Near Peer Learning To Facilitate Nursing Students’ First Medical Surgical Clinical Experience / Apprentissage par les pairs proches de manière à faciliter les premières expériences cliniques en médecine et chirurgie pour les étudiantes en sciences infirmières

Introduction and Background: Ensuring an appropriate clinical experience for students is becoming more challenging in the context of a global nursing shortage, more acutely ill clientele, and limited numbers of educators, academics and clinical instructors. Near Peer Learning Activities (NPLA) have been shown to be effective and may help students to feel prepared and confident to begin the clinical rotation. This study explored nursing students’ experiences in their first medical-surgical practicum following a NPLA involving Health and Physical Assessment (HPA). Methods: Educators at one Canadian University recently designed and implemented a NPLA in the clinical setting where junior nursing students performed a focused health and physical assessment on a patient, in an acute medical-surgical unit with the guidance of senior students. Ten nursing students who took part in the NPLA were individually interviewed. Thematic content analysis was used to generate the themes. Findings: Following the NPLA, two main themes captured the essence of the students’ experience: (1) making nursing real through near peer learning and (2) surmounting personal and contextual challenges in a first medical-surgical experience. Students “owned” their HPA skills, felt excited and prepared entering their medical-surgical placement. During the experience, however, students worried about not measuring up and the unreceptive learning environment. Conclusion: The NPLA provided a safe context for novice students to apply HPA and become familiar with the hospital setting, facilitating their transition into a challenging first medical-surgical practicum. Résumé Introduction et contexte : Assurer une expérience clinique appropriée aux étudiantes devient de plus en plus difficile dans le contexte d’une pénurie généralisée d’infirmières, d’une clientèle plus gravement malade et d’un nombre limité d’enseignantes, de professeures et de formatrices cliniques. L’efficacité d’activités d’apprentissage par les pairs proches (en anglais, Near Peer Learning Activities ou NPLA) a été mise en évidence; ces activités pourraient aider les étudiantes à se sentir plus confiantes et prêtes à débuter leurs stages cliniques. Cette étude a exploré les expériences d‘étudiantes en sciences infirmières lors de leur premier stage médico-chirurgical à la suite d’une activité d’apprentissage par les pairs proches quant à l’évaluation physique et de la santé (en anglais, Health and Physical Assessment ou HPA). Méthodologie : Les professeures d’une université canadienne ont récemment conçu et mis en place des activités d’apprentissage par les pairs proches dans un environnement clinique où des étudiantes infirmières débutantes dans une unité médico-chirurgicale de soins de courte durée effectuaient une évaluation physique et de la santé ciblée d’un patient avec l’aide d’étudiantes plus avancées dans leur programme. Des entrevues individuelles furent effectuées avec dix étudiantes en sciences infirmières qui avaient participé aux activités d’apprentissage par les pairs proches. L’analyse thématique de contenu a été utilisée pour générer les thèmes. Résultats : Les activités d’apprentissage par les pairs proches ont permis d’identifier deux thèmes principaux qui englobaient l’expérience des étudiantes : (1) concrétiser les soins infirmiers grâce à un apprentissage par les pairs proches; et (2) relever des défis personnels et contextuels lors d’une première expérience médico-chirurgicale. Les étudiantes « s’appropriaient » leurs habiletés en matière d’évaluation physique et de la santé, et étaient motivées et préparées à entrer dans leur stage médico-chirurgical. Au cours de l’expérience, cependant, les étudiantes se sont inquiétées de ne pas être à la hauteur et de se buter à un environnement d’apprentissage peu réceptif. Conclusion : Les activités d’apprentissage par les pairs proches ont créé un contexte sûr pour que les étudiantes novices mettent en pratique l’évaluation physique et de la santé et se familiarisent avec le milieu hospitalier, facilitant ainsi leur transition vers un premier stage médico-chirurgical stimulant

Nursing handoffs and clinical judgments regarding patient risk of deterioration : a mixed-methods study

Aims and objectives: To explore how change-of-shift handoffs relate to nurses’ clinical judgments regarding patient risk of deterioration. Background: The transfer of responsibility for patients’ care comes with an exchange of information about their condition during change-of-shift handoff. However, it is unclear how this exchange affects nurses’ clinical judgments regarding patient risk of deterioration. Design: A sequential explanatory mixed-methods study reported according to the STROBE and COREQ guidelines. Methods: Over four months, 62 nurses from one surgical and two medical units at a single Canadian hospital recorded their handoffs at change-of-shift. After each handoff, the two nurses involved each rated the patient’s risk of experiencing cardiac arrest or being transferred to an intensive care unit in the next 24 hours separately. The information shared in handoffs was subjected to content analysis; code frequencies were contrasted per nurses’ ratings of patient risk to identify characteristics of information that facilitated or hindered nurses’ agreement. Results: Out of 444 recorded handoffs, there were 125 in which at least one nurse judged that a patient was at risk of deterioration; nurses agreed in 32 cases (25.6%) and disagreed in 93 (74.4%). These handoffs generally included information on abnormal vital signs, breathing problems, chest pain, alteration of mental status, or neurological symptoms. However, the quantity and seriousness of clinical cues, recent transfers from intensive care units, pain without a clear cause, signs of delirium, and nurses’ knowledge of patient were found to affect nurses’ agreement. Conclusions: Nurses exchanged more information regarding known indicators of deterioration in handoffs when they judged that patients were at risk. Disagreements most often involved incoming nurses rating patient risk as highe

Acceptability and feasibility of recruitment and data collection in a field study of hospital nurses’ handoffs using mobile devices

Background The portability and multiple functionalities of mobile devices make them well suited for collecting field data for naturalistic research, which is often beset with complexities in recruitment and logistics. This paper describes the implementation of a research protocol using mobile devices to study nurses’ exchanges of patient information at change of shift. Methods Nurses from three medical and surgical units of an acute care teaching hospital in Montreal, Canada, were invited to participate. On 10 selected days, participants were asked to record their handoffs using mobile devices and to complete paper questionnaires regarding these exchanges. Nurse acceptance of mobile devices was assessed using a 30-item technology acceptance questionnaire and focus group interviews. The principal feasibility indicator was whether or not 80 complete handoffs could be collected on each unit. Results From October to December 2017, 63 of 108 eligible nurses completed the study. Results suggest that the use of mobile devices was acceptable to nurses, who felt that the devices were easy to use but did not improve their job performance. The principal feasibility criterion was met, with complete data collected for 176, 84, and 170 of the eligible handoffs on each unit (81% of eligible handoffs). The research protocol was acceptable to nurses, who felt the study’s demands did not interfere with their clinical work. Conclusions The research protocol involving mobile devices was feasible and acceptable to nurses. Nurses felt the research protocol, including the use of mobile devices, required minimal investment of time and effort. This suggests that their decision to participate in research involving mobile devices was based on their perception that the study protocol and the use of the device would not be demanding. Further work is needed to determine if studies involving more sophisticated and possibly more demanding technology would be equally feasible and acceptable to nurses

Nurses’ judgments of patient risk of deterioration at change-of-shift handoff : agreement between nurses and comparison with early warning scores

Background Nurses begin forming judgments regarding patients’ clinical stability during change-of-shift handoffs. Objectives To examine the agreement between incoming and outgoing nurses’ judgments of deterioration risk following handoff and compare these judgments to commonly used early warning scores (MEWS, NEWS, ViEWS). Methods Following handoffs on three medical/surgical units, nurses completed the Patient Acuity Rating. Nurse ratings were compared with computed early warning scores based on clinical data. In follow-up interviews, nurses were invited to describe their experiences of using the rating scale. Results Sixty-two nurses carried out 444 handoffs for 158 patients. While the agreement between incoming and outgoing nurses was fair, correlations with early warning scores were low. Nurses struggled with predicting risk and used their impressions of differential risk across all the patients to whom they had been assigned to arrive at their ratings. Conclusion Nurses shared information that influenced their clinical judgments at handoff; not all of these cues may necessarily be captured in early warning scores

Better marital adjustment is associated with lower disease activity in early inflammatory arthritis

Aim: The aim of this study was to examine the association between marital adjustment and disease outcomes in patients with early inflammatory arthritis. Materials and methods: Patients with average disease duration of 7.66 ± 3.79 months were recruited from a larger early inflammatory arthritis registry, which recorded sociodemographic data and disease characteristics. The acute phase reactant C-reactive protein (CRP) levels were measured and disease activity was estimated using the Disease Activity Score in 28 joints (DAS28). Patient and spouse perceived marital adjustment was assessed by the Dyadic Adjustment Scale (DAS). Results: The study sample consisted of 73 patients living with their spouses. The mean age of the study participants was 54.30 ± 12.09 years and 64.4% were female. Patient-perceived marital adjustment (DAS-Patient) was negatively correlated to CRP (P = 0.007) and DAS28 (P = 0.002). On multivariate analysis, DAS-Patient contributed to the dependent variable DAS28 after controlling for CRP. Conclusion: The current study indicates that better marital adjustment is associated with lower disease activity. The possible reciprocal relationship between marital adjustment and illness highlights the relevance for clinicians to include both patients and their spouses in interventions

Wive's marital role and phychosocial adjustment : a study of patient and spouse outcomes two months after a myocardial infarction

This correlational study examined the relationships among sex role attitudes and role behaviours (traditionality), marital adjustment, caregiving involvement, caregiver satisfaction, psychological distress and psychosocial adaptation in the MI patient and his wife at two months post infarction. The research also aimed to develop explanatory models of patient and spouse adjustment.A convenience sample of 130 couples was drawn from the cardiac units of four hospitals in a large metropolitan area. Data were collected during home visits using structured interviews and self-report questionnaires. Patients and wives were interviewed separately. Marital and psychosocial adjustment, psychological distress, sex role attitudes, and selected sociodemographic and control variables were assessed in both members of the couple. Husbands were questioned about their cardiac symptoms whereas wives were asked about their role behaviour, caregiving involvement, and caregiver satisfaction. Data were analyzed using Pearson correlations and hierarchical regression procedures.Correlations indicated that wives' traditionality (attitudes, role behaviour) was directly related to adjustment outcomes in only two instances: worse domestic and marital adjustment in husbands. However, traditionality was found to be associated with the sociodemographic factors (age, education, illness, social support) that were central to adjustment. The results of the regression analyses revealed that the husbands' and the wives' models of adjustment differ. The husband's adjustment is associated primarily with clinical factors while the wife's adjustment is related to both clinical and psychosocial factors. Caregiving enters in the adjustment model of both husbands and wives, but from somewhat different perspectives. Finally, having a previous MI figured prominently in both models and may be a crucial clinical factor for the couple's adjustment.These results suggest important factors to be considered in identifying couples at risk of poor adjustment outcomes and demonstrates the importance of both patient and spouse assessments during the early post-MI recovery period

Role overload, pain and physical dysfunction in early rheumatoid or undifferentiated inflammatory arthritis in Canada

Abstract Background Inflammatory arthritis impairs participation in societal roles. Role overload arises when the demands by a given role set exceed the resources; time and energy, to carry out the required tasks. The present study examines the association between role overload and disease outcomes in early inflammatory arthritis (EIA). Methods Patients (n = 104) of 7.61 months mean duration of inflammatory arthritis completed self-report questionnaires on sociodemographics, disease characteristics and role overload. Pain was assessed using the Short Form McGill Pain Questionnaire (MPQ) and physical functioning was measured with the Medical Outcomes Study Short Form 36 (SF-36) physical functioning score. Role overload was measured by the Role Overload Scale. Patients indicated the number of social roles they occupied from a total of the three typical roles; marital, parental and paid work. Results Participants’ mean age was 56 years and 70.2% were female. Role overload was not correlated to the number of social roles, however, it was positively associated with pain (p = 0.004) and negatively associated with physical functioning (p = 0.001). On multivariate analysis, role overload was negatively associated with physical functioning after controlling for the relevant sociodemographic variables. Conclusion This study identifies a possible reciprocal relationship between role overload and physical functioning in patients with EIA.</p