'Video-View-Point' - Video analysis to reveal tacit indicators of student nurse competence

For over 30 years, the assessment of the clinical competence of student nurses has been the subject of much theoretical debate, yet the definition of criteria based on observable indicators of competence remains problematic. In practice, however, different assessors will judge and agree, relatively quickly, whether a student is competent or not; whether they have got ‘it’. Articulating what ‘it’ is, is difficult; although ‘it’ appears to be collectively, yet tacitly, understood. These judgements provide the key to the definition of competence. This research solves the dilemma of revealing and investigating these tacit understandings through the video analysis of students in simulated practice. The findings of four initial exploratory studies confirmed that competence is an example of tacitly understood behaviour and identified the limitations of traditional research methods in this context. The practical challenges of analysing video were highlighted, leading to the development of Video-View-Point to solve these problems and to reveal the tacitly understood behaviours. This innovative hybrid research method combines analysis of multiple ‘Think Aloud’ commentaries with the ability to ‘point’ at the subject of interest. The analysis is presented as a time-stamped multimedia dialectic, a visually simple yet sophisticated collage of data which reveals relevant behaviours, including those which are tacitly understood. A bespoke software tool (BigSister) was designed to facilitate the data collection, and was tested against the most similar commercially available technology, an eye tracker. The test of Video-View-Point successfully revealed four tacitly understood indicators of competence: communication, processing clinical information, being in the right place, and being proactive. Video-View-Point offers huge potential for behavioural analysis in other domains

Authority as an interactional achievement: Exploring Deference to Smart Devices in hospital-based resuscitation

Over the years, healthcare has been an important domain for CSCW research. One significant theme carried through this body of work concerns how hospital workers coordinate their work both spatially and temporally. Much has been made of the coordinative roles played by the natural rhythms present in hospital life, and by webs of mundane artefacts such as whiteboards, post-it notes and medical records. This paper draws upon the coordinating role of rhythms and artefacts to explore the nested rhythms of the Cardio-Pulmonary Resuscitation (CPR) protocol conducted to restore the proper heart rhythm in a patient who has suffered a cardiac arrest. We are interested in how the teams delivering CPR use various ‘smart’ assistive devices. The devices contain encoded versions of the CPR protocol and are able to sense (in a limited way) the situation in order to give instructions or feedback to the team. Using an approach informed by ethnomethodology and conversation analysis (EM/CA) we analysed video of trainee nurses using these devices as they delivered CPR in dramatized training scenarios. This analysis helped us to understand concepts such as autonomy and authority as interactional accomplishments, thus filling a gap in CSCW literature, which often glosses over how authority is formed and how it is exercised in medical teams. It also helps us consider how to respond to devices that are becoming more active in that they are being increasingly imbued with the ability to sense, discriminate and direct activity in medical settings

Criteria to evaluate graduate nurse proficiencies in obtaining a health history and perform physical assessment in simulation-based education: a narrative review

Background: simulation is a technique being used increasingly in healthcare education which offers opportunities to evaluate nursing proficiencies. The use of valid and reliable instruments is recognised as the foundation for a robust assessment, however competency-based health assessment courses for graduate nurses can consequently become reductionist in measuring proficiencies.Objective: the specific review question was: In simulation-based education, what are the criteria that evaluate graduate nursing student’s competence in obtaining a health history and performance of patient assessment?Methods: eleven studies were included in the review. Papers were critically appraised with The Joanna Briggs Institute quasi-experimental studies checklist. Bloom’s taxonomy was used to structure this narrative review.Results: seven papers evaluated cognition through questionnaires and two papers used a Likert-scale to determine self-perceived knowledge. Six papers evaluated psychomotor skills with a behavioural checklist. Diversity of application was factored into the studies when testing affective skills. Three papers used Likert-scales to evaluate preparedness, six papers used Likert-scales to evaluate self-confidence and one used a Likert-scale to evaluate autonomy. Three papers used a checklist to evaluate professionalism. Four papers used faculty member/ standardised patient feedback.Conclusion: reductionist evaluation instruments create a barrier when evaluating competency. The limited validity and reliability of assessment instruments in simulation, as well as the lack of standardisation of affective skills assessment, presents a challenge in simulation research. Affective skills encompass attitudes, behaviours and communication abilities, which pose a significant challenge for standardised assessments due to their subjective nature.This review of the simulation literature highlights a lack of robustness in the evaluation of the affective domain. This paper proposes that simulation assessment instruments should include the standardisation of affective domain proficiencies such as: adaptation to patients’ cognitive function, ability to interpret and synthesise relevant information, ability to demonstrate clinical judgement, readiness to act, recognition of professional limitations and faculty/standardised-simulated patient feedback. The incorporation of the affective domain in standardised assessment instruments is important to ensure comprehensive assessment of simulation particularly in the development of health history and physical assessment proficiencies. Attention to all of the domains in Blooms taxonomy during simulation assessment has the potential to better prepare professionals for the patient care setting

Semantic annotation of ubiquitous learning environments

Skills-based learning environments are used to promote the acquisition of practical skills as well as decision making, communication, and problem solving. It is important to provide feedback to the students from these sessions and observations of their actions may inform the assessment process and help researchers to better understand the learning process. Through a series of prototype demonstrators, we have investigated the use of semantic annotation in the recording and subsequent understanding of such simulation environments. Our Semantic Web approach is outlined and conclusions drawn as to the suitability of different annotation methods and their combination with ubiquitous computing techniques to provide novel mechanisms for both student feedback and increased understanding of the learning environment

Medical emergencies requiring first aid at home: a population-based survey study

Background:Most medical emergencies requiring first-aid occur at home. Little is known about the prevalence of these medical emergencies.Objective:The objective of this study is to describe medical emergencies occurring at people's homes requiring first aid; characteristics, burdens and impact on functional outcome, and to address the national public knowledge and practice of first aid.Method:A confidential, cross-sectional survey, primarily based on the 2015 American Heart Association (AHA) and American Red Cross first aid guidelines, was conducted among adults (&gt;18 years) from 12 educational centers, under the Ministry of Awqaf and Islamic affairs, State of Kuwait.Results:A total of 3000 self-administered questionnaires were distributed from September 16 2019 to November 30, 2019. The response rate was 34% (n = 1033 participants) of which 1% (n = 11) were partially answered questionnaires leaving 1022 questionnaires for valid statistical analysis. The prevalence of medical emergencies was 118.5 out of 100000 per year and the level of public knowledge was 19%. Medical emergencies were more likely to occur in Hawali province (49%, n = 149), women were more likely to encounter medical emergencies (78%, n = 238). Victims above 18 years of age were more likely to experience hypoglycemia (39%, n = 55) and children were more likely to suffer from hypoglycemia (19%, n = 22) or burns (17%, n = 20). Compliance with First aid guidelines was seen in hypoglycemia (31%, n = 44) but lacking in burn incidents (44%, n = 15). Participants called the ambulance in seizures (50%, n = 13), with 62% of medical emergencies requiring attendance at a health-care facility and 29% requiring hospital admission. Of the victims, 15% missed school or a day of work, and 25% had impaired functional outcomes.Conclusion:Medical emergencies occurring at home are relatively common in Kuwait, and public training on first aid is low. Kuwait has unique medical emergencies, with hypoglycemia, seizures and burns being the most frequent emergencies that occur at home. These emergencies cause a burden on the health-care system with a quarter of them having negative impact on the victim's functional outcome.</p

Training CPR with a wearable real time feedback system

We present a study comparing the effect of real-time wearable feedback with traditional training methods for cardiopulmonary resuscitation (CPR). The aim is to ensure that the students can deliver CPR with the right compression speed and depth. On the wearable side, we test two systems: one based on a combination of visual feedback and tactile information on a smart-watch and one based on visual feedback and audio information on a Google Glass. In a trial with 50 subjects (23 trainee nurses and 27 novices,) we compare those modalities to standard human teaching that is used in nurse training. While a single traditional teaching session tends to improve only the percentage of correct depth, it has less effect on the percentage of effective CPR (depth and speed correct at the same time). By contrast, in a training session with the wearable feedback device, the average percentage of time when CPR is effective improves by up to almost 25%.</p