Lynda Atack

Emergency Medical and Health Providers' Perceptions of Key Issues in Prehospital Patient Safety

Abstract Objectives. To date, most patient safety studies have been conducted in relation to the hospital rather than the prehospital setting and data regarding emergency medical services (EMS)-related errors are limited. To address this gap, a study was conducted to gain an in-depth understanding of the views of highly experienced EMS practitioners, educators, administrators, and physicians on major issues pertaining to EMS patient safety. The intent of the study was to identify key issues to give direction to the development of best practices in education, policy, and fieldwork. Methods. A qualitative study was conducted using processes described by Lincoln and Guba (1985) to enhance the quality and credibility of data and analysis. Purposive sampling was used to identify informants with knowledge and expertise regarding policy, practice, and research who could speak to the issue of patient safety. Sixteen participants, the majority of whom were Canadian, participated in in-depth interviews. Results. Two major themes were identified under the category of key issues: clinical decision making and EMSs focus and relationship with health care. An education gap has developed in EMS, and there is tension between the traditional stabilize-and-transport role and the increasingly complex role that has come about through “scope creep.” If, as expected, EMS aligns increasingly with the health sector, then change is needed in the EMS educational structure and process to develop stronger clinical decision-making skills. Conclusion. The results of this study indicate that many individual organizations and health regions are addressing issues related to patient safety in EMS, and there are important lessons to be learned from these groups. The broader issues identified, however, are system-wide and best addressed through policy change from health regions and government.

Development of an online, team-based programme in telecare

Few health-care providers have experience of delivering telecare and access to formal training is limited. We therefore developed an online training programme in telecare. A participatory design approach was used and telecare providers were invited to participate in each stage of the course design cycle. The course content, learning activities and learning materials such as video were based on the results of interviews with providers from various health disciplines and observations in the telecare workplace. The approach led to the development of a six-week, multimedia, online course for members of the health-care team. Participants were asked to review the prototype course for completeness and accuracy of content, quality of course design and the utility of learning activities. Overall feedback was favourable. Learners found the course content and learning activities helpful, and it met their needs. The learning material was then reviewed by a panel of experts and further revisions were made. Including providers in the development process led to the creation of a course that appears likely to improve the implementation and practice of telecare.

The Impact of Validated, Online Health Education Resources on Patient and Community Members' Satisfaction and Health Behaviour.

Objective: While access to health education information has become easier, the quality of information retrieved from the Internet varies considerably. In response to the need for accessible, quality health information that is tailored to meet individual patient needs, a patient education website, called PEPTalk, was developed. The site houses text and video material that has been validated by practicing clinicians. A study was conducted to examine patient and community members’ satisfaction with PEPTalk and the impact of the health education materials on their health behaviour. Community staff and health providers’ experiences with the new technology were also examined. Design and method: A descriptive study using surveys and interviews was conducted with 57 patients, community participants and clinicians living in a large Canadian city and First Nations communities in Northern Ontario. Results: Participants’ PEPTalk Satisfaction scores ranged from moderately to highly satisfied. Participants found the information presented on PEPTalk useful and relevant, had improved their knowledge of health, and in most cases, altered health behaviour. Clinicians and community staff who referred participants to the PEPTalk website reported that the site provided reliable, evidence-based information that they were comfortable sharing with their patients and community members. Conclusion: There is an emerging role for tools that provide tailored health education. The health provider’s role regarding interpretation, discussion and follow-up remains essential, and tools such as PEPTalk need to be part of an overall health education strategy.

Virtual gaming to develop students' pediatric nursing skills: A usability test

BACKGROUND As competition for specialty clinical placements increases, there is an urgent need to create safe, stimulating, alternative learning environments for students. OBJECTIVE To address that clinical gap, our team developed a virtual game-based simulation to help nursing students develop their pediatric nursing skills. DESIGN A usability study was conducted using the Technology Acceptance Model as a research framework. SETTING AND PARTICIPANTS The study was conducted at a community college and included nursing students, nursing faculty/clinicians and two gaming experts. METHODS The two experts evaluated the game using a heuristic checklist after playing the game. Participants engaged in a think-aloud activity while playing the game and completed a survey and interview based on the Technology Acceptance Model to explore ease of use and utility of the game. RESULTS We found a high degree of user satisfaction with the game. Students reported that they had learned about pediatric care, they had become immersed in the game and they were keen to keep playing. Several design changes were recommended. CONCLUSION Usability testing is critical in the early stages of simulation development and the study provided useful direction for the development team in the next stage of game development.

Simulation and Gaming to Promote Health Education: Results of a Usability Test.

Objective: Motivating clients to change the health behaviour, and maintaining an interest in exercise programmes, is an ongoing challenge for health educators. With new developments in technology, simulation and gaming are increasingly being considered as ways to motivate users, support learning and promote positive health behaviours. The purpose of the present study was to develop an exercise simulation called BringItOn, which is targeted towards individuals who need to increase their physical activity for health, recovery or rehabilitation. BringItOn is a video-based simulation in which individuals use a Kinect system to capture their movements as they exercise. Design: A usability study was conducted to examine software ease of use and perceived usefulness. An expert heuristic evaluation was completed by a software engineer, and user testing was conducted using the think-aloud method, observation, survey and interviews. Results: The majority of participants were very enthusiastic about the exercise simulation’s potential to encourage exercise and activity. Three major benefits of the simulation were identified: (1) it promotes proper exercise technique; (2) individualised feedback similar to that received from a personal trainer was viewed as very motivating; (3) the software was ‘game like’, and made exercising fun. Conclusion: The simulation system has considerable potential as a component in an integrated rehabilitation programme for patients or as a health promotion activity for individuals. The results shed light on key components that health educators should look for in simulations if they hope to maximise user motivation and encourage a positive changes in health behaviour.

Getting the right information to the table: Using technology to support evidence-based decision making

Healthcare executives report that it is difficult to access the research literature and once found, it is frequently not relevant. A study was conducted to explore ways in which healthcare executives, enrolled in the EXTRA program, used a virtual desktop environment. Despite some design and function limitations, the desktop was perceived positively by most participants and was effective in supporting evidence-informed practice and decision making.

Implementing Telehomecare: Process and issues from managers’ perspectives

An innovative telehomecare project was recently undertaken in East York, Toronto to deliver integrated, video-based remote care to patients with chronic illnesses. Research conducted with healthcare managers uncovered a number of key issues, including organizational readiness, recruitment, funding/reimbursement, clinical care, support and training and sustainability. The results of the study indicate that implementing telehomecare involves much more than adding equipment; it is about change management and care re-design.