clinicalnursing

[clinicalnursing]

Iris Publishers - Iris Journal of Nursing & Care | Wishing you a Happy Thanksgiving Day

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

HPV: Impact on Women’s Lives

Authored by  Maria Cristina Porto e Silva*

Abstract

Objective:b> To identify the feelings involved in the discovery of HPV infection and to point out the impacts on the woman’s life after a positive result for human papilloma virus.

Method: This is a descriptive and cross-sectional study, based on a theoretical and methodological basis based on the principles of qualitative research whose data were analyzed according to phenomenological inspiration. The study population consisted of women who had the presence of HPV in the last result of the cytopathological examination. The data were obtained through semi-structured interviews consisting of guiding questions, which, after approval by the ethics committee and authorization of the participants, were recorded.

Result: Nine units of meaning were identified with the following themes: the repercussion in the lives of the participants, the importance of hope after the discovery of HPV, the patient’s uncertainties regarding HPV, the unknown disease, the diagnosis of HPV as an unexpected fact, pointing out the impacts after the discovery of the infection, the impact of the diagnosis on the relationship, confusion of thoughts about the diagnosis, anguish caused by the HPV result, alarmed by the next relationships, without reaction on the exam.

Considerations:b> Sexual behavior is linked to the growth of the diagnosis of human papilloma virus, considering that changes in habits, such as condom use during sexual intercourse even with a steady partner, are necessary for safe sexuality. Feelings of fear and worry happen through an unexpected result, which can contribute to the re-signification of the lived world.

Keywords: Human papillomavirus; Feelings; Women; Nursing

Introduction

The increase in the rates of Sexually Transmitted Infections (STIs) has been considering the behavioral change in sexual practices in society, being transmitted through sexual contact (oral, vaginal and anal) without the use of condoms, which can still occur in the form of vertical transmission during pregnancy, childbirth and through breastfeeding [1]. The human papilloma virus (HPV), an infectious agent that manifests itself through lesions known as culminated condyloma, genital wart or cock’s crest, has affected women in greater numbers, with contagious lesions that can be asymptomatic and transient, but some women develop persistent infections that can result in cervical cancer precursor lesions [2]. The persistent infection of some types of human papilloma has been the cause of cervical cancer, with infection by this virus being very frequent, and cellular alterations may occur and progress to cancer. The discovery can be by cytopathological examination or Pap smear, being curable in almost all cases [3]. Human Papillomavirus (HPV) considered a virus that causes a Sexually Transmitted Infection (STI) is the most common type, and worldwide, approximately 600 million people have HPV, and about 75-80% of the population acquire this virus. at some point in life [4]. The Human Papillomavirus (HPV) virus belongs to the Papovaviridae family of the genus Papiloma, it is a DNA virus composed of a circular double loop and the variants of the nucleotide sequences allowed to find more than 100 different types of viruses. It presents a tropism for epithelial cells where it replicates in the nucleus of squamous cells, generating infections by mucous membranes and skin in the form of warty lesions that compromise the epithelium [5]. Viruses are installed in basal epithelial cells, in which replication depends on the terminal differentiation of the host cell, promoting productive, transforming, and latent infections, that is, viral DNA replication occurs, absence of viral transcripts and transformation of infected cells into benign or malignant tumor cells [6]. The virus is transmitted to women and men through unprotected sex, in which a quarter of the population can present joint infection with two or more types of virus, thus being exposed to a greater risk of infection by oncogenic subtypes [5]. According to the National Cancer Institute, among subtypes of papailoma virus, there are those of oncogenic character and which may be related to cases of persistent infections, affecting mainly the cervix, but also the vagina, vulva, anus, penis, oropharynx and mouth. The treatment of women with HPV improves the quality of life, but unfortunately does not interrupt the chain of transmission of these infections, as HPV is not only curable for treatment and prevention [3]. Currently, the vaccine approved by the FDA (Food and Drug Administration) for women between 9 and 26 years old, which prioritizes girls between 11 and 13 years old who have not had sexual intercourse, is 100% effective and has no serious adverse event. Although the woman does not enter this age group and has already had sexual intercourse, vaccination is recommended, if she has contact with one type of virus, she may still be immunized against other viral types [7]. The vaccine that protects against Human Papillomavirus (HPV) was incorporated into the Unified Health System (SUS) in 2014 and is currently applied to girls and adolescents between 9 and 14 years of age (14 years, 11 months, and 29 days), boys and adolescents between 11 and 14 years old (14 years, 11 months and 29 days) of age and for groups with special clinical conditions [8]. The combination of the vaccine and regular Pap smear is the best way to guarantee the decrease in high rates of cervical cancer and in the future the disease will become less threatening to the lives of women [5]. A study reports that in view of the increasing involvement of women with STIs and the high influence caused by the socioeconomic context in the course of these infections, the importance of public policies that establish adequate strategies for their prevention, early diagnosis and treatment is highlighted, so that there is promotion of the quality of life of this population [4]. The increasing number of STI statistics has shown that the lack of knowledge both about the disease, as well as its transmission and prevention, has also been an impasse to change this scenario, thus making it a public health problem that has repercussions on the woman’s life and on the conjugal relationship. The study is important to strengthen a reflection on the sexual behavior of the population, allowing the knowledge of the feelings involved in the discovery of sexually transmitted infections mainly by the papilloma virus due to the impact it can have on the woman’s life, and consequently reflecting on the relationship the partner and in sex life. A study points out that health education is one of the main tools in contributing to knowledge about HPV infection, awareness about dissemination and care, promoting technical and popular knowledge and thus providing quality of life not only for the individual but also for the community [9]. For nursing, there is a need to act in preventing infection and promoting women’s health, with the consequence of improving the quality of life and mainly reducing the emotional disturbance that can surround the woman’s life. This study contributes to the community, as a means of clarifying the HPV contamination from the perspective of women who are affected by the precursor of cervical cancer, and thus helping professionals to have interventions focused on physical integrity and mental. Also, for supporting the preparation of the scientific community to develop strategies aimed at increasing the level of information of women and the health team, always promoting quality in the care and in the lives of the women affected. Therefore, the objective of the study was to identify the feelings involved in the discovery of the HPV infection and to point out the impacts on the woman’s life after the discovery of the infection.

Methodology

This research has its theoretical and methodological basis based on the principles of qualitative research, with a descriptive and transversal approach, whose proposal will be to understand human phenomena from a concrete experience, lived in daily life, in the phenomenological perspective adopted for the analysis of the collected data. The study scenario was the outpatient clinic of Hospital das Clínicas that serves the city of Pouso Alegre-MG and surrounding municipalities, being a reference to medium and high complexity care. Women were selected who presented the presence of Human Papillomavirus in the last result of the cytopathological or Pap test. The interviews were scheduled and carried out in the care unit itself, which, after approval by the ethics committee and signature of the free and informed consent term, were collected in a restricted, comfortable and bright place, favoring a quiet and private environment for the subjects of the study. research. The inclusion criteria included women who presented the results of the cytopathological or Pap test in the period of 6 months with a positive result for Human Papillomavirus; women aged 18 years or older; women who agreed to participate in the research. And the exclusion criteria were those who refused to be part of the research; women who have not had a cytopathological exam or Pap smear with Human Papillomavirus; women who presented the results of the cytopathological exam or Pap smear over 6 months with Human Papillomavirus. The data were obtained through semi-structured interviews, which, after approval by the ethics committee and authorization of the participants, were recorded. They were guided by a script consisting of the following questions: For you, what was it like to know that the Pap smear result had an infection with the Human Papillomavirus, a precursor of cervical cancer? What in your life does that mean? It’s because? This research was submitted to the evaluation of the Ethics Committee of the Vale do Sapucaí University respecting what is recommended by Resolution No. 466 of 2012 of the Ministry of Health, which deals with research with human beings. The data related to the women’s reports about what it meant to have the result of the cytopathological examination presenting the infection with Human Papillomavirus and what repercussions it brought to their lives, were analyzed according to the qualitative approach of phenomenological inspiration, by the following steps: the recordings were listened to carefully in its entirety, transcribed in full and the content of the interviews was read in order to learn about the phenomenon and simultaneously highlighted the main points of each speech. This stage was carried out with each participant, and the similarities identified in the set of interviews were grouped, which, in turn, were constituted in themes, considering similar aspects, divergences and, finally, presented in a descriptive manner, based on the statements of women.

Results and Discussions

Data collection was carried out with eight women and it was possible to analyze the statements based on two themes that relate to the guiding questions and the objective of the study:

• The impact on the participants’ lives

• Point out the impacts after the discovery of the infection.

Four categories emerged from the first theme:

• The importance of hope after the discovery of HPV

• The patient’s uncertainties regarding HPV

• The unknown disease

• The diagnosis of HPV as an unexpected fact. And the second theme allowed us to divide it into five units:

• The impact of the diagnosis on the relationship

• Confusion of thoughts about the diagnosis

• Anguish caused by the HPV result.

• Alarmed by the forthcoming relationships.

• No reaction to the exam.

The repercussions on the lives of the participants

The importance of hope after the discovery of HPV: The result of the cytopathological examination with cellular alterations implies for women a lack of knowledge about the scientific aspect, but it is frightening as to its effects in daily life. For some of these women after having a clear diagnosis, they remain in the hope of six months later to repeat and obtain normal results. A study found that when diagnosed with a sexually transmitted infection, specifically HPV, women are faced with a reality that is imposed on them and with which they will inevitably have to deal with the unknown and with the doubt of loyalty [10]. The search for strength to cope makes the woman find the hope of improvement, as in the speech: What I felt was that for me it was everything that if God wants it will be all right, that I was not beaten, that is it (P2). These feelings awaken to an understanding of the world from which they lived experience is founded on the subject’s perception, intertwining body-world, giving new meaning, feeling what it is like to be in the world creating meanings through the perception of the unfolding place of life. before you for the experiences [11]. Believing that everything can have a positive outcome is the basis for facing the difficulties imposed on the body by the lived world. Therefore, positivity and the encounter with religion is necessary support to face what lies ahead. Having knowledge about the characteristics of the HPV virus, will favor having a better view of your health status, and the need for continuous care, helping to adhere to the proposed health treatment [9]. Perception of the world that materializes with it, in the body that moves, that suffers, that interacts with the environment, assigning meanings.

The patient’s uncertainties regarding HPV: The first information about HPV generates uncertainty and the possibility of having cancer, in which some studies show that women associate warts on the genitalia as a synonym for a malignant tumor. When they receive the information that some types of HPV are likely to develop into cervical cancer, fear is a dominant feeling, revealing the ghost of cancer as a destructive force, an invasive and silent disease [12]. Acquiring HPV means living with doubt when discussing the evolution of the disease, in which it is not possible to give an exact prognosis of the pathology [12]. It is the certainty that you have plunged into the world-disease that scares you. The idealized world loses its meaning. Ah! I was really worried, because when I found out about warts, right?! I already had condyloma there, it was very, well, very embarrassing because we already think a lot of bullshit and I already had breast cancer so in my fear it was like having cancer in the uterus too (P3). Ah, I was sad, I was sad, it was one, “I don’t know” it was an exam result that left me shaken (P7) I was very scared thinking that I had cancer’ (P5). Thus, meanings, goals and limitations arising from being affected by the disease provide the meaning of oneself from the difficulties that they have been going through in their daily lives related to changes in their natural body. The investigated subject’s experience of falling ill suggests something in the field of impotence, that is, the loss of power and control over the situation experienced.

The unknown disease: HPV is unknown and even its treatment, due to lack of information, arouses feelings of insecurity and fear, in which the situation requires decision-making to face and move forward. Existence is not explained by objectivity, by the world of ideas, but by understanding and experiencing the world, the lived world. Therefore, with all the feelings and changes that occur in life, receiving a positive diagnosis for HPV, orienting yourself and understanding your current situation and starting to face the new reality, is important at this time [9]. The lack of adequate information can result in misconceptions, which can generate negative behaviors, given the statement below: It was a “thud” because we don’t have any information in the region where we are it should be more at the health center or something like that to pay more attention, more explanation, let’s say so. Clear doubts (P4). When sick the attention turns to the part that is not working, at this moment the harmony between the object body and the lived body is broken, with the meaning of the simple mechanical dysfunction reaching the being-in-the-world, it loses the conscience of coping and lives the anguish of the assumption. Unawareness or little knowledge is a reason to cause sadness and dread in the face of the perception of the partner, family, and oneself, in addition to the concern about possible changes in their routine with the family and work [9]. I stayed, I did not know what it was yet and then I got scared (P6). The impact of the diagnosis meant discovering having a sexually transmitted infection and living with it is sharing moments of fear, insecurity, revolt, and uncertainty [10]. However, being sick is a presence that changes life, transforming the way we experience our bodies, react, and perform tasks. Getting sick is a painful way to reveal the intimately bodily nature of our being. Having STI makes women more exposed to bad feelings about their prognosis, making them more psychologically vulnerable to negative emotions that May arise [12]. It was a horrible feeling, it was a painful, horrible feeling. Wow, I do not even know how to speak, it hurts too much, it hurts too much, it is like, something that, you know, wow! The time I heard about it ended with me and it was very hard, very painful, I cried for several days until we go on talking to a person, the person gives us a word of friend, we calm down because otherwise you cannot bear it. It is hard, I wish it to anyone, because it’s a horrible feeling (P8). The significant experience of a situation where there is no body that suffers, but an incarnate being that feels pain, expression, meaning. Fear and pain are mixed when experiencing the new reality of being a woman with HPV, feelings being most aroused by this diagnosis and by experiencing a new reality [9]. The changes resulting from these feelings bring continuous changes in your being, giving you meanings and meanings for the world body. Knowledge does not bring fear, it shows that it is possible to face the diagnosis, the absence of information and the opportunity to have it, it makes the woman negatively experience the existence in the world.

The diagnosis of HPV as an unexpected fact: The diagnosis of any disease is not something that inspires positive and pleasant feelings, knowing that you have HPV comes as a surprise mainly because many women do not know the real severity of the disease and only discover later how the virus is transmitted. The body is an ally of consciousness that expresses the meaning attributed to transformations organic. In the experience of pain and suffering, the consequences of what the disease is imprisoned. There is now no body-object affected by HPV, but together, a subject body that feels, that means and assigns meanings. Ah, I was shocked, right?! Because I did not expect that (P1). The lack of knowledge about the existence of the disease is also a way of demonstrating impotence in the face of the circumstances caused by the contamination [12]. Research on the diagnosis of cancer shows that fear of the unexpected can lead to loss of emotional balance and health [13].

Point out the impacts after the discovery of the infection.

The impact of diagnosis on the relationship: The partner in some studies is directly or indirectly related to the new situation that the woman is experiencing and recognizing as having HPV [2]. The impact it causes on the lives of women is linked to the loyalty and trust that is built in the marital relationship, so the possibility of a betrayal in the relationship may exist or the impact on fidelity may weaken with the discovery for both. In this process of interaction with oneself and the world, a series of feelings and thoughts permeate the world of life. Now it will have to give a new meaning to an unexpected and natural situation, and, thus, transform it, inventing a better future [9]. Ah so I do not know, I do not even know how to speak, I know I was very upset with fear of dying and so in the beginning, I do not know, I thought it was my husband who transmitted it to me (P5). Fights and marital instability can be a consequence experienced by women. Consequently, the result of an HPV test interferes with the marital relationship, leading to a change in the couple’s attitudes, non-acceptance and, consequently, the discontinuity of the relationship [14]. Ah it hurt my life a lot, mainly, you know, because I have little time that I got married again. So, it hurt a lot, it hurt my married relationship (P1). Sexuality throughout all personal existence is conceived as an existential need and part of the general existence of the human being. For a woman who experiences an STI experience and during so many feelings, the woman wonders about the betrayal of her partner and at the same time it is visible the guilt she carries, an extra burden of betrayal that mix and this can be the end many relationships as well as the continuity of a moment.

Confusion of thoughts about the diagnosis: Doubt, anguish and incredulity are feelings that share space with hope, optimism and belief, the diagnosis of the precursor disease of cervical cancer can bring ambiguity of emotions and feelings [2]. I do not know that, right?! The answer I do not know how to answer because it was generated (P2). This feeling is attributed to the lack of knowledge about the disease or the lack of adequate assimilation of the value attributed to that moment of diagnosis. When the test result is positive for the HPV virus, there is a mixture of thoughts that drive attitudes and many of these are related to relationships experienced, such as distrust in the relationship or lack of communication with family members, fear of judgment and what others might think and worry about [15]. In Symbolic Interactionism, the human being acts in relation to things based on the meanings they have for him. These things are understood as physical objects, human beings, institutions, ideas, human actions, and other situations experienced in the individual’s daily life [14]. When there is a report in which the woman does not know why this happened, it is possible to realize that she does not understand why it was transmitted, and the word cancer refers that there was a lack of understanding or clarity in the professional’s explanation. It may be a moment attributed to the denial of everything that may have led to this experience and what may still suffer as a result of an examination of this.

Anguish caused by the HPV result: The sadness in the speeches reflects the lack of dialogue with the people around it is generating more anguish, feeling alone is one of the most dangerous feelings since some people are susceptible to depression. What did it mean? Ah. I was sad, I had to do the treatments, I was depressed (P6). For me what it meant, then it meant so much like that you know, “ain” hurt, it meant you know I said my God I can die leaving my little girl of five years old that was horrible (P8). These present feelings can be in the first moments instated by the discovery; however, it can be the beginning to take the government of their lives and to re-signify the moment lived, establishing another look on the situation.

Alarmed by the forthcoming relations: Women feel insecure in trusting their partners, even if it is something lasting, the risk of infidelity is something that surrounds personal life. Aiming that an unprotected relationship can bring several diseases and one of them, HPV, the woman feels insecure and suspicious about entering into new relationships. Upon being aware that HPV is a sexually transmitted disease, fidelity will almost always be threatened, and the marital relationship destabilized [10]. The whole human experience cannot separate body and consciousness, so the experience of having HPV brings a new look at life and future relationships. No, it meant that I got smarter, you know, because I probably took it with sexual intercourse without a condom, so we get smarter in life (P3). Women with an unstable marriage show a confirmation of infidelity and in view of the situation, a decision is necessary, especially if there are children involved in the marriage.

No reaction on the exam: One of the most frequent questions is what to do now, that is, how they should react to the virus, who to tell or whether to tell. In fact, the questions never stop. The news in the medical professional’s office can be a shock and each one has a different reaction, however many remain unresponsive, and it is only after this state has passed that they begin to react to the solution of the problem. Being a carrier of HPV is also living with doubt, especially when discussing the evolution of the disease [10]. Some infections are most of the time asymptomatic and when presenting in the cytopathological result it is surprising for them, in people’s conception the diseases have symptoms and signs which facilitates the early diagnosis, unfortunately others are asymptomatic. Na, it meant like I felt a person kind of impotent without knowing what was going on, I only found out when they referred me to the woman’s health. Ah, because she has no clarification, there is, um, how can I speak, people do not take questions from us at the health center, do not take questions from us as it was taken here, right?! Explained exactly why? How did we get it? Huh?! So, it was like that. No symptoms yet (P4). The health professional can contribute to the construction of the meaning of having or not the disease and thus will be able to minimize the distress of this woman [15]. Oh, I can’t even explain why I think it’s something that nobody wants to know, right, an exam result that I think nobody wants. He came to say that I “had” this virus (P7). The woman reports that no one would like to know about this result, thereby increasing the denial of the diagnosis, while intervention for treatment should be the priority to stimulate positive feelings and acceptance. Existence is not explained by objectivity, by the world of ideas, but by understanding and experiencing the world, the lived world.

Final Considerations

Sexual behavior is linked to the growth of the diagnosis of Human Papillomavirus since changes in habits, such as condom use during sexual intercourse even with a steady partner, are necessary for safe sexuality, avoiding the sexually transmitted infection disorder. The knowledge deficit in relation to HPV is noticeable, the lack of knowledge is the mainstay for negative feelings, depression, anguish, and fear. Health professionals have an important role in raising awareness by acting in a safe and clear manner, using language that all women can understand. Information such as vaccination with quadrivalent HPV vaccine, the action of the virus on the woman’s body and prevention measures are topics that must be addressed in health actions, public places and meetings of the group of pregnant women, parents and educators as a way of alerting physical and emotional risks. Public policies must be implemented to prevent the disease, because when we talk about costs for managers, the prevention of cervical cancer is financially more economical than treatment. This is due to several factors, one of them, the low cost of the cytopathological examination, the training of health professionals in the primary care network, health actions in schools and information material distributed to the entire population. Considering that the nurse’s role is fundamental for the reduction of infection rates by the virus, acting in primary care actively capturing women resistant to the exam and guiding the population on the risks and benefits of care, are actions that help decrease the risk of increased infections. It is important to show women that emotional distress is greater than preventing cervical cancer.

To read more about this article: https://irispublishers.com/ijnc/fulltext/hpv-impact-on-women-lives.ID.000572.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Farcial Futile Pharmacy Fiasco-Let Pharmacy Return to Its Apothecary Roots!

Authored by  Seun Ayoade*

Conversation

Peruse the following hypothetical conversation at a hypothetical graduation ceremony.

Inquirer – Congratulations! You are now a pharmacist.

Pharmacist- Thank you.

Inquirer-So what can you do as a pharmacist?

Pharmacist-I can sell people drugs after the doctor prescribes them

Inquirer-Can you manufacture drugs?

Pharmacist-No I cannot. Chemists, chemical engineers, pharmaceutical scientists and pharmaceutical manufacturing technicians and technologists can do that.

Inquirer- So all you do is read the prescription, check your shelf and hand the drugs over to the patient.

Pharmacist-Basically, yes.

Inquirer-And you spent 5 years in university to learn that? My 10 year old can do that. Anyone who can read the doctor’s writing can do that. And these days with many doctors handing over electronic prescriptions you don’t even have to be able to read the squiggly scribbles.

Pharmacist [visibly angry]-Oh shut up! Pharmacists can also recommend ointments and creams for a cut or a bruise or burn, rash or infection.

Inquirer-So can I! I have done so many times. And I didn’t have to study for 5 years to learn that.

Pharmacist-I can give injections!!!

Inquirer-So can the heroin addict on the street. You don’t need to study for years to be able to find a vein. A layman can read a prescription and sell a drug. A layman can recommend creams and lotions. A layman can give a hypodermic injection. But a layman cannot mix chemicals together and produce a tablet or a capsule or a syrup. That is what a pharmacist should be able to do. I’d go to college for 4 years to be able to do that.

Pharmacist –Shame on you! This discussion is over.

Below are some of the most important drugs ever invented in the last 100 plus years and the discipline/profession/occupation of the inventors and discoverers.

There is not one pharmacist on the list! Some may say what of Sir David Jack [1924-2011] who discovered Beclometasone? He took a combined honours degree in BOTH chemistry AND pharmacy so was not a stand-alone pharmacist. The same thing applies to Nagai Nagayoshi [1844-1929] discoverer of ephedrine, who studied medicine, pharmacy AND organic chemistry. Even John Stith Pemberton (1831 to 1888) creator of Coca Cola who many pharmacists claim as “the most famous pharmacist” was actually a medical doctor! Right up to the start of the industrial revolution apothecaries were at the forefront of the discovery and invention of drugs. In those days medicine, surgery and pharmacy [apothecary] were three distinct professions. A sick person would visit the doctor (or the doctor would visit the sick person) for a diagnosis. The doctor could recommend a surgery (which the surgeon would be called upon to perform) or prescribe a medication. The patient would head for the apothecary [pharmacy] where the apothecary who also manufactured the medication would sell it to the patient. Medicine and surgery have since been combined into one profession. Pharmacy remains alone and is the worse for it! The same professional (medical doctor) today diagnoses, prescribes and cuts. The pharmacist still sells the medicine but does not manufacture it any longer. How sad! Perhaps it is because the pharmacy profession lost its highest meaning (drug manufacture) in its disjointed transition from apothecary that the profession now desperately seeks to ape medical doctors and has become so inward looking and hostile to other professions that it will not permit even a medical doctor or a holder of a first class degree from a related discipline (e.g. pharmacology) to pursue a master’s degree in pharmacy! Let pharmacy return to the apothecary model or be downgraded to a diploma occupation! [1-2] India has set an excellent example in this regard [3].

To read more about this article: https://irispublishers.com/ijnc/fulltext/farcial-futile-pharmacy-fiasco-let-pharmacy-return-to-its-apothecary-roots.ID.000571.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Increasing Nursing Retention to Reduce Financial Costs

Authored by  Wen Hsing Yang*

Opinion

Nurses play a major role in health care setting, providing the daily care to patients. Being a new graduate nurse is not easy especially when there is a great difference between the education environment and the real world of hospitals. New Graduate Registered Nurses (NGRNs) require additional support to adopt and adjust to the working environment. If not properly acclimated to the hospital environment, statistics show many new nurses leave their initial positions within the first two years of their hiring. To lower this statistic, appropriate decision-making skills, real world hospital knowledge and confidence building can be obtained through a variety learning methods. By participating in nursing residency, mentorship and specialized orientation programs, NGRNs are less likely to leave their initial positions thus saving the hospital the cost of retraining new nurses and using temporary nursing staff. Recent studies and statistics show the cost benefit of these training programs for NGRNs.

Some new graduate registered nurses (NGRNs) have a difficult time in their initial hospital positions and tend to quit these positions within the first two years of placement. Geographic relocation, long working hours, high stress environment and dealing with sickness and death are some of the main reasons cited in various reports. When these newly hired nurses are neither proper integrated nor well supported in a new environment, some have a tendency to quit. Unfamiliarity with health care systems, ignorance of safety issues, insufficient orientation and lack of experience can affect these nurses to the point of their being dangerous to patients and to themselves. High turnover rates for nurses in hospital settings can be costly and an inefficient use of hospital resources. To manage this loss of nursing staff, hospitals use temporary nursing staffing services to make up the shortage. Hospitals currently spend 11.7% of their nursing budget on temporary staffing in New York [1]. Reducing the current nursing turnover rate will help hospitals to save money and retain a more experienced staff while improving patient safety, but these solutions are still in the early stages of development. Standard, short (3 weeks) orientations are insufficient for most new nurses. Specialized orientation programs addressing the reasons for the turnover can have a positive impact on nurses’ skills, confidence and comfort level, resulting in lower turnover rates and greater hospital savings. Extended nursing residency, mentorship by experienced nursing educators, and focused internships on specialization are helpful to guide and train new graduate nurses. These programs are highly recommended by the Institute of Medicine [2].

Nursing school graduates are considered inexperienced health care providers. On the job training will improve the gap between theory and practice, but hospitals have many specialized departments (emergency room, pathology, hematology and oncology) that require more experienced nurses with multiple skills. Several solutions have been tried with varying degrees of success, but recent reports acknowledge the need for more on the job training to reduce nursing turnover within the first two years of a nurse’s initial hiring. The cost of nursing staff is expensive, including usage of agency nurses. Hospital finances are limited; patient’s satisfaction and performance will impact on their funding or budgeting. Hospital closings or merging with other hospitals means sharing the resources to improve the quality of care. It is imperative to improve nursing retention to preserve the hospital’s resources. Without proper training of the nurses in the first few years of their hiring, the goals can’t be met. There are many types of RN residency programs to help NGRNs transition into their careers successfully; the cost of these programs can be high due to the course structure, curriculum design, length, educators, mentors and resources to develop in the programs. Hospital administration must be shown that the cost on a transitional RN residency program can save the hospital money. Recruitment, orientation, and development costs, particularly for inexperienced nurses, may add new expenses to the hospital, but recent statistics show that these programs will ultimately save the hospitals money.

In conjunction with a large group of nursing organizations, the National Council of State Boards of Nursing developed Transition To Practice (TTP) programs specifically to address this important issue [3]. Through a survey of different studies, the primary purposes of most TTP programs are to integrate, train and retain NRGNs in their first working position in a hospital. Hospitals using a TTP ultimately had a greater return on investment (ROI), decreased nursing turnover rate, and improved patient safety by avoiding the use of temporary nurses. These statistics cannot be definitive due to the shortness of some of the studies, the size of the study sample and the fact that nurses still do leave initial jobs under certain circumstances. However, the cost analysis shows a positive ROI when using a structured TTP program compared to a limited program, with a net cost savings of $735 per NGRN [3]. In a cost benefit analysis of 15 community based hospitals, Trepanier and Associates [3] found a large reduction in nursing turnover in a 1 year period of a nursing residency program producing an estimated savings of over 15 million dollars. The same analysis showed an estimated savings of over 33 million dollars in contract labor usage from pre-residency to post residency [3].

Lee Memorial Health System (LMNS) developed a transitional orientation program called intern development specialists (IDS), designed to develop and retain competent RNs [4]. To assess nursing competence, two systems have been used: the performance based development system (PBDS) and the performance management services (PMSI). PBDS assessment is for patients to evaluate their expectations for critical thinking and interpersonal skills of nurses. The PMSI is used to assess and evaluates nurses’ competence. Guthrie, et al. [4] shows that only 35% of inexperienced nurses meet the entry expectations and 65% of new graduate RNs’ skill improved after post orientation. However, unsatisfactory results with this approach led to the creation of a Transitional Orientation Program (TOP). Although similar to an internship education, TOP begins with an assessment of the nurse before entering the institution. The TOP is then modified to create a more individualized approach matching the nurse’s areas of inadequacy and inexperience. The eventual changes allowed the TOP nurses to hit the PMSI benchmark at 67%, additionally supported by IDS. The IDS took an active role in the growth and development of these nurses through reviews, planning and development activities and making evaluations of the readiness of these nurses. Statistics based on the use of the IDS showed marked improvement among the nurses and substantial savings for the hospital. Guthrie, et al. [4] found that in 2011, the TOP outcome data with IDS reported a savings of $91,000 and the hiring of an additional two IDS personnel. This program reduced the amount of cost in the hospital.

In another medical facility, the Cohen Children Medical Centre (CCMC) was struggling to keep their newly hired nurses; in 2005, they experienced a one-year retention rate at 65% and a twoyear retention rate of 50% in their pediatric care unit [1]. Another example, 17.5% newly licensed RNs leave their first nursing job in a year and about 33.5% leave within 2 years [3]. In general, NGRNs do not retain their positions in these particular units. Friedman, et al. [1] found that before the fellowship program, the cost was more than $25,000 annually in CCMC. Some of the NGRNs feel shame when they fail to take care of their patients. This data shows the importance of the nursing residency, mentorship, and fellowship programs. Nursing residency programs include nurse leaders as mentors, essentials of critical care orientation (ECCO), both adult and pediatric versions, seminars, associate fellows, and master fellows. Based on the American Association of Critical care curriculum or the Association of Pediatric Hematology Oncology Nurses (APHON) curriculum or the Bone Marrow Core Transplant (BMT) curriculum, these programs offer NGRNs support and integrate NGRNs in their specialties in CMCC. Nurses’ turnover rate fell from 35% to 6% in a year. The Advisory Board Company [1] also found that reduction-nursing turnover can have a cost saving to the hospitals of 1.5 to 2 times a nurse’s salary.

Before the fellowship, the expense on agency or traveler nurses were $1,259,113, but after the fellowship the cost was reduced to $593,534 [1]. Friedman, et al. [1] posit that fellowship has a positive impact on net cost savings of $597,778. Financials are always difficult to be adjusted due to the need of staff, cost of supplies, taxes, expenses, regulations and policy. NSI Nursing Solution [5] shows that nursing turnover is a big issue nation-wide. The turnover rate is 17.1% and it costs hospitals from $5.2 to $8.1 million. The cost to replace a bedside RN ranges from $10,098 to $88,000 [6]. Since nurses play a major role in health care, reducing the turnover rate is necessary to reduce the costs. Not every institution resorts to a transitional training program to address nurse retention. The Professional Development Assessment tool was created to guide currently employed nurses into staying within the organization by focusing and pinpointing career paths within the hospital instead of leaving the institution [7]. Professional goals can be assessed once or twice on an annual basis to track the nurses career progress with the additional support of an experienced nurse as a guide or mentor.

In conclusion, nursing turnover rates and the predicted nursing shortage are serious issues in the US health care system. This is especially true for the aging baby boomers people who are living longer after reaching retirement age. The health care system needs to retain its trained nursing staff with the cost effective methods and decrease turnover rates among new nurses with improved mentorships and focused training methods. The competency of NGRNs needs to be assessed and evaluated. Professional attitudes, sensitive behaviors, technical skills and decision-making abilities need to be developed during the training process. Concentrated efforts to integrate them into the real hospital environment must be effective and efficient so that they will want to remain in their positions.

To read more about this article:https://irispublishers.com/ijnc/fulltext/increasing-nursing-retention-to-reduce-financial-costs.ID.000570.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

SARS, COVID-19 and Changing in Nursing Practice

Authored by  Wen Hsing Yang*

Introduction

SARS was a serious outbreak worldwide, resulting in studies in infection protocol and delivery of nursing care. This study compared conventional nursing practice with a modular design of nursing delivery by measuring the nature and frequency of nursing activities, efficiency, infection control practice, namely hand hygiene, as well as satisfaction levels among nurses and patients [1]. A descriptive and quasi-experimental study with modular nursing as the intervention, it consisted of a pre-intervention (T0) and two post-intervention phases (T1 and T2) in one medical and two surgical wards [1]. Several focus group meetings were conducted with senior nursing staffs from the three wards to enable the research team to acquaint staff with the model design and to solicit their input regarding proposed structure changes [1]. A series of educational sessions was provided to the staff. The data collection tools used to evaluate the modular nursing practice included: a work sampling, observation, checklist, focus interview with nurses, questionnaires to gauge nurses’ perceived competency and caring attributes, patient satisfaction questionnaires and a hand hygiene audit. The data was collected and analyzed from observations and responses to the questionnaires. No significant changes in direct care were reported but there was an increase in patient/family education due to continuity of care [1]. Also, results showed a general increase in nurses’ hand washing and personal break activities. However, due to time constraints on the nurses, a lapse on handwashing also was noted [1]. Increasing time in caring for patients showed a positive result in preventing urinary tract infection and reducing infection control. Handwashing was especially important in infection control. A stable nurse-patient ratio needs to be addressed to facilitate infection control.

Nursing Practice

COVID-19, a worldwide epidemic worse than SARS, is having a profound effect on nursing practice everywhere. First, the virus is new, the data on the virus was slowly realized and politically controlled by the original country, and the phenomenal rate of transmission was unexpected and deadly. The entire worldwide medical community was not prepared for this epidemic, even though some countries did have epidemic watchdog task forces. As the infection progressed and mortality increased, personal protective equipment (PPE) has shown to be the most necessary piece of equipment to protect medical staff from becoming infected by their patients [2]. Because of the rapid transmission through droplets and the rate of travel from country to country, the infection has hit the world unlike any virus in recent history. The United States was neither informed nor prepared, and the lack of PPE threatened the medical community as well as the public at large [3]. As New York became the epicenter of this virus, nurses were overworked, lacked proper protection, and became infected, despondent and depressed. The political decision makers have not paid enough attention to the medical experts; and the needs of the states to provide proper PPE supplies, testing and ventilator equipment have not been satisfied [3]. Nurses were being asked to reuse PPE after proper disinfection, but this is not sufficient to protect their own health. Nursing and doctor shortages are causing medical and nursing students to be drafted into practice before they complete their standard training. This dangerous precedent was necessary for the current situation but could lead to medical mistakes. However, nurses became extremely vocal and demanding about their own health and safety, and these voices will cause changes in the future in nursing practice. Because of the numbers of new infections, empty convention centers and emergency ships were turned into hospitals, but there was still a shortage of medical staff to work there [4]. Retired nurses and doctors were being asked to return to duty during this crisis.

The N95 respirator is the standard protection for procedures which involve small particles, and surgical masks are used to prevent splash and large droplet, an alternative form of protection when there is an N95 shortage [2,5]. Re-using N95 masks was recommended during the 2009 pandemic and is the subject of National Institute for Occupational Safety and Health current guidelines; these include swearing a simple mask over N95 to prevent contamination and using clean linens in place of simple masks for symptoms patients [6]. Crisis Standard of Care (CSC) includes fairness, duty of care, duty of steward resources, transparency, consistency, proportionality, and accountability [6]. CSC must be applied across all levels of healthcare system (virtual, outpatient and inpatient) and have processes in place to manage resources. Federal, state and local health departments must coordinate resources and share current data to avoid confusion and protect the medical community dealing with this virus. The top priority is to protect nurses and doctors from this virus. Without them, there is no proper plan and the medical community, as well as the population at large, is at risk. Communication among political leaders to protect the medical community is of utmost importance. Without the lifesaving PPE, our medical staffs are at risk. Without an informed, well trained medical staff, there is no future for any of us.

Nursing Education

I am currently working as a nursing educator. Due to the COVID-19 pandemic, I have been forced to teach my students through the internet. While not the best method, the administration cannot risk infecting my students by having them in hospital situations. Simulation is an alternative method to replace clinical hours for student nurses; it can be controlled by technology to present the symptom of patients’ condition, and to improve both their clinical judgment skills and their practical skills based on different kinds of simulation. This is totally doable to help students with their clinical skills so they can practice in the laboratory or virtual simulation. Simulation is used to ensure patient safety, to support innovative teaching strategies and to overcome faculty and preceptor shortage and the lack of clinical sites [7]. In general, simulation must match education goals for students to achieve the level of expertise required of a trained nurse. This is another way to train future nurses to function during an epidemic, even if it is not the best method for training.

Do you think we will learn anything from how nurses were affected by SARS in the early 2000s during this pandemic, or are we doomed to repeat the same mistakes?

In the 2003 SARS outbreak, 774 people died in the United States and SARS did not spread widely in the community [2]. SARS was spread by droplets and by close contact person to person, but it did not spread widely. The COVID-19 virus is also spread by droplets but has spread quickly and efficiently before the medical community realized its dangers. Now that our knowledge of this virus is more advanced, social distancing is being reinforced to prevent transmission. Social distancing is believed to flatten the transmission curve and slow the spread of COVID-19. However, lack of PPE is the new danger to healthcare workers. The important component of WHO intervention was to ensure all healthcare workers wear appropriate PPE [8]. In Hong Kong, nursing schools revised their curriculum, provided continuing education for all the healthcare workers regarding infection control measures, and revised public health policy to ensure the community is protected [9]. Infection control, isolation, and quarantine were implemented. Also, early detection, contamination and preventing spread of the disease were helpful to isolate the cases.

However, some infected people without symptoms can spread the diseases. This is much worse than SARS. We learned some lessons from SARS outbreak. But COVID-19 arrived when the President of United States was more interested in maintaining a robust economy than in providing life-saving healthcare. The result was that the United States had the highest death rate of COVID-19 in the world. The worst fear is that there may be an even more virulent, deadly virus waiting to emerge. Without proper protocols, changes in policy, stockpiling of necessary PPE and ventilators, and a complete reliance on the facts of the scientific community, the United States may not survive the next pandemic. Previous federal administrations had created a medical task force program for a possible pandemic, but the last administration let those task forces lapse, spread disinformation about the pandemic and created the current crisis by ignoring science. We need to have an annual budget commitment that can survive changes in federal administration with leadership experience to provide funding, staffs and awareness of possible future pandemics [10,11].

In conclusion

Since these deadly diseases can be spread quickly and easily around the world, a unified world-wide plan should be discussed and implemented among the most important international institutions that connect all countries, like the United Nations and the World Health Organization. At the top level, government officials must be honest about any future outbreak, work efficiently to stop its transmission, and provide maximum protection of the medical community that is needed to save the world. The medical community must determine all forms of prevention, management, protection and treatment, and it should not be disparaged by politics or disinformation. If the nursing community is not adequately trained, properly protected and physically and psychologically fit, there will be no one left to heal the sick.

To read more about this article: https://irispublishers.com/ijnc/fulltext/sars-covid-and-changing-in-nursing-practice.ID.000569.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Simulated Experiential Learning Activity to Empower Paid and Unpaid Caregivers in Dementia Care

Authored by  Brenda J Gamble*

Abstract

The number of people with dementia is rising worldwide. People with dementia are challenged by the symptoms of their illness, as well by discriminatory attitudes and actions. However, this stigmatization is not only experienced by people with dementia; it is also experienced by the paid and unpaid caregivers who provide care for people with dementia. Education is a key strategy to reduce stigma and improve the quality of life of individuals with dementia. It also has the potential to provide caregivers with meaningful forms of support. A systematic review of the literature demonstrated that the most effective educational intervention to change attitudes and reduce stigma are resources that incorporate an in person contact approach. Dementia Live™ is a simulation tool that places learners “in the shoes” of people with dementia and is used to raise awareness of what it might be like to live with dementia. The targeted population includes students, health care and social care workers, staff from hospitals, longterm care residences, retirement homes, and home care services, as well as friends, volunteers and family caregivers. This educational intervention can serve as a model to develop additional simulation tools to reduce all types of stigma to support a safe learning and work environment.

Keywords: Dementia; Stigma; Experiential learn; simulation

Abbreviations:

ELA: Experiential Learning Activity

PWD: People with Dementia

Paid caregivers: Health and Social Care Workers

Unpaid caregivers: Family, Friends and Volunteers

Introduction

A significant demographic shift is occurring world-wide, resulting in the proportion of people over 60 years of age nearly doubling by 2050 from 12 to 22% [1]. The aging population is not homogenous. Many older adults will enjoy a full and active life in old age, while others will experience declines in physical and mental health. Dementia is one of the major causes of disability and dependency among older adults [2]. Worldwide it is estimated that the number of people with dementia (PWD) will be 82 million in 2030, and 152 million in 2050 [2]. It is also estimated that double the number of people (i.e. 164 and 304 million) will be indirectly affected by dementia [2]. This number includes both health/ social care workers (i.e. paid caregivers) and family, friends and volunteers (i.e., unpaid caregivers).

PWD are challenged by both the symptoms of their illness and discriminatory attitudes and actions of family members, friends, caregivers, and society [3]. Stigmatization associated with dementia is also experienced by paid and unpaid caregivers supporting PWD [4]. The stigma associated with dementia prevents people from seeking help [5]. This is true for both PWD and their paid and unpaid caregivers. Reducing the discriminatory attitudes towards Citation: Brenda J Gamble. Simulated Experiential Learning Activity to Empower Paid and Unpaid Caregivers in Dementia Care. Iris J of Nur & Car. 3(4): 2020. IJNC.MS.ID.0005678 DOI: 10.33552/IJNC.2021.03.000568. Page 2 of 3 PWD can potentially contribute to establishing an environment that inspires healthy aging and supports an optimal quality of life for those living with dementia. Additionally, addressing discrimination about dementia will enable paid and unpaid caregivers to provide meaningful support to those in their care.

Discussion

Education is one of the key strategies to reduce stigma [6]. Livingston, Milne, Fang, and Amari [7] conducted a systematic review of the literature that revealed the most effective approach to reducing stigma are educational strategies that incorporate in-person contact and experience. Ontario Tech University, a certified age friendly university, is committed to teaching, learning and leading-edge research that will help find new and innovative approaches to dementia care.

Experiential learning activity

A simulated experiential learning activity (ELA) [8] was developed and implemented to address the stigma associated with dementia. The targeted population includes students, health care and social care workers, staff from hospitals, long-term care residences, retirement homes, and home care services, as well as friends, volunteers and family caregivers. The experiential learning approach adopted, incorporates classroom-based simulation to simulate in person contact and experience.

The tool, Dementia Live TM [9], provides individuals with the opportunity to engage in a simulation that exposes learners to the impact of dementia symptoms (e.g., cognitive impairment and sensory changes) on activities of daily living. During this simulation, participants gain a first-hand understanding of the anxiety, isolation, frustration, and confusion that people with dementia live with every day. While the simulation is part of the learning activity, additional elements are needed to enhance learning and encourage reflection on the experience.

The Charles, Bainbridge and Gilbert [10] educational model of exposure, immersion and mastery was adapted to inform the parameters of the simulated ELA. During the exposure phase, learners are provided with information and the facts related to dementia (e.g., definition, numbers of PWD, symptoms, impact of dementia on individuals, health and social care systems and society, etc.). The simulation tool [9] is used in the immersion phase. The overall goal of the simulation is for people to experience what it is like to complete an easy everyday task with altered vision, hearing, and tactile ability, all characteristics of people living with dementia. Debriefing is used in the mastery phase to promote learner reflection and feedback to enhance the learning experience [11].

The simulated ELA has been adapted for continuing education, graduate and undergraduate training using a variety of delivery modes including in person, hybrid and online teaching. As well, partnerships have been established with a variety of communitybased organizations to make the simulated ELA accessible to informal caregivers.

Conclusion

Dementia Live TM places learners “in the shoes” of PWD to raise awareness of what it might be like to live with dementia. Reducing the discriminatory attitudes towards PWD can contribute to establishing an environment that inspires healthy aging and supports an optimal quality of life for those living with dementia. Activities are currently underway to implement both formative and summative evaluations of the simulated ELA for learners. As well, an evaluation of the experiential learning activity, including the simulation, is being conducted. Why? Stigmatizing attitudes can vary ethically and culturally. For example, gender is an important consideration when examining the impact of stigmatization associated with dementia. It is primarily women who care for and support PWD—be it through paid work [12] or unpaid work [13].

Subsequently, the next steps will be directed at incorporating elements into the design of the experiential learning activity that addresses diversity and equity. Additional work will be undertaken to further evaluate the learning experience in different settings and populations. This will enable us to modify and adapt the simulated ELA as we move forward with the implementation of the experiential learning activity within different contexts and groups. This experiential learning activity has the potential to serve as a model to support a safe learning and work environment and thus, it is an important educational tool.

To read more about this article: https://irispublishers.com/ijnc/fulltext/simulated-experiential-learning-activity-to-empower-paid-and-unpaid-caregivers-in-dementia-care.ID.000568.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Correlates of COVID-19 Transmission: Challenges and Opportunities to Access Our Most Vulnerable Populations

Authored by  Donna M Dopwell*

Abstract

The novel coronavirus, also known as COVID-19, was recognized as a pandemic disease in March of 2020 [1]. In the months that followed, the number of cases reported has increased from 53,269 on March 9 to 63,965,092 as of December 3, 2020 [2]. The Americas carry the bulk (42.4%) of that number, and the United States of America is leading the world’s countries in COVID-19 cases at 13,563,731, or 21.2% of the world’s cases [2]. In the current study, the correlates of pandemic transmission were explored through the use of univariate frequency analyses, bivariate t-tests, and correlation analyses. Results indicated that states with higher frequencies of non-White residents, poverty, and underinsured and disabled residents. The Salutogenic Model was utilized to frame the discussion regarding challenges and opportunities for addressing the correlates in an equitable fashion [3].

Keywords: COVID-19; Coronavirus; Salutogenic model; Pandemic; Transmission

Abbreviations: WHO: World Health Organization, CDC: Centers for Disease Control and Prevention

Introduction

The coronavirus, also known as COVID-19, was recognized as a pandemic disease in March of 2020 with the number of worldwide cases reported at 53,269 on March 9 [1]. As of December 3, 2020, the World Health Organization (WHO) reported that the number of cases of COVID-19 had increased to 63,965,052 [2]. The Americas carry the bulk (42.4%) of that number, and the United States of America is leading the world’s countries in COVID-19 cases at 13,563,731, or 21.2% [2]. This is the case, even as the United States holds only 4.3% of the world’s population (approximately 330,667,000 and 7,704,107,400, respectively [3]. The United States also leads the world in deaths, with 268,482 of the 1,488,120 worldwide [3]. It is imperative that members of the helping professions assist in curbing the rise in cases and deaths, as the colder weather may cause our current spike in cases to increase even further [4].

One challenge healthcare professionals may face surrounds the gap between the need for resources to help in decreasing the number of infections and the access to such resources among the more vulnerable members of the population. Whenever pandemics have occurred in the past, the people who have fared worst had less money, and therefore fewer resources, to help them prevent sickness or access proper treatment in the event of infection. Guidelines on preparedness for pandemics include purchasing extra non-perishable foods, water, first aid kits, and other items to keep ready for the type of occasion we are currently experiencing [5]. Calls for keeping a six-foot distance from others and for wearing masks when outside of households are also being made by the Centers for Disease Control and Prevention [6] and the WHO [2] among others.

Not all who need to protect themselves from transmission or complications of COVID-19 will have the resources to do so. It is imperative that members of the population who are disadvantaged receive aid in addressing the distance between their needs and their related resources. The current study explores the variables correlated to COVID-19 transmission in the United States and considers challenges and opportunities to connect those populations most likely to contract the disease with the tools to help them to prevent such transmission. The discussion of next steps will incorporate the Salutogenic Model as a guide for practice.

Materials and Methods

All data used for this study were secondary data collected from the CDC [6] and Census [7] websites. The information used for this study was open-access, population-level, and de-identified. Data were taken from all states which had reported at least forty thousand cases of COVID-19 by December 3, 2020. That number was chosen because of the way that the CDC had been reporting cases at the time that the researcher began collecting data: forty thousand or more the highest level indicated at the time [6]. The data were stored in Microsoft Excel, and the Excel Analysis Tool pak was used for all statistical analyses.

The number of states reporting cases at or above forty thousand by June 30, 2020 was compared to the number reported between July 1, 2020 and December 3, 2020 (1=By 6/30/20; 2= After 7/1/2020). The frequency of states reporting at least one overrepresented non- White ethnoracial classification among the three largest groups (Hispanic/Latinx only; Black/African American only; Asian only) was determined. State poverty, uninsured, and disability rates in excess of the national levels were recorded and compared against time of reporting, through the use of independent samples t=tests. This study compared state and county COVID-19 transmission numbers [6] to multiple factors, such as the representation of non- White residents in a given county relative to that of the United States Census [7] the rates of poverty, health insurance acquisition under age 65, and disability under age 65.

A frequency histogram was developed in order to determine the trends in non-White overrepresentation in counties with the highest COVID-19 cases. Where states had no county level overrepresentation relative to the national numbers, a further histogram analysis was performed to compare to state levels. Histograms were developed for the counties which between zero and three of the variables poverty, disability, or lack of insurance higher than that of the nation. Bivariate analyses were conducted through the use of t-tests, and a correlation analysis was performed among variables, including time of reporting; percentages of Hispanic/Latinx, White, Asian, and Black/African American residents; and poverty, disability, and uninsured rates.

Results and Discussion

Approximately 44.2% (19) of the 43 states included in this study had reported at least 40,000 COVID cases to the CDC by June 30, while the remainder reported that number on or after July 1. Over half (24; 55.8%) of the states had at least one non-White group overrepresented relative to the national percentages. The mode was 1, meaning that the majority of states indicating any relative overrepresentation had only one such group. States with overrepresented Black/African American numbers made up 34.9% (15) of the total states, while overrepresentation of Hispanic/Latinx population members was 23.3% (10) and of Asian was 18.6% (8). The frequency histogram results indicated that the majority (74.8%) of counties in which the rates of COVID infection were highest had over-representation of at least one non-White group relative to the national numbers. Seventy-eight (51.7%) out of the 151 counties studied had one over-represented non-White group, followed by 38 (25.2%) counties which had zero over-represented non-White groups. Counties with two and three over-represented non-White groups numbered 26 (17%) and 9 (5.9%), respectively.

Six of the 43 states studied did not have overrepresented non- White groups relative to the national levels of 60.1% [6]. These states were all found to have White populations which were well over the national percentages, These states were: Iowa, with a state-level White population at 85.0%; Nebraska, with 78.2% White population; North Dakota, at 83.7%; South Dakota at 81.5%; Montana at 85.9%; and West Virginia, with a White population of 92.0%. When the rate of non-White overrepresentation per county was analyzed relative to the non-White state percentages, the pattern which had been viewed with the other states reappeared. Of the 15 counties reviewed here, only two (13.3%) had zero overrepresented non-White categories. One-third of the counties had three overrepresented non-White groups relative to state numbers, while counties with one and two non-White categories in excess of the state numbers each numbered four (26.7%). At 86.7%, the counties in these states with at least one overrepresented non- White category was higher than the percentage of 74.8% of the counties relative to the national numbers. In addition, when the two are combined into a listing of overrepresentation of county versus state OR nation, the number of counties with zero overrepresented groups becomes 25 out of 151 (16.6%), and the number of counties which show at least one overrepresented group amount to 126 (83.4%). The majority (82; 54.3%) of the counties have one non- White group, followed by two (30; 19.9%) and three (14; 9.3%).

Histograms of each of the non-White categories when both state and county numbers are considered indicate that approximately one-third of the counties have an excess of Hispanic/Latinx residents relative to national rates, 29.1% have a recorded Asian excess relative to state or nation, and 64.9% of the 150 counties have Black/African American numbers overrepresented relative to state or nation. This information indicates that one of the elements of vulnerability to transmission of COVID-19 is the presence of more non-White population members in excess of either state or nation counts, and that in particular, areas with higher counts of Black/African American individuals are quite vulnerable.

The frequency of counties having at least one of the poverty or health risk indicators showed that the number in excess of national levels which was most often identified was 2 (60; 40.0%). The next highest frequency was 3 indicators over national levels (40; 26.7%). The number of counties having one indicator was 23 (15.3%), and 27 (18.0%) counties had zero. When the numbers were broken down based on the specific indicators, the researcher found that 109 (72.7%) of the counties had higher poverty levels than that found in the nation, and over half (85; 56.7%) of the counties had higher rates of uninsured population members than overall U.S. rates, while slightly under half (70; 46.7%) of the counties had higher rates of disabled individuals under the age of 65.

The researcher performed t-tests to determine the relationships between time of reporting and percentage of non-White members of the state populations. There were significant relationships found for time of reporting (By June 30 or On or After July 1) relative to all three non-White groups (p=0.00), where the states reporting by June 30 were more likely to include over-representation of any of the non-White groups versus states reporting on or after July 1. A significant finding was recorded with a t-test comparing the time of reporting to disability percentage (p=0.05), where earlier reporting (M=0.09, SD=0.00) was related to higher disability percentages (M=0.12, SD=0.01). No significant results were yielded when time of reporting was analyzed relative to poverty or lack of insurance percentages, indicating that these were not important factors in timing of COVID-19 transmission.

A correlation analysis was performed for the variables of Time of Reporting, Percent Hispanic/Latinx, Percent White, Percent Asian, Percent Black/African American, Poverty Percent, Percent Disabled Under 65 Years, and Percent Without Health Insurance Under 65 Years. There was a high positive correlation between poverty percent and disability (0.77), and a moderate negative association between Asian percent in the population and percent disabled under 65 (-0.55). The weak to moderate correlations between the presence of non-White populations and time of reporting indicated that areas with higher percentages of non-White residents were more likely to have early reports of numbers over 40,000.

The Salutogenic Model of health promotion, developed by Aaron Antonovsky [8], asserts that health professionals should consider their patients as falling along a continuum of ease to disease, rather than a binary sick or not sick structure, and that the goal of health interventions would be to help the patients to move toward greater ease and lesser disease. In viewing the results of the study through the lens of the Salutogenic Model, we might first consider that the indicators of greater ease include higher percentages of White members of the population and insured persons, and lower rates of poverty and disability. In this case, promoting greater ease and lesser disease would focus on ensuring that populations identified as disabled or in poverty have equitable access to knowledge and resources to help them avoid contracting COVID-19, and that insurance or alternative payment methods such as sliding scale options be made available in order to allow those who do contract COVID-19 to receive the best care possible, as early as possible. The presence of at least one non-White group in most areas suggests racism may be at play. While health professionals may not be able to address these issues on a larger scale, it is imperative to remain aware of this possibility and how it might affect access to healthcare options and likelihood of early detection and treatment of COVID-19 symptoms.

Limitations of the study include that the use of secondary data may mean that there are inaccuracies in reporting which the researcher is not able to address, and that the lack of standardization among states may affect whether and how data have been reported. In addition, data collection methods incorporated data from two sites, which were not developed to be comparable, and the researcher needed to choose from available data and work to ensure that comparisons between and among variables used could be properly identified. Another limitation is that the CDC information stops at the county level, meaning that while the researcher could make some educated guesses relative to the possibilities at the city or town level, they cannot be fully realized with the data as they currently are available.

Conclusion

The COVID-19 pandemic has caused a shift in the lives of many across the globe. The United States, in particular, has a very high percentage of cases having been reported since the start of the pandemic. Due to its relatively high rate of cases, and the recent uptick in numbers, it is necessary for researchers and health professionals to understand which factors might increase the likelihood of need among members of the population, and to target prevention and health promotion strategies to those whose needs do not match the availability of resources.

The current study highlights that people who are already at relative disadvantage in the United States have the added stressor of greater likelihood of contracting COVID-19, meaning that those who are diagnosed are more likely to need support in addressing it. Similarly, those same populations would likely require assistance in preventing transmission, including information and resources such as masks and hand sanitizers. Equitable solutions would need to incorporate knowledge of the challenges faced by residents of different areas, and seek to allay those challenges by empowering these residents with the knowledge and resources which can assist them, without requiring people who are already disadvantaged to choose between health-promoting behaviors connected to COVID-19 and health-promoting behaviors connected to their lives regardless of COVID. Salutogenic Model allows health professionals the space to recognize the challenges, while simultaneously acknowledging the opportunities to bring about improved health. The model allows practitioners to incorporate empathy and understanding to the overarching circumstances, while starting the helping process by meeting the individual patient where they are.

Future research should seek to understand the phenomenon from a more localized perspective, such as cities or towns within different counties, or by studying the differences between rural and urban locations. In addition, further studies could compare the United States to other countries to determine any more widespread concerns. Variables such as percent of uninsured residents could be investigated relative to level of comprehensiveness of the states’ insurance plans. Finally, analysis of this pandemic relative to prior pandemic diseases, especially the influenza of 1918 [9] could shed some light on patterns across time.

To read more about this article: https://irispublishers.com/ijnc/fulltext/correlates-of-covid-transmission-challenges-and-opportunities.ID.000567.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Dimensions of the Inter-sectoral collaboration in Maternal Health Promotion Activities: Experts Viewpoint

Authored by  Soad Mahfoozpour*

Abstract

Background: A significant portion of maternal mortality has social causes. Inter-Sectoral Collaboration (ISC) is among important strategies for decrease the Maternal Mortality Rate (MMR). The present study aimed to explain participants’ viewpoint on the dimensions of the Inter-Sectoral Collaboration in Maternal Health Promotion Activities (MHPA) in Developing Countries.

Methods: In this qualitative phenomenological study, data were collected using semi-structured interviews with experts from 2019 to 2020. The participants were selected using the purposive sampling method; interviews were continued until reaching data saturation. Data were analyzed using the content analysis method with the MAXQDA software.

Results: From the participants’ view, ISC in the maternal health services has the 3 main themes and 9 sub-themes. The main themes were “Transparency”, “Participation” and “Coordination”.

Conclusion: The collaboration of activities within and outside of the health domain is a fundamental approach to promoting maternal health, so formulating effective community policies based on the dimensions of collaboration should be considered.

Keywords: Inter-sectoral collaboration; Mothers Health; Content Analysis

Background

Maternal mortality is an important indicator for health status in all countries. Despite the World Health Organization’s (WHO’s) goal of reducing maternal mortality, many countries have not attained it [1,2]. Many preventable deaths of pregnant mothers occur due to determinants out of health sector [3]. The factors affecting maternal health are complex; coordination and interactive plans between the health sector and other sectors of society are essential to improve the pregnant mothers’ health [2]. Some developed countries have been focused on ISC planning within and outside the health sector to reduce maternal mortality and improve their health, for example in the Republic of Korea, 25 laws have been adopted to coordinate implementation at different ministries to improve child nutrition and reduce obesity [4]. The structures of the ISC process vary from country to country and affected from the structure of the organizations and legislation of the country [5]. Commitment between sectors for collaboration can be achieved through the establishment of an understanding within the framework of policies, treaties, and legal support. Community policymakers can facilitate cross-sectoral communication through coordinated programs. For example, a coordinated program to reduce violence in society is a joint task of the police and the judiciary [2,4]. In other words, coordinated action by the education system, the police and the judiciary, as well as other relevant parts can identify the causes of violence and eliminate the roots of violence [6]. There is no coherence policy in Iran for ISC in maternal health services. Despite the planned efforts, maternal mortality rate is still far from the Millennium Development Goals [7,8]. A number of mothers lose their lives due to the lack of physical access to well-equipped health centers and in some cases, educational inequities between the rich and poor areas as well as the differences between regions in health literacy and self-care information [9]. In some parts of developing countries, differences in mothers’ access to social facilities Leads to maternal death; unfavorable roads and road accidents as well as lack of access to adequate food resources are other causes of maternal mortality [10]. Increasing knowledge and understanding of dimensions of inter-sectoral coordination and collaboration is necessary to create a higher sense of responsibility.

Objectives

The aim of this study was to extract the dimensions of the Inter-sectoral collaboration in maternal health promotion activities through interviews with experts in 2020.

Methods

This qualitative study was of content analysis type. After obtaining permission from the relevant institutions, explaining the study to the Interviewees and obtaining written consent, semi-structured, face-to-face interviews were conducted in the environment proposed by the participants. The interviews lasted 30-90 minutes. The study was performed among health departments at the universities of Tehran and Tehran Provincial Government.

Participants

Semi-structured interviews were conducted with 20 health staff of the medical sciences universities in Tehran, 10 faculty members from the relevant fields and 20 service providers both inside and outside the health sector which were selected by purpose-based method. The interviews based on having sufficient information about the study and research questions, proceeded until reaching data saturation. Experts in this study included graduate and postgraduate healthcare professionals and faculty members in midwifery, gynecology, epidemiology, sociology and social medicine with at least three years of experience.

Data collection

In this semi-structured study, the following questions were asked to achieve the participants’ viewpoint:

• Is cross-sectoral coordination in maternal health services necessary?

• In your opinion, in what areas can cross-sectoral coordination in maternal health services be?

• What do you think about the dimensions of cross-sectoral coordination in maternal health services?

After reaching data saturation, the interviews ended. Each interview lasted about 60 to 90 minutes.

Data analysis

• The interviews with experts were first recorded and then transcribed. In data analysis:

• First, the text of the interviews was carefully read.

• The text of the interviews’ interpretation was carefully written.

• The themes were identified by discussion between the members of the research team.

• To overcome any doubts and making the results conclusive, the text was revised.

• In the next step, the texts were compared, and the themes were identified.

• At this stage, the themes were discussed by the members of the research group.

• Finally, the themes were extracted. Code analysis was performed with MAXQDA-10.

Rigor

Goba and Lincoln methods were used to confirm the accuracy of the study [11]. Data transferability was determined through the review and approval of seven experts and the credibility of data from the interviews was confirmed by approval of the participants at the same time as the data collection and with the use of the viewpoints of six faculty members. Data confirmability was determined using the views of five faculty members who did not participate in the study; the study procedures were recorded and its coherence was identified. To confirm dependability, notes were taken while the data was collected and the collected data was merged.

Ethical considerations

The study was launched after permission from the Ethics Committee and obtaining a written certificate from the University. Considering the confidentiality of the information and the results of the research, the consent form was signed by the participants.

Results

Study interview content were analyzed and a total of 150 codes were obtained. In the next step, the codes were summarized in 9 sub themes and 3 main themes (Table 1).

Theme 1: Transparency

Transparency refers to the free flow of information. The theme of transparency includes the three subthemes of “Determining Specific Processes of Sectors”, “Transparency in infrastructure” and “The clarity in policy-making”.

Determining specific processes of sectors

This sub-theme refers to determining the specific duties and plans of the different sectors that work together. For appropriate ISC, the process relationship through which the health sector structure with other sectors should be identified; therefore clear inter-sectoral process planning in the ISC is very important [5]. Below are some of the participants’ experiences: “In Intersectoral Collaboration, each sector must know its tasks; clear processes can be purposeful and bring partnership to the expected result. It clarifies the interactions and relationships across levels of hierarchy and performance between sectors” (Participant No.12). “Careful planning and transparent processes improves performance and facilitate the achievement of a common organizational goal. Lack of transparency often misleads common processes “(Participant No.1). Other participants said: “In each collaborative effort, the designation of a goal-based program is the first step in health management” (No.5). “It’s not just in the health sector, in each joint activity; each sector must know its share in plan and what is expected from each side, what role does each person in this scenario?” (No.12).

Transparency in infrastructure

The resources (Human and Financial) for ISC should be determined precisely according to the objectives.

“The access to resources is necessary for determining the level of collaboration, collaboration at the level of the ministry, provincial or city level have unique resource structure, therefore transparency is necessary to achieve a common goal “(Participant 7). Another expert believed that: “Health financing is initially focused on paying for health care and health interventions, but then; how to use these funds to purchase health care and different interventions will be important to maximize treatment outcome”. A faculty member said: “In intersectional collaboration financial risk is shared across sectors, the payers aren’t responsible for the total cost of delivery of intervention / service, therefore interventions as well as the purchase of services are facilitated” (No.7).

The clarity in policy-making

The opinion of one of the hospital managers was as follows: “Promoting the health of pregnant mothers is possible through the partnership of civil society organizations and cooperation the private and public sector, achieving common goals depends on clear and defined policies. Health is an inter-sectoral subject and isn’t limited to the health sector. Transparency of common policies and strategies between the sectors is necessary to achieve common goals in public health” (No.3).

Theme 2: Participation

This theme consists of the subthemes of “Participation in plans “, “Other Sectors Involvement in Intervention “and” Comprehensive evaluation of Access to goals”.

Participation in plans

The dominant concept concerning participatory plans is sectors contribution to achieve object by providing funding for project implementation. One of faculty members believes that: “In order to achieve the goals of ISC in maternal health each participant consider collaborative share in policy making and process plan (No.17). Another believed that: “In ISC, each side has a duty defined according to the goals; for achieving these goals, the sectors must be aware of the necessity of the implementation of the processes”(No.8). “The relevant departments and authorities promise to move towards the goals, but In some cases, implementation and operation of obligations haven’t Predicted and appropriate plan; since there isn’t monitoring, we only see that due to poor road conditions, many mothers still do not have access to well-equipped centers and they lose their lives”( No.16).

Other sectors involvement in intervention

Maternal health is a multisectoral approach, so interventions to pregnant mothers’ health promotion can be effective when all sectors work together. A health policymaker believes that: “The intervention performances of the various sectors of education and economics, politics and health are interrelated and changes in thinking and acting in one sector are likely to affect other sectors” and others said: “Each sector has specific tasks and capabilities. The maternal health strategies don’t achieved by one sector alone, only the multiple health needs of pregnant mothers can be met if all the relevant interventions in a collaborative and coordinated manner” (Governor’s Expert, No.13).

Comprehensive evaluation of access to goals

In process management, Step-by-step and final evaluation is necessary to determine access to defined goals. One expert said: “All stakeholders should take a participatory process in promoting maternal health, the performance of sectors should be measured together according to the achievement of common goal” (No.10).

Coordination

Today, due to the complexity of communities and health needs, coordination between the health sector and other social sectors has a basic need to provision of care. This theme consists of the subthemes of: “Integrative Frameworks for Collaborative Planning”,” Accountability in Activities” and “Inter-sectoral Conflict management”.

Integrative frameworks for collaborative planning

For prevention from failure in access the collaborative health goals, a comprehensive planning framework is an important factor. One expert from hospital management committee believed that:”A comprehensive framework in all stages of planning, an implementation and evaluation program prevents any process owners from getting confused. A practical framework is needed to strengthen joint programs to promote maternal health and prevent avoidable deaths”(N.12).

Accountability in activities

Accountability in participatory maternal health activities is a governance approach that engages citizens’ health sector and civil society organizations in a collaborative process. A faculty member said: “The interventions to promote maternal health are multidimensional, user and service provider relationships, related sections of the community are sometimes disrupted due to lack of proper coordination. Accountability can lead to trust, cooperation, and interaction between the parties” (No.3).

Intersectoral conflict management

During the participatory process, when common goals are not properly defined or financial disputes arise, members may experience a variety of operational conflicts that require proper management to access the goals [12]. One of the participants said that: “Different goals, perspectives and interests may create different perceptions of the stakeholders and lead to conflict, in some cases; participants have been able to overcome these differences by using common strategies” (No.9).

Discussion

Pregnant Mothers Health is largely dependent on outside the health sector. Other sectors usually contribute to health through governance, policy-making, and action. To properly perform the process ISC in MHPP, identifying the dimension and responsibilities of the parties is essential. One of the main themes of ISC in MHPP was transparency, which resulted from three subthemes. The concept of “Determining Specific Processes of Sectors” is determining the plans of different sectors to achieve common crosssectoral goals [13]. During the design of coordinated inter-sectoral interventions for the prevention of heart disease, Schnackenberg concluded that transparency in health and other sector programs is essential to reducing mortality and achieving goals ; Also, having specific programs can prevent stakeholder confusion [11]. The Wilunda et al believe that transparency in the provision of health services to pregnant mothers is important because each sector with accurate and complete information can participate in the planning and implementation of agreed processes [9].”Transparency in infrastructure” was another subtheme that in most studies, two dimensions of structure and provision of resources (or Financial transparency) have been emphasized [4,6,10]. It is recognized that lack of transparency in the structure of joint processes between different sections of society and the health sector may be an obstacle to proper decision making [14]. Musavi et al in a study concluded that the lack of transparency in the structure of participatory activities is a major obstacle in setting operational goals [12]. The reason for emphasizing transparency in the structure is to facilitate the various stages of planning and policymaking, as well as the implementation of joint programs related to maternal health [15]. “The clarity in policy-making” was one of the main themes of effective ISC in the maternal health. In most cases, commitment means adherence to the principles and treaties that the parties define in order to achieve certain goals [15]. All cross-sectoral activities should be clearly planned and based on the needs of the sectors [11]. Gebre et al specified the clarity of policy-making in organizations in three dimensions: emotions, norms, and continuity. It seems that at intersectoral level, due to the extent of the processes, wider dimensions have been emphasized by participants for ISC [16]. The role of social “participation” with the health sector in the prevention of disease and mortality has been shown in many studies [15,16,17]. Various factors outside the health sector can affect pregnant mothers’ health. Collaboration between the health sector and other sectors of society is essential to promote maternal health and the existence of joint programs to achieve a common goal [14]. “Other Sectors Involvement in Intervention” were another sub-theme of participation in this study. In many cases, health promotion interventions in vulnerable groups require the cooperation of the health sector and other sectors of society [15]. Strengthening the potential of other sections of society to implement health in all policies is done through continuous efforts to strengthen inter-sectoral interventions [11]. Many of the factors inside and outside the organizations providing services to pregnant mothers affected from economic and social factors and lack of proper management of intervention could lead to noncompliance with bilateral obligations [17]. Another dimension of participation is “Comprehensive evaluation of Access to goals”; the evaluation process is a series of formal actions to assess the performance of the organization within a specified interval time and includes assessment all the behaviors and activities of individuals or organizations in relation to achieving a specific goal in a specific period [18]. Mothers’ health is one of the indicators of development in the country; thus, all sectors that directly or indirectly contribute to the promotion of maternal health are required to develop their own operational plans. Acting in isolation and, in some cases, the lack of a coherent assessment system can lead to irreparable harm to the health of mothers. In many cases, periodic and end-of-term evaluations can reduce costs significantly [19]. The results of the study Yuqi Ta correspond to the result of this study; they also concluded that achieving goals will not be possible unless all stakeholders define goals for themselves; both in stages and in a final form, and pursue the achievement of those goals [20]. “Coordination” is another key theme of ISC in the field of maternal health promotion. The stakeholders can develop and approve a clear framework that reflects a common view of the issue (s) that needs to be addressed [18]. “Integrative Frameworks for Collaborative Planning” is subtheme of coordination. The proposed framework can play a major role in increasing the efficiency and effectiveness of the ISC by adopting an integrated concept because the ISC functions are highly interrelated Lodenstein also described the development of a participatory framework for joint activities as a factor in studying the dimensions of cross-sectoral coordination in the control of chronic diseases. He summarized inter-sectoral collaboration framework in the control of chronic diseases to three subthemes: “clear shared management”, “relationship” and “resources” [21]. Accountability in Activities in maternal health management is inter and intra sectoral response to customer (pregnant mothers) needs [14]. The cultural values of the community and process owners in the field of maternal health and the values of all stakeholders (internal and external clients) should be respected. Considering the values of individuals at all levels involves the durability of fulfilling the obligations [7, 21].

Conclusion

The results of this study are consistent with the study Chol et al; they concluded in their study that accountability is one of the important dimensions of cross-sectoral coordination activities to promote adolescent’s health [22]. Various dimensions have been described in some studies for accountability; Kirkham et al. reported a significant positive correlation between different dimensions of accountability such as informational, functional, and ethical dimensions with the legal dimension of accountability [23]. The political accountability is fundamental in justice-based policies; according to the results of macro-level studies, the factors promoting the health of different population groups are affected by political accountability [24]. Stakeholders in the collaborative process, may endure some form of mental or operational conflict, it has been due to lack of proper communication or financial disagreements [25]. Stakeholders have been able to dominate these conflict by using their common collaborative goals [26]. Based on the results, transparency, participation, and coordination are among ISC dimensions; to achieve maximum potential, policy makers and managers in the field of maternal health at multi levels should provide the necessary conditions for realizing the above mentioned.

Author’s Contribution

Masoomeh shakeri, Soad Mhfoozpour, were responsible Study design and design and data collection and Mahmood Modir and negin choopanii the data analysis and final revisions to the paper content.

Ethical Approval

This article is part of the results of my dissertation entitled “Designing a Model for Promoting Mothers’ Health Using Multi-criteria Decision-making” which was approved with the IR.IAU.Z.REC.1399.075 Code of Ethics. In this study, all ethical considerations, including obtaining permission from the relevant organization and experts, also ensuring the confidentiality of results and presenting the results to the relevant organizations were considered.

To read more about this article:https://irispublishers.com/ijnc/fulltext/dimensions-of-the-inter-sectoral-collaboration-in-maternal-health-promotion.ID.000566.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Understanding of Patient Engagement and its Impact on Healthcare Systems

Authored by  Sima Marzban*

Abstract

COVID-19 pandemic draws stakeholders’ attention to strategies highlighting the patients’ potential role and responsibilities in improving healthcare outcomes. Before outbreak, there has been a constant effort to inform and educate patients to be compliant and adhered to the treatment pathways that are planned for medical conditions based on existing evidence, insurers’ policies, and providers’ preferences. But rapid healthcare market transition reveals the game-changing impact of patients’ priorities and personal decisions on how they behave and respond to the available services. Facts supports the crucial need for in-depth understanding of Patient Engagement that prefers patients valued, informed, heard, activated to contribute to all aspects of care, even to the changes in care policies, decisions and processes. Patients have the right to access health records, prescriptions, and sources of information to take responsibility and control over their individual care. At the same time, they have the capacity to change decisions and personalize the care process based on individual variables in order to improve the system design and circumstances. As a result, passive unilateral patient engagement efforts such as patient and family education should evolve to active two-ways hearing of the patient voices incorporating their needs and expectations in individual care planning as much as health systems redesign and development. This evolution will be built on two fundamental changes;

• how patient-centeredness and patient engagement is defined and directed by payers, providers, and supplier industries,

• how accreditation and healthcare quality institutions measure, assess and evaluate patient-oriented interactions and reports.

Patient engagement requires exploring clinical and non-clinical insights from patients’ eyes in addition to the other stakeholders’ perspective to reduce the gaps between therapeutic systems’ and patients’ actual needs and preferences.

Introduction

Patient engagement is a growing scheme around healthcare systems. It is also a strategy to adapt to a situation (like the pandemic) in which patients are less likely to visit clinical providers in order to receive treatment alternatives. The Medical Institute (IOM) considers access to appropriate medical information and clinical knowledge to be a source of control over individuals’ healthrelated decisions [1]. While available information and patient education seems to be only a part of the concept. Activating patients to the extent that they take responsibility and actions to prevent further disease progression and obtain better wellness status depends on approaches beyond patient education. Nonetheless engaging patients guarantees better quality and lower cost, return on investment, improved outcome measures, informed adherence to care plan, and medication [2].

As regards, patient-related issues such as shortcomings in social determinants of health including health literacy, income, nutrition, and housing, causes patient engagement barriers [3]. That is why inequity drivers would negatively influence patients and families’ capacity to take an active role in engagement. It looks critical to know to what extent existing patient advocacy/engagement programs or technological solutions have enabled and mobilized patients to play crucial role in improving individual treatment or population outcomes. Eventually, how current engagement strategies are aligned with patients’ expected outcomes.

Patients Role Evolution

Patient engagement is primarily understood by the smooth flow of information between providers and patients to ensure timely access to the needed resources. To this end, technology developers have designed numerous versions of platforms facilitating appointments, documentation, monitoring, and evaluation of clinical performance. Furthermore, artificial intelligence fulfills digital communication platforms through analytics of big clinical databases to predict future trends in the clinical environment. Achieved insights accommodate supplier industries, insurers, and clinical providers’ intensity to obtain insights on the business environment and plan for proactive changes in their professional performance.

On a higher level of deliberate, patient engagement requires cultural views and an organizational atmosphere that values the patients as health right owners, efficient sources of improvement, and investment partners. In that situation, patient empowerment is presumed beneficial not only for patients and families but also for policy developers and clinical providers. Transformative thoughts and beliefs are needed to support patients for being an honest advocate and organizational partner who puts his/her health in our hands for the best of actions to achieve scientific, professional, and business goals. Smart organizations are sensitive to customer insights in which the user experience, behaviors, and decisions mirror the gaps in care and communication. In a mature type of organization, patient engagement embeds in policy, practice, management, and evaluations, in addition to the cultural values and leadership initiatives. Keeping patients active and influential to the clinical teams subsequent a chain of activities that bring “patient insights to tangible impacts.”

Patient Insights and Healthcare Improvement

Traditionally, quality improvement efforts are designed by reviewing clinical facts and audits conducted and recorded by providers. Numerous studies indicate that patient-driven insights, which are provided from cognitive and behavioral data sources, guarantee informed decisions for improvement [4]. There is a remarkable difference between clinical insights and patient insights. Electronic medical records drive clinical insights to support clinical decisions and actions by providers. Most clinical insight systems are designed to capture, track, and save documents of clinical dimensions such as symptoms, signs, appointments, billing process, diagnostics, and results [5]. Payors and providers recognize the included data categories. Whereas, patients experience emotional changes, life quality challenges, behavioral needs, economic concerns, information gaps, decision requirements, employment issues, cultural conflicts, and family situations that influence the healing process somehow more influential than medications and clinical interventions. Patient insights exponentially add the value of medical data processing to draw a full picture of elements that influence the patient’s health outcomes.

To read more about this article: https://irispublishers.com/ijnc/fulltext/understanding-of-patient-engagement-and-its-impact-on-healthcare-systems.ID.000565.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

The Patient’s Voice in the Development of Complex Interventions

Authored by  Malene Beck*

Abstract

Listening to ill persons and letting their perspectives guide the design and assessment of clinical interventions permits a considerably important illumination of illness diversity, as well as given insight in these people’s needs, wishes and values. This paper represents reflections on the creation of knowledge concerning the importance of aesthetics in hospital settings. Applying a phenomenological-hermeneutic methodological approach to qualitative data of patients’ experiences is concerned with regards to investigating what being-in-the-world means in specific environmental settings during hospitalization. There are few published studies that describe the meaning of developing and evaluating complex interventions based on qualitative data. This paper illuminates how a phenomenological-hermeneutical approach can be of guidance when developing interventions in nursing practice. In this context, there is a discussion of the value of conducting a Ricoeur-inspired analysis and interpretation.

Keywords: Qualitative studies; Patients’ experiences; Complex interventions; Paul Ricoeur; Phenomenology-hermeneutics

Let Ill Persons’ Stories Breathe in Complex Interventions

Nursing care has always consisted of actions towards increasing patient well-being during sickness. However, in the twenty-first century, the complexity of clinical practice has increased due to the evaluation of technology, specialized knowledge on diagnoses and enhanced ways of handling the care and treatment of ill people [1]. In a multifaceted nursing care setting, a number of various research methods are required to understand and characterize today’s practice. Researchers around the world have been occupied with designing, developing and evaluating new interventions in clinical practice in order to improve treatment for the ill persons.

Traditionally, the golden standard for research in interventional nursing care has been an experimental study design with interventions that compare a treatment, service, actions or other components with a control group [2]. According to [2], the best practice is to develop interventions systematically, using the best available evidence and appropriate theories. This implies using a carefully phased approach, starting with a series of pilot studies targeted at each of the key uncertainties in the design, moving on to an exploratory stage and then a definitive evaluation. The results should be disseminated as widely, accurately and persuasively as possible, with further quantitative measurements to assist and monitor the process of implementation [2].

In the book ‘Complex interventions in Health. An overview of research’ methods the authors present novel reflections and suggest including patients’ perspectives when conducting complex interventions in clinical practice [1]. The authors also underline the importance of actions taken by nursing care professionals with the aim of improving the patients’ experiences during illness. When they use the term ‘intervention’, they subsume terms such as ‘activities’ and ‘actions’ that are often used to describe the work of nurses or other persons laboring in nursing and social care [1]. They outline just how pervasive the complexity is in almost all nursing care interventions. However, there is a lack of knowledge about how the recipients of a given intervention actually experience nursing care and what is important to them in relation to clinical interventions. Hence, publishing qualitative research findings and highlighting processes within complex interventions have not receive same attention as publishing results of traditional studies relying on a ‘golden’ stand approach [3].

The thought of involving perspectives of the ill people during illness in order to achieve new knowledge about how it is to be “a patient” has undergone an increased focus in healthcare as well as in healthcare research. As concluded by [4], who investigated what counts as evidence-based practice, an overall acknowledgement of patients’ experiences being a part of evidence-based practice has grown. However, when developing and evaluating clinical interventions dialogues between researchers and ill persons are often missing. Therefore, interventions based on dialogues with ill persons need to be enhanced in order to explore the ill persons’ needs and wishes during illness. Based on the argument of dialogue being an essential way to gain insight into ill persons’ perspectives of what is meaningful during sickness, the aim of this paper is to show how the voices of the ill, through dialogue, can provide important perspectives when conducting complex interventions in clinical practice.

Dialogue as a Way Towards Insight

The Greek philosopher Socrates (469-399 BC) introduced the idea of being in dialogue. Dialogue, which in Greek means ‘through words’, is about the intention that is present when people talk together. The importance of identifying what it means to be “a patient ”in certain settings or when receiving nursing care while complex interventions are being conducted is essential, because this sheds light on aspects that are significant to ill persons, but are blurred or even hidden from researchers and healthcare professionals [5].

The French philosopher Paul Ricoeur (1913-2005) [6-10] explained why it is important to use dialogue to gain knowledge about human beings. Ricoeur (1991) [9] thoroughly elucidated how dialogue can be considered as a phenomenon that, in particular, allows people to share their experiences of being-in-the-world with each other. Ricoeur (1991) [9] emphasized that our understanding of the world can be broadened through language. Through stories, impressions from life as it is lived can be expressed. Such stories can be interpreted and thus provide new knowledge about how life is experienced. [6] pointed out how language can create community, which is illuminated in following quotation: ‘Exteriorization and communicability are one and the same thing for they are nothing other than this elevation of a part of our life into the logos of discourse. There the solitude of life is for a moment, anyway, illuminated by the common light of discourse’ (p. 19). Using Ricoeur’s hermeneutic phenomenology, we are able to discover more about the world through language than what we have already experienced, perceived and understood. However, to expand and qualify our understanding of ill persons’ situations during sickness, it is important in a professional context that we open up new ways of interpreting the world. Based on this point of view, this article argues that entering into dialogue with ill people is imperative in the process of developing practices that seek to change clinical practice to common good.

[11] points out that a recognition of the fundamental questions about what it means to be human during sickness is needed. This is due to the fact that the former efforts of understanding ill persons’ life situations during hospitalization have received less attention than, e.g., measurements from blood tests, cardiographs, and stethoscopes [11]. Therefore, [11] argue for a hunt towards the existential questions that ill people might have during illness, since caring science cannot be reduced to what is measurable. Illness is first and foremost a significant experience that we live through, and therefore, according to [11], health professionals must be attentive to what interventions mean to the ill persons in order to align their actions towards encountering human (existential) needs during illness and hospitalization.

The Importance of Addressing Ill Persons’ Voices in Qualitative Research

Qualitative research is a generic term for studies that are conducted on the basis of descriptive data and is recognized as a science of words. If you want to understand the characteristic aspects of what it means to be human, you must be where people live their lives and be aware of the mental aspects of life [12]. However, an awareness of something cannot stand alone; awareness is always an ‘awareness of something to someone’s and herein lies a close link between phenomenology and hermeneutics. Data generation inspired by a phenomenological-hermeneutical approach helps researchers describe and unfold the experiences of humans (professionals, patients, etc.) [13].

Adopting a phenomenological-hermeneutic perspective does not provide us with a certain method but entails that we partake in the understanding that it is important how we as human beings live our lives and how this is experienced [12]. Therefore, investigating nursing practice from a phenomenological-hermeneutic perspective stresses that what is experienced by the ill is an important source of information. If we do not care about ill persons’ experiences – their life-world in other words– we do not care about them and are therefore practicing inhumane care as expressed by Andreasen (2006a) [12].

In nursing care, the concepts ‘phenomenological perspective’ and ‘patient perspectives’ are used in various contexts. However, as Andreasen (2006b) [14], as well as other well-known nursing philosophers e.g., Kari Martinsen (2018) have pointed out, it appears that the meaning of these words is not quite clear being just ‘humanistic garnish’ and buzz words. Phenomenological approaches mean investigating a given phenomenon to gain insight into its eidetic meaning. Thus, phenomenological research questions provide (new) knowledge of what is often ‘taken for granted’ (Heidegger 1920) in everyday life. Max van Manen (2018) [15] describes phenomenological research as studies of ‘what gives itself’ in lived experiences. Conducting studies about ill person’s perspectives and paying attention to how it is experienced to be in the world as a person with an illness in a hospital setting, it becomes possible to critically reflect on how clinical development can include important aspects from these individuals’ point of view. This substantiates an important point made by Ricoeur; that narration on lived life reveals the experienced meaning [16]. Taking this point into research of complex interventions therefore includes an obvious advantage.

Dialogue is Connected to Conducting Qualitative Research

Complex clinical interventions underpinned by a qualitative approach are rare. Despite this, such an approach has the potential to illuminate aspects that are meaningful to ill people. Studies within nursing have demonstrated how complex interventions with qualitative methods is meaningful to hospitalized patients [17- 21]. Ill persons are longing for homeliness and aesthetic elements when hospitalized [18]. Hence, the importance of understanding ill persons’ life-world perspectives and translating this understanding into clinical practice needs to be subsequently unfolded. In qualitative research, dialogue with ill persons has provided new knowledge to enrich the already existing literature, because reflections on meanings inherent in stories told by ill persons receiving care are unfolded. Thus, it can be argued that giving a voice to patients during an intervention in clinical practice is important, because its heads light into lived experiences from the hospital environment [19,21]. Being in peace and quietness is not always possible for ill persons while being hospitalized [17,18]. Therefore, studies have focused on improving specific environmental settings in hospitals with focus on the aesthetics [19]. Performing a complex intervention inspired by the guidelines within the MRC framework [2,22], underpinning a qualitative approach is likely to emphasize how a clinical environment can be developed with respect to the patients that are admitted to hospitals during their course of illness [19-21]investigating the ill person’s perspectives on the hospital environment through a dialogue, as a part of an intervention, revealed that individuals were longing for homeliness, because they experienced being in a chaotic setting comparable to a railway station [15-18]. Combined with implementation proposal Prodger (2003) and suggested politics (Hospital Caterers Association (HCA) 2004) from the literature, an environment-changing intervention can be designed [19]. Accordingly, increased focus on aesthetic elements, that is anticipated to create a sense of homeliness, can become key aspects of clinical interventions [20,21].

The meaningfulness and quality of such patient-focused interventions can be appraised by interviewing the ill hospitalized persons about their experiences of the ‘new’ environment [19]. According to Moore et al. (2015) [23], process evaluation is an essential part of designing interventions; hence, it can be used to assess the fidelity and quality of the implementation. Qualitative approaches is well-suited to helping shed light on the pathways through which the intervention generated its impacts, i.e., why it was successful or not, how the intervention worked, and how it could be optimized [5].

The Necessity of Interpreting Patient’s Experiences

As stated by Crowther et al. (2017) [24] interpretation is a key aspect when crafting stories within the phenomenologicalhermeneutic tradition. Hence, understanding relies on a reflexive engagement within horizons of understanding and interpretation [25]. Ricoeur (1988) [10] argued that human existence embodies thoughts, experiences, feelings and actions that can be recounted by the use of language. He ascribed great significance to narratives, as they allow an interpretation of human existence. In this line of view, ill persons’ lives are told through narratives. Accordingly, ill persons’ narratives gathered by interviews and transcribed into text can be considered as a work of reflecting how it is to be in the world as an ill person in a particular situation.

Ricoeurs philosophy of narratives and interpretation can also guide the interpretation [26], (Blinded for review). In three phases –naïve reading, structural analysis and critical interpretation and discussion– a dialectical movement from an initial “naïve” understanding towards a “sophisticated” understanding is permitted [7,27]. The interpretation constitutes new knowledge that may be the source of reflections in the development of interventions, because interviews, the interpretation of them, provides insight of how an intervention to ill people are meaningful.

Reflections on Interventions Guided by Qualitative Approaches

Ill persons’ perspectives are important when designing, developing and evaluating interventions [20]. Philosopher Uffe Juul Jensen (2013) [28] argues that in dealing with ill people, it is important to adopt a “patient’s point of view” to put the expert judgements into perspective and contribute to a wider and deeper understanding. By acknowledging ill persons’ perspectives, we can enhance the possibilities of moving in a sustainable direction when developing clinical practice. Moreover, Jensen also argues that applying a “patient perspective” to diagnoses, care and treatment contributes to counteracting the individual’s suffering of being lost in a busy and noisy hospital ward with professionals focused on identifying and removing the disease (ibid.).

Therefore, the “patient perspective” is not a special way of handling or relating to the ill persons, but rather, a way of understanding their life situations [25]. From this angle, it is an art or practice that unfolds in a partnership between nursing care professionals and ill persons, aiming to ease suffering and thus promoting nursing (ibid.). In this sense, the ill persons can be seen as ‘experts’ in the role of being ill. Thus, what is meaningful to ill people must be interpreted in order to understand important aspects of “patient perspectives” on living with a disease. Since multiple aspects of nursing will persistently have blind spots, we can anticipate having a continuous need for knowledge about how the ‘experts in being ill’ respond to the given nursing services. Acknowledging ill persons’ experiences can help us create interventions that are more meaningful, not only for the individual but also for the professionals providing nursing care.

As stated by Richards and Hallberg (2015) [1], the priorities of academic researchers and clinical specialists are often different from the concerns of ill persons. What is important to these ill people determines the meaning of interventions; hence, the ill person’s point of view validates the relevance of the interventions in clinical practice. Developing knowledge for practice is an ongoing process, and the problem or question in focus needs to be studied from several perspectives before entering the stage where a complex intervention can be considered.

As pointed out in the beginning, Craig, et al. (2008) [2] underlined that best practice is to develop interventions systematically, using the best available evidence and appropriate theories. We argue that the ill person’s perspective holds a significance in itself. For example, essential aspects of hospital mealtimes has been described and documented by conducting an intervention guided by the ill persons’ voices [16-20]. If only the quantitative research questions had been prioritized, then the humane aspect of interventional studies had been lost, which would have been crucial in relation to the individual’s ability to create an appetite during hospitalization [18,20]. Focusing primarily on measuring food intake or counting calories during the intervention, the relationship between appetite and feeling safe and comfortable during mealtimes would never have shown its phenomenological face [29-31]. Therefore, it is crucial that research based on phenomenological-hermeneutic approaches be considered as a new and uplifting perspective in the ongoing discussion about whether to use quantitative or qualitative research methods. Thus, listening to the ill persons’ voices during the development of complex interventions illuminate existential issues or phenomena’s, as well as ill persons’ values, experiences and situation during sickness.

To read more about this article: https://irispublishers.com/ijnc/fulltext/the-patients-voice-in-the-development-of-complex-interventions.ID.000564.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

The Impact of Flipped Learning on Engagement with the Learning Process in Pre-Licensure BSN Students

Authored by  Carlo Guy Parker*

Abstract

The U.S. faces a nursing shortage and contributing to that shortage are high attrition rates for nursing students and RNs. One solution to decrease attrition is to increase student engagement with the learning process. One way to increase engagement is changing pedological methods. This study looks at the impact of a novel pedological method, flipped learning on student engagement. This study compares the flipped method to the tradition lecture method. Student engagement was measured with a valid and reliable tool, the SCEQ. The study design was quantitative, experimental and contained repeated measures. BSN students (N=131) were either instructed with the flipped method or traditional method. The SCEQ was reliable and showed that there was an increase in student engagement in the flipped group (p<.05) and no change in the tradition lecture group (p=.315). Nurse educators should consider implementation of flipped learning as part of an effort to decrease nursing student attrition.

Background

The United States faces a nursing shortage that is projected to worsen in the next decades as the baby boomers age and many nurses retire [1]. According to the American Association of Colleges of Nursing (2017) [2] there is a limited educational capacity to train new nurses driven by a lack of qualified faculty and clinical space. This resulted in 64,067 qualified nursing school applicants being rejected by nursing programs in 2016-2017. In addition, there is high attrition rate among nursing students prior to graduation, 20 to 50% [3] and high attrition by Registered Nurses, 10-26%, once in practice. These two factors, limited capacity and high attrition rates mean that it is imperative that nurse educators try to minimize student nurse attrition to maximize the number of new nurses produced and retained in nursing. The literature suggests that student engagement with the learning process may play a role in the problem of attrition and retention in nursing. Increasing engagement in students and RNs with the learning process offers the potential to address the issues mentioned here [4].

The construct being measured in this study was nursing student engagement in the learning process. Student engagement has been defined by Kuh (2009) [5] as the “quality of effort and involvement in productive learning activities” by students. Students who are engaged in their course work have been shown to achieve better grades, more personal satisfaction with their education, higher institutional retention and increased graduation rates [6,7]. In addition, critical thinking, considered a key ability required to be successful as a nursing student and as a practicing registered nurse, is linked positively in the literature to student engagement [8]. The lack of nursing student engagement is correlated with course failure and dropping out of college [9]. There is evidence that engagement in nursing students is lower than in other healthcare professions [10]. In addition, low nursing student engagement may indicate future problems with hospital retention related to clinical performance of registered nurses [4].

One way to increase student engagement, which is supported in the literature, is to change the pedogeological method utilized to deliver the content. To increase student engagement in the learning process changing the content deliver method to the flipped classroom has been one approach used [11-13]. The change was to depart from the standard lecture method utilized in most classrooms and utilized a flipped learning approach [14]. The Flipped classroom approach changes the way instruction is delivered to the students. Lectures are video recorded for the students to view prior to coming to class. The students work on the lower level concepts like understanding and meaning prior to class. In class the instructor actively engages in the material with the students, focusing on the higher-order activities like applying, analyzing, evaluating and creating in a team-based, active environment. This increases meaningful contact time between the student and instructor and contact between students. This active learning process created by the flipped classroom promotes critical thinking [15-17]. Students come to class and apply the material to real word situations to develop real solutions the problems they see daily as student nurses. The traditional method refers to lecture with supporting audio-visual presentations and tests.

Aim

This research was conducted to determine if using the flipped instructional method compared to traditional lecture influences nursing student engagement in learning. The research question was, will the flipped classroom method, when compared to the traditional lecture method influence the level of nursing student engagement in the learning process?

Methods

Approval for the study was obtained by the Institutional Research Board prior to any data collection. A quantitative experimental repeated measures design was utilized to determine the effect of class delivery method on nursing student engagement. Engagement was measured using the Student Course Engagement Questionnaire (SCEQ) [18]. The instrument is in the public domain and not copyrighted. SCEQ is a valid and reliable 23-item Likert tool. The tool asks subjects to rate their learning efforts and selfmotivation related to their class work on the continuum of: very characteristic of me, characteristic of me, moderately characteristic of me, not really characteristic of me, not at all characteristic of me. The SCEQ has been used to measure both undergraduate and graduate student’s levels of engagement across multiple disciplines, in US populations as well as many international studies and found to be valid and reliable. To determine the appropriate sample size a power analysis was performed utilizing G*3 Power [19,20]. The results indicated that a sample size of 60 for each group would be sufficient, a total of 120 subjects.

Purposive sampling was utilized to recruit subjects for this study. The sample was recruited from the undergraduate students (BSN) at a single university in the western USA. The study was conducted on 4 different cohorts of BSN nursing students. Students were recruited and provided detailed information about the study. Volunteers who consented completed a paper and pencil SCEQ. Nursing students (N=131) in their junior year taking a nursing research and evidence-based nursing class participated in this study. All subjects had the same faculty member as an instructor. Within the sample there were two groups. The first group (n=64) received instruction in the traditional method, lecture. During that time (1 year) a flipped class version of the course was developed, vetted and approved through the curriculum process. The 2nd group (n= 67) received instruction by the flipped classroom method. The questioner was completed at the beginning of the class and at the end of the class. None of the students reported having experienced a flipped class prior to this study. The sample demographics in the flipped group was 93.4% female, 91% Caucasian. The average age was 26 years old. The demographics for the traditional lecture method was similar, 92.3% Female, 91.4% Caucasian.

Results

A dependent groups t-test was used to analyze the data (SPSS version 20). Reliability of the SCEQ was checked with Cronbach’s alpha for group one, traditional lecture (α= .69) and Group two, the flipped classroom (α= .74). There was a significant (two-tailed) difference between student engagement levels (p<.05) after taking a flipped class. The mean SCEQ score after (M= 4.28, SD=.72) was higher than the score before the flipped class (M= 4.02, SD=.89); t (66) = -2.59. The group that took the traditional lecture class did not show a significant change in engagement levels (p=.315).

Conclusions

The results of this study are consistent with what the literature has demonstrated about student engagement with the learning process and Flipped learning as a pedological method of content delivery. Educators in both the academic and clinical setting should consider using the flipped classroom to increase student and RN engagement in the learning process. Further studies need to be conducted to determine if flipped leaning and increased engagement are correlated with higher level of knowledge and skill retention, as well a workforce retention of RNs, and retention of BSN students. There are limitations to this study. The study was conducted at a single site, only Nursing Research and EBP classes studies. In addition, the sample is not diverse. This study should be replicated with a larger, more diverse sample as well as be a multisite study. The flipped method should also be compared to fully on online methods of content delivery. The study should be conducted with a diverse group of practicing RN to see if the increase in engagement is present in that population because of flipped learning pedagogy. It is imperative that nurse educators employ evidence-based pedological strategies as part of a comprehensive effort to decrease nursing student and RN attrition rates. This approach should help the nursing shortage by reducing attrition.

To read more about this article: https://irispublishers.com/ijnc/fulltext/the-impact-of-flipped-learning-on-engagement-with-the-learning-process.ID.000563.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Screening to Identify the Unrecognized Victims in Practice: Implementing an EBP HITS Domestic Violence Tool in Neurology

Authored by  MaryAnn Martin*

Abstract

Domestic violence (DV) or intimate partner violence (IPV) is the cause of major physical and emotional health consequences in neurological patients; yet many are not screened or referred for DV services. A need for the DV screening was identified for this project since the neurology practice did not have a DV screening policy and limited research for screening in neurology practices is in the literature. This pilot quality improvement (QI) study occurred in a 3-office private neurological practice in South Florida that treated 300 to 400 patients per month. The problems associated with the complications of DV among neurological patients can create increased psychological and chronic pain conditions while also leading to reduced quality of life from the sequalae related to the DV trauma. This QI quasi-experimental study aimed to evaluate the Nurse Practitioner (NP) provider screening and referral rates pre and post educational intervention using the evidence-based practice (EBP) HITS DV screening tool (Hurts, Insults, Threatens, Screams). The secondary objectives of the project were to translate this to screening practice by educating the staff on the evidenced based DV training and implementing an organizational policy for universal domestic violence screening. The Ace Star model of evidence-based practice was utilized as the conceptual framework (Permission for use was obtained via email from the author Dr. Kathleen Stevens). The ACE framework offered the 5 steps to evaluate and implement effective practice and organizational policy change. Final results of the study indicated an increase in provider compliance post educational intervention with DV screening and referral rates. The research questions were answered with further data analysis demonstrating an increase in provider DV screening and referrals with pre and post percentage scores. Scores ranged from 0.3% pre intervention screened and 87 % patients screened post intervention. DV referrals pre intervention were 0.6% and post referral were 100 % with the 10 patients that screened positive in the one-month time period. Results were consistent with other literature indicating provider screening barriers and more women screened positive on the HITS tool with 8 women and 2 men out of 10 positive screens in the one-month time period.

Keywords: Domestic Violence; Intimate Partner Violence; HITS DV screening tool; neurological complications; ACE Star model.

Introduction

The current gap in literature indicates that only 10 % of health care providers are currently screening for domestic violence (DV) in practice [1,2]. DV has been shown to occur across genders, races, and economic classes and is not only against women with a 50 % occurrence between genders in some cases [3]. DV is a sensitive topic to discuss for both the provider and the victim. Domestic violence and intimate partner violence (IPV) terms are often used interchangeably. Literature has indicated that it takes time for the victim to open up about the domestic violence experiences. As a result, the problem is often missed by providers or takes multiple visits to be recognized by the provider or for the patient to feel comfortable to divulge this sensitive information to the provider. Chapin, et al. (2011) [2] study evaluated provider self-efficacy and confidence with education in DV screening and indicated that education was an important factor for medical providers to be more confident advocates for DV screening. Currently, DV screening policies vary among health care organizations and providers. Currently, DV screening is predominantly performed in Emergency Departments but DV is also seen in neurological patients sustaining injuries. Neurological patients present with head trauma and spinal injuries but literature indicates that these patients are not being screened and identified in this specific practice. These injuries can lead to continued problems and complications that can exist well past the abuse and trauma with contribution to other health conditions like seizures, cardiac problems, gastrointestinal problems, decreased memory and cognition, and migraines headaches [4,5]. The HITS domestic violence screening tool developed by Dr. Kevin Sherin et al. (1998) [6] has been identified as a short, efficient and highly sensitive screening tool with a Cronbach alpha of 0.80. The HITS tool can be implemented into a practice to help screen and identify neurological patients (victims) potentially experiencing DV. The HITS DV screening tool stands for acronym (HURTS, INSULT, THREATEN, and SCREAM) that is verbally given to the patient and scored based on a five-point Likert scale: never, rarely, sometimes, fairly often, and frequently [6]. The answer for each question is given 1 point ranging up to 5 points and the scores can range from 4 to 20. A positive screen is considered with a score of 10 or above. If the screen is positive, it is recommended that the provider further discuss the score with the patient and determine if the patient is suffering from DV abuse an offer resources and services to meet the patient’s needs [6].

PICOT

The quality improvement project used the PICOT (population, intervention, comparison, outcomes, and time) framework to guide the project. The PICOT question was the following: In a neurology practice treating adult patients over the age of 18 (P), does an educational intervention implementing the HITS domestic violence screening tool (I) versus usual care (C) have an impact on Nurse Practitioner’s (NP’s) screening and referral practices (O) over a 1-month time period (T)?

Research Questions

• Question #1: Does implementation of the HITS DV screening tool influence Nurse Practitioners screening practices?

• Question #2: Does implementation of the HITS DV screening tool influence Nurse Practitioners referral practices?

Objectives

The study objectives were to evaluate the impact of screening and referral rates of a nurse practitioner after education and universal implementation of the HITS DV screening tool in a neurological practice.

Conceptual Framework

The main focus of this QI project was to identify patients experiencing domestic violence via utilization of the HITS DV tool. It was essential for the provider to understand the importance of recognizing and identifying victims of DV so these victims could be referred to appropriate services in the community. The conceptual framework selected for this project was the ACE star model developed by Kathleen Stevens (2004) at the University of Texas Health Sciences at San Antonio. This study utilized all of the ACE star model 5-star points to demonstrate knowledge transformation at the following stages:

• Discovery Research: Neurological practice did not have a DV screening policy. It was necessary to gain approval and consent from the administration and organization for the project.

• Evidence Summary: Literature review identified a gap in DV screening in practice with limited literature identified for screening in neurological practices. Gained approval from IRB. Gained approval from Dr. Sherin to utilize the HITS DV screening tool via email. Gained approval from Dr. Stevens to utilize the ACE star model.

• Translation to guidelines: Reviewed USPTSF (2013) guidelines for Domestic violence recommendations. Implemented universal screening into the Neurology practice with translation to practice with final implementation of a DV screening policy.

• Practice Integration: Educate the staff on DV, gather the pre and post knowledge data from staff using evidence-based education, implement universal screening process using the HITS DV screening tool.

• Process and Outcome evaluation: Gather 1-month retrospective patient data pre education and intervention, implement project, check reliability of HITS scoring with staff, periodic checks of universal screening process, at 1-month completion of project gather and evaluate NP screening and referral data retrospectively in the electronic medical record (EMR). Analyze the collected data for demographic characteristics and provider DV screening and referral rates. Deliver the executive summary to the project organization and develop the policy change for DV screening in practice to ensure sustainability plan [7].

Design, Setting, Sample and IRB approval

The study was implemented in a 3-office privately owned neurology practice in South Florida and permission was obtained for the project from the administration. The Neurology practice treated a variety of patients ranging from Multiple Sclerosis, Epilepsy, Stroke, head and neck injuries, and Alzheimer’s. On a monthly basis approximately 300-400 patients were seen by the Nurse Practitioner (NP) provider. All staff voluntarily agreed to participate in the QI project. Universal screening using the HITS DV screening tool was implemented in the clinic to ensure that all patients over the age of 18 received the same screening process, informed consent, and screening information. Private screening guideline recommendations were followed according to the US Preventative Services Task Force (USPTSF) recommendations (2013) [8] and patients were given information on the universal screening process prior to receiving the universal DV screening tool. If patients declined to be screened, or they wanted their family member in the room the patient was not screened and were excluded from the project. Institutional Review Board (IRB) approval was received for this project.

Educational Intervention

Prior to the start of the project, all staff that worked directly with patients were given the DV education training. Education on Domestic violence included the following items: recognizing DV, the cycle of DV, information on the HITS screening tool, education on the scoring of the HITS tool, and referral recommendations. If the HITS screening scores were 10 or greater (positive screens), information on where to refer and available DV services in the community and nationally were provided to the staff and NP to give to the patients. Detailed information on private screening and screening recommendations were also provided in the educational training.

Project Implementation

A 1-month retrospective chart review was performed on 322 charts. The post implementation project was performed over a period of 1 month after the education was provided. Reliability and validity were maintained during the screening process with verification of the HITS scoring on 5 of the first day patients by the provider and the project investigator to compare screening scoring. At completion of the 4 weeks, 300 retrospective charts were reviewed for documentation of the universal HITS screening tools, positive screens, and documented provider referrals. The same data collection form was used to gather the NP provider screening and referral rates and demographic information only on age and gender of the referred and screened.

Data Analysis

A total of 263 DV patients screened out of the 300 total patients resulted in an 87 % screening rate post intervention in the onemonth universal DV screening period. These results were compared to pre intervention DV screening rates with results showing 0.31 percent out of 322 retrospective charts reviewed with no universal screening policy in place at the office. Out of the 263 DV screened patients, 28 patients declined to be screened, which was 9 % that were offered screening by the provider. The remainder of the patients were not screened for various reasons mostly related to barriers with the providers schedule being too busy. A total of 10 patients screened positive post intervention and were referred which indicated a 4.2 percent of the 235 patients actually screened. This indicated a significant increase from the 0.31 percent screened and 0.62 percent referred in the pre intervention retrospective chart review.

Limitations

Several limitations were identified in this pilot study. The actual sample size and provider sample size was small. It would be recommended to perform this study with more providers of varying licenses ranging from: Nurse Practitioner, Medical Doctor, and Physician Assistant. The 1-month retrospective pre and post chart review lead to small patient chart data set so randomization could not be implemented on the chart review. As a result, all charts were reviewed. It would be recommended for a longer duration for the retrospective chart review over at least a 6 months study time period to improve the significance of the study. Further evaluation on barriers to screening with an attitudes and barriers survey should be performed since provider time constraints were evident with lack of universal screening on all patients seen during the 1-month intervention. In addition, 9 percent of the convenience sample population declined to be screened and reason for the decline was not evaluated and should be further evaluated in another study. Provider time constraints in screening has been indicated in other studies as a significant barrier [9].

Conclusion

Literature gaps currently exist in regards to evaluating patients experiencing domestic violence in the neurological setting with evidenced based practice screening. The study provides findings showing a significant percentage increase in NP provider domestic violence screening and referral rates in the neurological practice post educational intervention and utilization of the HITS domestic violence screening tool. Screening in the neurology practice may be able to make a difference for many neurological patients living as unrecognized domestic violence victims. Screening and identification can help improve patient outcomes in this higher risk population group.

To read more about this article: https://irispublishers.com/ijnc/fulltext/screening-to-identify-the-unrecognized-victims-in-practice.ID.000562.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Assessment of Undergraduate Nursing Students’ Attitudes and Perceptions towards the Use of Computer Technology in Healthcare Settings

Authored by  Antonieto Alaban*

Abstract

The use of computer technology in nursing education and practice has grown exponentially. It has provided advanced opportunities for learning and in the practice of evidence-based nursing care. The study aimed to assess the attitudes of undergraduate nursing students at King Faisal University in Saudi Arabia towards the use of computer technology in healthcare settings. Using a non-probability sampling method, one hundred and fifty (150) nursing students of first, second and third year were selected.

The data were collected using the Pretest for Attitudes Towards Computers in Healthcare (PATCH) Assessment Scale v. 3. Significant finding demonstrated that only a small number of students (7.3%) had a very positive view of the potential use of computer technology in the healthcare. This finding indicates that undergraduate nursing students have limited computer exposure as part of the curriculum and may not be adequately prepared to work independently with the computers in the workplace once they graduate. Nursing programs should integrate specific software within BSN curriculum to help beginning nurses to work in an environment that increasingly relies on computer technology for patient safety.

Keywords: Attitudes; Computer technology; Undergraduate nursing students; Healthcare settings

Abbreviations: PATCH: Pretest for Attitudes Towards Computers in Healthcare, BSN: Bachelor of Science in Nursing

Introduction

The integration of computer technology into the nursing curriculum is essential to ensure success throughout the education and future careers of nursing students [1]. As nursing advances into a more complex and evidence-based calling, nurses got to be capable in computer utilization and be able to communicate over an assortment of healthcare-system demands [2]. Thus, it is mandatory for nursing students to learn and acquire necessary technological knowledge and skills in a variety of settings around the globe [2]. Furthermore, nurses will be expected to utilize computers for their personal learning and promoting quality patient care and safety [3].

Only few studies evaluated undergraduate nursing students’ level of informatics competencies based on the review of literature [4]. Moreover, very few studies focused on student technology knowledge, attitudes, and skills [5]. Having said that, identifying the variables that will predict informatics competency will help to develop appropriate strategies to prepare informatics competent graduates and further yield valuable insight for informatics curriculum development [4]. To ensure that nursing graduates are competent in the era of electronic healthcare delivery, it is essential to assess the attitudes of undergraduate nursing students.

The outcome of this research will help evidence-based planning and implementation of eHealth in the hospital and generate additional insight on the topics to be included in the Nursing Informatics syllabus taught to undergraduate nursing students at King Faisal University to better prepare them in facing challenges of technology use in the health care settings.

Materials and Methods

The study assessed undergraduate nursing students at the College of Applied Medical Sciences, King Faisal University. A nonprobability convenience sample was selected, and a quantitative descriptive research method was applied. Selection criteria for participants included nursing students who were studying in the first, second, and third year of the nursing program and were willing to participate. Fourth year students were excluded in the study for having completed a full course on Nursing Informatics in the previous year. One hundred fifty students (150) participated in the study.

A descriptive study design using quantitative approach and structured questionnaire (Pretest for Attitudes Towards Computers in Healthcare (PATCH) Assessment Scale) were used to measure the undergraduate nursing student’s level of attitudes towards computer usage. The P.A.T.C.H. Assessment Scale v. 3 developed by June Kaminski to assess health worker’s attitudes towards computer use. This scale is a valid and reliable, selfreport measure of attitudes towards computers in healthcare. The scale was administered along with a brief demographic form. The demographic data form consisted of four items selected to elicit data about the background of the participants in the study including age, marital status, year of study, and computer ownership.

Results and Discussion

The findings revealed that almost half of the participants (n=71, 47.3%) had realistic views of current computer capabilities and applications in health care as indicated in their responses to the questionnaire. Very few of the participants (n=21, 14%) showed limited awareness of the applications of computer technology in health care. Only a small number of the participants (n=11, 7.3%) had very positive view of the potential of computer use in healthcare setting. Moreover, the mean score of the participants was 4.28±0.84 (M±SD) which indicates being comfortable with the user-friendly computer applications and had a realistic view of how computers are currently used in healthcare settings. The findings of association showed that the levels of attitude were not associated with age, marital status and whether or not the participants owns a computer application.

Conclusion

The findings indicate that undergraduate nursing students generally held positive attitudes towards the use of computers in healthcare settings. However, most undergraduate nursing students received limited computer exposure as part of their curriculum and may not be adequately prepared to work independently with computers in the workplace once they graduate. Thus, the researchers suggest that nursing programs integrate-specific software within BSN curriculum to help beginning nurses to work efficiently in an environment that increasingly relies on computer technology to promote patient safety.

To read more about this article: https://irispublishers.com/ijnc/fulltext/assessment-of-undergraduate-nursing-students-attitudes-and-perceptions-towards.ID.000561.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Creating a Sustainable Clinical Adjunct Faculty Mentorship Program

Authored by  Jennifer Marie Litchfield*

Abstract

Background: A mentoring program supports people to manage their own learning needs so that they may maximize their potential in the clinical setting. The mentorship program paired newly hired clinical faculty, waivered faculty, and/or clinical faculty who request it, with senior colleagues in the nursing program. The mentor/mentee pair met throughout the academic year to work toward goals that they develop together and are required in the job description for clinical adjunct instructors. Monthly meetings were required. A final summary meeting occurred face to face. The mentor completed a progress note during each meeting with a final summary note sheet completed at the end of the mentoring period. Offering stipends to full-time faculty assists with faculty engagement. Mentoring is a powerful tool that helps new clinical faculty achieve personal and professional goals.

Questions: What supports/resources are needed for new adjunct clinical faculty? Will full-time faculty participate in a mentorship program? What are the responsibilities of the mentor/mentee? How are mentees prepared for the role? How are mentors prepared for the role? How do mentors and faculty assess the progress and satisfaction of new faculty members?

Issues: The National League for Nursing (NLN) Board of Governors published a position statement, Mentoring of Nurse Faculty, in 2006. The statement encourages the thoughtful use of mentoring as a resource to foster the career development of faculty, develop the enrollment and retention of nurse educators, and create a positive work environment [1].

Purpose: The purpose is to explore the needs for newly hired adjunct clinical faculty. The nursing program must meet regulatory requirements of the Board of Registration in Nursing regarding newly hired and waivered nursing faculty.

Themes: Engagement, nursing faculty shortage, and workload.

Introduction

“Mentoring of new faculty by nurses experienced in the faculty role is the single most influential way to bring our new cohorts into the circle of academia, thereby preventing the isolation, frustration, and dissatisfaction commonly seen in new nursing faculty. Mentoring assists our new peers, as well as their mentors, in the growth and maturation of their professional selves [2].”

Engagement

Mentoring requires a partnership between the mentor and mentee. In order for the mentorship to be successful, likenesses should occur. Couplings of mentor/ mentee must be grounded on personality, philosophical beliefs, and clinical teaching areas [2]. The Nurse of the Future will purpose efficiently within nursing and interdisciplinary teams, developing open communication, shared respect, collective decision making, learning, and development [3].

Teamwork and Collaboration

Nursing Faculty Shortage

The average age of faculty members is increasing. According to the American Association of Colleges of Nursing, “the average ages of doctorally-prepared nurse faculty holding the ranks of professor, associate professor, and assistant professor were 61.6, 57.6, and 51.4 years, respectively. For master’s degree-prepared nurse faculty, the average ages for professors, associate professors, and assistant professors were 57.1, 56.8, and 51.2 years, respectively [4,5].”

Workload

Newly hired faculty must be oriented within the school to fully understand the nursing department. Offering new faculty (mentees) reduced workloads during the first year and decreasing workloads for mentors facilitates an extensive orientation.

Conclusion

The mentorship program pairs newly hired clinical faculty, waivered faculty, and/or clinical faculty who request it, with senior colleagues in the nursing program at Becker College. Mentoring is a powerful tool that helps new clinical faculty achieve personal and professional goals.

To read more about this article:https://irispublishers.com/ijnc/fulltext/creating-a-sustainable-clinical-adjunct-faculty-mentorship-program.ID.000560.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Student Evaluation of Nursing Simulation Lab Learning Experience

Authored by  Kawther Hamash*

Abstract

Objective: Describe and examine the effect of influential factors in simulation labs on the students’ total experience in learning the concepts taught in the didactic portion of nursing courses at a four-year university.

Background: Nursing education is developing leading to a great emphasis on new, effective strategies that focuses on using simulation labs to enhance students’ clinical judgment and critical thinking. The end of semester student evaluation of teaching (SET) of simulation labs reflect factors that can affect the students’ learning experience. SET of simulation labs helps faculty plan for future changes in course objectives based on the students’ needs.

Method/design: Two hundred and eighty-five anonymous student evaluations of teaching simulation lab surveys were collected retrospectively for the academic years of 2014 through 2016.

Results: Multiple regression analysis showed that the most influential item was “Lab experiences clarify the lecture material.” The least influential item was “I can complete the lab activities in the time allotted.” Students were mostly concerned about how the simulation lab will prepare them to better understand the associated didactic course material and concepts. Students’ evaluations were also affected by the availability and quality of simulation equipment used in the simulation lab.

Conclusion: Students’ evaluation of simulation provided input about factors that can affect how and what students are learning during simulation time. Using students’ input in the evaluation of the simulation lab will help nurse educators strengthen the nursing curriculum and make necessary changes to meet the course objectives, students’ needs, and external learning outcomes.

Keywords: Simulation; Nursing; Influential factors; Student evaluation; Learning; Clinical

Introduction

Nursing education is changing which places a greater emphasis on enhancing effective teaching strategies used including didactic, clinical, and simulation labs [1]. Recently, healthcare has recognized the importance of using simulation labs to enhance students’ clinical judgment. The current healthcare trends are directing toward encouraging the use of simulation labs in nursing education [2]. Nursing simulation labs provide nursing faculty the ability to expose students to real-life acute care scenarios that allow students to learn how to provide safe nursing care in such a setting once they become a Registered Nurse (RN). Simulation labs also help the students develop nursing skills and build clinical reasoning abilities that focus on patient outcomes [3]. Simulations facilitate the introduction of static nursing skills that are usually demonstrated by using case studies and computer-generated scenarios [4,5]. Additionally, simulation labs benefit students by allowing them to manage a variety of clinical situations in a safe learning environment before attending to actual patients [6].

Identifying the outcomes planned for simulation labs at the beginning of each academic year is critical for the successful implementation of needed changes that were identified in the student evaluations and feedback. Each simulation course’s outcomes need to be integrated with the didactic course outcomes and objectives to ensure consistency between both courses. Also, simulation objectives should address/evaluate the integration and application of knowledge learned, critical thinking, clinical judgment, and prioritization in each nursing course and students’ involvement in the evaluation of the simulation labs is necessary as they measure learning outcomes and course objectives at the end of the simulation course [7].

Students provide feedback at the end of each semester to evaluate their learning experience in simulation labs. Student feedback is a rich source for evaluating their learning experience and addressing students’ needs in future simulation sessions. A student’s comfort, confidence, and satisfaction level at the end of each simulation session is important and should be used as an ongoing assessment to identify changing needs that emerge during the implementation of simulation labs and used to improve students’ learning experience [3]. It is recommended to evaluate a course’s learning outcomes from the student’s perspective to enhance their learning experience [7]. Students’ evaluation and feedback collected at the end of each semester can be used as a tool to plan for future changes that can address the students’ needs and the nursing program’s outcomes. Thus, the evaluation of simulation lab experience can be a good source of information for instructors to use to enhance the students’ learning experience. Multiple factors can influence the students’ evaluation of their learning experience. These factors were categorized into students’ background/ characteristics, faculty characteristics, school characteristics, and use of learning strategies [8]. In this study, we focused on the school and lab characteristics, and the characteristics of the instructor.

Role of supplies

Simulation labs in the nursing field are equipped with different fidelity level mannequins and computerized systems to run roleplaying scenarios that mimic real-life patient situations. Simulation equipment is a resource that can be used to facilitate the learning experience for students with different learning styles. High quality, also called high fidelity, simulation resources allow students to have real-life experience in a safe learning environment. Mannequins are controlled by computer equipment to allow students to practice different essential skills [9,10]. High fidelity simulation mannequins are often expensive which means offering true-life scenarios may be an obstacle for schools with a low simulation budget. Lower fidelity mannequins do not offer the same quality of student learning experience compared to new, higher fidelity mannequins. Thus, the quality of supplies provided in simulation labs can influence students’ learning experience.

Role of the instructor and use of time

A simulation is run by a facilitator who can be the course lead instructor or a graduate student assisting the lead instructor. The role of the facilitator is important in the students’ simulation learning experience. The facilitator’s role is managing and organizing the simulation sessions as well as provide effective feedback and debriefing toward the end of each simulation session. Facilitators play a key role in managing the students learning experience by providing a comfortable environment and effective time management techniques. The simulation facilitator is responsible for helping the students apply the knowledge gained from different clinical scenarios to make safe clinical judgments and build the basic and advanced skills required to care for patients in the clinical setting [7,11,12]. The instructor’s preparedness and effective use of simulation lab time can change the students’ perspectives about the effectiveness of simulation labs. Thus, instructors need to integrate the students learning outcomes in the didactic courses with the simulation lab activities to ensure its congruency with the simulation lab learning outcomes.

Simulation sessions are usually planned by the facilitator to meet the course objectives. Simulations run by the instructor offers the students the chance to receive ongoing feedback to correct their actions to promote the patient’s outcomes [4,13]. At the end of a simulation, students engage in a debriefing where they can ask questions, discuss actions are taken and address actions that could have been done differently which allows the students to think more critically of their actions performed and clinical judgments made during the simulation and discuss the impact of said actions and what could be done differently [13]. On the other hand, simulations run by assisting students are associated with some limitations. Student planned simulations are planned on multiple dates with the facilitating student simulating a remote room and the students gather at the end of the simulation for debriefing. Students will not receive ongoing feedback or cues while the simulation session is running [13]. This difference highlights the students’ needs as reported in their evaluation of simulation labs and emphasizes the need to use the students’ evaluations in building plans to change the approach of running simulations in nursing labs [7,14]. The student summaries of labs and course evaluations serve different purposes that can be used for program growth and decisions related to the accreditation process [1]. The success of accredited nursing programs is measured using a comparative measure such as the NCLEX-RN examination. Students’ evaluation of lab and course evaluation can assist in improving the annual success rates in this competency examination [1].

Tools used for student evaluation of simulation lab learning experience

The type of tools used in students’ evaluations of nursing simulation labs was inconsistent. The literature revealed that most of the nursing studies focusing on simulation labs used different evaluation tools and measured a different outcome. For example, Lewis and Ciak [15] used the National League for Nursing (NLN) to measure satisfaction and self-confidence to evaluate students’ learning and confidence levels after implementing simulation labs. In another study, Portsman, et al. [3] used the Psychomotor Skills Performance subscale (PSP) and the Clinical Competency Appraisal Scale (CCAS) to evaluate the students’ competency of the skills learned in simulation. Jeffreys, et al. [1] used multidimensional tools for student evaluation, and Casida and Shapkof [11] used a threedimensional tool in a retrospective study to evaluate students’ perception of simulation teaching. The tool reflects the cognitive, psychomotor, and affective domain of students’ learning [11]. There is no standardized tool used for evaluating the simulation lab experience, thus the focus on the outcome measure, and the evaluation tool was inconsistent across the different studies.

Based on Speaking of Teaching [16] evaluation tools should have specific areas the students evaluate their instructor’s ability to engage them in the simulation activities and how well the simulation activities were integrated into the didactic course objectives. Speaking of Teaching [16] has suggested four target areas that need to be addressed in students’ evaluations to help improve faculty teaching strategies. The first target is to state and relate the course objectives of the simulation lab sessions with the objectives of the didactic course. The second target is the presentation of the course material at an appropriate pace that covers the concept of each session. The third target is assisting students in developing and enhancing their conceptual understanding and critical thinking skills and the final target is the incorporation of course assignments to focus on problem-solving and the application of existing knowledge and provides a summary from the time spent in the simulation lab [16]. Although students’ evaluations of simulation labs are important in enhancing their learning experience, discrepancies in the measurement of outcomes and evaluation tools used in different studies will limit the benefit of the prior study results. Instructors are unable to find prior research studies that provide them with recommendations on how to use students’ evaluation of simulation courses to make future changes. To help instructors improve their teaching of simulation labs and use of student’s evaluations to enhance their student’s learning experience, the current study is planned to identify factors that can influence student positive learning experience in a simulation lab at a four-year university.

Material and Methods

Data collection and instrument

purpose of this study is to describe and examine the effect of influential factors in simulation labs on the student’s total experience in learning the concepts taught in the didactic portion of nursing courses in the department of nursing in a Midwestern university. Institutional review board approval was obtained before collecting retrospective data. The simulation lab evaluation forms were administered online in the nursing department by Class Climate (CC) in the academic years of 2014 through 2016.

The CC survey includes items that focus on the simulation lab learning experience and the survey is conducted at the end of each semester. Responses to CC survey questions are recorded anonymously and student responses are kept at a university teaching and learning center to protect the confidentiality of the course faculty and the students. Students are encouraged to complete the online survey objectively. Survey items are measured on a Likert type scale ranging from [1] “strongly disagree” to 5 “strongly agree”. To maintain the confidentiality of the instructor and student information, the evaluation dataset collected represents a de-identified set of student responses to the evaluations of nursing simulation labs. The data was saved in an Excel worksheet and converted to SPSS file for data analysis. The survey used by the department evaluated students’ ratings of lab course evaluation items. The tool includes seven items that measure different aspects of students’ lab experience. The seven questions assess the students’ evaluation of their simulation laboratory experience. The eighth question measures the students’ overall experience with the simulation lab. The evaluation questions were developed based on the course objectives from a valid set of items that were developed and recommended by the university.

Multiple linear regression analysis was used to identify the effect of seven aspects of simulation lab learning on the students’ experiences in learning concepts. The dependent variable (DV) is “the lab experiences assist me in learning concepts” while the independent variables (IVs) are the attributes of the seven items collected in student evaluations.

Statistical analysis was performed using SPSS version 24. This study included data from 285 de-identified course evaluations of baccalaureate undergraduate nursing students. Of these, 248 were female students and 37 were male students. Around 63.5% of the sample was enrolled full time in the nursing program. Descriptive statistics of means and standard deviations (SD) of the measured items are shown in Table 1. Distributions of the items are shown a large majority of the responses are four or five, making the distributions of all items left-skewed (Table 1&2).

The regression analysis Table 2 showed that the model explained 81.6% of the variance in the students’ total learning experience. The results showed that 6 out of 7 items had a statistically significant effect on the students’ learning concepts (at α<.05) and these statistically significant items were positively related. The first and most influential item was “Lab experiences clarify the lecture material” (B = 0.297, P < 0.001). The positive parameter estimates of 0.297 mean that if this item was increased (improved) by one unit, then the effectiveness of lab experiences in assisting students in learning concepts (DV) will increase (improve) by 0.297 unit, and all other parameter estimates can be interpreted in the same way. The second influential item was “The lab in this course has adequate facilities” (B = 0.188, P < 0.001), followed by the third most influential item, “The lab is a worthwhile part of the didactic course” (B = 0.162, P < 0.001). “The nursing simulation lab procedures are clearly explained” (B = 0.158, p = 0.001) ranked as the fourth most influential item and “Instructor can answer my questions about what I should be doing in the lab” (B = 0.134, P = 0.013) is the fifth most influential. The sixth and least influential item was “I am able to complete the lab activities in the time allotted” (B= 0.112, P = 0.008). The seventh item, “The lab sessions were well organized” in the “Lab evaluation tool” showed a negative relationship but was not statistically significant (B = -0.06, P = 0.166), therefore, the organization of the lab sessions were not considered as an influential item from the students’ perspectives.

Discussion

This study aimed to examine factors that influence “students’ learning of concepts in the simulation lab.” Most factors tested in the simulation lab evaluation tool were significantly related to the students’ overall lab experience indicating that the simulation lab is a rich area for student learning. Based on the study results, students were mostly concerned about how the simulation lab will prepare them to better understand the associated didactic course material and concepts which was reflected in the “Lab experiences clarify the lecture material” and “The content of the lab is a worthwhile part of this course” items. The results also indicated that students’ learning experiences were affected by the availability and quality of simulation equipment used in the simulation lab, as indicated by the second influential factor in this study “The lab in this course has adequate facilities”.

The clarity in explaining the nursing procedures and skills as demonstrated by the nursing instructor was the most influential factor in affecting the students’ lab experience. The value of the lab experience as an important part of the didactic course also reflects how the didactic course objectives were met during the simulation lab experience. In this study, the importance of the content demonstrated during the simulation lab was the third most influential factor. Barth [17] argued, the clarity of instruction provided in the students’ lab was included as an item on the survey. Barth [17] found the clarity item on the evaluation tool did coincide with the quality of instruction. In other words, there was an association with the outcome variable “quality of instruction.” The instructor’s quality of instruction as an item relates to the preparation of the instructor and how well the concepts were demonstrated in the simulation session. Barth [16] found that students who noticed the preparation of the instructor reported having better overall learning experiences. Thus, higher quality instruction will lead to higher student satisfaction in their learning experience. Schumacher [18] student’s Health Education Systems, Inc. (HESI) examination (i.e.: a predictor exam for NCLEX-RN examination) was higher among students who had a combination of classroom and simulation teaching. This exam detected higher critical thinking abilities, increased students’ self-confidence, and increased knowledge acquisition among students who had a simulation lab during their learning experience [4]. The lab experience allows instructors to link the objectives of the didactic courses to the simulated real-life scenarios.

Students rated the contribution of simulation lab in explaining the didactic course material (lab experiences clarify the lecture material) higher than the quality and availability of simulation equipment (the lab in this course has adequate facilities). This result agrees with Casida and Shpakoff [11] study in which students rated simulation labs as an effective learning experience for learning critical care nursing skills. This highlights the importance of simulation labs in evaluating the students’ understanding of the concepts learned in the didactic courses and their application of the knowledge learned in making clinical judgments in a simulation environment that mimics the actual clinical settings [11].

This study supports the current trends of the importance of simulation as an effective approach for advancing nursing students’ clinical skills in a non-threatening learning environment. In this study, students rated “lab procedures are clearly explained to me” item as the fourth influential factor in the overall students’ learning experience, indicating incredible importance of clear and concise skills demonstrations by instructors to optimize simulation effectiveness. Instructors play a major role in using students’ lab time effectively to allow students to have hands-on experience to practice essential skills.

Simulation labs run by instructors had a preference over simulation labs run by teaching assistants in the nursing field [17]. In this study, students rated the guidance received from their instructor as the fifth influential factor which was reflected by the item “My instructor can answer my questions about what I should be doing in the lab”. Luctkar-Flude et al. [17] compared students’ preference on having an instructor to lead simulation labs versus teaching assistant (i.e. graduate students) and found students preferred simulations led by instructors as it provided them with the guidance needed for demonstrating nursing skills, clarifications of emerging questions, reinforcement of avoiding errors in the practical demonstration of the skills, realism, and problem-solving strategies in a collaborative way. This highlights the importance of emphasizing running the simulation labs by instructors [17]. Simulations led by instructors allow students to receive cues, ongoing feedback, and debriefing at the end of simulation which cultivates critical thinking. This supports the building of a supportive learning environment, helps reduce the students’ anxiety level, and boosts the students’ confidence level with their psychomotor skills and knowledge.

The effective use of students’ learning time expended in the labs was ranked as the sixth most influential factor as indicated by “I am able to complete the lab activities in the time allotted” item. This indicates students are concerned about how their time is being managed by the instructor for a higher quality of learning outcomes and not that the instructor is wasting the student’s time. In this study, the effective use of lab time in which it allows a time slot for students to practice their learned procedure had the lowest weight in affecting the students learning experience. However, it was a statistically significant factor and counted toward the total explained variance. This result shows that students are concerned about what concepts or skills they learn during each period in the simulation lab more than when it was allocated [4].

The organization of the clinical lab day provides the instructor and students with the best time management to achieve the objectives of each clinical day. The students’ responses to the seventh influential factor, “The lab sessions are well organized”, surprisingly indicated that the order and way in which the lab sessions were organized was of no interest to the students. This result was unexpected based on its level of importance for the nursing students. In this study, nursing students tend to value achieving the course objectives during the simulation time more than the order of activities scheduled for their simulation day. This result contradicts the literature results possibly because of the nature of clinical skills the students learn that differs in the level of importance to the students from didactic classes. However, this factor was not statistically significant in influencing the students learning experience. The importance of organizing course material was reflected in Barth [17] which found that the organization of the course material was a significant factor related to the quality of instruction in the didactic classes.

Students’ evaluation of the simulation of clinical courses would provide a great source of information for effective curriculum planning if used effectively. Thus, it necessitates the use of a comprehensive tool that measures the three different aspects of students’ learning experience which includes the cognitive, affective, and psychomotor dimensions of learning. Accurate student evaluation scores can assist nursing educators to build simulation lab course syllabi successfully based on the students learning perspectives and enhance the students’ learning experience [1]. Other factors that measure the multidimensional aspects of the students’ learning experience (e.g., the psychomotor, cognitive, and affective domains) should be addressed in the student’s course evaluation tool [1,11]. In nursing, addressing the external learning outcome measures such as NCLEX-RN and the competency rating of the employer are other important aspects of nursing learning outcomes that should be included in the student course evaluation tools. Students’ input on these factors can assist nursing educators in making decisions for curriculum changes and improving choices of teaching strategies.

The effective use of time management of the simulation lab represented a higher influential level for students’ learning experience than the actual organization of tasks presented for each simulation lab. Students appreciated the prioritization of the skills learned and enforcing their knowledge and skills rather than having an organized fixed plan for their class. This indicates that meeting some versus all of the learning objectives during the assigned simulation time can help students achieve their learning needs more than having a set of objectives for a specific planned simulation time. Students rated their ability to demonstrate their skills during the simulation time as the last influential item. This reflects that students care about achieving their learning needs rather than demonstrating a procedure or a skill. This result agrees with the Luctkar-Flude et al. [12] study in which students preferred to have an instructor-led simulation where they can ask questions, receive cues from the instructor, and receive ongoing feedback and have a planned debriefing at the end of simulation sessions rather than having a step-organized simulation lab that is led by students in which the student-instructor will observe what the students are doing based on step-order during the lab and offer a debriefing at the end of the simulation session.

This study indicates simulation lab experience is important in enriching and explaining the concepts learned in nursing didactic courses and preparing students for providing effective care for patients at the clinical sites. Students’ evaluation of simulation provided input about factors that can affect how and what students are learning during simulation time. Using students’ input in the evaluation of the simulation lab will help nurse educators strengthen the nursing curriculum and make necessary changes to meet the course objectives, students’ needs, and external learning outcomes.

Study Limitations

The tool used for collecting students’ evaluation of simulation labs was short. Due to the retrospective nature of the data collection method of simulation course evaluation, the qualitative information on students’ perspectives was not available for analysis. Thus, the students’ interpretation of the items listed and their description of the simulation experience was not addressed. The demographics and the background of the simulation facilitator were not available to compare between instructor-led and student-led simulations. Besides, the course information such as the name of the course and the level of students enrolled in it was not available to compare the effectiveness of simulations in different nursing courses. Due to the non-random nature of our sample, the study results cannot be generalized.

Conclusion and Recommendation

Simulation provides students with a non-threatening learning environment that can boost students’ confidence and clinical judgment. This study revealed multiple factors can affect the students learning experience. Addressing these factors based on the students’ perspectives can help nursing educators plan appropriate curriculum changes to match the students’ and nursing program’s learning outcomes. In this study, the most influential factors in students’ evaluation of their learning experiences were the congruency between didactic courses and simulations, the availability of quality supplies, and the clarity of simulation and instructors preparedness. Nursing faculty need to continue improving the simulation lab experience by addressing the students’ feedback at the end of semester evaluation of simulation course. Instructors also need to provide continuous monitoring for the effectiveness of their teaching practices by using student evaluation (SET) of simulation results in planning their future simulation classes. Student evaluation of simulation is considered an important and efficient way of learning about students’ perspectives toward lab activities and enhancing the quality of nursing student learning experiences. Building improvement plans based on the students’ perspective in students’ evaluations will enable instructors to teach more efficiently. Future studies need to look at the narrative students’ evaluation of simulation experience and analyze it based on categories that relate to the course outcomes. To use the student evaluation as a useful tool in teaching, instructors need to reflect on their belief of the course outcomes and make changes to allow students to build their conceptual understanding of the material.

To read more about this article: https://irispublishers.com/ijnc/fulltext/student-evaluation-of-nursing-simulation-lab-learning-experience.ID.000559.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

Does a Nurse Led Surveillance Program Using a Verbal Reminder Intervention Impact Catheter-Associated Urinary Tract Infection Rates?

Authored by  Rachel Akpom*

Abstract

Catheter-Associated Urinary Tract Infection (CAUTI) is a common occurring hospital-acquired infections (HAIs) secondary to the use of indwelling urinary catheters (IUCs). This DNP project evaluated the impact of a nurse-led surveillance program using a verbal reminder intervention on CAUTI rate, IUC days, and nurses’ knowledge of the Centre for Disease Control (CDC) on CAUTI guidelines in a medical surgical unit in a large hospital in Texas. This study used a pre and post-test design. Control group data were obtained from a three-month retrospective CAUTI rate and IUC duration information from electronic medical records of discharged patients. The period reviewed was from October 2017 to December 2017. During the intervention period, nurses implemented a nurse-led surveillance program using a verbal reminder intervention to prompt timely removal of indwelling urinary catheters. Data collection included CAUTI incidents, IUC days, and improvement on nurses’ knowledge of the CDC CAUTI guidelines before and after implementation. Descriptive statistics of CAUTI incidents and IUC days were computed and analysed. The results show a decrease in CAUTI incidents from 1 for the pre-intervention group to 0 for the post-intervention group. The number of patients with IUCs for three days decreased from 36(30.51%) before implementation to 9 (7.63%) after implementation. T-test analysis was performed for Nurses’ knowledge using Minitab 18 Statistical Data Analysis Software. Nurses’ knowledge test revealed a significant improvement in mean scores from 77% before implementation to 91.5% after implementation.

Keywords: Catheter associated urinary tract infection (CAUTI); Lowa model; Medical-surgical unit; Indwelling urinary catheter; Nurse-led surveillance

Introduction

Catheter-Associated Urinary Tract Infection (CAUTI) is a frequently occurring urinary tract infection among hospitalized patients. CAUTI is preventable, yet it continues to be a frequently occurring infection incident among hospitalized patients worldwide, because of prolonged duration of IUC being constantly in physical contact with the bladder. The constant physical touch of IUC with bladder causes increase in bacteria accumulation and transmission to the bladder; resulting in CAUTI [1-5]. As a result, patients experience prolonged hospitalization, and increased healthcare costs. CAUTI increases the risk of patient’s discomfort, health complications, and can lead to sepsis and death. It is vital for the nurse to understand the importance of evaluating the indwelling catheter days and understanding the importance of having these indwelling urinary devices removed if no longer necessary for medical care.

Nurses spend most of their working hours with patients at the bedside and nurses were the best modality to implement this intervention to make a positive impact in this organization. The use of a nurse-led surveillance program using a verbal reminder intervention system to monitor indwelling urinary catheters was a daily intervention that monitored the duration of IUCs and reminded physicians of the presence of indwelling catheters (ICs). This interventional quality improvement DNP project ensured timely discontinuation of ICs when the use of ICs was no longer required for the patient’s medical condition and treatment. Nurses’ active participation in preventing the risk of CAUTI had an impact on patients’ outcomes which reduced patients’ discomfort, prolonged length of hospitalization, unnecessary infection, and even death. Hospitals have benefitted from this intervention since the facility did not experience loss of financial compensation for patient care related to CAUTI. The focus of this project was to evaluate the effect of a nurse-led surveillance program using a verbal reminder intervention on catheter duration and CAUTI rate.

PICOT Question

In hospitalized adult patients >18 years of age, does the use of a nurse-led surveillance program using a verbal reminder intervention system of the indwelling urinary catheter compared to organization standard protocol affect CAUTI rates over a 3-month period?

Research Questions

The research questions for this study were:

• Did CAUTI rates decrease after implementation of a nursing staff education program using an evidence-based nurse-led surveillance verbal reminder system?

• Did IUC days decrease after implementation of a nursing staff education program using an evidence-based nurse-led surveillance verbal reminder system?

• Did implementation of a nursing staff education on CDC guidelines helped reduce CAUTI rates as evidenced by improved scores on the nursing staff post-test?

Purpose

The purpose of this DNP project was to implement and study the effect of a nurse-led surveillance program using a verbal reminder intervention of IUC on CAUTI rate in a medical-surgical unit. The three outcome objectives of this quality improvement project were the following:

• to reduce urinary catheter infections,

• to reduce urinary catheter days, and

• to evaluate nursing knowledge using CDC CAUTI guidelines.

To accomplish these project objectives, nurses played a significant role in the process of this project.

Conceptual and Theoretical Framework

The conceptual framework used to guide this project was the Iowa Model of Evidence-based Practice (EBP) [3] for healthcare excellence. The Iowa Model is one of the most frequently used models for evidence-based research studies by healthcare providers to produce positive patient outcomes. Nurses are the frontline healthcare providers. They spend most of their professional hours in providing direct care to patients, which includes IUC management. As a result, it is crucial that nurses are well educated on EBP related to IUC management to ensure healthcare excellence, and to improve patient outcomes. Additionally, it was important to encourage Nurses’ active participation in IUC management through surveillance and verbal reminder system to prevent CAUTI incidents.

Relevance to Nursing Practice

The Iowa Model was relevant to nursing practice because it emphasized the use of Evidence-Based Practice (EBP) by healthcare providers. Nurses were at the frontline of patient care. Therefore, Nurses’ consistent implementation of EBP in IUC management improved patient outcomes. The goal of this project was to decrease CAUTI rate to 0 or below the CDC national benchmark of 1.07/1000 IUC days on the proposed unit. A nurse-led surveillance program using a verbal reminder intervention of the presence of IUC to physicians is an intervention based on EBP, and it was consistent with the Iowa Model for EBP to promote excellence in healthcare.

Setting

The setting of this DNP project was in a medical-surgical unit in one of the hospitals in Texas. The unit provided care to all medical-surgical patients regardless of the nature of their surgical procedure. The nurses working in the medical surgical unit were Associate and BSN prepared Registered Nurses. The unit has a daily average census of 4 to 8 patients with indwelling urinary catheters. The daily average population of patients was 20 to 28 with eight licensed nursing staff. The patients’ ages are 30 years and above.

Patient Selection

A computer-generated random sample method was used to select 118 patients’ charts for retrospective chart review of patients who had indwelling urinary catheters during hospitalization between October and December 2017. The urine culture results, IUC insertion date, and discontinuation date were reviewed during these same dates. The durations of IUCs were collected using the IUC insertion dates and discontinuation dates identified in the chart. These datasets were used to compare to the CAUTI data collected during the surveillance intervention period of this study. A 3-month retrospective CAUTI data was collected from the electronic medical records of 118 patients with the assistance of the infection control nurse using the retrospective CAUTI data collection form for patients admitted between October 1st, 2017 and December 31st, 2017. G-Power analysis indicates that a minimum of 105 sample size would be required respectively to achieve a .95 level of power.

Intervention

At the initiation of this project, a 1-week implementation trial was performed to ensure that the registered nurses understood the forms and process of this study. The purpose of having the implementation trial was to ensure validity and reliability of the process. During the 1-week period, the unit registered nurses had one-on-one consultations with the researcher for clarifications. The researcher observed the unit nurses’ use of the nurse-led surveillance program using a verbal intervention; the researcher provided feedback at the time as needed. During the intervention period, the registered nurses were responsible for implementation of the nurse-led surveillance program using a verbal reminder intervention daily on the unit. Additionally, the registered nurses were responsible for collecting CAUTI data daily and were also responsible for ensuring removal of the ICs after the physician’s order was obtained to discontinue the IUCs and they were responsible during the process to document the intervention that occurred on a daily IUC surveillance forms. At the completion of this study, to ensure sustainability, the nurse manager was encouraged to ensure that quarterly in-service training will be conducted in the future to ensure that the knowledge, process, and procedures for the nurse-led surveillance program using a verbal reminder intervention will be sustained.

CAUTI Surveillance Program

A nurse-led surveillance program using a verbal reminder intervention was implemented in a medical surgical unit involving Registered Nurses’ daily routine on hospitalized patients whose care required the use of IUCs. Registered Nurses reminded physicians of the presence of IUCs and requested for revaluation of the continuous use of the IUCs. The nurse-led surveillance program using a verbal reminder intervention prompted physician’s order for discontinuation of ICs.

Results

The result showed that out of the 118 patients in preintervention group, three patients (2.54%) had IUCs for one day, 79 patients (66.95%) had IUCs for two days while 36 patients (30.51%) had IUCs for three days. For post-intervention group, the number of patients with IUC duration of 1 day was 4 (3.39%). The number of patients with IUC duration of 2 days was 105 (88.98%) and the number with IUC duration of 3 days was 9 (7.63%). A descriptive statistic showed a decrease in the number of patients who had IUC duration at 3 days from 36 to 9 respectively however, the rates were higher in 1 and 2 IUC days in the post-intervention groups. Compared to total sample, the number of patients with IUC duration of 3 days decreased from 30.51% in pre-intervention group to 7.63% in post-intervention group.

Summary

The use of a nurse-led surveillance program using a verbal reminder intervention was implemented during the post intervention period. IUC discontinuations increased in the post intervention group. CAUTI incidents decreased in post intervention sample. CAUTI rate for all patients’ electronic medical records reviewed before implementation of this project was 3.71%. When compared to post-implementation CAUTI incident, the unit’s CAUTI rate decreased from 3.71% to 0%. To evaluate knowledge level of Registered Nurses on CDC Guidelines on CAUTI the nurses were given a pre- and post-tests about CAUTI. The pre-test scores were compared to post-test scores for each nurse, during this project. Minitab 18 statistical data analysis software program was used to analyze the scores. The results showed a statistically significant difference (p<= 0.05) in the scores of nurses between pre-test and post-test scores.

To read more about this article: https://irispublishers.com/ijnc/fulltext/does-a-nurse-led-surveillance-program-using-a-verbal-reminder-intervention-impact-catheter.ID.000558.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf

[clinicalnursing]

Iris publishers- Iris Journal of Nursing & Care (IJNC)

The Evolution of Nursing Faculty During Unprecedented Times

Authored by  Tori Canillas-Dufau*

Abstract

With the arrival of the COVID-19 pandemic, nursing education has made unprecedented rapid changes in policy and procedure directly impacting faculty, students, and didactic, clinical, and skills laboratory instruction. There has been a constant ebb and flow in the development of government mandates, accrediting body guidelines, clinical partnering organizational protocol, and infection control procedures all aimed at reducing the spread of the Coronavirus. As a result, nursing faculty have had to evolve as well. In this rapid transition, nursing faculty have had to quickly learn and apply online course design, and have done so with unwavering student-centered dedication and astonishing speed. Even prior to the pandemic, nursing students had consistently reported high levels of anxiety, self-doubt, and stress during their nursing education programs. These feelings have only been magnified during these times of uncertainty and have also negatively impacted students’ sense of self-efficacy. However, nursing faculty have been instrumental in helping students to handle these recent losses and adapt to the new “normal.” Hence, nursing faculty interaction with students has “expanded” to include purposeful focused behaviors and strategies that not only encourage and support students, but also reduce their perceived stress and develop and sustain student self-efficacy through periods of great change and loss. The evolution of nursing faculty during this pandemic has been characterized by incredible resourcefulness, unrelenting dedication, and selfless compassion in how instruction is delivered, and in interactions with a diverse, multigenerational nursing student population at a deeper level of connectedness.

Introduction

Historically, nurses have served in a variety of different arenas from community-based and home care settings to acute and ambulatory care settings. To this end, within the highly specialized area of nursing education, and despite a shortage of qualified nurse educators, it has been the nursing faculty that have consistently prepared future nurses to continue the tradition of the provision of safe, quality nursing care and service.

Nursing education leadership and nursing faculty must respond to Boards of Nursing mandates, health care industry needs, and societal trends in shaping and revising curriculum and implementing teaching strategies to best meet the needs of an everchanging and diverse, multigenerational student population. However, with the arrival of the COVID-19 pandemic and its subsequent changes to daily life, nursing education leadership has had to make a number of unprecedented rapid changes in policy and procedure directly impacting faculty, students, and didactic, clinical, and skills laboratory instruction. Additionally, with COVID-19 as the impetus, there has been a constant ebb and flow in the development of government mandates, accrediting body guidelines, clinical partnering organizational protocol, and even infection control procedures all aimed at reducing the spread of the Coronavirus. As a result, nursing faculty have had to evolve as well.

Nursing Faculty Role Evolution

Traditionally, like most nurses, nursing faculty have worn many hats and have a number of very specific responsibilities unique to serving in an educational setting. It is important to note that according to the American Association of Colleges of Nursing (AACN) Fact Sheet: Nursing Faculty Shortage, the average age of nursing faculty ranges from 50.6-62.4 years dependent upon their level of academic preparation and rank held (AACN, 2019) [1]. Regardless of the type of academic program, or the level of educational destination (e.g., vocational, prelicensure, graduate, or doctoral), in addition to scholarly activity and service to the institution, one of the main responsibilities of nursing faculty to students is the facilitation and evaluation of learning and instructional delivery in the classroom, clinical, and/or online settings.

As a direct result of the current pandemic, the nursing faculty role has evolved and nursing faculty have had to make two very rapid changes in how students are served. These two obvious and immediate changes are: 1) how instruction is delivered; and, 2) how nursing faculty interact with students. These essential and necessary changes have re-emphasized the importance of the role of nursing faculty in nursing student success.

Instructional Delivery Transition

Although the use of technology has been quite commonplace in the nursing classroom, nursing skills laboratory, clinical site, and online learning environment, its frequency of use and how it is utilized have had to change. Prior to the pandemic, although not required, it was not unusual to find the use of technology and a variety of different software applications used to enhance learning in the nursing classroom setting. Software applications such as Kahoot! PowerPoint, Prezi, Socrative, and Whiteboards were widespread among nursing faculty.

In the clinical setting and in preparing nursing students for transition to the clinical setting, the use of mock electronic health records, interactive manikins, and low and high-fidelity simulation have become very popular in nursing education skills laboratories. In the online learning environment, seasoned online nursing faculty have been utilizing various learning management systems and e-learning platforms such as Blackboard, Canvas, and Moodle for years.

With social distancing requirements and in light of safety concerns for students and faculty, nursing programs around the country have opted to not only postpone most clinical rotations involving direct patient care assignments, but also on-campus classroom meetings. Creative options for both classroom instruction and clinical practice education that would be acceptable to Boards of Nursing, accrediting bodies, and industry were required almost overnight. Thereby, forcing the evolution of nursing faculty requiring no-choice in the use of technology and digital tools for both didactic and clinical instruction.

At the unified request of Deans of Nursing, Nursing Program Directors, and other nursing education program leadership, Boards of Nursing gave temporary approvals to methodically increase simulation instruction hours to meet on-site clinical practice hours. Yet, in spite of several researchers having documented nursing faculty resistance and barriers to the use of technology in the past [2-5], nursing faculty did not hesitate to rise to the occasion. Those nursing faculty that had not previously utilized simulation responded quickly by taking and completing courses on simulation in order to meet this need. Those nursing faculty that had previously utilized simulation volunteered to collaborate, mentor, and support their novice colleagues. For didactic instruction, experienced nursing faculty who had previously taught online would have little difficulty during the pandemic in meeting students’ learning needs in terms of the use of technology, setting up the online course, and facilitating the course. Conversely, nursing faculty that had either taught hybrid courses or nursing faculty that had taught only faceto- face courses who may have lacked digital literacy were instantly challenged with moving instruction to an online delivery model. In this rapid transition, these nursing faculty had to quickly learn and apply online course design, and have done so with unwavering student-centered dedication and astonishing speed. Subsequently, countless nursing faculty are now utilizing virtual classroom solutions like Adobe Connect, Google Classroom, Newrow Smart, WizIQ, and Zoom for the very first time.

Nursing Faculty and Student Interaction

Even prior to the pandemic, nursing students had already consistently reported experiencing high levels of anxiety, selfdoubt, and stress at different stages of various levels of nursing education programs [6-9]. These feelings plague nursing students whether they are new to an undergraduate prelicensure program, in the middle of their program, graduating seniors, or even studying at the graduate or doctoral levels. In spite of where the student is in their nursing education, these feelings have only been magnified during these times of uncertainty and have also negatively impacted students’ sense of self-efficacy. A positive, strong self-efficacy has been correlated to human accomplishment and maintenance of psychological well-being [10].

Adding to these feelings of anxiety and self-doubt, some nursing students may have never even taken an online course before this seemingly overnight mandatory transition to remote learning. However, one well documented constant significant to increasing nursing student self-efficacy and improving nursing student success is the positive and supportive relationship between nursing faculty and nursing students; and, this is especially critical in nursing students of color [11-12]. Therefore, how nursing faculty interact with students to manage such feelings and improve student’s selfefficacy has also had to evolve.

During this uncertain time, it clearly became the role of the nursing faculty to not only serve as the instructional guide and learning facilitator, but also to be a more obvious role model, mentor, and counselor for students both collectively and individually. Nursing students were now forced to deal with abrupt changes related to the added stress of classes moving online, alternate methods of clinical training, and in some cases delayed program completion. Yet, students have had very little time to grieve the loss of the way things were and adapt to these new stressful changes. There is a clear inverse relationship between nursing students’ perceived stress and self-efficacy, and these stressors compromise students’ self-efficacy and their ability to complete their educational program [13-14]. Thus, nursing faculty are instrumental in helping students to handle the losses and adapt to the “new normal.” Hence, nursing faculty interaction with students has expanded to include purposeful behaviors that not only encourage and support students, but also focused behaviors and strategies that reduce their perceived stress and develop and sustain student self-efficacy through periods of great change and loss.

These purposeful focused behaviors and strategies require more time and expediency than rendered under prior circumstances, and include providing exceptionally prompt feedback on course work, same day response times of less than 24 hours to email communications and discussion thread posts, using personal cell phones for text messaging, and offering expanded office hours several times per week at non-traditional times. Modeling behaviors such as empathy and flexibility as demonstrated by extending due dates for assignments, offering open-book quizzes, sharing extra resources at no cost to students, and providing opportunities for group projects and make-up exams help to show understanding and build trust with students. Additionally, appropriate self-disclosure and not being afraid to share vulnerability and humanness, especially during a crisis, promotes connectedness with students. Offering students authentic praise for their efforts, resiliency, perseverance, and steadfast determination positively reinforces the behavior expected of students, as well as decreases their stress while increasing their self-efficacy.

Conclusion

The evolution of nursing faculty during this pandemic has been characterized by incredible resourcefulness, unrelenting dedication, and selfless compassion in how instruction is delivered, and in interactions with a diverse, multigenerational nursing student population at a deeper level of connectedness. The outcomes have indeed re-emphasized the importance of the vital role nursing faculty play in ensuring nursing student success.

Although it may be too early to tell definitively, there appears to be an increase in student engagement, and an improvement in student learning and student satisfaction secondary to this evolution. Additionally, and, of clear equal importance, nursing faculty interactions with students have been more empathetic, genuine, and caring. Consequently, nursing student self-efficacy has been sustained as despite the unprecedented changes caused by this global health disaster, nursing students are staying the course and demonstrating that they indeed believe they can complete their education with the support of nursing faculty.

To read more about this article: https://irispublishers.com/ijnc/fulltext/the-evolution-of-nursing-faculty-during-unprecedented-times.ID.000557.php

For more  Open Access Journals in Iris publishers please click on: https://irispublishers.com/pdf/peer-review-process-iris-publishers.pdf