Understanding Of Patient Care Research Articles

Optimizing Health Professions Education through a Better Understanding of “School-Supported Clinical Learning”: A Conceptual Model

Interventions connecting school and clinical practice can align requirements and enhance learning outcomes. Current models and theories of clinical learning leave gaps in our knowledge about how learning processes and outcomes can be optimized by schools. In this paper, we discuss findings about threats and opportunities in the use of school standards, tools, and support in clinical learning, including underlying mechanisms, in the context of nursing education. Opportunities include competency frameworks that can challenge students to push their limits despite a task-oriented ward culture. Assignments and tools can deepen students’ understanding of patient care, help them compare different experiences and stimulate self-regulated learning. Threats include rigid performance criteria that guide students’ selection of learning opportunities, extensive written formats, and individualization of self-regulated learning. These threats can lead to added workload and disengagement. Based on the critically constructed argument that the role of schools in clinical learning should be acknowledged in the literature, we present a conceptual model to do so. The use of this model provides design principles for learning environments at the interface of school and practice within health professions education. Eventually, learning outcomes can be achieved efficiently without unnecessary interference with students’ engagement in patient care and student-supervisor interactions.

An integrated simulation-based early clinical exposure module in cardiovascular physiology

Objectives: A good conceptual understanding of physiology is very important to build a strong foundation for medical students. It is a daunting job for teachers to emphasise the clinical relevance of basic science subjects as exposure to patients invariably starts after these subjects have been taught. With the introduction of early clinical exposure in the newly revised Indian undergraduate medical curriculum, this problem can be addressed to a certain extent. We developed an integrated simulation module for teaching cardiovascular physiology to pre-clinical students as a part of early clinical exposure. Materials and Methods: We included 145 medical students of a Private Medical College of a Deemed to be University in Mangalore, Karnataka, India. The teaching module covered the topics of cardiovascular physiology such as functional anatomy, cardiac cycle, normal electrocardiogram (ECG), arrhythmia, arterial pulse examination, heart sounds and hands-on cardiovascular examination using a variety of simulators. The assessment was done by pre-test and post-test. A retro-pre questionnaire was used to assess their self-perceived knowledge gain and level of clinical skills. Feedback on overall experience was collected from the participants. Results: The student feedback showed that learning experience was life-like (98.6%), effective, innovative and enjoyable (99.3%) and making the overall experience of learning easier (95.2%). It also improved participation, communication (93.8%), clinical skills and a better understanding of patient care (99.3%). The results of the retro- pre questionnaire to assess their self-perceived knowledge gain (95%) and level of clinical skills (96%) were highly satisfactory. The assessment of knowledge domain showed 100% of the students achieved pass percentage (>50%) with significant difference among pre- and post-test scores. Faculty (100%) opined that simulation-based teaching resulted in effected learning. Conclusions: The use of simulation-based teaching in cardiovascular physiology as part of early clinical exposure leads to enhanced learning and clinical application. This will stimulate interest in subject and promote better learning.

Architecture and optimization of data mining modeling for visualization of knowledge extraction: Patient safety care

Visualization of the knowledge extraction process is a front line to reveal the detail process and data structure, which is an advanced technique for the presentation of data modeling. However, the mechanisms for healthcare are challenging and dynamic processes to gain a clear insight or understanding of patient care. In this paper, we proposed a new approach of architecture and optimization of data mining modeling for visualization of knowledge extraction by analyzing clinical data sets to define the determinant attributes through modeling techniques. Therefore, architecture for the visualization of the knowledge extraction process is a systematic approach to support users to the best of their knowledge of the issues over the challenge of visualizing techniques. The proposed approach is capable and dynamic to handle and analyze large-scale data in its dimension and context. Such a variable is defined using various techniques to characterize them towards the detection of determinant variables as its influential circumstance. We focused on modeling based visualization as model representation, factor's interaction and integration. The detection process experimented in a different approach and justification as discussed in section five. The finding showed a deep understandability for an advanced and dynamic data mining modeling techniques to integrate applications with domain contexts for the optimal and understandable decision process. The strength of this approach is the depth for visualization towards the knowledge extraction process and its understandability for users as per their background and circumstances. It is also essential to inference for architecture based modeling and visualization for large scale data. Researchers, physicians, experts, and other users are the potentials to refer to these novel ideas and findings.

Stories and perspective taking: Augmenting dental students’ understanding of patient care

Introduction Medical schools have reported on the integration of humanities, through literature, which offer diverse content and approaches that can be used to enhance patient care. The integration of humanities in dental education is a recent development. At the International Medical University (IMU) Malaysia, a literature module which focused on perspective taking activities was offered to the Bachelor of Dentistry program. We aimed to study if the module impacted dental students’ understanding of patient care. Methods Third-year undergraduate dental students were facilitated to discuss stories, engage in perspective taking activities and keep a portfolio for assessment in the Stories and Perspectives selective. Thematic analysis was used to analyze the data in their portfolios. Results The dental students identified key learning points that would better prepare them for patient-centered care. Three themes emerged: (1) facilitate empathy in students, (2) stimulate self-awareness in students, and (3) motivate students to be perceptive communicators. Students were able to appreciate the complexities of care giving as it involved taking into account the thoughts and feelings of the other while recognizing their own mental state. They further valued the choice of appropriate words and actions in mediating this process. Conclusion The potential for incorporating humanities based approaches to teach patient care to dental students is favorable. Reading stories and extending this to perspective taking activities to induce creative ways to shift between experiences of self and other is a positive approach in preparing health professionals for care giving encounters.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice.

To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety. New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care. Qualitative descriptive approach using semi-structured interviews. Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1). Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety. Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses. Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.

Fertility preservation in gynaecologic cancers.

Due to substantial improvement in the diagnosis and treatment of gynaecologic cancers, a better understanding of patient care needs to be revised. We reviewed the literature related to fertility preservation strategies in gynaecological cancer and discussed current general management approaches. New technical modalities and patients’ own desire for motherhood should be integral and paramount in the clinical evaluation to significantly contribute to preserving fertility in those women diagnosed with gynaecologic cancers during the reproductive years.

Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality

Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital.

Abstract W P353: Stroke Beat the Clock: A Lesson in Staff Engagement for Quality Stroke Care

Background and Purpose: The introduction and continued growth in electronic medical record use introduced overall challenges in filtering critical information on stroke and TIA patients, and an opportunity for improvement in chart navigation in the care of stroke patients. The purpose for the game was to improve the ease of navigating the patient’s course of treatment from arrival through discharge in a timely and efficient manner. Methods: The game was developed to familiarize the stroke unit staff nurses with pertinent information in the electronic medical record. The navigational guide was distributed to the staff for study or review prior to the onset of the game. Each day tracers were completed using designated charts for speed, accuracy and care plan development. Prizes were given for participation, champions posted daily and the overall winners were recognized by the department as well as a hospital board member, a local stroke champion. Results: Every participating nurse improved in both time and accuracy during the eight week period. There was an increased participation of this new process as it afforded the staff the ability to independently summarize a patient’s course of treatment in a shortened period of time. Subsequently, there were requests for similar tools for additional disease processes. Concurrent chart reviews showed better documentation in plan of care development, increased productivity, and improved connection with patient and family members. Conclusions: Stroke Beat the Clock proved to be an effective tool in teaching the nurses how to navigate the electronic medical record for pertinent information from patient arrival to discharge accurately. Improvements in speed with consistency provided the nurses a better understanding of patient care as they coordinate with the multidisciplinary team involved in stroke care and recovery.

When Policy Meets the Personal: General Practice Nurses in Australia

A significant focus of current health policy in Australia is to expand both the number and role of general practice nurses. Multiple new payment incentives have been instituted to encourage the use of practice nurses. This study explored the way these policies have framed their work. Multimethod research using observation, workspace photographs and interviews with nurses, doctors and managers collected through rapid appraisal in 25 practices in two states, followed by case studies of the role of nurses in seven practices over one year. Many respondents reported unanticipated benefits in general practice functioning and teamwork as a result of employing a nurse, though this had not been a policy aim. Within funding constraints, nurses created new roles and manipulated old roles to fit their personal understanding of patient care. Policy initiatives targeting practice nurses are often based around tasks and system issues, rather than the personal creation of care and quality that patients require and nurses seek. Incentives in this study were targeted at both the uptake of nurses and specific nursing activities. Policy development and funding structures would benefit from better understanding of nurses as agents of connectivity (rather than simply as performers of tasks) as well as the nature of teamwork in practices.

Atlas of Uncommon Pain Syndromes.

The Johns Hopkins University, Baltimore, Maryland. pstaats@jhmi.eduAtlas of Uncommon Pain Syndromes.By Steven D. Waldman, M.D., J.D. W.B. Saunders, Philadelphia, 2003. Pages: 262. ISBN: 0721693725. Price: $99.At the turn of the twentieth century, Sir William Osler, arguably America's greatest physician, claimed that if a physician knew all about syphilis and its manifestations, that person would understand all of medicine. Because untreated syphilis affects all organ systems, a thorough knowledge of syphilis led to a comprehensive understanding of medicine. At the turn of the twenty-first century, this paradigm has switched from syphilis to pain. Thus, a thorough understanding of pain and all of its manifestations will lead to a thorough understanding of patient care. Pain remains the greatest healthcare crisis in America, costing the American people billions of dollars in direct healthcare costs as well as untold billions in lost productivity and disability. Yet the average medical student receives 1–2 h of training in pain medicine and virtually no training in making difficult diagnoses.It is not surprising, then, that on almost every clinic day, I evaluate a patient whose painful condition has been misdiagnosed. The modern pain physician should strive to establish a diagnosis, design the most appropriate therapeutic plan, and implement that plan. Given this context, Dr. Waldman's book is much needed and fills a glaring void in the pain literature as well as that of the general medical community. This text also complements Dr. Waldman's previous efforts:Interventional Pain Medicine , the Atlas of Pain Management Injection Techniques , and the Atlas of Common Pain Syndromes , which are loaded with useful clinical information and are extremely valuable for practicing physicians. The Atlas of Uncommon Pain Syndromes is no different and sets a new standard for physicians who will no longer have a valid excuse for never having heard of slipping rib syndrome or quadriceps expansion syndrome . Together, these books allow pain physicians to begin their work with a solid foundation.For the physician studying for the boards, this text, which is clear and easy to read, provides a relatively comprehensive list of fascinomas that appear on board examinations. The book contains 71 chapters divided into 13 sections according to the general anatomic location of the pain syndrome. Each chapter presents a brief description of the clinical syndrome, signs and symptoms, appropriate testing, differential diagnosis, recommended treatment, complications and side effects (sometimes just “complications” and sometimes “complications and pitfalls”), and “clinical pearls,” or advice gleaned from clinical experience. The identification of the appropriate International Classification of Diseases, 9th Edition , code at the beginning of each chapter is valuable to both clinicians and billing personnel. On occasion, however, Dr. Waldman recommends unconventional treatment techniques, and it would have been equally helpful if he had included the current procedural terminology codes for these procedures (i.e. , cervicothoracic interspinous bursitis injection).The text is not without shortcomings. Despite the easy accessibility of information, the text covers only a limited number of treatment algorithms and options. Don't turn to this book for the latest treatment strategies; for example, information on the treatment of spinal headache omits conservative therapies, such as abdominal binders. In some cases, unsupported treatment strategies receive unequivocal endorsement; for example, the section describing the use of nerve blocks to treat Ramsay Hunt syndrome notes, “Failure to use sympathetic blockade immediately and aggressively, especially in the elderly, may sentence the patient to a lifetime of suffering from postherpetic neuralgia.” Although most of us believe this to be true, the medical literature does not support such a dogmatic statement. Given the lack of firm evidence for many of the recommended therapies, the reader should be cautious in uncritically accepting some of these recommendations. Along this line, the value of this book would have been enhanced with the inclusion of references to more extensive information on the various pain syndromes.