Creating Optimal Clinical Learning Environments Through Interprofessional Bedside Rounding Models: Lessons From the iPACE Story.

ABSTRACT: The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and implemented at Maine Medical Center in 2016 as part of the Accreditation Council for Graduate Medical Education's Pursuing Excellence in Clinical Learning Environments (CLE) demonstration project. The model is based on the belief that, in optimal CLEs, residents are trained in team-based, interprofessional collaborative care and use clinical care experiences to innovate in the areas of patient safety and quality of care. The model's inclusion of systems engineering principles, such as design thinking, allows teams to design, customize, and iteratively improve their own iPACE model.The iPACE model was further developed and disseminated with support from an American Medical Association Reimagining Residency grant and from the MaineHealth health system's medical education and clinical leadership. iPACE started as a small pilot project on a single inpatient unit and has evolved to become the standard for inpatient team rounds at the bedside. iPACE has received positive feedback from patients, demonstrated benefits to care team members and resident education, and proven its value to the health system through sustained reductions in length of stay and cost of care metrics. The iPACE project has fulfilled MMC's original goal of intentionally redesigning its CLEs to expose residents to high-functioning interprofessional teams with the goal of improving patient care and safety. The model has shown direct learner benefits through increased faculty observation and improved quality of feedback. Interprofessional bedside rounding models like iPACE have the potential to imprint learners with the skills and behaviors essential to provide collaborative patient-centered care. Strategies exist that improve resident and faculty engagement in bedside rounding models like iPACE and should be employed to encourage teaching and learning at the bedside.

Where Are We Now? A Follow-up Survey on Regulation of Simulation Use in United States Prelicensure Nursing Programs.

Background: Approval of simulation in substitution of traditional clinical hours increased in nursing programs during the COVID-19 pandemic, yet these temporary and inconsistent between states. Variability and a return to "pre-pandemic" limits on simulation use amplify questions about consistency of learner outcomes. Methods: Boards of Nursing (BONs) of the United States and District of Columbia (DC) were queried to verify accuracy of simulation regulations posted on the International Nursing Association for Clinical Simulation and Learning (INACSL) regulatory map and to identify factors contributing to regulatory changes. Results: Approximately half of respondents indicated information posted on the INACSL regulatory map is accurate for their state. Almost 30% of respondents indicated information is not accurate. Some states could not confirm accuracy of simulation regulations posted. Conclusions: Many nursing programs expanded the use of simulation during the COVID-19 pandemic. Reverting to "prepandemic" limited simulation use presents a missed opportunity to advance nursing education and align simulation regulation with the growing body of evidence supporting its outcomes.

Selective attentional processing to fall-relevant stimuli among older adults who fear falling.

Fear of falling is known to affect more than half of community-dwelling older adults over 60 years of age. This fear is associated with physical and psychological effects that increase the risk of falling. The authors' theory is that attentional processing biases may exist in this population that serve to perpetuate fear of falling and subsequently increase fall risk. As a starting point in testing this proposition, the authors examined selective attentional processing bias to fall-relevant stimuli among older adults. Thirty older adult participants (M(age) = 70.8 ± 5.8), self-categorized to be Fearful of Falling (FF, n = 15) or Non-Fearful of Falling (NF, n = 15) completed a visual dot-probe paradigm to determine detection latencies to fall-threatening and general-threat stimuli. Attentional processing was defined using three index scores: attentional bias, congruency index, and incongruency index. Bias indicates capture of attention, whereas congruency and incongruency imply vigilance and disengagement difficulty, respectively. Both groups showed an attentional bias to fall-threat words but those who were fearful of falling also showed an incongruency effect for fall-threat words. These findings confirm that selective attentional processing profiles for fall-relevant stimuli differ between older adults who exhibit fear of falling and those who do not have this fear. Moreover, in accordance with current interpretations of selective attentional processing, the incongruency effect noted among fall-fearful older adults presents a possibility for a difficulty disengaging from fall-threatening stimuli.

The functions of art-making in CISD with children and youth.

Very little has been written about the use of art materials in the debriefing process with young children apart from the familiar assumptions of increasing comfort in the situation and providing a more concrete way for young children to communicate. In this study, art-making was introduced as an integral, although optional, component of the debriefing process in order to examine more fully the functions of art-making in this context. This paper describes a research process and findings from a series of debriefings with four different groups of children and adolescents who had experienced either primary traumatic effects (i.e., were present during a traumatic event) or secondary traumatic effects (i.e., were impacted by a trauma that happened to someone else). The analysis of the artwork and of the comments of the participants are integrated within a theoretical framework combining ideas from the fields of art therapy and the treatment of trauma. From this analysis, there is a description of four functions of art-making in CISD with this population: (a) to increase comfort and emotional safety, (b) to promote expression of thoughts and feelings, (c) to enhance appropriate containment of emotion, and (d) to support ego-strengths. The primary contribution of this research is to offer a clear articulation of the rationale for the consistent use of art-making in CISD with children and youth, and to do so in a way that makes this option available for all debriefers, not just those who are trained as art therapists.