Joan Roche

Error identification and recovery by student nurses using human patient simulation: Opportunity to improve patient safety

This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance.

Human patient simulation: teaching students to provide safe care

The use of human patient simulation as a teaching methodology for nursing students has become popular. Using human patient simulation effectively demands paying careful attention to the details of the simulation, debriefing, and evaluation processes. Our experience in designing simulation experiences and evaluating student behaviors confirms the resource-intensive nature of human patient simulation and the need for clear, measurable objectives. When used properly, human patient simulation offers a unique opportunity to teach nursing students important patient safety principles.

Research regarding methods of assessing learning outcomes.

As the use of simulation-based assessment expands for healthcare workers, there is a growing need for research to quantify the psychometric properties of the associated process and outcome measures.

Perceptions on the Use of Telehealth by Homecare Nurses and Patients With Heart Failure: A Mixed Method Study

The purpose of this study was to explore perceptions on effectiveness of telehealth for Heart Failure (HF) management beyond the initial acceptance phase in a home care setting. Participants included 31 home care nurses for surveys, 9 nurses for focus groups and 4 patients with HF and the telehealth nurse for interviews. Telehealth was perceived to benefit by contributing objective assessments, timely information regarding patient status, a sense of security, and patient accountability. However, barriers to use of telehealth included inadequate staff training, lack of guidelines for client referrals and integration of telehealth in nursing workflow, lack of trust in equipment’s accuracy, and certain patient characteristics. The study exposed the role played by inadequate systemic guidelines and patient characteristics as factors affecting long-term use of telehealth for HF.

Using simulated clinical scenarios to evaluate student performance.

Given the high financial investment that nursing education programs make to incorporate high-fidelity simulation training, it is important to evaluate its usefulness in student learning and evaluation. Faculty developed an evaluation tool for simulated clinical scenarios, using both high- and low-fidelity modalities that delineated components and their relative weights, adapted to match the changing expectations for evolving novices. The authors discuss scoring, debriefing, and remediation.

Eye Tracking as a Debriefing Mechanism in the Simulated Setting Improves Patient Safety Practices

Introduction:Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. Methods:An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. Results:All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking–only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as “Compares patient stated name with name on ID band.” Conclusions:Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Intentionality and Hatha Yoga An Exploration of the Theory of Intentionality, the Matrix of Healing—a Growth Model

Hatha yoga increases self-awareness and well-being. Intentionality is creating motivation and then action. This qualitative study explored intentionality during hatha yoga sessions using narrative analysis. The results supported and expanded Zahoureks theory of intentionality, the matrix of healing, and provide new insights into intentionality in healing.

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

Background:Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. Purpose:The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele–home care. Methodology:A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. Results:The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Clinical Implications:Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis

BackgroundPatient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness.MethodsThis surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH.ResultsCompared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care.ConclusionsCompared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population.

The future of home and hospice care. Linking interventions to outcomes.

The pressure on home care and hospice nurses to reach successful outcomes in a cost-effective manner mandates that they become well versed in how to analyze data. The goal of outcome research is to relate patient outcomes to the interventions provided. This article discusses the challenges of outcomes research and how it differs from and relates to performance improvement, and it explores solutions to common problems.