The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review

© the authors 2012. Background: Simulation is defined as a technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. The use of simulation for educational purposes began decades ago with the use of low-fidelity simulations and has evolved at an unprecedented pace. Debriefing is considered by many to be an integral and critical part of the simulation process. However, different debriefing approaches have developed with little objective evidence of their effectiveness. Objectives: The aim of this review was to identify, appraise and synthesise the best available evidence for the effectiveness of debriefing as it relates to simulation-based learning for health professionals

The impact of person-centred care on patient safety: An umbrella review of systematic reviews.

BACKGROUND:Nursing literature frequently emphasises the benefits of person-centred approaches for healthcare quality and safety. OBJECTIVE:This umbrella review aimed to synthesise the combined evidence from systematic reviews assessing the impact of person-centred care interventions on patient safety. DESIGN:A three-step review process included a preliminary review of literature, a comprehensive search, and manual searching of reference lists and forward citations of selected reviews. The review protocol was registered with Prospero (CRD42018090048). DATA SOURCES:Reviewers searched 10 databases for systematic reviews published in English-language peer-reviewed journals between 2000 and 2019: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, JBI Database, Medline, ProQuest Health & Medicine, PROSPERO Register, PubMed and Scopus. REVIEW METHODS:Covidence software was used to manage screening and eligibility. Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. RESULTS:From an initial total of 3412 potential titles, 16 reviews met the inclusion criteria. The selected reviews examined the impact of person-centred care for diverse groups of patients (children, adults and older people) in varied settings. Most systematic reviews assessed experimental studies, generally comparing person-centred interventions with 'usual care', often demonstrating limited evidence of impact on safety. Reviews addressed several patient safety outcomes relevant to nursing, including falls, infections, medication use and misuse, and mortality rates. The systematic reviews were generally well conducted, although several included studies of poor or fair quality. Given the heterogeneity of the interventions, outcomes and research designs of studies included in the selected reviews, we were unable to draw unequivocal conclusions about the implications of person-centred care for patient safety in this umbrella review. However, there was some encouraging evidence that person-centred care initiatives may result in reduced rates of falls (in acute care and residential aged care settings). The review also highlighted reductions in agitation for people with dementia and some improvement in anti-psychotic medication use in older people with dementia. CONCLUSIONS:Although abundant evidence exists demonstrating the positive effects of person-centred care on healthcare quality and on patient (and provider) wellbeing, there is little research focussing specifically on the impact of person-centred care on patient safety. Thus, there is scope for further high-quality nursing research into how person-centred interventions improve specific patient safety outcomes in order to inform more widespread adoption of person-centred practice

Recommendations from recent graduates in medicine, nursing and pharmacy on improving interprofessional education in university programs: A qualitative study

Background: Interprofessional education (IPE) has been recognized as an innovative approach for the development of a collaborative, practice-ready health workforce, but is not used consistently in undergraduate health professional programs. We sought to explore the reflections of graduates on the IPE experiences they had during their undergraduate education and training. It was anticipated that having completed their pre-vocational education and spent up to two years working in a clinical environment, recent graduates would be well-placed to provide insights into the value of the IPE opportunities they had, and to suggest approaches for improving these opportunities in undergraduate programs. Methods. This study was part of a larger research project (Interprofessional Education for the Quality use of Medicines; IPE for QuM) which used focus groups as part of an interpretive research design to inform other aspects of the research. Here, we report on focus groups with recent graduates recruited from area health services across Australia. Results: Sixty-eight recent graduates working in New South Wales, Western Australia, and Tasmania participated in 12 focus group sessions. In this paper, we report on new graduates' reflections on their experiences of IPE as part of their university degree, as well as their recommendations to improve interprofessional education before graduation. The new graduates were unanimous in valuing IPE from their current perspective of being in the health workforce. Most IPE experiences recalled were regarded as positive, but those valued most highly were experiences that involved genuine engagement and opportunities to interact with students in other professions working on a relevant problem. Clinical placement was a missed opportunity with few structured meaningful interprofessional learning experiences. Surprisingly there was little social contact between professions in universities even when programs were co-located, thus reinforcing professional silos. Conclusions: The graduates provided many insightful reflections about the value of university-based IPE and their preparedness for clinical practice. Although universally acclaimed as a good idea there is much room for improvement. We put forward a set of suggestions to improve IPE and guide the design of future IPE efforts. © 2014 Gilligan et al.; licensee BioMed Central Ltd

Designing a Women’s Refuge: An Interdisciplinary Health, Architecture and Landscape Collaboration

University programs are currently faced with a number of challenges: how to engage students as active learners, how to ensure graduates are ‘work ready’ with broad and relevant professional skills, and how to support students to see their potential as agents of social change and contributors to social good. This paper presents the findings from a study that explored the impact of an authentic, interdisciplinary project with health, architecture and landscape students. This project facilitated students’ entrée into the lived experience of women and children requiring refuge services as a result of homelessness and/or domestic violence. Students collaborated with stakeholders from the refuge sector, visiting sites, undertaking individual research, exchanging ideas and problem-solving, to develop a design guide for a women’s refuge. Focus groups were conducted at the conclusion of the activity to gauge students’ perceptions of the value of the activity. Results indicated that the ‘hands-on’ and collaborative nature of the learning experience in a real-world context was valued, primarily due to its direct relevance to professional practice. Architecture and landscape participants reported an increase in their understanding and knowledge of refuge clients, and many expressed a commitment to further learning and contribution to the sector. Nursing students felt that the authentic learning experience helped prepare them for the ‘real world’ of practice and that it aided the development of their professional identities and capacity to effect real-world change. The learning activity had a positive impact on knowledge acquisition and students’ confidence to act as agents of social change

'Grey nomad' travellers' use of remote health services in Australia: a qualitative enquiry of hospital managers' perspectives.

BACKGROUND: For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as 'Grey Nomads'. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the 'baby boomer' generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946-1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may "burden" already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. METHODS: The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. RESULTS: These nursing managers described a strong service and community ethos. They regarded travellers' healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. CONCLUSION: Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia's national transition to electronic health records including a patient-held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs

Academic literacy diagnostic assessment in the first semester of first year at university

One vital aspect of the first semester of the first year at university is how academic literacy expectations are made explicit though teaching and assessment practices at the disciplinary level. This paper describes how an academic literacy diagnostic process, and the MASUS tool, was used to ascertain the academic literacy profile of a cohort of undergraduate nursing students [N=569] at the beginning and end of their first semester. Key findings of this quantitative descriptive case study were that only just over half of commencing students possessed appropriate academic literacy skills in all four aspects of the diagnostic and nearly 20% scored in the lowest band—suggesting difficulty with multiple aspects of academic literacy. By the end of semester, 77% of the students who had scored in the lowest band of the MASUS at the beginning of the semester had improved their scores to the middle or highest band, and 73% of them eventually attained a pass or higher grade for the course. The findings of this study suggest that large-scale academic literacy diagnostic assessment, when embedded and contextualized within a course of study, is an effective means of providing the early feedback and targeted support that many commencing university students need

First year students’ perceptions of academic literacies preparedness and embedded diagnostic assessment

This paper reports findings from the second stage of a mixed-methods study of embedded academic literacies and diagnostic assessment—specifically first-year nursing students’ perceptions of the MASUS procedure. We found overwhelming support from participants (85%) in favour of embedded diagnostic assessment. The main reasons for this were receiving constructive, individualised feedback and insights into expectations and requirements. This was important as over a quarter of participants said they had “no idea” about the academic literacy requirements of university when they commenced their program and 60% had not formally studied for at least seven years. Those without recent study experience or with prior poor academic performance expressed high levels of anxiety about academic literacy requirements and lacked confidence in their writing abilities. These findings indicate how stressful the process of mastering academic literacies is for many first-year students’ and highlight the potential benefits of embedding for retention and engagement.</jats:p

Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis.

Background: The COVID-19 pandemic has given rise to more virtual simulation training. This study aimed to review the effectiveness of virtual simulations and their design features in developing clinical reasoning skills among nurses and nursing students. Method: A systematic search in CINAHL, PubMed, Cochrane Library, Embase, ProQuest, PsycINFO, and Scopus was conducted. The PRISMA guidelines, Cochrane's risk of bias, and GRADE was used to assess the articles. Meta-analyses and random-effects meta-regression were performed. Results: The search retrieved 11,105 articles, and 12 randomized controlled trials (RCTs) were included. Meta-analysis demonstrated a significant improvement in clinical reasoning based on applied knowledge and clinical performance among learners in the virtual simulation group compared with the control group. Meta-regression did not identify any significant covariates. Subgroup analyses revealed that virtual simulations with patient management contents, using multiple scenarios with nonimmersive experiences, conducted more than 30-minutes and postscenario feedback were more effective. Conclusions: Virtual simulations can improve clinical reasoning skill. This study may inform nurse educators on how virtual simulation should be designed to optimize the development of clinical reasoning