Awakenings: An Equine Assisted Learning Research Project

Objective. The purpose of this pilot study was to determine if and how the Awakenings Equine Assisted Learning program was effective at improving the professionalism, confidence, communication skills and adaptability of students preparing for careers as Anesthesiologist Assistants. Background. Equine Assisted Learning (EAL) is a rapidly growing experiential model that utilizes horses to enhance participants\u27 awareness of their own non-verbal language, communication styles, projection of self-confidence and competence, and problem-solving abilities (Chandler, 2012; Green, 2012, 2013; Kane, 2012; Trotter, 2012). Methods. As a part of their regular educational and clinical rotations, first year students in the Anesthesiologist Assistant (AA) program participated in a 6- week training that included weekly, 2 -hour Equine Assisted Learning (EAL) sessions. Each session, the AA students participated in a 2- hour experiential equine assisted activity, specifically designed to address a certain target area necessary for their development as professionals in this field. The participants completed a pre and post assessment with 93 items that measured development as they relate to the EAL sessions. Results. The data was analyzed using t-tests, exploratory factor analysis, and qualitative self-reports. Confidence, empathy, awareness, and communication were the most significant factors. Conclusion. The qualitative data reinforced the quantitative findings that showed significant improvement in the objective factors as a result of the EAL sessions

Service readiness for inpatient care of small and sick newborns: Improving measurement in low- and middle-income settings

Background: In 2018, 2.5 million newborns died; mainly from prematurity, infections, and intrapartum events. Preventing these deaths requires health systems to provide routine and emergency care at birth, and quality inpatient care for small and sick newborns. Despite high potential impact, inpatient newborn care is not consistently measured. Methods: For this PhD, I conducted a bottleneck analysis using data from 12 national workshops regarding delivery of inpatient newborn care in low- and middle-income countries (LMIC). Using WHO guidelines, grey literature and expert consultation, I mapped the components required to deliver inpatient care and reviewed these against three health facility assessment tools. Finally, I carried out an online survey to elicit global practitioner opinions regarding levels of newborn care, paralleling those used for monitoring emergency obstetric care in LMIC. Results: In 12 high-burden countries in sub-Saharan Africa and Asia, health financing and workforce were identified as the greatest bottlenecks to scaling up quality inpatient care, followed by community ownership. My review identified 654 components required to deliver inpatient care. These are inconsistently measured by existing health facility assessments. The 262 survey respondents agreed on 12 interventions to comprise a package of care for small and sick newborns; selected levels of care varied by clinical background and experience in LMIC. Conclusion: Inpatient newborn care faces multiple health system challenges, particularly to ensure funding and skilled staffing. Standard facility numbers and staffing ratios by defined levels of care are important for countries to benchmark service delivery progress. Due to the large number of components required for delivering quality care, newborn “signal functions” could be selected by level of care to parallel emergency obstetric care indicators. Improved measurement of service readiness requires sustained focus on interoperability of routine measurement systems, and further research to better capture the experience of newborn inpatient care for families

Safety Measures to Reduce Medication Administration Errors in Paediatric Intensive Care Unit

Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals’ opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice

2014 Abstract Booklet

Complete Schedule of Events for the 16th Annual Undergraduate Research Symposium at Minnesota State University, Mankato

Doctor of Philosophy

dissertationThe cost of medication errors is burdensome to patients, institutions, and frontline providers. Nurses are accountable for and vulnerable to institutional safe medication practices and make this responsibility their highest priority; yet, contextual factors relevant to nurses' work encompassing medication administration are not well understood. The aim of this ethnographic study was to identify and describe nurses' work in the context of medication administration, errors, and organizational safety. Using nonparticipant observation (92 hours) and 37 unstructured interviews with nurses, administrators, and pharmacist in a mid-sized hospital in the United States, I found the nature of nurses' work characterized by: 1) chasing a standard of care, 2) prioritizing practice , and 3) renegotiating routines. These characteristics were inextricably linked to organizational structures, the medication management system, competing obligations, and shifting of priorities. Data were divided into two articles: 1) Nurses' Work in the Context of Medication Administration: Untenable Expectations provides a thick description of everyday experiences on the unit, medication administration, and the potential for errors. From these data, I present an emerging theoretical model. 2) The Paradox of Safety in Medication Management is a microanalysis of the medication use process with a specific focus on patterns of medication errors in the hospital, and the role of the pharmacists as a "stop-gap" between the physicians and patients in the recognition and interception of medication errors. These results enhance our understanding of why present efforts targeting the reduction of medication errors may be ineffective

An Appreciative Inquiry into Medication Administration by Registered Nurses: The Untold Story

Registered nurses (RNs) worldwide are educated and authorised to administer medications as part of their role. The framework used to guide the practice of safely administering the right dose of the right medication by the right route to the right patient at the right time is known internationally as the 'five rights'. The five rights framework is pervasive in the nursing literature and has underpinned a plethora of research studies focused on medication error identification and management. Most of these studies seek error rates and causes and rarely explore the actions or experiences of nurses who administer medications, other than in relation to their adherence to the five rights framework. This study offers a different perspective. This two-phase qualitative, appreciative inquiry used Medication Services Queensland's (2009a) rights framework as the basis for observing the medication administration practices of RNs in a regional hospital in Queensland, Australia. The five rights framework in this region has been extended for public health system employees by the addition of a sixth right that requires the nurse to offer the patient the right to refuse the medication. The observation phase provided a rich contextual backdrop for the next phase, in which the participants were interviewed about their experiences. The participants were asked to explain their observed practices. The study found that by taking an appreciative inquiry approach to medication administration, person-centred nursing practices that contribute to the safe administration of medication emerged. This alternate view of medication administration has the potential to encourage further research and development of hidden strengths in nursing practices such as coordination and management of medication related processes

2019 EURēCA Abstract Book

Listing of student participant abstracts

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

WHO guidelines on drawing blood : best practices in phlebotomy

Phlebotomy uses large, hollow needles to remove blood specimens for lab testing or blood donation. Each step in the process carries risks - both for patients and health workers. Patients may be bruised. Health workers may receive needle-stick injuries. Both can become infected with bloodborne organisms such as hepatitis B, HIV, syphilis or malaria. Moreover, each step affects the quality of the specimen and the diagnosis. A contaminated specimen will produce a misdiagnosis. Clerical errors can prove fatal. The new WHO guidelines provide recommended steps for safe phlebotomy and reiterate accepted principles for drawing, collecting blood and transporting blood to laboratories/blood banks.Development of this publication was supported by Cooperative Agreement CDC-RFA-CI09-903 from: the Department of Health and Human Services/Centers for Disease Control and Prevention (CDC), Atlanta, United States of America (USA); the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Global AIDS Program (GAP).ISBN 978 92 4 159922 1CDC-RFA-CI09-90

Proceedings of the Salford Postgraduate Annual Research Conference (SPARC) 2011

These proceedings bring together a selection of papers from the 2011 Salford Postgraduate Annual Research Conference(SPARC). It includes papers from PhD students in the arts and social sciences, business, computing, science and engineering, education, environment, built environment and health sciences. Contributions from Salford researchers are published here alongside papers from students at the Universities of Anglia Ruskin, Birmingham City, Chester,De Montfort, Exeter, Leeds, Liverpool, Liverpool John Moores and Manchester