Acute Care Training Research Articles

Advanced Practice Registered Nurses Student Cross-Specialty Procedural Training: Effective Collaboration and Student Experience.

Intraprofessional simulation and training in acute care nursing specialties can generate synergies that will promote safe, quality patient care. Implementation of multiple intraprofessional simulations across the life span allowed for sharing of faculty and simulation resources. Simulations encompassed both adult and pediatric patients and consisted of airway skills, point-of-care ultrasound, and a multi-skills day encompassing vascular access experiences, chest tube placement, and lumbar puncture. During 5 years, 235 graduate students across three advanced practice nursing specialties participated in the intraprofessional simulation. Learner feedback showed improved confidence, benefit to future practice, and improved clinical judgment via these intraprofessional simulations. Future development of standardized and validated assessments to evaluate each skill will provide quantitative metrics for each clinical skill set and patient population. Further, additional initiatives will include both continuing and expanding intraprofessional simulation offerings, as well as developing interprofessional simulations with physician assistant and perfusionist colleagues. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Medical Students' Perceptions on Identifying and Addressing Emotional Responses in Emergency Medicine: Pilot Investigation.

Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. This study aimed to evaluate medical students' perspectives and emotional preparedness for handling acute care and trauma. We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources.

“Adapted” Motivational Interviewing to Engage Hospital Nurses in Fall Prevention Education

Hospital nurses often experience challenges when teaching older adults about fall prevention strategies. The goal of this project was to provide evidence-based training to hospital nurses to facilitate patient engagement with fall prevention measures. Methods: An “Adapted” Motivational Interviewing (MI) for fall prevention (AMIFP) training in acute care was developed and introduced to nurses as part of a Veterans Affairs-Nursing Academic Partnership (VANAP) initiative. Pre/post surveys were completed by 61 nurses (71% response rate) at an acute care hospital in the United States. Results: After the single AMIFP training, nurses reported having increased knowledge about patient engagement related to fall prevention. Moreover, feelings of confidence related to using some MI skills for fall prevention increased after training. Conclusion: Even a brief AMIFP training for nurses can have a positive impact on improving hospital nurses’ knowledge and attitudes to engage patients in fall prevention education.

SIMULATION TRAINING OF STAFF IN STROKE DEPARTMENTS IS A CATALYST OF THE QUALITY OF COMPREHENSIVE MEDICAL CARE FOR PATIENTS WITH ACUTE STROKE.

The article describes the development of technology and the experience of implementation of simulation training of emergency medical care in acute stroke. The positive effect of simulation training in acute care of cerebrovascular accidents was proven by a significant increase in the availability of modern revascularization techniques, improvement of patient management in the clinical practice of trainees, saving time for logistics and decision-making, strengthening of the teamwork, and confident knowledge of treatment algorithms. The widespread use of educational technology of simulation training may be recommended in order to quickly provide the medical personnel with key clinical competencies, implement teamwork based on professional training and efficiency and build team interaction; establish a unified approach throughout the region (megapolis) to the use of standards and algorithms of emergency stroke care.

Twelve tips for developing a systematic acute care curriculum for medical students

There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students’ reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals.

Barriers and enablers to implementing \u2018DEALTS2\u2019 simulation-based train-the\u2013trainer dementia training programme in hospital settings across England: a qualitative study

BackgroundDespite approaches to provide effective dementia training in acute care settings, little is known about the barriers and enablers to implement and embed learning into practice. We were commissioned by Health Education England to develop and evaluate a new dementia training intervention ‘Dementia Education And Learning Through Simulation 2’ (DEALTS2), an innovative simulation toolkit to support delivery of dementia training in acute care across England. This study aimed to explore barriers and enablers experienced by trainers implementing DEALTS2 and extent to which it impacted on delivery of training and staff clinical practice.MethodsWe conducted twelve one-day DEALTS2 train-the-trainer (TTT) workshops across England in 2017 for National Health Service Trust staff employed in dementia training roles (n = 199 trainers); each receiving a simulation toolkit. Qualitative data were collected through telephone interviews 6–8 months after TTT workshops with 17 of the trainers. Open ended questions informed by the Kirkpatrick model enabled exploration of implementation barriers, enablers, and impact on practice.ResultsThematic analysis revealed six themes: four identified interrelated factors that influenced implementation of DEALTS2; and two outlined trainers perceived impact on training delivery and staff clinical practice, respectively: (i) flexible simulation and implementation approach (ii) management support and adequate resources (iii) time to deliver training effectively (iv) trainer personal confidence and motivation (v) trainers enriched dementia teaching practice (vi) staff perceived to have enhanced approach to dementia care. Trainers valued the DEALTS2 TTT workshops and adaptability of the simulation toolkit. Those supported by management with adequate resources and time to deliver effective dementia training, were likely to implement DEALTS2. Trainers described positive impacts on their teaching practice; and perceived staff had enhanced their approach to caring for people with dementia.ConclusionsTrainers explained individual and organisational barriers and enablers during implementation of DEALTS2. The flexible simulation and implementation approach were key to supporting adherence of DEALTS2. To ensure wider implementation of DEALTS2 nationally, Trusts need to allocate appropriate time to deliver effective dementia training. Future research should measure staff behaviour change, patient perspectives of the intervention, and whether and how DEALTS2 has improved health and care outcomes.

68 General Pediatric Skills – Are we Doing Enough During Training to Prepare Pediatricians for Practice?

Abstract Background Exposure to and training in acute care during pediatrics residency training varies. Furthermore, there is evidence that pediatric and neonatal resuscitative skills, like cardiopulmonary resuscitation, and management of acute care patients is often lacking.1,2 Several studies have shown that only 2.5 of every 1000 pediatric emergency department patients require significant resuscitative efforts3. Thus training for such an event is extremely important because mastering the skills involved are less likely to come with experience. Currently, it is unknown how comfortable community pediatricians feel managing acute care situations, nor if their comfort level changes depending on where they are trained. Objectives Our study aimed to determine if the training general pediatricians receive is sufficient to achieve a high comfort level in acute care that is sustained after 5 years in practice. This study explored pediatricians’ comfort levels with pediatric and neonatal acute care, as set out by the objectives of training in pediatrics from the Royal College of Physicians and Surgeons of Canada. Design/Methods An anonymous cross-sectional survey was piloted to a random sample of pediatricians in the province of Ontario, obtained through the College of Physicians and Surgeons of Ontario. Demographic data regarding practice type and duration was collected as well as training data about courses done in Pediatric Advanced Life Support (PALS) and Neonatal Resuscitation Program (NRP). Using a five-point Likert scale, pediatricians were asked to judge their comfort with different pediatric and neonatal acute care skills and clinical vignettes. Comfort level ranking ranged from 1 (very uncomfortable) to 5 (very comfortable). Skills included are listed in Figure 1. Baseline characteristics were described using frequency measures of proportions and medians and interquartile ranges when appropriate. For general pediatricians and specialists, we used the Mann-Whitney test to determine if there is a difference between the mean sum ranks of comfort level depending on whether the pediatrician was practicing for more or less than 5 years. Results One thousand surveys were mailed, of which 248 were completed (response rate = 24%). Among respondents, 142 (54%) practiced general pediatrics and 68 (32%) were specialists. The majority of respondents practiced in a city, large city or metropolis (84%). In total, 169 (81%) of all survey respondents and 37 (74%) of general pediatricians have been in practice for five years or more. For all respondents, 150 (64%) felt comfortable or very comfortable with neonatal resuscitation team lead. There was no difference in comfort level with leading a neonatal resuscitation team based on years of practice (less than 5 years versus greater than and equal to 5 years) (p=0.69). This result did not change when considering the general pediatrician only (p=0.14). Of all respondents, 113 (48%) felt comfortable or very comfortable with pediatric resuscitation team lead. There was a significant difference in comfort level with leading a pediatric resuscitation team based on years of practice (less than 5 years versus greater than and equal to five years) (p=0.03) with more comfort being seen over time. When analyzing only for general pediatricians, that difference became insignificant (p=0.07). No difference was found in reported comfort in most skills and length of time in practice. However, comfort level is significantly positively correlated with the number of times a skill was performed. Interestingly, a significantly negative correlation was found between comfort level as pediatric resuscitation team lead and number of years in practice (p=0.03). Conclusion The findings of this pilot survey suggest that ensuring competence in acute care in residency training is of utmost importance given that comfort with pediatric and neonatal resuscitation appears to remain static over time. The skills that pediatricians report most discomfort in are a target for continuing professional development or should be revised in the objectives of training of pediatrics.

Do UK military General Practitioners feel adequately skilled in the provision of care to the acutely unwell or injured patient?

BackgroundGeneral Practice training in the civilian and military environments follows a common training pathway, yet the scope of practice of a military General Practitioner (GP) varies significantly. A level of...

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Nurse Practitioner Job Satisfaction and the Healthy Work Environment.

Development and pilot of an interprofessional pediatric resuscitation program for non-acute care inpatient providers

ABSTRACTMultiprofessional ward healthcare providers are generally unprepared to assemble and engage in the initial resuscitation of pediatric inpatients. This is important as the performance of these first-responders, in the several minutes prior to the arrival of acute care support, may have significant effects on overall patient outcome. Accordingly, we aimed to develop and pilot a training program intended for non-acute care inpatient providers, relevant to their working context. Using the latest theory and evidence in medical education, we created an interprofessional, entirely in-situ, simulation-based small-group activity. The activity was then piloted for four months with the goals of assessing perceived usefulness, as well as implementation factors such as participant accessibility and overall resource requirements. A total of 37 interprofessional (physician and nursing) staff were trained in 16 small group sessions over four months. Post-participation questionnaires revealed that the activity was perceived to be highly useful for their practice; especially the rapid cycle deliberate practice instructional method, and the increased focus on crisis resource management. Resource requirements were comparable to, and perhaps less than, existing acute care training programs. This project describes the preliminary steps taken in creating a curriculum intended to improve interprofessional resuscitation performance across an institution.

Early warning systems and rapid response to the deteriorating patient in hospital: A realist evaluation.

To test the Rapid Response Systems programme theory against actual practice components of the Rapid Response Systems implemented to identify those contexts and mechanisms which have an impact on the successful achievement of desired outcomes in practice. Rapid Response Systems allow deteriorating patients to be recognized using Early Warning Systems, referred early via escalation protocols and managed at the bedside by competent staff. Realist evaluation. The research design was an embedded multiple case study approach of four wards in two hospitals in Northern Ireland which followed the principles of Realist Evaluation. We used various mixed methods including individual and focus group interviews, observation of nursing practice between June-November 2010 and document analysis of Early Warning Systems audit data between May-October 2010 and hospital acute care training records over 4.5years from 2003-2008. Data were analysed using NiVivo8 and SPPS. A cross-case analysis highlighted similar patterns of factors which enabled or constrained successful recognition, referral and response to deteriorating patients in practice. Key enabling factors were the use of clinical judgement by experienced nurses and the empowerment of nurses as a result of organizational change associated with implementation of Early Warning System protocols. Key constraining factors were low staffing and inappropriate skill mix levels, rigid implementation of protocols and culturally embedded suboptimal communication processes. Successful implementation of Rapid Response Systems was dependent on adopting organizational and cultural changes that facilitated staff empowerment, flexible implementation of protocols and ongoing experiential learning.

A roadmap for acute care training of frontline Healthcare workers in LMICs

This 10-step roadmap outlines explicit procedures for developing, implementing and evaluating short focused training programs for acute care in low and middle income countries (LMICs). A roadmap is necessary to develop resilient training programs that achieve equivalent outcomes despite regional variability in human capacity and infrastructure. Programs based on the roadmap should address shortfalls in human capacity and access to care in the short term and establish the ground work for health systems strengthening in the long term. The primary targets for acute care training are frontline healthcare workers at the clinic level. The programs will differ from others currently available with respect to the timelines, triage method, therapeutic interventions and potential for secondary prevention. The roadmap encompasses multiple iterative cycles of the Plan-Do-Study-Act framework. Core features are integration of frontline trainees with the referral system while promoting research, quality improvement and evaluation from the bottom-up. Training programs must be evidence based, developed along action timelines and use adaptive training methods. A systems approach is essential because training programs that take cognizance of all factors that influence health care delivery have the potential to produce health systems strengthening (HSS).

Factors associated with success in the oral part of the European Diploma in Intensive Care.

The oral part of European Diploma in Intensive Care diploma examinations changed in 2013 into an objective structured clinical examination-type exam. This step was undertaken to provide a fair and reproducible clinical exam. All candidates face identical questions with predefined correct answers simultaneously in seven high throughput exam centres on the same day. We describe the factors that are associated with success in part 2 European Diploma in Intensive Care exam. We prospectively collected self-reported data from all candidates sitting European Diploma in Intensive Care part 2 in 2015, namely demographics, professional background and attendance to a European Diploma in Intensive Care part 2 or generic objective structured clinical examination preparatory courses. After testing association with success (with cutoff at p < 0.10) and co-linearity of these factors as independent variables, we performed a multivariate logistical analysis, with binary exam outcome (pass/fail) as the dependent variable. Structural equation modelling was used to gain further insight into relations among determinants of success in the oral part of the European Diploma in Intensive Care. Out of 427 candidates sitting the exam, completed data from 341 (80%) were available for analysis. The following candidates' factors were associated with increased chance of success: English as native language (odds ratio 4.3 (95% CI 1.7-10.7)), use of Patient-centred Acute Care Training e-learning programme module (odds ratios 2.0 (1.2-3.3)), working in an EU country (odds ratios 2.5 (1.5-4.3)), and better results in the written part of the European Diploma in Intensive Care (for each additional SD of 6.1 points odds ratios 1.9 (1.4-2.4)). Chance of success in the European Diploma in Intensive Care 2 decreased with increased candidates 'age (for each additional SD of 5.5 years odds ratios 0.67 (0.51-0.87)). Exam centres (7 in total) could be clustered into 3 groups with similar success rates. There were significant differences in exam outcomes among these 3 groups of exam centres even after adjustment to known candidates' factors (G1 vs G2 odds ratios 2.4 (1.4-4.1); G1 vs G3 odds ratios 9.7 (4.0-23.1) and G2 vs G3 odds ratios 3.9 (1.7-9.2)). A short data collection period (only one year) and 20% of missing candidates' data are the main limitations of this study. Younger age, English as native language, better results in written part of the exam, working at a European country and the use of PACT for preparation, were factors associated with success in the oral part of the European Diploma in Intensive Care exam. Despite the limitations of this study, the differences in outcome among the exam centres will need further investigation.

The Experience of Advanced Practice Nurses in US Emergency Care Settings

IntroductionLittle information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. MethodsAn exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. ResultsThe educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. DiscussionIntegrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting.Image 1

Developing a Sustainable Need-Based Pediatric Acute Care Training Curriculum in Solomon Islands.

The Johns Hopkins Hospital Pediatric Emergency Department (PED) was invited to collaborate with the National Referral Hospital (NRH), Solomon Islands, to establish an acute care pediatric education program for the country's inaugural class of national medical graduate trainees. To develop and evaluate a sustainable, need-based post-graduate training curriculum in pediatric acute care, resuscitation, and point-of-care ultrasound. A need-based training curriculum was developed utilizing the ADDIE model and was implemented and revised over the course of 2 years and two site visits. Implementation followed a train-the-trainer model. The curriculum consisted of high-yield didactics including workshops, simulations, hands-on ultrasound sessions, and lectures at the NRH. A mixed-methods design was used to evaluate the curriculum, including pre/posttesting, qualitative group discussions, and individual surveys. The curriculum was revised in response to ongoing learner evaluations and needs assessments. Continuing educational sessions after the site visit demonstrated sustainability. The curriculum included 19 core topics with 42 teaching sessions during the two site visits. A total of 135 pre/posttests and 366 individual surveys were collected from 46 trainees. Completion rates were 78.2% for surveys and 71.3% for pre/posttests. Pre/posttest scores increased from 44 to 63% during the first site visit and 69.6 to 77.6% during the second. Learners reported a mean 4.81/5 on a standard Likert scale for curriculum satisfaction. Group discussions and surveys highlighted key areas of knowledge growth, important clinical care advances, and identified further needs. Initial sustainability was demonstrated by continued ultrasound sessions led by local graduate trainees. A collaborative team including Johns Hopkins PED staff, Solomon Islands' graduate trainees, and NRH administration initiated a professional education curriculum for the first class of Solomon Islands' medical graduates. Knowledge growth and positive impacts of the program were reflected in learner survey and test scores. Graduate trainees were identified as local champions to continue as course instructors. This innovative curriculum was developed, revised, and initially sustained on site. It has been successful in introducing life-saving pediatric acute care and graduate training in Solomon Islands.

Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?

Should Primary Care Nurse Practitioners be Permitted to Work in Acute Care Settings?

A Retrospective Study of Physiological Observation-reporting Practices and the Recognition, Response, and Outcomes Following Cardiopulmonary Arrest in a Low-to-middle-income Country.

Background and Aims:In Sri Lanka, as in most low-to-middle-income countries (LMICs), early warning systems (EWSs) are not in use. Understanding observation-reporting practices and response to deterioration is a necessary step in evaluating the feasibility of EWS implementation in a LMIC setting. This study describes the practices of observation reporting and the recognition and response to presumed cardiopulmonary arrest in a LMIC.Patients and Methods:This retrospective study was carried out at District General Hospital Monaragala, Sri Lanka. One hundred and fifty adult patients who had cardiac arrests and were reported to a nurse responder were included in the study.Results:Availability of six parameters (excluding mentation) was significantly higher at admission (P < 0.05) than at 24 and 48 h prior to cardiac arrest. Patients had a 49.3% immediate return of spontaneous circulation (ROSC) and 35.3% survival to hospital discharge. Nearly 48.6% of patients who had ROSC did not receive postarrest intensive care. Intubation was performed in 46 (62.2%) patients who went on to have ROSC compared with 28 (36.8%) with no ROSC (P < 0.05). Defibrillation, performed in eight (10.8%) patients who had ROSC and eight (10.5%) in whom did not, was statistically insignificant (P = 0.995).Conclusions:Observations commonly used to detect deterioration are poorly reported, and reporting practices would need to be improved prior to EWS implementation. These findings reinforce the need for training in acute care and resuscitation skills for health-care teams in LMIC settings as part of a program of improving recognition and response to acute deterioration.

Should Palliative Care Nurse Practitioners be Required to Have Acute Care Training?

Should Palliative Care Nurse Practitioners be Required to Have Acute Care Training?

P046: The “Nightmares-FM” course: an effective simulation-based acute care training method for family medicine residents

Introduction / Innovation Concept: Acute care skills are difficult to teach but can be improved using high-fidelity simulation training. We developed a comprehensive acute care “Nightmares-FM” simulation course (NM) for our Family Medicine residents and compared it to our standard simulation teaching- episodic Acute Care Rounds (ACR). Methods: NM course consisted of an initial 2 day session followed by 3 follow-on sessions interspersed throughout the PGY-1 year. ACR participants got access to 3 sessions interspersed throughout the PGY-1 year, each focusing on a different aspect of acute care. Both groups got access to the NM manual which covered the relevant topics: shock, arrhythmias, shortness of breath, altered level of consciousness and myocardial infarction. The manual is physiology-based and written specifically at the level that an average Family Medicine resident would be expected to perform at during on-call crises or emergency medicine rotations. 12 residents participating in the NM and 12 residents in time-matched ACR filled out questionnaires asking them to rate their level of knowledge of various aspects of acute care. Self-reported changes before and after each session, and at the end of the year, were analyzed using Wilcoxon matched pairs test. End of the year mean scores were compared using a two sided t-test. Finally, we developed a high-complexity acute care Objective Structured Clinical Examination (OSCE): COPD exacerbation with septic shock requiring use of positive pressure ventilation, fluids and vasopressors. The groups participated in the OSCE in February of their PGY-2 year and were graded using a validated scoring sheet marked by two independent expert video reviewers. Curriculum, Tool, or Material: NM initial 2-day session significantly improved the resident’s self-assessment scores on all 20 items of the questionnaire (p&lt;0.05). Time matched ACR improved 11 out of 20 items (p&lt;0.05) level. Follow-up NM sessions improved 5-8 out of 20 items, (p&lt;0.05). Follow-up ACR sessions improved 1-5 out of 20 items, (p&lt;0.05). End of the year means were higher for 13/20 items in the NM group (p&gt;0.05) The NM group scored significantly higher on both the mean scores of OSCE individual categories: Initial assessment, Diagnostic workup, Therapeutic interventions and Communication and teamwork (p&lt;0.05) and the Global Assessment Score (p&lt;0.026). Conclusion: “Nightmares-FM” course is more effective than our standard curriculum at teaching acute care skills to Family Medicine residents.

A collaborative approach to training ward nurses in acute care skills in resource limited settings: the nursing intensive care skills training (nicts) project

Early recognition and prevention of deterioration of ward patients can improve patient outcomes and reduce critical care admissions [1]. In low and middle income countries (LMICs), with often minimal access to critical care therapies, the benefit may be even greater. However training to assist ward nurses develop acute care skills remains limited in such settings. As part of the NICST portfolio of acute care training, the Sri Lankan nursing faculty sought assistance to deliver a 2 day course for ward nurses [2].