Paramedics' experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study.

BACKGROUND: Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases. METHODS: This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers. RESULTS: Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers. CONCLUSIONS: This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

Supporting learners in prison healthcare work-integrated learning settings through simulation: a cross-sectional study.

BACKGROUND: Nursing students and nurse preceptors indicate that a comprehensive orientation is vital to successful work-integrated learning placements in Prison Health Services. The aim of this study was to implement and evaluate a Prison Health Service orientation package that included innovative asynchronous online video simulations with branched decision-making and feedback opportunities to stimulate learning and improve students' feelings of preparedness for a placement in this setting. METHODS: A cross-sectional pre and post design was used to evaluate the resource. Students were given access to the package and invited to complete a pre-placement survey evaluating the resource and their feelings of preparedness for placement. Following placement, they re-evaluated the resource in terms of how well it prepared them for the placement and how well prepared they felt. Third year Australian undergraduate nursing students from one university who completed a Prison Health Service work-integrated learning placement in 2018, 2021, and 2022 were invited to participate. Placements were unavailable in 2019 and 2020. Independent t-tests were used to determine differences in scale means and level of preparedness between pre- and post-survey responses. RESULTS: Twenty-three of 40 (57.5%) eligible nursing students completed the pre-placement survey and 13 (32.5%) completed the post placement survey. All respondents to the pre-placement survey indicated that they felt satisfactorily, well, or very well prepared after completing the orientation package prior to their clinical placement. Students were significantly more likely to consider themselves well prepared by the package after they had attended placement (p < .001). All students post placement indicated that overall, the simulation resources and the specific simulation scenario about personal boundaries and management of manipulative behaviours was useful for their placement. The majority of students would recommend the orientation package to other students. Suggestions for improvement included streamlining the resource to reduce the time to complete it. CONCLUSIONS: Asynchronous online simulation with the capacity for branched decision making and feedback along with a comprehensive online orientation package were perceived as useful to prepare undergraduate students for placement in the Prison Health Service work-integrated learning setting.

Supporting Australian clinical learners in a collaborative clusters education model: a mixed methods study.

BACKGROUND: Nursing student numbers have risen in response to projected registered nurse shortfalls, increasing numbers of new graduates requiring transitional support and pressure on clinical placements. A Collaborative Clusters Education Model, in which Entry to Practice facilitators coach ward-based registered nurses to support students' and new graduates' learning, may address placement capacity. The research aim was to evaluate the acceptability of the Collaborative Clusters Education Model to stakeholders by examining their perceptions of the facilitators and barriers to the model in its implementation. METHODS: A convergent mixed methods evaluation approach was adopted. The study took place in a large Australian health service in south-east Queensland. Participants included Bachelor of Nursing students, Entry to Practice facilitators, ward-based registered nurses, academics and new graduates. A mixed methods design was used. Elements included an online survey of nursing students, and interviews with new graduates, Entry to Practice facilitators, ward-based registered nurses, and academics. Descriptive statistics were calculated on quantitative data. Thematic analysis was conducted on qualitative data. RESULTS: Participants included 134 (of 990) nursing students (response rate 13.5%), five new graduates, seven Entry to Practice facilitators, four registered nurses, and three nurse academics. Students rated facilitators' effectiveness highly (4.43/5 ± 0.75), although this finding is tempered by a low response rate (13.5%). For learners, the model provided access to learning experiences, although preferences for sources of support differed between students and new graduates, and further clarification of responsibilities was required. For other stakeholders, three themes emerged: students' and new graduates' integration into the workplace can promote learning; tensions arise in new ways to approach performance assessment; and aligning expectations requires high levels of communication. CONCLUSIONS: This evaluation found that acceptability was good but at risk from limited clarity around roles and responsibilities. Further research into this model is recommended.

Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars.

OBJECTIVE: To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. DESIGN: A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. SETTING: Rural community palliative care. PARTICIPANTS: One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). MAIN OUTCOME MEASURES: Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. RESULTS: Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20-0.86); P = 0.02). CONCLUSION: This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.

Supporting near-peer teaching in general practice: a national survey.

BACKGROUND: Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. METHODS: A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. RESULTS: Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. CONCLUSIONS: Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support. Guidelines may be required to help supervisors better support learners in this role and manage quality issues related to teaching.

How effective and acceptable is Web 2.0 Balint group participation for general practitioners and general practitioner registrars in regional Australia? A pilot study.

OBJECTIVE: General practitioners (GPs) and general practice registrars report work-related stress. Balint groups may improve coping mechanisms. However, attendance at a face-to-face Balint group is difficult for rural doctors due to distance constraints. The study aim was to evaluate online Balint groups for rural doctors and determine effect size for a full-scale trial. DESIGN: A mixed-methods approach, including a pre-post controlled trial and thematic analysis of qualitative data. SETTING: Rural primary care. PARTICIPANTS: Thirteen GPs and 8 general practice registrars completed the study. INTERVENTIONS: Balint groups were delivered over 8-9 fortnightly online sessions. GPs and GP registrars participated in separate groups. Data were collected on work-related affect, psychological medicine skills and professional isolation using the Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. MAIN OUTCOME MEASURES: Change scores on Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. RESULTS: Balint participants' scores were significantly higher post-intervention on the Psychological Medicine Inventory (mean 6.49 (±0.20) versus 5.43 (±0.26); P < 0.01) and Warr's Work-Related Affect (mean 4.09 (±0.09) versus 3.60 (±0.12); P < 0.01) scales than control group scores. Effect size on these scales ranged from 0.46 to 0.50. The greatest challenge was technical problems related to insufficient broadband speed. CONCLUSIONS: Online Balint groups appear to improve rural doctors' psychological medicine skills and work-related affect. New data on effect size will inform a full-scale trial. Improved national broadband infrastructure may enhance online support opportunities for rural doctors.

Vertically integrated shared learning models in general practice: a qualitative study.

BACKGROUND: The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders' perceptions of shared learning in general practices in northern NSW, Australia. METHODS: A qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices. A thematic analysis was conducted on 33 transcripts by three researchers. RESULTS: Participants perceived many benefits to shared learning including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload. Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to: receive remediation, address a specific deficit or immediate learning needs, learn communication or procedural skills, be given personalised feedback or be observed by their supervisor during consultations. Learners' acceptance of shared learning appeared partially dependent on their supervisors' small group teaching and facilitation skills. CONCLUSIONS: Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners. Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model thereby maximising learners' learning outcomes and experiences.

A comparison of the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students.

AIM: This paper reports a study examining the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students with the aim of informing undergraduate curricula. BACKGROUND: In comparison with registered nurses, physician status is a risk factor for non-compliance with hand hygiene guidelines. Little research has been conducted to determine if differences between the professions in relation to hand hygiene are apparent at the undergraduate level. Cross-disciplinary studies that may provide an insight into this topic are lacking. METHODS: A questionnaire was administered to a convenience sample of 117 nursing and 119 medical students in a large university in Rome, Italy, to determine their hand hygiene knowledge, beliefs and practices. The data were collected in 2007-2008. RESULTS: Nursing students' hand hygiene knowledge (F = 9·03(1,230); P = 0·003), percentage compliance (Z = 6·197; P < 0·001) and self-reported hand hygiene practices (F = 34·54(1,230); P < 0·001) were significantly higher than that of medical students. There were no statistically significant differences between hand hygiene beliefs. Mean scores on the knowledge questions were low for both groups, reflecting primarily a knowledge deficit in relation to the use of alcohol-based hand rubs to decontaminate hands in the healthcare setting. CONCLUSION: Statistically significant disciplinary differences in hand hygiene knowledge and self-reported practices were apparent among undergraduate Italian healthcare students. Further research is needed to determine the causative factors. The overall low scores on the knowledge items indicate that these students require further education on hand hygiene, particularly in relation to the use of alcohol-based hand rubs.

Facilitating learning on clinical placement using near-peer supervision: A mixed methods study.

BACKGROUND: Graduating nursing students report lower competence in leadership and delegation skills, which may be due to lack of sufficient opportunities to practice leadership skills such as delegation and supervision. A near-peer clinical supervision model, in which third-year students supervise first-year students on placement, may provide a mechanism to develop graduating students' leadership skills while improving the learning experience for junior students. OBJECTIVES: To evaluate nursing students' experiences and perceptions of participating in a near-peer clinical supervision model. DESIGN: A mixed methods design including an anonymous post-placement survey of students, and a group interview. SETTINGS: Medical and surgical wards in three Australian hospitals. METHOD: Forty-three first-year nursing students were supervised by 92 third-year nursing students on clinical placement under the supervision of a registered nurse in a near-peer supervision model. RESULTS: Twenty-seven first-year (69.2%) and 43 third-year (46.7%) students completed the questionnaire. First-years reported that being supervised by a senior student was a positive experience and would recommend it to other students (4.49/5 ± 0.71), and indicated that third-year students behaved professionally, were knowledgeable, and provided opportunities to ask questions (4.52-4.81/5). Third-year students reported gaining confidence, teaching, delegation and leadership skills (4.21-4.49/5). Qualitative responses supported the quantitative findings. Additional findings were the need for greater preparation of ward registered nurses to work in the model. CONCLUSIONS: Both groups enjoyed working in a near-peer clinical supervision model. The model provided opportunities for senior students to develop leadership and delegation skills and a positive experience of placement for junior students. Further attention to preparation of ward registered nurses would improve model delivery.

Continuous curriculum review in a bachelor of nursing program: preventing curriculum drift and improving quality.

Higher education institutions have rigorous internal accreditation processes for new courses and typically require thorough course reviews every 5 years. Courses such as nursing must also be accredited by professional registration boards. However, in the years between initial accreditation and formal reaccreditation cycles, the risk of a widening gap between the accredited curriculum and the taught curriculum is real when there is no process to monitor the changes that individual unit assessors make to their subjects as they teach them. This curriculum drift may interfere with the intended development of graduate attributes and the taxonomic structure of assessment tasks across the course. This article describes the implementation of a formative continuous curriculum review process that prevents curriculum drift and enhances the quality of a bachelor of nursing curriculum.

Infectious illness prevention and control methods and their effectiveness in non-health workplaces: an integrated literature review.

BACKGROUND: Infectious illness in the workplace places a substantial cost burden on employers due to productivity losses from employee absenteeism and presenteeism. AIM: Given the clear impacts of infectious illness on workplaces, this review aimed to investigate the international literature on the effectiveness and cost-benefit of the strategies non-healthcare workplaces use to prevent and control infectious illnesses in these workplaces. METHODS: MEDLINE, CINAHL Plus with Fulltext and Business Source Complete were searched concurrently using EBSCO Host 1995-2016. FINDINGS: Infection prevention and control strategies to reduce workplace infectious illness and absenteeism evaluated in the literature include influenza vaccination programs, use of alcohol-based hand sanitiser and paid sick days. While the reported studies have various methodological flaws, there is good evidence of the effectiveness of influenza vaccination in preventing workplace infectious illness and absences and moderate evidence to support hand hygiene programs. DISCUSSION: Some studies used more than one intervention concurrently, making it difficult to determine the relative benefit of each individual strategy. Workplace strategies to prevent and control infectious illness transmission may reduce costs and productivity losses experienced by businesses and organisations related to infectious illness absenteeism and presenteeism.

Student nurses' perceptions of clinical placements in Australian Prison Health Services: A mixed methods study.

Increasing demands for clinical placements have forced tertiary institutions to look for alternative placements for third year nursing students. While Prison Health Services provide an opportunity for nursing students to engage in care of offender populations with significant chronic illnesses, there has been little evaluation of such placements. Third year undergraduate nurses (18/46) participated in a mixed methods study to provide evidence-based research on students' perceptions of clinical placements in Prison Health Services. Quantitative and qualitative data were collected via an anonymous survey and individual interview. Whilst the majority of students valued the opportunity to increase their knowledge and clinical skills and felt supported by preceptors, challenges included being psychologically ill-prepared for the physical and emotional aspects of placement, and witnessing poor attitudes and behaviours of staff, which impacted on the quality of their experience. Recommendations include changes to orientation programs and introduction of simulation to help students feel better prepared and supported during placements in prison settings. Refining the selection process for placements in this setting will also help to ensure student suitability for clinical placement in Prison Health Services.

Registered and enrolled nurses' knowledge of hepatitis C and attitudes towards patients with hepatitis C.

A questionnaire was used to determine registered and enrolled nurses' knowledge of, and attitudes towards patients with hepatitis C. The research aim was to discover if nurses held discriminatory attitudes towards patients with hepatitis C, and to determine how their knowledge of hepatitis C and their demographic characteristics impacted on their attitudes and practices. One thousand questionnaires vere distributed to nurses (20 were returned unopened). One hundred and sixty of the remaining 980 were returned (16.3%). The majority of nurses reported non-discriminatory attitudes towards patients with hepatitis C. A number of variables impacted on nurses' level of hepatitis C knowledge and their willingness to care for patients with hepatitis C. These variables included nurses' level of experience, perceptions of personal risk of contracting hepatitis C in the workplace, and recent incidents of sharps injuries. Strategies to reduce the level of staff anxiety related to hepatitis C infection and risks of transmission may further increase the willingness of nurses to care for hepatitis C positive persons.

A whole-of-curriculum approach to improving nursing students' applied numeracy skills.

BACKGROUND: Nursing students often perform poorly on numeracy tests. Whilst one-off interventions have been trialled with limited success, a whole-of-curriculum approach may provide a better means of improving applied numeracy skills. OBJECTIVE: The objective of the study is to assess the efficacy of a whole-of-curriculum approach in improving nursing students' applied numeracy skills. DESIGN: Two cycles of assessment, implementation and evaluation of strategies were conducted following a high fail rate in the final applied numeracy examination in a Bachelor of Nursing (BN) programme. Strategies included an early diagnostic assessment followed by referral to remediation, setting the pass mark at 100% for each of six applied numeracy examinations across the programme, and employing a specialist mathematics teacher to provide consistent numeracy teaching. SETTING: The setting of the study is one Australian university. PARTICIPANTS: 1035 second and third year nursing students enrolled in four clinical nursing courses (CNC III, CNC IV, CNC V and CNC VI) were included. METHODS: Data on the percentage of students who obtained 100% in their applied numeracy examination in up to two attempts were collected from CNCs III, IV, V and VI between 2008 and 2011. A four by two χ(2) contingency table was used to determine if the differences in the proportion of students achieving 100% across two examination attempts in each CNC were significantly different between 2008 and 2011. RESULTS: The percentage of students who obtained 100% correct answers on the applied numeracy examinations was significantly higher in 2011 than in 2008 in CNC III (χ(2)=272, 3; p<0.001), IV (χ(2)=94.7, 3; p<0.001) and VI (χ(2)=76.3, 3; p<0.001). CONCLUSIONS: A whole-of-curriculum approach to developing applied numeracy skills in BN students resulted in a substantial improvement in these skills over four years.

'Learners as teachers' in general practice: stakeholders' views of the benefits and issues.

OBJECTIVES: To explore stakeholders' perceptions of learners teaching (near-peer teaching) in general practice in order to inform training policy. DESIGN: Qualitative semi-structured interviews were conducted with 29 general practice stakeholders. Interviews continued until data saturation was reached. Transcribed interviews underwent thematic analysis. SETTING: Nine general practices in NSW, Australia. PARTICIPANTS: Eleven general practitioner supervisors, eight general practice registrars, two prevocational general practice placement programme trainees, and eight medical students. RESULTS: Learners expressed positive attitudes towards learners teaching, and half were already teaching. Learners and supervisors felt near-peer teaching could enhance their own learning. Supervisors suggested near-peer teaching reduced time pressures on themselves, helped them to keep current, was a form of succession planning, and brought financial benefits to the practice. Having time to assess the capabilities of learners prior to allocating them teaching roles was considered important. Strategies suggested by learners to encourage near-peer teaching include asking learners to teach, mentoring, providing short but regular opportunities to teach, highlighting the clinical relevance of teaching skills, having longer placements for medical students, and allowing learners to teach in areas of interest, expertise or need. CONCLUSIONS: Participants looked favourably upon learners teaching in general practice, and felt it could enhance learning. Suggestions were made to facilitate near-peer teaching in general practice. Further quantitative research with a larger and more diverse sample is required to determine if these results can be generalised to the wider general practice population.

Evaluating a community-engaged vertically integrated teaching and learning pilot project.

OBJECTIVE: To evaluate a community engaged vertically integrated teaching and learning pilot project. METHOD: Thematic analysis of focus group interviews was used to examine 27 general practitioners' (GPs'), registrars' and medical students' perceptions of a vertically integrated workshop in adolescent health and subsequent small group health education sessions at two secondary schools. Pre- and postintervention surveys were used to measure changes to participants' knowledge, confidence, and attitudes towards registrars and students teaching in general practice. RESULTS: Knowledge scores (7.46 ± 1.17 vs 9.54 ± 1.17; t = -9.6, P <0.001), and scores on the Confidence to Teach (3.34 ± 0.51 vs 4.09 ± 0.33; t = -6.61, P <0.001), and Vertically Integrated Teaching (4.01 ± 0.40 vs 4.30 ± 0.42; t = -3.45, P <0.05) scales increased significantly following the intervention. Scale reliability ranged from 0.74 to 0.87. Participants enjoyed the collegiality of learning together in a vertically integrated model. The experience stimulated self-reflection on teaching skills and a desire for peer review of teaching. Suggestions for improving the intervention included building a clearer link between the facilitation skills learnt in the school setting and how to implement them in general practice, and providing more targeted support for GPs on facilitating sessions with multiple levels of learner involved. CONCLUSIONS: A community-engaged vertically integrated teaching and learning model has the potential to increase participants' confidence to teach in small groups, and create a more positive perception of registrars and students teaching in general practice. The concept would benefit from further longitudinal research with a wider sample.

Health care workers' knowledge of hepatitis C and attitudes towards patients with hepatitis C: a pilot study.

A questionnaire was developed to determine health care workers' (HCWs) knowledge of, and attitudes towards, hepatitis C in order to inform an education strategy to prevent discrimination towards hepatitis C-positive patients. The study's aim was to determine the questionnaire's reliability and validity. Fifty-eight of 100 questionnaires distributed to HCWs were returned. The internal consistency of the scale was 0.7 following the removal of one item. The face validity of the instrument was high. It was found that a number of demographic variables impacted on HCWs' level of knowledge regarding hepatitis C and their willingness to care for patients with hepatitis C. Further research with a larger sample size is needed to clarify these issues.