary and secondary school settings and the impact of these experiences on their attitudes towards students with special needs and their readiness to teach in mainstream inclusive settings. Sixteen of the participants had completed 2 or more placements. Data were collected using semistructured interviews and analysed to categorise the observed and enacted practices and define themes that contribute to a deeper understanding of preservice teachers’ learning about inclusion through their practice in schools. The 4 identified themes show that contact, responsibility for instruction, modelled practices, and expectations for student learning all have significant impacts on the quality and outcomes of preservice teachers’ placements. Findings suggest that placement settings do not consistently represent contexts where aspiring teachers are exposed to the types of meaningful contact or successful experiences claimed to be fundamental preparation for inclusive practice. The implications for the preservice teachers themselves and for their future practice are discussed.

Measuring the quality of care in kinship foster care placements

Kinship foster care placements have become significantly more prevalent in both Canada and the United States. However, there are limited resources for child protection services (CPS) workers to assess the quality of the kinship caregiver placements. Although several measures exist to screen caregivers for general foster care, there are no instruments available for the assessment of quality in kinship foster care. Thus, the current study reexamined a kinship caregiver assessment using data from a study conducted at the Children and Family Research Center (CFRC). Inter-item and item-scale reliability coefficients were calculated for caregiver responses (N = 37) using Cronbach’s alpha and ordinal alpha through polychoric correlation matrices. Analyses revealed five distinct scales with good internal consistency (ordinal α > 0.75), suggesting a useful assessment tool. With the continuing shift to increased kinship placements, it is important that CPS workers have access to validated measures for this placement setting. Findings provide an innovative kinship caregiver measure to be used in the field of child welfare, and support further research in this area.

Redefining the Role of Drain Amylase Value for a Risk-Based Drain Management after Pancreaticoduodenectomy: Early Drain Removal Still Is Beneficial

BackgroundThe application of postoperative pancreatic fistula (POPF) risk stratification and mitigation strategies requires an update of the protocol for an early drain removal after pancreaticoduodenectomy (PD). The aim of the study is to highlight the unreliability of a single drain fluid amylase (DFA) cutoff-based protocol in the setting of a risk-based drain management. MethodsThe role of postoperative day one (POD1) DFA in predicting POPF was explored in the setting of both selective drain placement and early drain removal protocols. Receiver operating characteristics (ROC) curves were used to assess the POPF diagnostic performance in terms of negative predictive value (NPV) of several POD1 DFA cutoffs in different clinical scenarios according to POPF risk and mitigation strategies. ResultsThe areas under the curve (AUCs) for POD1-DFA were 0.815 for intermediate risk and pancreaticojejunostomy (PJ) (best cutoff 1000 IU/L, NPV 92.9%), 0.712 for intermediate risk and PJ with external stent (best cutoff 1000 IU/L, NPV 88.8%), and 0.574 for high risk and external stent (best cutoff 250 IU/L, NPV 93.7%). Independent predictors of POPF were body mass index, pancreatic texture, and early drain removal, whereas POD1 DFA was not. ConclusionIn the era of risk stratification and mitigation strategies, selective early drain removal still is associated with a reduced rate of POPF. However, a single protocol based on POD1-DFA is not suitable for all clinical scenarios after PD.

An Exploration of Novice Nursing Student’s Experiences of Mentoring in Practice Placement Settings in the United Kingdom

TThis study focuses on the experience of new UK student nurses of being mentored in the workplace (placement) setting. There is only limited nursing literature that focuses on the experience of being mentored, whilst there is significant material that examines the role of the mentor. With half of the course being spent in the placement setting, the role of the mentor is pivotal in supporting the student and their learning. Adopting a qualitative design, data was collected through small-group interviews with a cohort of first-year nursing students. Data analysis followed in the form of standard thematic analysis. The Communities of Practice model developed by Lave & Wenger was applied as a theoretical lens. Two main themes emerged from the analysis process: the process of belonging; and that of developing identity as a learner. Whilst there was consensus with the literature in that it was felt that the mentor had a key role to play in supporting and facilitating learning, the participants also felt that the mentor supported them to settle into the team. Further, it was found that until the learner felt part of the wider placement clinical team, the process of learning may be hindered. An argument is presented advocating better preparation of students for learning in the workplace setting as this will enable them to assimilate better the learning offered by mentors and the wider healthcare team.

Use of Continuous Infusions of Eptifibatide and Cangrelor in Large Vessel Occlusion Acute Ischemic Stroke After Emergent Carotid Artery Stenting

Placement of carotid stents in the setting of large vessel occlusion (LVO) is sometimes necessary in patients with steno-occlusive disease of the extracranial internal carotid artery (ICA) or ICA dissection. Use of antiplatelet agents is required to prevent in-stent thrombosis; however, after an LVO, a decompressive hemicraniectomy may be necessary. After placement of a carotid stent, a fine balance must be obtained between preventing stent-related thromboembolic complications while also maintaining the possibility of quickly and safely performing a decompressive hemicraniectomy, if indicated. In this case, we discuss the novel use of continuous eptifibatide and cangrelor infusions after carotid stent placement to maintain stent patency, while preserving the option of emergent hemicraniectomy. A 55-year-old man presented with left hemispheric ischemic symptoms due to flow failure from a left ICA dissection. He underwent emergent angiography with angioplasty and stenting of the petrous and ascending cervical segments of the left ICA. The procedure was complicated by an embolization of thrombus to a left middle cerebral artery (MCA) M2 division branch, resulting in an occlusion, which could not be opened. The patient was placed on short acting intravenous antiplatelet agents (eptifibatide infusion for 60 h and cangrelor infusion for 24 h) for prevention of in-stent thrombosis while under close observation for potential neurologic decline and need for decompressive hemicraniectomy. After 84 h of observation, the patient did not experience a decline and the antiplatelet infusions were discontinued after he received aspirin and a loading dose of clopidogrel. Intravenous eptifibatide or cangrelor infusions are short-acting antiplatelet options that can be used in patients with acute ischemic stroke from LVO in the setting of ICA stent placement when there exists a potential for decompressive hemicraniectomy. J Neurol Res. 2020;10(3):99-103 doi: https://doi.org/10.14740/jnr591

Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices.

The success of left ventricular assist device (LVAD) therapy is hampered by complications such as thrombosis and bleeding. Understanding blood flow interactions between the heart and the LVAD might help optimize treatment and decrease complication rates. We hypothesized that LVADs modify shear stresses and blood transit in the left ventricle (LV) by changing flow patterns and that these changes can be characterized using 2D echo color Doppler velocimetry (echo-CDV). We used echo-CDV and custom postprocessing methods to map blood flow inside the LV in patients with ongoing LVAD support (Heartmate II, N = 7). We compared it to healthy controls (N = 20) and patients with dilated cardiomyopathy (DCM, N = 20). We also analyzed intraventricular flow changes during LVAD ramp tests (baseline ± 400 rpm). LVAD support reversed the increase in blood stasis associated with DCM, but it did not reduce intraventricular shear exposure. Within the narrow range studied, the ventricular flow was mostly insensitive to changes in pump speed. Patients with significant aortic insufficiency showed abnormalities in blood stasis and shear indices. Overall, this study suggests that noninvasive flow imaging could potentially be used in combination with standard clinical methods for adjusting LVAD settings to optimize flow transport and minimize stasis on an individual basis.

Understandings of mentoring in school placement settings within the context of initial teacher education in Scotland: dimensions of collaboration and power

ABSTRACT This study critically addresses mentor and mentee understandings of mentoring primary education student teachers within existing operations of power in the context of Scottish Initial Teacher Education. Semi-structured interviews of mentors and student teachers were used to elicit relational understandings of the mentoring process within an instrumental, collective case study research design. Findings indicate that participants understood mentoring as a multifaceted process aimed at supporting the professional learning of student teachers. The article addresses the main mentoring relationship between the class teacher mentor and student teacher mentee. Analysis of their responses suggests an understanding of mentoring as involving both personal and professional dimensions. From these dimensions emerge the focus of this article: implicit collaboration and conceptions of power as a relational duality situated within a more Foucauldian ‘flux’ form. Critical discussion of findings extends understandings of the complexity of the mentoring process with reference to perceptions of collaboration, power and their co-existence. Conclusions focus on the need for a quality, consistent mentor education programme to promote an informed knowledge and understanding of the complex nature of mentoring in order to improve the quality and consistency of mentee learning experiences.

Bathing routines in different infant placement settings: an ethological study

ABSTRACT This study used an ethological approach to explore the behavioural adaptation of nineteen infants during their first six weeks in Residential Care (RC), or a Foster Family (FF) or an Infant-Mother Centre (IMC). Direct observations were conducted once a week at bath time. Observed behaviours were: sleep-wake states, visual exploration, motor activity, facial and vocal expressions. Non-parametric analyses showed that, in RC, the duration of bathing was the shortest and babies expressed more crying and withdrawal and less locomotor abilities and vocalizations. By contrast, in IMC, the bathing time was the longest and babies spent the least time in crying and showed the most locomotor abilities and vocalizations. The placement in FF showed intermediate results. This study showed sleep-wake states and behaviours that found variable expression depending on the placement environment and therefore could be considered as markers of the baby’s adaptation to his placement milieu in follow-up quantitative studies.

Use of Continuous Infusions of Eptifibatide and Cangrelor in Large Vessel Occlusion Acute Ischemic Stroke After Emergent Carotid Artery Stenting

Placement of carotid stents in the setting of large vessel occlusion (LVO) is sometimes necessary in patients with steno-occlusive disease of the extracranial internal carotid artery (ICA) or ICA dissection. Use of antiplatelet agents is required to prevent in-stent thrombosis; however, after an LVO, a decompressive hemicraniectomy may be necessary. After placement of a carotid stent, a fine balance must be obtained between preventing stent-related thromboembolic complications while also maintaining the possibility of quickly and safely performing a decompressive hemicraniectomy, if indicated. In this case, we discuss the novel use of continuous eptifibatide and cangrelor infusions after carotid stent placement to maintain stent patency, while preserving the option of emergent hemicraniectomy. A 55-year-old man presented with left hemispheric ischemic symptoms due to flow failure from a left ICA dissection. He underwent emergent angiography with angioplasty and stenting of the petrous and ascending cervical segments of the left ICA. The procedure was complicated by an embolization of thrombus to a left middle cerebral artery (MCA) M2 division branch, resulting in an occlusion, which could not be opened. The patient was placed on short acting intravenous antiplatelet agents (eptifibatide infusion for 60 h and cangrelor infusion for 24 h) for prevention of in-stent thrombosis while under close observation for potential neurologic decline and need for decompressive hemicraniectomy. After 84 h of observation, the patient did not experience a decline and the antiplatelet infusions were discontinued after he received aspirin and a loading dose of clopidogrel. Intravenous eptifibatide or cangrelor infusions are short-acting antiplatelet options that can be used in patients with acute ischemic stroke from LVO in the setting of ICA stent placement when there exists a potential for decompressive hemicraniectomy. J Neurol Res. 2020;10(3):99-103 doi: https://doi.org/10.14740/jnr591

Evidence-based practice conversations with clinical supervisors during paramedic placements: an exploratory study of students' perceptions.

Objective Paramedic education providers teach the latest evidence-based practice when students attend academic classes. Clinical placements are an important aspect of paramedic training, however, they can pose a potential area of conflict regarding approaches to practice, in particular when it comes to evidence-based practice knowledge and decision-making processes. To better understand the continuum between academic classes and clinical placement, this study explored students understanding of evidence-based practice conversations, determined the prevalence of these whilst on clinical placement, and considered whether students believe their future participation in evidence-based practice conversations could be improved. Methods An exploratory cross-sectional self-administered electronic questionnaire was conducted with paramedic students from an Australian university. The questionnaire was validity checked prior to implementation. Results One hundred and sixty-eight 2nd and 3rd year paramedic students completed the questionnaire (response rate = 66%). Although most students (82%) understood what constitutes an evidence-based practice conversation, only 23% reported learning about evidence-based practice conversations, and 18% reported practicing evidence-based practice conversations during their clinical placements. Regression analysis found that the gender of the supervisor and age of the student significantly affected the likelihood of learning about or practicing evidence-based practice conversations (p=0.029, p = 0.049 respectively) whilst on clinical placement. Students did not feel that evidence-based practice questioning would have possible negative repercussions, however most (83%) felt they needed to improve their evidence-based practice communication skills. Conclusions Paramedic students and clinical supervisors rarely engage in evidence-based practice conversations during clinical placement. Further research into evidence-based practice communication in the clinical placement setting is required to ensure a consistent approach to the training of future paramedics.