Sarah Thompson

From professional silos to interprofessional education: campuswide focus on quality of care.

Objectives The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration. Methods Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning. Results Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience. Conclusion This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

Using "Think Aloud" to capture clinical reasoning during patient simulation

Abstract Think Aloud (TA), a strategy in which subjects are instructed to verbalize thoughts as they occur while completing an assigned task, was integrated into a study of clinical reasoning during high fidelity patient simulation by baccalaureate nursing students. TA methods in nursing education research with patient simulation have not previously been reported. Concurrent TA (verbalization of thoughts in short-term memory) and retrospective TA (reflective thoughts verbalized during an immediate post-simulation interview) methods facilitated the collection of rich and meaningful data. Students demonstrated distinct patterns in verbalization during concurrent TA, including public and private thoughts, narration of care, and the use of the pause to facilitate clinical reasoning. Retrospective TA data provided rich descriptions of reflection-on-action. TA provides a rich source of data regarding clinical reasoning as experienced by the baccalaureate nursing student during high fidelity patient simulation.

Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Embracing quality and safety education for the 21st century: building interprofessional education.

The education of health professions students is rooted historically in time-honored and silo-bound traditions of pedagogy and content not easily influenced by outside forces. However, the quality chasm work of the Institute of Medicine, Institute of Healthcare Improvement, Quality and Safety Education for Nurses, and other groups has led to a remarkable willingness to change at one academic health sciences university. This article describes one universitys strategies, challenges, and successes in delivering interprofessional educational programs. Four interprofessional learning activities, developed using a plan-do-study-act model and focused on teamwork, quality, and safety, are presented. Challenges and successes encountered are described as well as a curricular framework to enhance sustainability.

A New Model for Long-Term Care: Balancing Palliative and Restorative Care Delivery

ABSTRACT Nursing homes have been mandated to maintain or promote the physical and psychological functioning of residents since the enactment of the 1987 Omnibus Reconciliation Act. Although this restorative approach to care has improved outcomes for some residents (Institute of Medicine, 2001), it ignores the reality that all permanently placed residents will die. A new model for long-term care, one that includes a simultaneous restorative and palliative approach to care delivery, is proposed. Palliative care principles provide a guiding framework for changing care delivery. Basic tenets, such as resident and family viewed as a unit of care, interdisciplinary teamwork, and interdisciplinary plans of care, provide a basis for specific operational suggestions. Operational strategies, such as psychosocial and spiritual support for family, resident decision making and participation in goal setting, expertise in aggressive pain and symptom control, and bereavement services following resident death, are described.

Policy Issues in End-of-Life Care

The purpose of this policy brief is to bring attention to the urgent systems-level matters that impede progress in improving end-of-life care in the United States. Despite advances in care of the dying over the last 20 years, many recalcitrant system-level barriers prevent high-quality end-of-life care that is consistent with clinical and ethical standards and reasonably adheres to patient and family wishes for care and compassion. A major barrier is the orientation of health care toward rescue medicine despite the fact that most deaths today result from long-standing chronic disease. Recommendations for policy changes are suggested, and nursings role in advocating for policy change is explored.

A measure of palliative care in nursing homes.

CONTEXT Efforts to improve care for nursing home residents stand to be enhanced by measures to assess the degree to which staff provide palliative care. As the incidence of death in nursing homes increases with the aging population, the gap in measurement must be addressed. To that end, we report the development and psychometric testing of a nursing home palliative care survey. OBJECTIVES The purpose of this study was to evaluate the psychometric properties of the Palliative Care Survey (PCS) for use in nursing homes. METHODS Psychometric evaluation of the instrument was completed in two phases. Phase 1 focused on individual item analyses and subsequent revision or deletion of items, and Phase 2 evaluated evidence for reliability and validity. Phase 1 included 26 nursing homes and staff (n=717), and Phase 2 included 85 nursing homes and staff (n=2779). Data were analyzed using item-total correlations, Cronbachs alpha, confirmatory factor analysis, and analysis of variance. RESULTS Support was obtained for a 51-item PCS made up of two constructs, Palliative Care Practice and Palliative Care Knowledge. CONCLUSION The PCS measures the extent to which the nursing home staff engage in palliative care practices and have knowledge consistent with good end-of-life care. Both practice and knowledge are an essential foundation to providing good end-of-life care to nursing home residents. Efforts to improve care for the dying in nursing homes have been slowed by an absence of measurement tools that capture care processes, a gap that the PCS reported here helps fill.

Symptom occurrence and associated clinical factors in nursing home residents with cancer.

Little is known about the factors that contribute to symptoms in nursing home residents with cancer. We compared rates of symptoms in residents with (n = 1,022) and without cancer (n = 9,910) and examined physiologic, psychologic and situational factors potentially related to symptoms in residents with cancer. Pain, shortness of breath, vomiting, weight loss, and diarrhea were significantly (p < .05) more prevalent in residents with cancer. Cancer treatments, comorbid illnesses, and situational factors were not consistently correlated with symptoms. Improved symptom control was especially needed for the 30% of residents with cancer who clinically deteriorated within 3 months of admission; physical dependence and deteriorating clinical status were associated with pain, shortness of breath, and weight loss.

Cue recognition by undergraduate nursing students: an integrative review.

Patients express multiple cues, ranging from subtle to overt. Clinical cues may signal changes or the presence of stability in the patients condition. Little is known about the number and types of cues recognized by beginning nurses. This article reports the results of an integrative review of the literature published between 1964 and 2013 concerning recognition of clinical cues by undergraduate nursing students. Search terms included cue, cue recognition, clinical cue, and clinical reasoning. Twenty-seven studies met inclusion criteria. Initial evidence exists of differences in cue recognition between novice and expert nurses. Influences on cue recognition include familiarity with the patient or the patients health condition. Cue recognition does not necessarily predict presence or quality of nursing actions. International research concerning cue recognition by nurses is in its infancy. Opportunities exist to further the science through use of rigorous design and multisite sampling.

Student-Perceived Influences on Performance During Simulation.

BACKGROUND Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing. METHOD This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data. RESULTS Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance. CONCLUSIONS More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].