5 Skills Every Preceptor Needs

This infographic is a quick view of a published and referenced tool to support efficient and effective precepting in a busy clinical environment. The tool helps the preceptor to organize their constructive feedback and close the loop with the student on learning moments.https://digitalcommons.unmc.edu/iae_inforgraphic/1000/thumbnail.jp

Investigating Infection Control Behavior in Nurses: Determinants of donning and doffing behaviors

In a small mixed methods study, nursing behaviors related to infection control were evaluated as nurses participated in a video recorded patient care simulation. The scenario asked the nurse to care for a patient in both airborne and contact isolation precautions with small high definition cameras mounted in a real hospital room. The patient was simulated by a live actor with an artificial intravenous line. The simulation scenario asked the nurse to assess their patient and give them some pain medication. The simulation experience was followed by a Think Aloud session while participants watched their individual simulation performance. The session was audio recorded and then transcribed for qualitative analysis. In an effort to determine how physical restrictions or personal characteristics impacted nursing behaviors, participants were asked to complete a demographic survey and complete a range of motion demonstration in front of a video camera before the study session ended. Nursing behaviors noted in the video recordings and insights from the nurses in the Think Aloud sessions will be reviewed in relation to these determinants of behavior. Frequent errors in donning and doffing occur in spite of personal experiences with exposure. The errors seen in most participants did not correlate with range of motion issues such as joint mobility or flexibility. Educational interventions for nurses at the bedside may need to address common misconceptions in isolation care processes

Investigating Infection Control Behavior in Nurses: Impact of Computer Charting

In a small mixed methods study, nursing behaviors related to infection control were evaluated as nurses participated in a video recorded patient care simulation. The scenario asked the nurse to care for a patient in both airborne and contact isolation precautions with small high definition cameras mounted in a real hospital room. The patient was simulated by a live actor with an artificial intravenous line. The simulation scenario asked the nurse to assess their patient and give them some pain medication. The simulation experience was followed by a Think Aloud session while participants watched their individual simulation performance. The session was audio recorded and then transcribed for qualitative analysis. In this facility computers are taken into the patient rooms on carts to support patient care processes like medication administration and clinical charting. It is expected that these carts be used to care for patients in isolation rooms. Nurses are responsible for wiping computer equipment down before and after use with antimicrobial wipes. Several patterns emerged regarding the use of computers in the care of isolation patients. Both personal safety for the nurse as well as the transmission of infectious diseases from patient to patient became major themes. Nursing behaviors noted in the video recordings and insights from the nurses in the Think Aloud sessions will be shared in this presentation

Early Developmental Screening in High-Risk Communities: Implications for Research and Child Welfare Policy

Early detection of developmental delays in children living in high-risk communities enables effective intervention and promotes positive outcomes. Until now, the mechanisms by which these risks and benefits arise and persist have yet to be documented from a synergistic perspective. We take a dynamic, ecological theoretical approach to examine the interplay between developmental surveillance, professional support and parental understanding of children's developmental progress. The Regional ASQ Developmental Screening Project* used geo-mapping to target the highest risk communities in three metropolitan Detroit counties. Statistical analyses using paired t tests compared screening results for 1,640 children in high-risk communities to results for 24,220 children living in surrounding communities. Children in high-risk communities had a substantially higher risk of developmental delay than the rest of Metro Detroit (43% vs. 28%). There were significant differences in the overall scores from the initial screens (M =2.38, SD = .788) to subsequent screens (M = 2.46, SD =.706): t (1,640) = -5.104 p < .05, suggesting that risk of delay decreases over time. There were statistically significant differences in the overall risk for developmental delay and within in the domain of fine motor development. These results 19 provide an empirical basis to develop prevention and intervention programs and child welfare policy. We suggest ways to build capacity at the individual, institutional, and societal levels. Future research should focus on exploring the unique interplay of community-level risk with family and child level risk and protective factors

Using a Critical Safety Behavior Scoring Tool for N95 Respirator Use to Evaluate Training Interventions

Background: Hospitals struggle nationally to educate healthcare workers on the safe use of N95 respirators as part of their respiratory protection programs. Practical and effective interventions are needed to improve this clinical behavior which is critical to healthcare worker safety in airborne precautions, hazardous drug administration, and pandemic response. This analysis specifically investigated two just-in-time training interventions that would be practical to implement in a hospital setting. Method: A simulation approach was used to evaluate two interventions for N95 respirator use at a Midwestern Academy Hospital system (n=62, 32 control, 30 treatment). Healthcare workers were asked to don and doff an N95 respirator while being video recorded in an empty hospital corridor and room. After a randomized intervention was applied, they repeated the respirator donning and doffing while being video recorded. One intervention used an instructional video alone, while the other used the same instructional video but added a video reflection intervention. The video reflection intervention asked the participant to review and score their first performance of N95 donning and doffing using a Critical Safety Behavior Scoring Tool (CSBST). The research team used the same CSBST to score all performances of donning and doffing for comparison and evaluation. Result: This session will explain the critical safety behaviors at pre-test and post-test for the two intervention groups and describe the impact of the two types of just-in-time training on demonstrated N95 respirator skills. The video alone and video reflection scores were not significantly different at pretest. Scores were significantly higher on the post-test for the reflective practice intervention. Findings related to demographic information such as years in healthcare, frequency of use, history of needlestick, and fatigue will also be discussed. Conclusion: Video reflection may be one intervention that improves compliance with critical safety behaviors for just-in-time training on N95 respirator use. Further work should examine the video recorded findings for measurement elements that should be expanded in a scoring tool to include issues such as facial hair, hairstyle, and the quality of hand hygiene. Intervention studies should also examine how often the training must be repeated to maintain competency. This intervention may have implications for the training of other critical safety behaviors in infection control and other high-risk procedures

Building a Bigger Tent in Point-of-Care Ultrasound Education: A Mixed-Methods Evaluation of Interprofessional, Near-Peer Teaching of Internal Medicine Residents by Sonography Students

BACKGROUND: Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography. METHODS: Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews. RESULTS: Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique. CONCLUSION: An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited

Peer Feedback on Teaching for Health Professions Lectures

The Peer Feedback on Teaching Rubric was developed to support health professions educators in assessing their teaching. It provides a rubric of meaningful feedback to individuals to make improvements in learning and engagement. The rubric can be used to evaluate both in-person and online lectures. Educators can use the rubric in three ways: For self-reflection to assess their own teaching To observe a master teacher to identify important teaching techniques and see how they are effectively implemented To receive peer feedback by having a fellow educator evaluate a live teaching sessionhttps://digitalcommons.unmc.edu/iae_tools/1000/thumbnail.jp

Clinical challenges in isolation care

OVERVIEW: In 2014, the authors published the results of a study investigating nurses\u27 use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care

Method for investigating nursing behaviors related to isolation care.

BACKGROUND: Although an emphasis has been placed on protecting patients by improving health care worker compliance with infection control techniques, challenges associated with patient isolation do exist. To address these issues, a more consistent mechanism to evaluate specific clinical behaviors safely is needed. METHODS: The research method described in this study used a high fidelity simulation using a live standardized patient recorded by small cameras. Immediately after the simulation experience, nurses were asked to view and comment on their performance. A demographic survey and a video recorded physical evaluation provided participant description. A questionnaire component 1 month after the simulation experience offered insight into the timing of behavior change in clinical practice. RESULTS: Errors in behaviors related to donning and doffing equipment for isolation care were noted among the nurses in the study despite knowing they were being video recorded. This simulation-based approach to clinical behavior analysis provided rich data on patient care delivery. CONCLUSION: Standard educational techniques have not led to ideal compliance, and this study demonstrated the potential for using video feedback to enhance learning and ultimately reduce behaviors, which routinely increase the likelihood of disease transmission. This educational research method could be applied to many complicated clinical skills