Beverly A. Williams

A systematic review of selected evidence on improving knowledge and skills through high-fidelity simulation

A systematic review of the evidence published between 2000 and 2010 was undertaken using the following databases: CINAHL, ProQuest, MEDLINE, Science Direct, OVID and Chinese Academic Journal. Empirical studies determining the effects of high-fidelity simulation on knowledge and skills in nursing or medical education were considered. As a result, nine English and seventeen Chinese studies were retrieved. They included sixteen randomized controlled trails (RCTs), one nonrandomized-controlled trial, and nine quasi-experimental studies. The high-fidelity simulation did enhance the scores on knowledge and skill exams but its contribution to objective structured clinical evaluation is mixed. The majority of reviewed RCTs are of low methodological quality. It is necessary to conduct additional RCTs with larger sample sizes to determine whether performance can be enhanced by high-fidelity simulation.

Measuring Health Literacy in Individuals With Diabetes A Systematic Review and Evaluation of Available Measures

Objective. To identify instruments used to measure health literacy and numeracy in people with diabetes; evaluate their use, measurement scope, and properties; discuss their strengths and weaknesses; and propose the most useful, reliable, and applicable measure for use in research and practice settings. Methods. A systematic literature review was conducted to identify the instruments. Nutbeam’s domains of health literacy and a diabetes health literacy skill set were used to evaluate the measurement scope of the identified instruments and to evaluate their applicability in people with diabetes. Results. Fifty-six studies were included, from which one diabetes-specific (LAD) and eight generic measures of health literacy (REALM, REALM-R, TOFHLA, s-TOFHLA, NVS, 3-brief SQ, 3-level HL Scale, SILS) and one diabetes-specific (DNT) and two generic measures of numeracy (SNS, WRAT) were identified. These instruments were categorized into direct measures, that is, instruments that assess the performance of individuals on health literacy skills and indirect measures that rely on self-report of these skills. The most commonly used instruments measure selective domains of health literacy, focus mainly on reading and writing skills, and do not address other important skills such as verbal communication, health care system navigation, health-related decision making, and numeracy. The structure, mode, and length of administration and measurement properties were found to affect the applicability of these instruments in clinical and research settings. Indirect self- or clinician-administered measures are the most useful in both clinical and research settings. Conclusion. This review provides an evaluation of available health literacy measures and guidance to practitioners and researchers for selecting the appropriate measures for use in clinical settings and research applications.

A comparison of competencies between problem-based learning and non-problem-based graduate nurses.

Competence is essential to ensuring safe, ethical and legal nursing practice. Various teaching strategies are used in nursing education in an effort to enhance graduate competence by bridging the gap between theory learned in the classroom and professional practice as a nurse. The objective of this comparative descriptive research was to determine if there was a difference in self reported competence between graduates from PBL and non PBL (NPBL) nursing programs. A convenience sample of 121 graduate nurses in one Canadian province, who had been practicing for at least 6 months took part in the study. The researcher designed questionnaire included both forced choice and open ended questions. There was no statistical significance difference between the PBL and NPBL graduates on self reported entry-to-practice competence. However, several significant themes did emerge from the answers to open ended questions which asked graduates how their nursing programs prepared them to meet the entry-to-practice competencies and what program improvements they might suggest. Unlike the NPBL graduates, the PBL graduates identified the structure and process of their programs as instrumental in their preparation to meet the entry-to-practice competencies. PBL graduates associated their abilities to think critically and engage in self-directed evidence-based practice as key to enabling them to meet the competencies. A common theme for program improvement for both PBL and NPBL graduates was a request for more clinical time.

Chronic disease self-management for individuals with stroke, multiple sclerosis and spinal cord injury

Purpose. The purpose of this study was to explore the experience of people with neurological conditions who take the chronic disease self-management (CDSM) programme. The CDSM programme is used to teach skills to manage chronic conditions, and prevent secondary conditions. Few studies have explored the use of the CDSM programme with people with neurological conditions, in spite of the long standing and sometimes unpredictable nature of those conditions. Method. This qualitative study explored the experience of people with stroke, multiple sclerosis (MS) and spinal cord injury (SCI) who participated in the CDSM programme. We completed individual interviews using a semi-structured interview guide with 22 individuals with stroke, MS and SCI. Results. Five categories emerged from the interview discussions including: (1) pre-programme influences; (2) group; (3) factors affecting learning opportunities; (4) workshop content and (5) outcomes. Conclusions. The results of this study provide insights regarding the optimal way to present the CDSM programme to people with neurological conditions.

Knowledge of urinary incontinence among Chinese community nurses and community-dwelling older people

The purpose of this study was to describe knowledge of urinary incontinence among community nurses and community-dwelling older people in China. The descriptive study was undertaken in 2007 using a cross-sectional research design. A random sampling method was used to recruit 100 Chinese older people and 100 Chinese nurses in JinShan and NanHui communities, Shanghai, China. All participants completed all items of a demographic survey and the Urinary Incontinence Knowledge Scale (UIKS). Based on the literature, the UIKS was developed in 2007. The value of content validity index tested by five experts was 0.75. Measures of internal consistency (Kuder-Richardson formula 20) were 0.72 for the community nurses and 0.69 for the older people. The UIKS consisted of 30 items with dichotomous choices (Correct = 1; False or Do not know = 0). The mean UIKS score of the nurses (mean 20.7, SD 3.5) was significantly higher than that of the older people (mean 13.4, SD 4.0) with a 95% confidence interval for difference in means 6.3-8.4 (t = 13.84; df = 198; P < 0.001). Although community nurses had moderate knowledge of the impact of incontinence, they still lacked knowledge of risk factors, symptoms, prevention, treatment, and management. Older people had poor knowledge about risk factors, symptoms, impact, prevention, treatment and management of urinary incontinence. Because of their knowledge deficits, community nurses and older people viewed urinary incontinence as a normal part of the ageing process. The findings suggested that both nurses and older people in the community had educational needs related to the incontinence. Further studies to develop specific educational programmes concerning urinary incontinence are suggested. Ways to enhance support and acceptable forms of specific content knowledge, process measures and regulatory enforcement require additional exploration.

Attitudes toward urinary incontinence among community nurses and community-dwelling older people.

PURPOSE: The purpose of this study was to describe attitudes toward urinary incontinence among nurses and community-dwelling older people. SUBJECTS AND SETTING: Random samples of 100 community-dwelling persons older than 60 years and 100 nurses practicing in community health service centers were invited to participate in the study set in Shanghai, Peoples Republic of China. DESIGN: A descriptive cross-sectional design was used to gather self-report data for this study. INSTRUMENTS The UI Attitude Scale (UIAS) was used to measure attitudes toward UI. RESULTS The response rate was 100% for all groups. Most respondents indicated that family support was important in dealing with UI (98% nurses, 83% older people), and UI is preventable (63% nurses, 56% older people). Nurses were more likely to perceive that UI can be effectively treated (92% vs 76% older people, P 5 .002), managed (91% vs 76% older people, P 5 .004) and hinders social interactions (88% vs 73% older people, P 5 .007) than community-dwelling adults. Older persons were more likely to perceive UI as shameful (32% vs 6% nurses, P 5 .000), their own fault (44% vs 4% nurse, P 5 .000), and frustrating to be taken care of (54% vs 15% nurses, P 5 .000). Older persons with UI were more unwilling to talk about incontinence (45% vs 17% nurses, P 5 .000), and more often considered UI not serious enough to warrant treatment (29% vs 2% nurses, P 5 .000). CONCLUSION: The findings indicated a greater need for community education program on UI among community nurses and older people in China. Strategies to alter attitudes toward UI should be explored.

Health Literacy and Nurses’ Communication With Type 2 Diabetes Patients in Primary Care Settings

BackgroundThe use of the interactive communication loop has been recommended as an effective method to enhance patient understanding and recall of information. ObjectiveThe aim of the study was to examine the application of interactive communication loops, use of jargon, and the impact of health literacy (HL) when nurses provide education and counseling to patients with type 2 diabetes in the primary care setting in Alberta, Canada. MethodsEncounters between nurses and patients with type 2 diabetes were audio recorded, and a patient survey including a HL measure was administered. Topics within each interaction were coded based on five key components of the communication loop and categories of jargon. ResultsNine nurses participated in this study, and encounters with 36 patients were recorded. A complete communication loop was noted in only 11% of the encounters. Clarifying health information was the most commonly applied component (58% often used), followed by repeating health information (33% often used). Checking for understanding was the least applied (81% never used), followed by asking for understanding (42% never used). Medical jargon and mismatched language were often used in 17% and 25% of the encounters, respectively. Patients’ HL did not materially affect patterns of communication in terms of using communication loops; however, nurses used less jargon and mismatched words with patients with inadequate HL. DiscussionThe overuse of medical jargon accompanied with underuse of communication loop components jeopardizes patients’ comprehension and retention of information that they need to know to properly self-manage their diabetes. Nurses need to develop more effective ways to communicate concepts critical to chronic diabetes self-care education and management.

Perceptions About Self-Management Among People with Severe Asthma

Aim. The purpose of this study was to explore the perceptions about self-management among people who were being followed up in a severe asthma clinic by asthma specialists for confirmed, overall severe asthma. Such insight informs how best to tailor programs for this difficult to treat patient population. Method. In-depth tape-recorded interviews of eight adults with severe asthma were transcribed and analyzed for salient themes using content analysis. Results. To self-manage their illness, over time participants sought asthma information from a variety of sources that they often viewed as inadequate due to lack of scope and or plain language. The most valued sources of asthma information were encountered after referral to an asthma specialist and were health professionals and a pulmonary rehabilitation program. Conclusion. There is a need to examine the content of asthma information sources for their relevance to and influence on the behavior of patients with severe asthma.

Decision-making and evidence use during the process of prenatal record review in Canada: a multiphase qualitative study

BackgroundPrenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada.MethodsPhase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2.ResultsPrenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications.ConclusionsDecision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.

The influence of undergraduate education on professional practice transition: A comparative descriptive study

BACKGROUND Graduates from Problem/Context Based Learning (CBL) undergraduate nursing programs often express concern that they may not be as well prepared for transition to graduate nursing practice as their colleagues from more traditional lecture-based programs. AIMS To determine if there is a difference in how graduates from CBL and non-CBL programs describe their transition to graduate practice within the first 2 years of graduation. METHODS This was a comparative descriptive study that involved the use of a web-based survey. A convenience sample of 163 graduate nurses with 1 to 2 years of experience consented to be part of the study. They completed a researcher-designed questionnaire, which consisted of 26 items based on entry to practice competencies identified by the provincial professional nursing organization. RESULTS There was no significant difference in the transition experience of graduates from CBL and traditional education programs within their first 2 years following graduation. These results confirm the findings of authors who compared transition among CBL and non-CBL graduates who had graduated anywhere from six months to several years following graduation. CONCLUSIONS It is clear that CBL programs do prepare graduates to successfully transition into graduate nurse practice. Graduates from both CBL and non-CBL programs indicated a need for more formal agency sponsored orientation and transition assistance programs at the beginning of their initial employment.