Improving Pediatric Medical Nurses’ Confidence in Caring for Pediatric Mental Health Patients: A Pilot Project Large Academic Pediatric Health System in the Pacific Northwest

Problem Description Pediatric mental and behavioral health care needs continue to increase across the nation. Approximately ten percent of pediatric hospitalizations are for a primary mental or behavioral health condition (Canvara & Johnson, 2020). With the increase in hospitalizations for mental health (MH) needs, pediatric psychiatric units are at capacity, and MH patients are admitted to pediatric general medical/surgical units for care. Most of the nurses that work on these units have not received pediatric mental health education outside of nursing school curricula and report a lack of confidence in their ability to care for pediatric MH patients. With the pediatric MH population growing, meeting the needs of these patients with nursing care is essential. Setting This DNP project was conducted at a large pediatric health system in the Pacific Northwest with over 2,000 nurses. This project was implemented on a 32-bed pediatric medical unit that employs approximately 82 nurses. Children experiencing primary mental health diagnoses in this unit include major depressive episodes, autism spectrum disorder, suicidal ideation, and eating disorders. Rationale Evidence suggests that one way to improve the MH care patients receive is through education. Kolb’s Experiential Learning Theory (ELT) provided a theoretical framework to develop a course that incorporated didactic content with a concrete learning experience. Standardized Patient (SP) simulation was used and is a modality that aligns with Kolb’s ELT. It allows a nurse to practice concepts in a realistic scenario while getting feedback directly from a patient (actor) on how the nurse’s actions impacted the patient and their behavior. Mental Health SP simulations improve both knowledge and self-efficacy in nurses significantly. Project Aims This DNP project sought to identify and implement an educational program that included SP simulation to improve nurses’ confidence in caring for pediatric MH patients in a pediatric inpatient medical unit. Project Outcomes Five short-term outcomes (STOs) measured the success of this DNP pilot project. Project outcomes included course participation goals, nurse confidence (self-efficacy) improvement, nurse knowledge improvement, decreased behavioral resource support requests, and improved epic care plan documentation data. Implementation and Evaluation Plan Project implementation consisted of facilitator/Standardized Patient (SP) training with six planned classes over eight weeks. Nurses self-enrolled in the course and completed a pre-knowledge and pre-self-efficacy assessment. During the scheduled course time, nurses went through a curriculum that consisted of one and a half hours of trauma-informed care and crisis management content followed by two hours of standardized patient simulation. Post-knowledge assessments and self-efficacy assessments were completed within two weeks post-course. Results Twenty-two percent (n=20) of eligible pediatric medical nurses participated in the pilot study. Overall, nursing self-reported confidence increased by 25%, and nursing knowledge increased by 4% post-education and SP simulation. Additionally, calls for direct nurse knowledge and coaching support to the behavioral response team decreased by 8%. Unfortunately, due to contextual factors, nursing care plan documentation was not assessed. However, one unexpected outcome was an improvement in patient belonging and safety screening by 13%. Interpretation The findings in this study align with the literature suggesting that mental health care education, specifically SP simulations, increases the knowledge and self-efficacy required of nurses to care for pediatric MH patients. This is likely due to incorporating experiential learning as a framework for educational design. Potential limitations to the results reported include a lack of pre- and post-requirement sample size (n=16) and the use of primary data tools the project manager developed. Despite the limitations, this pilot project suggests that an educational program including SP simulation aligns with the evidence and improves participant knowledge and confidence. The use of the Pediatric Mental Health Standardized Patient Simulation Course will expand to a nurse residency program in the next year. Conclusion Implementing a Pediatric Mental Health Standardized Patient Simulation Course improved non-mental health nurse self-efficacy in caring for mental health patients on the medical unit. This was validated not only through quantitative descriptive data but also qualitative feedback from the nurse participants. As caring for mental health patients becomes a norm for nursing in all units/divisions of nursing, investing in a learning environment where nurses can safely practice these challenging skills is important to ensure nurses feel prepared

Current and Future Advances in Surgical Therapy for Pituitary Adenoma

The vital physiological role of the pituitary gland, alongside its proximal critical neurovascular structures means pituitary adenomas cause significant morbidity or mortality. Whilst enormous advancements have been made in the surgical care of pituitary adenomas, treatment failure and recurrence remain challenges. To meet these clinical challenges, there has been an enormous expansion of novel medical technologies (e.g. endoscopy, advanced imaging, artificial intelligence). These innovations have the potential to benefit each step of the patient journey, and ultimately, drive improved outcomes. Earlier and more accurate diagnosis addresses this in part. Analysis of novel patient data sets, such as automated facial analysis or natural language processing of medical records holds potential in achieving an earlier diagnosis. After diagnosis, treatment decision-making and planning will benefit from radiomics and multimodal machine learning models. Surgical safety and effectiveness will be transformed by smart simulation methods for trainees. Next-generation imaging techniques and augmented reality will enhance surgical planning and intraoperative navigation. Similarly, the future armamentarium of pituitary surgeons, including advanced optical devices, smart instruments and surgical robotics, will augment the surgeon's abilities. Intraoperative support to team members will benefit from a surgical data science approach, utilising machine learning analysis of operative videos to improve patient safety and orientate team members to a common workflow. Postoperatively, early detection of individuals at risk of complications and prediction of treatment failure through neural networks of multimodal datasets will support earlier intervention, safer hospital discharge, guide follow-up and adjuvant treatment decisions. Whilst advancements in pituitary surgery hold promise to enhance the quality of care, clinicians must be the gatekeepers of technological translation, ensuring systematic assessment of risk and benefit. In doing so, the synergy between these innovations can be leveraged to drive improved outcomes for patients of the future

Textual Mediation in Simulated Nursing Handoffs: Examining How Student Writing Coordinates Action

In clinical nursing simulations, a group of students provide care for a robotic patient during a structured scenario. As care is transferred from one group to another, they participate in a patient handoff, with outgoing students passing key information onto incoming students. In healthcare, the nursing handoff is a critical and perilous communication moment that is mediated by a range of participants and texts. Drawing on observations and video recordings of 52 simulation handoffs in the United States, this article examines how two student-designed texts – a collaborative patient chart and individual notes – are leveraged during the handoff. I also consider how handoff talk and writing changes as student nursing knowledge increases over the course of a year. By focusing on textual mediation of the simulated nursing handoff, this article contributes to existing research on professional writing pedagogy and to nursing scholarship on the handoff. Ultimately, it argues that a textual mediation framework can help bridge class room and professional contexts by evaluating student writing not for how successfully it meets a set of imposed criteria but for how effectively it supports classroom activities

Digital Twins for Patient Care via Knowledge Graphs and Closed-Form Continuous-Time Liquid Neural Networks

Digital twin technology has is anticipated to transform healthcare, enabling personalized medicines and support, earlier diagnoses, simulated treatment outcomes, and optimized surgical plans. Digital twins are readily gaining traction in industries like manufacturing, supply chain logistics, and civil infrastructure. Not in patient care, however. The challenge of modeling complex diseases with multimodal patient data and the computational complexities of analyzing it have stifled digital twin adoption in the biomedical vertical. Yet, these major obstacles can potentially be handled by approaching these models in a different way. This paper proposes a novel framework for addressing the barriers to clinical twin modeling created by computational costs and modeling complexities. We propose structuring patient health data as a knowledge graph and using closed-form continuous-time liquid neural networks, for real-time analytics. By synthesizing multimodal patient data and leveraging the flexibility and efficiency of closed form continuous time networks and knowledge graph ontologies, our approach enables real time insights, personalized medicine, early diagnosis and intervention, and optimal surgical planning. This novel approach provides a comprehensive and adaptable view of patient health along with real-time analytics, paving the way for digital twin simulations and other anticipated benefits in healthcare.Comment: 6 page

Train-the-trainers in hand hygiene : a standardized approach to guide education in infection prevention and control

Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries.Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training.Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively.Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.peer-reviewe

A Competence-Based Online Learning Video and In-Situ Simulation to Improve Perioperative Anesthesia Nurse Practitioner Self-Efficacy in Responding to Anesthesia Emergencies

Background: Nurse Practitioners (NPs) are broadly educated to the population-based role in which they practice. Further education in subspecialties is essential as more NPs are working autonomously in highly specialized care areas. Problem: In the Department of Anesthesia at a large urban hospital, perioperative anesthesia NPs lack formal training in the subspecialty of anesthesia, which contributed to a lack of self-efficacy when responding to anesthesia emergencies. Methods: An asynchronous multimodal brief instructional video accompanied by an in-situ simulation of an anesthesia emergency was developed to increase knowledge and confidence in perioperative anesthesia nurse practitioner response to anesthesia emergencies. Results: A total of 8 perioperative anesthesia NPs (73% of the staff) participated in the multimodal educational intervention, and 100% of the participants experienced an increase in knowledge to locate emergency anesthesia equipment, along with increased confidence levels in responding to an anesthesia emergency scenario after watching the video and performing the insitu simulation. Conclusion: Deploying a multimodal educational video along with an in-situ simulation was effective in increasing participant’s self-efficacy when responding to an anesthesia emergency, and was found to be feasible. Inadequate educational resources, poor inclusivity of the NPs in the culture of education, and limited time allotted for education were addressed by providing open access of the video on the internet. In-situ simulation reinforced education through a realistic hands-on scenario and provided repetition with the use of Rapid Cycle Deliberate Practice

Teamwork training using patient simulation

Teamwork is an important factor in safe healthcare. Simulation based team training (SBTT) is a method to gain the non-technical skills important for proficient teamwork. This thesis evaluated SBTT using different modalities and evaluation levels, looking at whole teams of either medical students or full professionals. In study I 15 medical students participated in a target-focused scenario-based teamwork practice during a one-day course. Their team behaviour skills were video-recorded and their attitudes towards safe teamwork assessed in this observational cohort study. Team behaviour skills showed improvement after five scenarios in a full-scale patient simulator environment, while no change in attitudes toward safe teamwork were detected. In study II 54 medical students participated in three video-recorded scenarios (n=36). Clinical performance improved in one variable; the frequency of sum-ups. Changes in individual experiences could be detected early during SBTT; self-efficacy improved after training. Individual teamwork behaviours did not change after this half-day course. Participants communicated to a greater extent and experienced higher mental strain and concentration in the role of leader than in the role of follower. Study III investigated whether training with high-fidelity simulators (HFS) could increase trainees’ experience of realism in task performance and facilitate the trainers’ task, resulting in different behaviour and individual experiences than training with low-fidelity models (LFM). A case control study was conducted with 34 teams using either a LFM (n=17) or a HFS (n=17). Professionals involved in paediatric emergencies performed one video-recorded emergency scenario in situ in an authentic emergency room. The trainees’ time to deliver oxygen was significantly longer (p=0.014) when using a HFS, which was interpreted as more realistic timing of task performance. Leaders experienced a higher level of mental strain during training with a HFS. There was a reduction in the trainers’ frequency of interventions in the scenarios as well as their mental strain, signifying potential for the trainers to focus more on trainees’ behaviours and performance during training using a HFS. In study IV all staff members (n=152) in an intensive care unit (ICU) were trained during one day. An observational cohort study (case control design on sick leave and staff turnover) was conducted. The training was performed in situ at the ICU and preceded by an interactive lecture concerning human factors. Before training, the medical professions’ perceptions of safety differed. After the training period, nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived that the quality of collaboration and communication with physician specialists improved. In addition, nurse assistants’ perception of the Safety Attitude Questionnaire (SAQ) factors teamwork climate, safety climate and working conditions were more positive after the project and in concert with nurses’ perception of safety climate. In comparison to a control ICU during the study period, the number of nurses quitting their job and nurse assistants’ time on sick leave was reduced. In conclusion, the SBTT protocols applied in these studies are promising. A one-day course seems to benefit medical students’ teamwork behaviour. During a half-day course, i.e. early phase of training, aspects of clinical performance were improved as well as self-efficacy. Equipment fidelity influenced trainees’ clinical performance to some extent, but the trainers’ performance and experience to a larger extent. Leaders, followers and the different medical professions reported different experiences and attitudes. This finding accords with earlier studies on professions but has not been well studied earlier in the context of leaders and followers. All professions benefited from one day of SBTT in an ICU, but it was expressed in different ways