Current Issue : January - March Volume : 2017 Issue Number : 1 Articles : 7 Articles
Background: A major focus in nursing education is on the judgement of clinical performance, and it is a complex\nprocess due to the diverse nature of nursing practice. A holistic approach in assessment of competency is advocated.\nDifficulties in the development of valid and reliable assessment measures in nursing competency have resulted in the\ndevelopment of assessment instruments with an increase in face and content validity, but few studies have tested\nthese instruments psychometrically. It is essential to develop a holistic assessment tool to meet the needs of the clinical\neducation. The study aims to develop a Holistic Clinical Assessment Tool (HCAT) and test its psychometric properties.\nMethods: The HCAT was developed based on the systematic literature review and the findings of qualitative studies.\nAn expert panel was invited to evaluate the content validity of the tool. A total of 130 final-year nursing undergraduate\nstudents were recruited to evaluate the psychometric properties (i.e. factor structure, internal consistency and test-retest\nreliability) of the tool.\nResults: The HCAT has good content validity with content validity index of .979. The exploratory factor analysis reveals\na four-factor structure of the tool. The internal consistency and test-retest reliability of the HCAT are satisfactory with\nCronbach alpha ranging from .789 to .965 and Intraclass Correlation Coefficient ranging from .881 to .979 for the four\nsubscales and total scale.\nConclusions: HCAT has the potential to be used as a valid measure to evaluate clinical competence in nursing\nstudents, and provide specific and ongoing feedback to enhance the holistic clinical learning experience. In addition,\nHCAT functions as a tool for self-reflection, peer-assessment and guides preceptors in clinical teaching and assessment...
Background: Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which\nis increasingly being used in public health settings, either as a stand-alone approach or in combination with other\nstructured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed,\npreventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are\nadditionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing\neffectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites\nin England. The aim of this process evaluation component of the trial is to determine the extent to which\nMotivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with\nclients.\nMethods: Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected\nduring the ââ?¬Ë?pregnancyââ?¬â?¢ and ââ?¬Ë?infancyââ?¬â?¢ phases of the FNP programme. They were analysed using The Motivational\nInterviewing Treatment Integrity (MITI) coding system.\nResults: A competent level of overall MI adherent practice according to the MITI criteria for ââ?¬Ë?global clinician ratingsââ?¬â?¢\nwas apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner\ncompetency variables, there was a large variation in the percentage of recordings in which ââ?¬Å?beginner proficiencyââ?¬Â\nlevels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the ââ?¬Ë?MI adherent behaviourââ?¬â?¢\nvariable in the pregnancy phase to 6.7 % for ââ?¬Ë?percentage of questions coded as openââ?¬â?¢ in the infancy phase.\nConclusions: The results suggest that it is possible to deliver a structured programme in an MI-consistent way.\nHowever, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as\nopen can be more difficult to achieve in such a context. This is an important consideration for those involved in\ndesigning effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both\nMI and the structured programme...
Background: Swallowing difficulties are common, and dysphagia occurs frequently in intensive care unit (ICU)\npatients after extubation. Yet, no guidelines on postextubation swallowing assessment exist. We aimed to\ninvestigate the safety and effectiveness of nurse-performed screening (NPS) for postextubation dysphagia in\nthe medical ICU.\nMethods: We conducted a retrospective cohort study of mechanically ventilated patients who were extubated in a\n20-bed medical ICU. Phase I (no NPS, October 2012 to January 2014) and phase II (NPS, February 2014 to July 2015)\nwere compared. In phase II, extubated patients received NPS up to three times on consecutive days; patients who\nfailed were referred to speech-language pathologists. Outcomes analyzed included oral feeding at ICU discharge,\nreintubation, ICU readmission, postextubation pneumonia, ICU and/or hospital mortality, and ICU and/or hospital\nlength of stay (LOS). Subgroup analysis was done for patients extubated after >72 h of mechanical ventilation, as the\nlatter may predispose patients to postextubation dysphagia. Multivariable adjustments for Acute Physiology and Chronic\nHealth Evaluation (APACHE) II score and comorbidities were done because of baseline differences between the phases.\nResults: A total of 468 patients were studied (281 in phase I, 187 in phase II). Patients in phase II had higher APACHE II\nscores than those in phase I (27.2 �± 8.2 vs. 25.4 �± 8.2; P = 0.018). Despite this, patients in phase II showed a\n111 % increase in (the odds of) oral feeding at ICU discharge and a 59 % decrease in postextubation pneumonia\n(multivariate P values 0.001 and 0.006, respectively). In the subgroup analysis, NPS was associated with a 127 %\nincrease in oral feeding at ICU discharge, an 80 % decrease in postextubation pneumonia, and a 25 % decrease in\nhospital LOS (multivariate P values 0.021, 0.004, and 0.009, respectively). No other outcome differences were found.\nConclusions: NPS for dysphagia is safe and may be superior to no screening with respect to several patient-centered\noutcomes....
Background: Hypertension is the premier modifiable risk factor for recurrent stroke. In sub-Saharan Africa (SSA)\nwhere the stroke burden is escalating, little is known about the role of behavioral interventions in enhancing blood\npressure (BP) control after stroke.\nOur objective is to test whether an m-Health technology-enabled, nurse-led, multilevel integrated approach is\neffective in improving BP control among Ghanaian stroke patients within 1 month of symptom onset compared\nwith standard of care.\nMethods: This two-arm cluster randomized controlled feasibility pilot trial will involve 60 recent-stroke survivors.\nUsing a computer-generated sequence, patients will be randomly allocated into four clusters of 15 patients each\nper physician: two clusters in the intervention arm and two in the control arm. Patients in the intervention arm will\nreceive a simple pillbox, a Blue-toothed UA-767Plus BT BP device and smartphone for monitoring and reporting\nBP measurements and medication intake under nurse guidance for 3 months. Tailored motivational text messages\nwill be delivered based upon levels of adherence to the medication intake. Both groups will be followed up for\n6 months to compare BP control at months 3, 6 and 9 as primary outcome measure. Physicians assessing BP\ncontrol will be blinded to arms into which patients are allocated. Secondary outcome measures will include\nmedication adherence scores and Competence and Autonomous Self-regulation Scale scores. A qualitative study\nis planned after follow-up to explore the lived experiences of participants in the intervention arm.\nDiscussion: A feasible and preliminarily effective intervention would lead to a larger more definitive efficacy/\neffectiveness randomized controlled trial powered to look at clinical events, with the potential to reduce\nstroke-related morbidity and mortality in a low- to middle-income country....
Background: Japan is getting older and older. More than 26% of the population is 65 years or over. Therefore,\nthe needs and quality of geriatric nursing should be improved. At the same time, the standards and requirements in\ngeriatric intermediate care facilities (GIFs) are also changing. However, the quality of geriatric care in Japan is\nnot in a satisfied level. In order to improve the quality of geriatric nursing, reconsidering professionalism in nurses\nis crucial. Moreover, it is important to address appropriate working environment of nurses to develop, maintain\nand enhance their professionalism.\nObjectives: The aim of this study was to obtain insights to the professionalism of nurses in geriatric intermediate\ncare facilities from the perspectives and experiences of geriatric care.\nMethodology: A qualitative exploratory descriptive research design was used in this study. The study participants\nwere three clinical nurse specialists of geriatric nursing and five nurse managers from geriatric care facilities. A\npurposive sampling was used.\nResults: Five descriptive themes related to the professionalism of nurses in geriatric care facilities were identified:\nautonomy, comprehensive care, patient advocacy, educational activities, and work with other specialists.\nConclusions: Professionalism identified in this study is similar to that of clinical nurses that was reported\nprevious studies. However, some sub-categories indicate the characteristics of geriatric care facilities, such as\ndecision making when a physician is absent, which is included in autonomy, and the life model, which is included\ncomprehensive care....
Background: Recovery after stroke is long-term and demanding. Optimising community-residing stroke survivors�\ncapability to self-manage their health is integral. Recent systematic reviews have shown that stroke selfmanagement\nprogrammes were associated with significant improvement in stroke survivors� health-related quality\nof life and self-efficacy. However some programmes were not designed with an underpinning theoretical\nframework. The aim of this study is to compare the effectiveness of a nurse-led stroke self-management\nprogramme with usual care on recovery of community-residing stroke survivors.\nMethods/Design: A single-blinded, two-arm, randomised controlled trial will be conducted. Patients with a history of\nfirst or recurrent ischaemic or haemorrhagic stroke who will be discharged to home settings will be recruited from\nacute stroke units of three acute public hospitals in Hong Kong. The estimated sample size is 160 (80 participants per\ngroup). Eligible participants will be randomised to receive either usual care or a 4-week nurse-led community-based\nself-management programme plus usual care after discharge. The programme, underpinned by Bandura�s constructs of\nself-efficacy and outcome expectation, includes one individual home visit, two community-based group sessions, and\nthree follow-up phone calls. Primary outcomes include stroke survivors� self-efficacy and outcome expectation of\nperforming self-management behaviours. Secondary outcomes include health-related quality of life, satisfaction with\nperformance of self-management behaviours, depressive symptoms, and community reintegration. Participants will be\nassessed at baseline and at 8 weeks after randomisation. Generalised estimating equations will be performed to\nevaluate the significance of changes in outcomes over time by treatment condition. Research ethics approvals were\nobtained.\nDiscussion: It is expected that stroke survivors receiving the stroke self-management programme will have improved\nself-efficacy, outcome expectation, and performance of stroke self-management behaviours. Enhanced quality of life\nand level of community reintegration, and decreased depressive symptoms are also expected. The study results will\nprovide valuable evidence to inform future identification and evaluation of best approach to deliver stroke selfmanagement\nprogrammes to enhance community-residing stroke survivors� recovery....
Background: Belongingness has been argued to be a prerequisite for students� learning in the clinical setting but\nmaking students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace\nparticipatory practices is a framework that views clinical learning environments to be created in interaction\nbetween students and the workplace and hence, are dependent on them both. The aim of this study was to\nexplore the interdependence between affordances and engagement in clinical learning environments. The research\nquestion was: How are nursing students influenced in their interactions with clinical learning environments?\nMethods: An observational study with field observations and follow-up interviews was performed. The study setting\ncomprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students\nduring entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and\nclinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with\nthe data collection.\nResults: The results revealed that students strived to fill out the role they were offered in an aspirational way but that\nthey became overwhelmed when given the responsibility of care. When students� basic values did not align with those\nenacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting\nstudents into the community of nurses and the practice of care. Students demonstrated hesitance regarding their\ndesire to belong to the workplace community.\nConclusion: The results imply that the challenge for clinical education is not to increase the experience of belongingness\nbut to maintain students� critical and reflective approach to health care practice. Additionally, results suggest students to\nbe included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer\nof clinical education...
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