Although some pre-licensure nursing programs now require use handheld devices retrieve and manage (Farrell & Rose, 2008; Williams & Dittmer, 2009), few researchers have studied nurse educators' perspectives about the use of handheld devices and support software in clinical teaching. The current pilot study explored the reported experiences of clinical instructors (CIs) after using Nursing CentralTM (NC), nursing-oriented software program (www.unboundmedicine.com/products) in clinical teaching. METHOD NC contains five electronic, quick reference guides (Taber's Medical Dictionary, Davis's Drug for Nurses, Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests, Davis's Diseases and Disorders, and Handbook of Nursing Diagnosis). It also enables online journal searching via Medline and the download of tables of content of favorite journals. Instrument A survey developed by the research team contains 23 Likert-rated items with responses ranging from 1 (strongly agree) 5 (strongly disagree). The items assessed experiences learning use NC (n = 3), of use (n = 5), ways NC was used (n = 6), and attitudes toward NC (n = 9). Two text boxes collected qualitative perspectives and comments. Sample To join the study, CIs met the following inclusion criteria: a) taught in third-year clinical practice, b) owned handheld c) emailed Unbound Medicine for trial NC at no charge, and d) used NC during at least one seven-week clinical rotation nursing students. After the trial period of use, study explanation and voluntary online survey were emailed participants for data collection. Ten Cls who met the criteria completed the voluntary survey. The participants ranged from 26 47 years of age (M = 39.8 years). The highest educational level for nine CIs was baccalaureate; one had graduate degree, and six were enrolled in graduate studies. The CIs had one 19 years of experience (M = 5.95 years). Four reported having beginner and six reported having advanced computer skills; no participant reported expert computer skill. Nine CIs reported their first use of NC during this study; eight reported using handheld device for six months. RESULTS Quantitative Findings Mean responses for 14 items were greater than 4.0, with the overall mean 4.26. (See Table.) Scores for items related learning use NC were high (M = 4.97). For example, CIs reported being confident and glad they learned use Scores for perspectives on of use were positive (M = 4.17) but there was range of responses. While CIs rated both use of NC (M = 4.6) and finding information (M = 4.5) easy, scores were lower for ease of downloading (M = 3.63) and taking longer than expected learn use the software (M = 3.86). These scores suggest that some CIs experienced challenges in setting up NC. CIs were found use NC to get for clinical teaching (M = 4.4). Although they advised use the Davis Drug Guide (M = 4.5), CIs were less likely access NC answer questions of other health care professionals (M = 3.9). CIs demonstrated relatively high agreement that they will continue use NC in clinical teaching (M = 4.1) and that NC may prevent medication errors (M = 4.0). Means were lower for preference for NC over traditional textbooks (M = 3.8). Qualitative Findings The text box comments reflected benefits and pitfalls of using NC in clinical teaching. One CI noted that students had purchase handheld device, but was surprised see how many already owned one. One CI cautioned that NC is a great resource for quick things but does not have the depth...to have good understanding of diagnosis... Still need have the textbooks. Another described Diseases and Disorders as the most ineffective resource, as it rarely gave me the about the keyword that I would use. …
In this paper, we draw on the authors' collective experiences as qualitative researchers undergoing research ethics reviews. We highlight specific areas within our standard national guidelines that support qualitative research. Using case examples, we illustrate how diverse interpretations of these guidelines can be inconsistent and problematic for qualitative researchers. We outline recommendations for transparency, reciprocity, and streamlining of the review process. It is our hope that adoption of these recommendations will lead to a more collegial evaluative process, thereby contributing to the advancement of knowledge.
ABSTRACT Objective: The objective of this scoping review was to examine and map the literature on defining and assessing nursing informatics competencies for nurses and nursing students. Introduction: Over the past three decades, nursing informatics competency research has evolved markedly within countries and nursing roles. It is important to examine the available literature on defining and assessing nursing informatics competencies to inform education, clinical practice, policy, and future research. Inclusion criteria: We considered literature that defined or assessed the concept of nursing informatics competency as a combination of knowledge, skills, and attitudes. This included nursing informatics competencies of nurses and nursing students in a variety of health care or academic settings. Methods: An extensive search was conducted in Ovid MEDLINE, CINAHL Plus with Full Text via EBSCO, Ovid Embase, Ovid PsycINFO, ProQuest ERIC, Health and Psychosocial Instruments, ProQuest Australian Education Index, ProQuest Education Databases, ProQuest Dissertations and Theses Global, OCLC PapersFirst, Scopus, Web of Science Core Collection, Wiley Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports. The initial search was conducted in May 2017 and updated several times. Nursing informatics websites were searched for gray literature, including unpublished research and organizational documents. Additional papers were identified based on a search of reference lists of all the included papers. Neither language nor date restrictions were applied. Two reviewers assessed each of the included papers independently. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives. Results: Fifty-two papers were included. Thirty-four papers identified nursing informatics competencies, grouped into four categories: i) nursing informatics competencies for students, entry-level nurses, or generalist nurses; ii) nursing informatics competencies for a specific nursing role; iii) recommendations for consensus on defining core nursing informatics competencies at the international level; and iv) forecasting future nursing informatics competencies as per evolving nursing roles. Eighteen papers reported on nursing informatics competency assessment tools. Results were discussed in a narrative format supported by tables. Conclusions: This review provided insights to the state of the science on defining and assessing nursing informatics competencies for nurses and nursing students. Several nursing informatics competency lists are available, and despite some variations in domains of nursing informatics competency and indicator statements, they mostly share common themes. This literature demonstrates a heightened awareness of the importance of nursing informatics competency; however, the availability of many lists may be challenging for frontline nursing staff, nursing educators, administrators, researchers, and students to assimilate. Further research is needed to reach a consensus on core domains of nursing informatics competency and associated indicators, preferably per nursing roles, with international involvement and consensus. Additionally, while many nursing informatics competency assessment tools exist, further research is needed to examine psychometric properties of some of these tools.
Simulation-enhanced interprofessional education (sim-IPE) is a growing component of undergraduate health curricula, preparing learners for the practice environment and, in doing so, redefining practice culture. The Canadian Interprofessional Health Collaborative (CIHC) has established a national competency framework of integrative competency domains focused on fostering core skills, attitudes, and values in an effort to evolve interprofessional collaboration (IPC). This framework serves as the foundational underpinning for IPE within all health professions. Partnering for Patti is a sim-IPE experience collaboratively developed by faculty from Bachelor of Nursing and Respiratory Therapy programs within two Atlantic institutions leveled for third-year nursing and respiratory therapy students. This event provides an opportunity for participants to enhance their knowledge of the six CIHC IPE domains, and improve their understanding of and appreciation for IPC. Within this context learners must work together, and rely on the expertise of both professional groups to critically think through and improve a declining client scenario. Once complete, debriefing and reflective journaling help participants solidify learning and deduce new frames of understanding. It has been hypothesized that this event enhances student knowledge of CIHC IPE domains, and creates a deeper appreciation for, and understanding of IPC. The primary objective of this research was to determine if participants' understanding of CIHC IPE domains improved, and if perceptions of their own and the other profession were reframed as a result of this innovation.This article describes the educators' approach in setting up and delivering this learning experience and the results of this event through students' perceptions. This cross-sectional study used a descriptive mixed-methods design. Two data collection tools were used to explore changes in participants' perceptions and event feedback.Data analysis found that the majority of participants identified value in this IPE learning experience. Qualitative and quantitative findings suggest participants developed a deepened appreciation for IPC and an improved understanding of the CIHC IPE competency domains.The evaluative findings of this study support the value of Partnering for Patti as a novel IPE learning experience. Although it is unclear to what degree objectives were met, findings strongly support continued integration of this learning experience.
Review question/objective The overall objective of this systematic review is to synthesise the best available evidence on the experiences, beliefs, opinions, and desires of patients, families and nurses with regard to patient presence during hand-off reports. In meeting this objective, this review will consider the following review questions: 1.What are the expressed experiences of patients, families and nurses about patient presence during hand-off reports? 2.What do patients, families, and nurses believe are the advantages and disadvantages of patient presence during hand-off reports? 3.What are the circumstances that influence (prevent or allow) patient and family involvement in hand-off reports? 4.How much involvement in hand-off report do patients and families desire? Background The importance of hand-off reports in the delivery of patient care is reflected by the attention they are given within the literature, increasingly so in recent years. The World Health Organization (WHO)1 tells us that “underestimated is the handing over of patient information from an outgoing provider to an incoming one” (p. 66). In addition, a 2005 survey by the Joint Commission2 found almost 70% of sentinel events were the result of communication errors, including those that occur during hand-off reports. The heightened interest in exploring hand-off report processes may be due, in part, to changing workflow practices within health care environments3, furthering awareness of the role of communication in promoting patient safety4, and the need to ensure efficient use of limited health care resources5. Although many researchers identify hand-off reports as a necessary practice6, 7, 8, an alarming and consistent finding is that current approaches to hand-off reports may not be an efficient use of nurses' time and may actually compromise patient safety9, 10, 11. Nurses working in hospitals typically begin their shifts with a hand-off report, an activity that can occur up to four times in a 24 hour period. The purpose of hand-off reports is to share pertinent information about patients on a particular hospital unit. The data shared generally include information about diagnosis, age, patients' current condition, other health care professionals involved in the care, and any new or pending procedures12, 3, 10. The process for hand-off reports varies within and between institutions and nursing groups. Some of the more typical methods consist of taped-recorded reports, written reports, and face-to face communications between nurses and other health care professionals; all of which regularly occur at the time of shift change, specifically between health care professionals finishing their shift and those just starting. In recent years, various forms of technology have been used to facilitate hand-off reports13 and although such tools may be helpful they add another dimension to an already complex and controversial process. Irrespective of the method used to perform hand-off reports, it is questionable if the input of patients and families is considered during information exchanges. Research over the last 40 years shows that hand-off reports may actually threaten patient safety. Richard 14 noted a number of significant problems with the sharing of information during nurse hand-off reports. These include the omission of essential information and the sharing of information incongruent with patients' actual conditions. Safety is compromised when critical pieces of data pertaining to patients' care are not sufficiently transferred from one provider to another15, 16, 17, 18, 19, 14, 8, 20. Safety is also compromised when too much time is spent away from patients in order to convey information that could be deemed irrelevant or unnecessary to share during a report. Needleman and colleagues5 report hand-off reports consume up to 15% of nurses' work while Ekamn 21 found 38% of nurses' time is spent on the exchange of information. These errors can be potentially fatal and are linked to the reliance on the practitioners' recall16, 18, 19. Time spent in hand-off reports is costly, and takes valuable time away from providing direct patient care 22. As much as 93.5% of information shared during hand-off reports is readily accessible within patients' health records, care plans, or other data sources23, 13, 24, 22, 25, 26. Considering the demands placed on practitioners' time, these findings raise questions about the value of lengthy hand-off reports. More importantly, the question of how to maximise value within hand-off processes remains unanswered. A systematic review by Cohen and Hilligoss27 concludes that although hand-off reports in hospitals are highly complex and time consuming, they are essential in the delivery of safe and efficient patient care. In general, controversy about the approach to hand-off reports is significant and ongoing3. A recent systematic review by Poletick and Holly10 also questions the quality of information exchange between nurses, finding several problematic practices within hand-off report processes. According to Poletick and Holly10, nurses' communicative behaviours are not grounded upon best practice guidelines but rather a reliance on the familiar or ritualistic/habitual norms. While acknowledging the lack of a consistent approach and the multiple modes of communications (verbal, written, electronic) used during hand-offs in acute care hospitals, identifying the most appropriate and safest approach to hand-offs was beyond the scope of this review. Given that Poletick and Holly call for a consistent format and approach to hand-offs, there is a need to build on their work by examining the research on specific hand-off report approaches, and the inclusion of patients and families in the process. Both WHO1 and the Joint Commission28 concur, with the former calling for greater patient involvement in their own health care and the latter urging both patients and families to participate actively in information exchanges amongst practitioners. Patients and families offer invaluable and underutilised information about their health status. It is at the moment of hand-off reports where nurses, patients and their families may be brought together to engage in information exchanges. Research shows patients involvement in their health care is linked to improved health outcomes and enhanced patient safety29. A systematic review by Schwappach30 found overall support for patients assuming a more active role in their health care, particularly in those aspects of their care that are presumed to be routine, such as the transmission of their health information. Findings also show that patients are more willing to be engaged in their care if they feel supported by members of the health care team. This systematic review does not question the significance of hand-off reports or the prevailing concerns that are known to jeopardise both patient safety and the efficient use of time. The main objective of this review is to further refine what is known about patient and family presence during hand-off reports. The Cochrane and Joanna Briggs Institute (JBI) libraries of systematic reviews were searched finding no previous systematic reviews on this topic, either published or identified as being underway. The omission of a systematic review on patient presence during nurses' hand-off reports is a gap in the literature and is contrary to the notion of patient engagement. Since the most alarming challenges are identified within hospitals, namely acute care settings, the focus of this systemic review is to analyse research that is relevant to hand-off reports in this context. In addition, since nurses are the largest group of health care professionals, delivering a significant portion of patient care in hospital environments31, nursing will be the discipline that is analysed within this systematic review. A systemic review of the viewpoints of nurses, patients and family members on patient presence during hand-off reports will help health care professionals, including nurses, refine hand-off report practices. Such changes may subsequently provide more meaningful and comprehensive information exchanges which, in turn, could potentially improve patient-care delivery outcomes. Inclusion criteria Types of participants The review will consider studies that include patients, families, and nurses' experiences of patient presence during hand-off reports, or patients, families, and nurses' beliefs, opinions, and desires related to patient presence during hand-off reports. All patients will be included regardless of age, health condition, reason for the hospital admission, or experiences with hand-off reports. Families will include any individual or group identified as family within the materials under review. Nurses will include all licensed nurses including registered nurses, practical nurses, nursing assistants, nurse researchers, and advanced practice nurses. Studies and texts presenting emergency department and operating room settings will be excluded. The former, because they may not include patients that are admitted to hospital, and the latter, due to the level of consciousness. Types of intervention(s)/phenomena of interest The qualitative component of this review will consider studies that investigate the experiences of patients, families and nurses pertaining to patient presence during hand-off reports. The quantitative component of the review will include surveys of beliefs, opinions, views that answer review questions two, three and four. The textual component of this review will consider publications that describe the experiences, beliefs, opinions, views of patients, families and nurses of patient presence during hand-off reports. For this systematic review hand-off reports are defined as transfer of information amongst health care providers between shifts. Patient presence is defined as hand-off reports that transpire while the patient is in attendance. Types of studies The qualitative component of this review will consider qualitative evidence including, but not limited to ethnography, hermeneutics, phenomenology, grounded theory, narrative inquiry, and action research. The quantitative component of the review includes surveys of beliefs, opinions, views that answer review questions two, three and four. The textual component of the review will consider expert opinion, discussion papers, position papers and other text. Search strategy The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilised in this review. An initial limited search of MEDLINE and CINAHL will be undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all included databases.Third, the reference list of all identified reports and articles will be searched for additional studies. Studies published in English will be considered for inclusion in this review. Studies published in any year will be considered for inclusion in this review. The databases to be searched include: CINAHL Cochrane Library Embase Google Scholar Health Source: Nursing / Academic Edition Knowledge Network Scotland MEDLINE ProQuest Nursing and Allied Health Source PsycINFO PubMed Science Direct Scopus Web of Science The search for unpublished studies will include: Google Mednar New Zealand Nursing Research Database OAIster ProQuest Dissertations and Theses science.gov Scirus Theses Portal Canada Virginia Henderson International Nursing Library Initial keywords to be used will be: handoff (and its variants: handoffs; hand-off; hand-offs; hand off; hand offs) handover (and its variants: handovers; hand-over; hand-overs; hand over; hand overs) signoff (and its variants: signoffs; sign-off; sign-offs; sign off; sign offs) shift report (and its variant: shift reports) bedside report (and its variants: bedside reports; bed-side report; bed-side reports) nursing report (and its variants: nursing reports; nurse report; nurse reports) patient room (and its variants: patient's room; patients' rooms) patient bedside (and its variants: patient's bedside; patients' bedsides; patient's bed-side; patients' bed-sides) patient attitude (and its variants: patient's attitude; patients' attitudes) patient perspective (and its variants: patient's perspective; patients' perspectives) patient view (and its variants: patient's view; patients' views) patient centered care (and its variant: patient centred care) family attitude (and its variants: family attitudes; attitude(s) of the family) family perspective (and its variants: family perspectives; perspective(s) of the family) patient view (and its variants: patient's view; patients' views) point of view (and its variant: points of view) family centered care (and its variant: family centred care) consumer participation Assessment of methodological quality Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Quantitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Textual papers selected for retrieval will be assessed by two independent reviewers for authenticity prior to inclusion in the review using standardised critical appraisal instruments from the JBI Narrative, Opinion and Text Assessment and Review Instrument (JBI-NOTARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. Data collection Qualitative data will be extracted from papers included in the review using the standardised data extraction tool from JBI-QARI (Appendix II). Quantitative data will be extracted from papers included in the review using the standardised data extraction tool from JBI-MAStARI (Appendix II). Textual data will be extracted from papers included in the review using the standardised data extraction tool from JBI-NOTARI (Appendix II). Data synthesis Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings (Level 1 findings) rated according to their quality, and categorising these findings on the basis of similarity in meaning (Level 2 findings). These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesised findings (Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form. Quantitative papers will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Textual papers will, where possible, be pooled using JBI-NOTARI. This will involve the aggregation or synthesis of conclusions to generate a set of statements that represent that aggregation, through assembling and categorising these conclusions on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesised findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the conclusions will be presented in narrative form. Conflicts of interest No conflict of interest.
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