An overview of risk prediction models and the implications for nursing practice

Chronic heart failure is a common and costly condition and is one of the most common causes of hospitalisation and emergency department presentations in the elderly. This paper discusses risk prediction models in chronic heart failure, their utility in clinical practice and describes the implications for nursing practice. Based on a review of the literature, a description is presented of current risk models for chronic heart failure; the use of risk models in other conditions and the benefits of applying valid and reliable measurement tools in clinical practice. Consideration is given for clinical as well as non-clinical factors being incorporated into risk prediction models

Ethical implications of digital images for teaching and learning purposes: an integrative review

Rachel Kornhaber,1–3 Vasiliki Betihavas,4 Rodney J Baber,5 1School of Health Sciences, Faculty of Health, University of Tasmania, Rozelle, NSW, 2School of Nursing, The University of Adelaide, Adelaide, SA, 3Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards, NSW, 4School of Nursing, University of Sydney, Sydney, NSW, 5Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia Background: Digital photography has simplified the process of capturing and utilizing medical images. The process of taking high-quality digital photographs has been recognized as efficient, timely, and cost-effective. In particular, the evolution of smartphone and comparable technologies has become a vital component in teaching and learning of health care professionals. However, ethical standards in relation to digital photography for teaching and learning have not always been of the highest standard. The inappropriate utilization of digital images within the health care setting has the capacity to compromise patient confidentiality and increase the risk of litigation. Therefore, the aim of this review was to investigate the literature concerning the ethical implications for health professionals utilizing digital photography for teaching and learning. Methods: A literature search was conducted utilizing five electronic databases, PubMed, Embase (Excerpta Medica Database), Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, and Scopus, limited to English language. Studies that endeavored to evaluate the ethical implications of digital photography for teaching and learning purposes in the health care setting were included. Results: The search strategy identified 514 papers of which nine were retrieved for full review. Four papers were excluded based on the inclusion criteria, leaving five papers for final analysis. Three key themes were developed: knowledge deficit, consent and beyond, and standards driving scope of practice. Conclusion: The assimilation of evidence in this review suggests that there is value for health professionals utilizing digital photography for teaching purposes in health education. However, there is limited understanding of the process of obtaining and storage and use of such mediums for teaching purposes. Disparity was also highlighted related to policy and guideline identification and development in clinical practice. Therefore, the implementation of policy to guide practice requires further research. Keywords: digital photography, ethics, education, informed consent, practice guidelines, health professionals, photography, teaching materials, health car

A Cognitive Load Theory Simulation Design to Assess and Manage Deteriorating Patients

Background:Cognitive load theory (CLT) uses an understanding of brain architecture for educational design, withimplications for simulation. Since working memory is limited, minimising extraneous cognitive loadimproves learning of new tasks (intrinsic load) and use of existing knowledge (germane load). Thisstudy evaluates the effectiveness of low-fidelity simulation (LFS) utilising CLT principles in theassessment and management of the deteriorating patient (AMDP).Method:CLT design principles informed the choice of LFS and simulation design. The self-rated ability of13 undergraduate nurses across seven aspects of AMDP was measured in a pre-post design.ResultsSelf-rated ability increased from 2.98 (SD = 0.19) to 4.47 (SD = 0.12) (p Conclusion:This study indicates that CLT informed design has benefits for simulation. LFS may be preferred toHFS for AMDP teaching and medical simulation for novice learners

Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?

Background Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes. Aim To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure

Resilience and the rehabilitation of adult spinal cord injury survivors: A qualitative systematic review

© 2017 John Wiley & Sons Ltd Aim: To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience. Background: Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation. Design: A qualitative systematic review and thematic synthesis of the research evidence. Data sources: CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used. Review methods: Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience. Results: Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports. Conclusion: Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes

A systematic review examining the effectiveness of blending technology with team-based learning.

BACKGROUND: Technological advancements are rapidly changing nursing education in higher education settings. Nursing academics are enthusiastically blending technology with active learning approaches such as Team Based Learning (TBL). While the educational outcomes of TBL are well documented, the value of blending technology with TBL (blended-TBL) remains unclear. This paper presents a systematic review examining the effectiveness of blended-TBL in higher education health disciplines. OBJECTIVES: This paper aimed to identify how technology has been incorporated into TBL in higher education health disciplines. It also sought to evaluate the educational outcomes of blended-TBL in terms of student learning and preference. METHOD: A review of TBL research in Medline, CINAHL, ERIC and Embase databases was undertaken including the search terms, team based learning, nursing, health science, medical, pharmaceutical, allied health education and allied health education. Papers were appraised using the Critical Appraisal Skills Program (CASP). RESULTS: The final review included 9 papers involving 2094 student participants. A variety of technologies were blended with TBL including interactive eLearning and social media. CONCLUSION: There is limited evidence that blended-TBL improved student learning outcomes or student preference. Enthusiasm to blend technology with TBL may not be as well founded as initially thought. However, few studies explicitly examined the value of incorporating technology into TBL. There is a clear need for research that can discern the impact of technology into TBL on student preference and learning outcomes, with a particular focus on barriers to student participation with online learning components

Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review.

BACKGROUND: The role and scope of nursing practice has evolved in response to the dynamic needs of individuals, communities, and healthcare services. Health services are now focused on maintaining people in their communities, and keeping them out of hospital where possible. Community based nurse-led clinics are ideally placed to work towards this goal. The initial impetus for these services was to increase patient access to care, to provide a cost-effective and high quality streamlined service. OBJECTIVES: This systematic review aimed to identify the impact of nurse-led clinics in relation to patient outcomes, patient satisfaction, impact on patient access to services, and cost effectiveness. METHODS: A review of community based nurse-led clinic research in Medline, CINAHL and Embase was undertaken using MeSH terms: Nurse-managed centres, Practice, Patterns, Nurse, Ambulatory Care, keywords: nurse-led clinic, nurse led clinic, community and phrases primary health care and primary care. Papers were appraised using the Joanna Briggs Appraisal criteria. RESULTS: The final review comprised 15 studies with 3965 participants. Most studies explored patient satisfaction which was largely positive towards nurse-led clinics. Patient outcomes reported were typically from self-report, although some papers addressed objective clinical measures; again positive. Access was reported as being increased. Cost-effectiveness was the least reported impact measure with mixed results. CONCLUSIONS: Nurse-led clinics have largely shown positive impact on patient outcomes, patient satisfaction, access to care and mixed results on cost-effectiveness. Future research evaluating NLCs needs to adopt a standardised structure to provide rigorous evaluations that can rationalise further efforts to set up community based nurse-led clinical services

What are the factors in risk prediction models for rehospitalisation for adults with chronic heart failure?

Background: Risk prediction models can assist in identifying individuals at risk of adverse events and also the judicious allocation of scare resources. Our objective was to describe risk prediction models for the rehospitalisation of individuals with chronic heart failure (CHF) and identify the elements contributing to these models. Methods: The electronic data bases MEDLINE, PsychINFO, Ovid Evidence-Based Medicine Reviews and Scopus (1950-2010), were searched for studies that describe models to predict all-cause hospital readmission for individuals with CHF. Search terms included: patient readmission; risk; chronic heart failure, congestive heart failure and heart failure. We excluded non-English studies, pediatric studies, and publications without original data. Results: Only 1 additional model was identified since the review undertaken by Ross and colleagues in 2008. All models were derived from data sets collected in the United States and patients were followed from 60 days to 18 months. The only common predictors of re-hospitalisation in the models identified by Ross and colleagues were a history of diabetes mellitus and a history of prior hospitalisation. The additional model extends its scope to include the non clinical factors of social instability and socioeconomic status as predictors of rehospitalisation. Conclusions: In spite of the burden of hospitalisation in CHF, there are limited tools to assist clinicians in assessing risk. Developing risk prediction models, based on patient, provider and system characteristics may assist in identifying individuals in the community at greatest risk and in need of targeted interventions to improve outcomes. © 2011

Identifying health literacy levels and modifiable risk factors in adults with cardiovascular disease

Challenges for adults with cardiovascular disease include rehospitalisation, decrease in quality of life and poor compliance related to health literacy