Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

An evaluation of a new domiciliary physiotherapy service

The aim of this research was to undertake an evaluation of domiciliary physiotherapy, by assessing the cost effectiveness of a new Domiciliary Physiotherapy Service (DPS) and by analysing the process of domiciliary physiotherapy practice. The main element of the work was a randomised controlled trial of the DPS, in which an experimental group receiving domiciliary physiotherapy assessment and intervention was compared with a control group receiving conventional care. Hypotheses that domiciliary physiotherapy would improve clients' independence in activities of daily living (ADL) and health status, and reduce clients' use of other services, were tested. The null hypotheses related to ADL and health status could not be rejected, possibly because of a smaller than intended sample size, and/or the masking of real effects by sample attrition, or lack of sensitivity of the outcome measures. There was evidence to suggest that the DPS may have significantly increased, rather than decreased, the proportion of clients with at least one contact with another health or social service. The analysis of the process of domiciliary physiotherapy developed as the RCT progressed. An interpretive account of domiciliary physiotherapy practice, framed within the author's own experiential knowledge, was constructed using quantitative and qualitative data from DPS treatment records, GP referral forms, and interviews with clients, carers and experienced community-based therapists. The interpretive analysis has underpinned a new `reciprocal learning' model of domiciliary physiotherapy, which may assist practitioners working in the field. The way forward for domiciliary physiotherapy practice may be to acknowledge that measurable clinical outcomes cannot easily be determined, and that criteria for assessing the value of domiciliary physiotherapy should be based on client and carer perspectives

Tele-Intervention Resources

The restrictions of the COVID-19 pandemic forced many early intervention (EI) providers and families to adopt an emergency virtual service delivery model. The exigent nature of the pandemic necessitated the rapid transition to virtual early intervention, often without the benefit of training and guidance for both providers and caregivers regarding the use of virtual platforms, objectives, procedures, and the overall dynamics of the virtual session. As restrictions begin to ease and in-person home visits once again become possible, many providers and caregivers may be wondering how tele-intervention (TI) services might fit in ongoing early intervention for children who are deaf or hard of hearing. It will be necessary to review desired family outcomes and the components of high-quality TI services as caregivers and providers determine their intervention plan forward together. The purpose of this article is to highlight resources pertaining to the provision of high-quality TI services in keeping with recommended family-centered early intervention practices

The Perceptions and Rehabilitation Experience of Older People After Falling in the Hospital

Purpose: Falls are a major cause of disability and mortality due to injury. To reduce fall rates and improve health outcomes, it is important to design services based on patient experience and engagement. This study aimed to explore the experiences of older patients who fell during their hospital stay. Design: Five patients from two rehabilitation wards in the United Kingdom participated in this qualitative study. Methods: Semistructured interviews, incident reports, and medical records provided information about each fall. Thematic, discourse, and descriptive analysis were used to analyze data. Findings: The data demonstrated how a fall impacted patients’ experience of rehabilitation and resulted in changes to mobility, self-confidence, management of falls risk, avoidance of daily activities, and increased assistance from others. Conclusions: Falling in hospital can influence patients’ ability to reach their potential of an optimal level of functioning. Clinical Relevance: There is a need to place an equal and mutual understanding on the physical, psychological, and social impact of falling to reduce falls and improve functional outcomes

Living with pain or living in pain : narrative journeys with low back pain

This study used a qualitative method to focus on the perspectives, beliefs and expectations of low back pain sufferers. The research was undertaken within a hospital based pain clinic. In recent years low back pain research has proliferated, and the epidemiological evidence suggests that back pain is an increasing problem. Much attention has been paid to the impact of low back pain on the population, and to the increasing cost in economic and health terms. Biomedical and psychological evidence abounds to shape acute and chronic management of low back pain, but there is a dearth of information about the viewpoint of those suffering pain. This study attempted to bring the understanding of the back pain sufferer to the fore. Issues of quality of life, functional ability and the impact of back pain on their lifestyle were explored, along with the influence of contextual factors in relation to how back pain sufferers perceived themselves and how others perceived them. A narrative method was utilized to illuminate the journey with pain. Nine interviews were conducted, and the interpretation and presentation of the narratives generated was influenced by Ricoeur’s interpretative theory. Thematic analysis revealed that doctorability, agency, control, separation or acceptance of the pain and the concept of future life were key features within the narratives. The analysis highlighted that for the majority in this study pain arrived uninvited following a traumatic accident or incident, and back pain became a chronic condition. It was always unwanted and initially it was unexpected as the usual script for pain is one of a transient incapacity followed by recovery. It was precisely this deviation from the norm that resulted in difficulties for the people suffering the pain. Biographical differences did not appear to be identifiable in the themes discerned in the stories, nor in the overall structure.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

of the Nature of the Preparation of Practice Educators in Five Health Care Disciplines

Overview This study aimed to investigate university-based preparation of physiotherapy practice-based educators, in order to explore perceived needs and identify principles of good practice. Physiotherapy (alongside occupational therapy, radiography, dietetics and nursing) was studied throughout the UK and Ireland. Questionnaires were sent out to all pre-registration physiotherapy courses (n=37) and 21 were returned, giving a response rate of 57%. The questionnaire findings were synthesised with analysis of policy documents and the wider literature Current practice Students must complete a minimum of 1000 hours of assessed satisfactory clinical practice under the supervision of a practice-based educator, who must be a registered physiotherapist. All universities provide training for clinical educators, but the nature of provision varies. There is a nation-wide shortage of clinical placements within physiotherapy at a time when student numbers are rising. The debate on how to counteract the placement crisis centres on three main issues: • The requirement for specialist physiotherapy practice placements in defined areas. • Models of clinical supervision where physiotherapy practice educators are responsible for more than one student. • The timing of physiotherapy placements within the curriculum and competition for placements in particular geographical areas. The perceived benefits of being a clinical educator include the contribution it makes to continuing professional development, fulfilment of professional responsibility and the opportunity to market services to potential recruits. Problems associated with taking students on placement were perceived to derive largely from resource constraints. Discussion Several areas of innovative practice emerged in the areas of practice educator preparation, interprofessional student learning, models of student supervision and evidencing student competence in specialist areas. The Chartered Society of Physiotherapy has recently launched a scheme for accrediting clinical educators (ACE) that it hopes will be adopted across all courses. Summary Increasing student numbers places growing pressure on an already stretched placement resource. There are many challenges in providing appropriate clinical learning experiences, particularly as physiotherapy moves increasingly towards primary care and interprofessional working. It is recommended that managers, universities and the multidisciplinary team should adopt key roles in supporting physiotherapy practice-based educators. Profile PHYSIOTHERAPY content

Warming Can Boost Denitrification Disproportionately Due to Altered Oxygen Dynamics

Background: Global warming and the alteration of the global nitrogen cycle are major anthropogenic threats to the environment. Denitrification, the biological conversion of nitrate to gaseous nitrogen, removes a substantial fraction of the nitrogen from aquatic ecosystems, and can therefore help to reduce eutrophication effects. However, potential responses of denitrification to warming are poorly understood. Although several studies have reported increased denitrification rates with rising temperature, the impact of temperature on denitrification seems to vary widely between systems. Methodology/Principal Findings: We explored the effects of warming on denitrification rates using microcosm experiments, field measurements and a simple model approach. Our results suggest that a three degree temperature rise will double denitrification rates. By performing experiments at fixed oxygen concentrations as well as with oxygen concentrations varying freely with temperature, we demonstrate that this strong temperature dependence of denitrification can be explained by a systematic decrease of oxygen concentrations with rising temperature. Warming decreases oxygen concentrations due to reduced solubility, and more importantly, because respiration rates rise more steeply with temperature than photosynthesis. Conclusions/Significance: Our results show that denitrification rates in aquatic ecosystems are strongly temperature dependent, and that this is amplified by the temperature dependencies of photosynthesis and respiration. Our result

A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

Background: Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design. The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion. The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and additional stabilization with a hinged elbow fixator. Trial Registration. The trial is registered at the Netherlands Trial Register (NTR1996)