Exploring medical and nursing students' perceptions about a patient safety course: a qualitative study.

BACKGROUND: Educating health professionals on patient safety can potentially reduce healthcare-associated harm. Patient safety courses have been incorporated into medical and nursing curricula in many high-income countries and their impact has been demonstrated in the literature through objective assessments. This study aimed to explore student perceptions about a patient safety course to assess its influence on aspiring health professionals at a personal level as well as to explore differences in areas of focus between medical and nursing students. METHODS: A dedicated patient safety course was introduced for year III medical and year II and IV nursing students at the Aga Khan University (2021-2022). As part of a post-course assessment, 577 participating students (184 medical and 393 nursing) wrote reflections on the course, detailing its influence on them. These free-text responses were thematically analyzed using NVivo. RESULTS: The findings revealed five major themes: acquired skills (clinical, interpersonal), understanding of medical errors (increased awareness, prevention and reduction, responding to errors), personal experiences with patient safety issues, impact of course (changed perceptions, professional integrity, need for similar sessions, importance of the topic) and course feedback (format, preparation for clinical years, suggestions). Students reported a lack of baseline awareness regarding the frequency and consequences of medical errors. After the course, medical students reported a perceptional shift in favor of systems thinking regarding error causality, and nursing students focused on human factors and error prevention. The interactive course format involving scenario-based learning was deemed beneficial in terms of increasing awareness, imparting relevant clinical and interpersonal skills, and changing perspectives on patient safety. CONCLUSIONS: Student perspectives illustrate the benefits of an early introduction of dedicated courses in imparting patient safety education to aspiring health professionals. Students reported a lack of baseline awareness of essential patient safety concepts, highlighting gaps in the existing curricula. This study can help provide an impetus for incorporating patient safety as a core component in medical and nursing curricula nationally and across the region. Additionally, patient safety courses can be tailored to emphasize areas identified as gaps among each professional group, and interprofessional education can be employed for shared learning. The authors further recommend conducting longitudinal studies to assess the long-term impact of such courses.

Incorporating Patient Safety and Quality Course Into the Nursing Curriculum: An Assessment of Student Gains.

BACKGROUND: Training nursing students on quality and patient safety (PS) is crucial to ensuring safe healthcare practices given the key role nurses play on the healthcare team. The aim of this study was to evaluate the impact of quality and PS course on the knowledge, and system thinking of students at different stages of the undergraduate nursing course. METHODS: A 4.5-day quality improvement and PS course was conducted at the Aga Khan University School of Nursing and Midwifery for 146 second- and 139 fourth-year students. Students' knowledge, self-assessment of knowledge and skills, and system thinking were assessed using pretest and posttest. RESULTS: Of the total of 20 points, the course significantly improved students' knowledge by a mean of 4.91 points for second-year students (95% confidence interval [CI], 4.32-5.51) and 3.46 points for fourth-year students (95% CI, 2.90-4.02) between pretest and posttest. For systems thinking, the Systems Thinking Scale scores increased by 0.41 points (95% CI, 0.29-0.52) for second-year students and 0.33 points (95% CI, 0.22-0.44) for fourth-year students out of the total of 5 points. The self-assessment scores significantly increased on postcourse assessment for second (P < 0.05) and fourth-year students (P < 0.001). Positive experience reported by students in the narrative reflections complemented these results. CONCLUSIONS: There was a significant increase in nursing students' knowledge, self-efficacy, and system thinking after participating in this short PS course. Replication at a national level may improve safety knowledge and skills among nursing students with subsequent gains in the safety of healthcare delivery in Pakistan.

Experiences of Undergraduate Medical, Nursing Students and Faculty regarding Flipped Classroom: A Mixed Method Study at Private Medical University in Pakistan.

The 'flipped classroom (FCR)' is a teaching pedagogy where students are actively involved in the learning process. It reduces passivity, enables students to become active learners through reasoning and concept application and facilitates student interaction with their peers and instructors. This instructional approach enhances retention and decreases distraction by engaging students. OBJECTIVES: The purpose of this study was to train the faculty of the medical college and school of nursing in developing FCRs as an innovative teaching and learning strategy, to facilitate them in conducting flipped sessions for their students and to explore the experiences of medical, nursing students along with faculty members regarding the FCR they had attended and conducted. SETTING: Private medical college. PARTICIPANTS: A total of 442 students from medical college and school of nursing and midwifery participated in the evaluation survey with a female to male ratio of 339:103. Students who attended the flipped class sessions were included in the study sample. Students who did not complete the forms were excluded from the study. Nine faculty members who attended the workshop, agreed to facilitate the FCR session were invited to participate in the focus group discussion. RESULTS: Both medical and nursing students found FCR format stimulating. A significantly higher proportion of medical students (73%) found the FCR more engaging and interesting than a traditional lecture as compared with nursing students (59%) (p=0.009). Similarly, 73% of medical students believed the learning objectives of both the non-face-to-face and face-to-face sessions were shared with them as compared with the 62% of nursing students who believed the same (p=0.002). A significantly higher proportion of medical (76%) versus nursing (61%) students found the FCR format more useful for application of their theoretical knowledge into clinical practice (p=0.030). CONCLUSION: Students found the FCR more engaging and interesting in terms of applying theoretical knowledge into practice. Similarly, faculty found this strategy as effective but challenging in terms of involving and engaging students in the learning process. It is recommended to conduct more FCR sessions for an interactive and student-centred learning, but proper planning of the session and using variety of technological tools to engage learners is a key to success.

Nurse-led culturally relevant smoking reduction intervention among cardiovascular and respiratory patients in Pakistan.

INTRODUCTION: Socioeconomically deprived populations are at greater risk for smoking-induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse-led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse-led smoking reduction intervention performed at out-patient clinics in Karachi, Pakistan. METHODS: A single group pre-and post-test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021. INTERVENTION: The multi-modal nurse-led intervention consisted of two face-to-face motivational counseling (30-min) and free nicotine replacement therapy with telephonic counseling and follow-ups offered to all eligible patients for 2 months. RESULTS: The nurse-led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1-week follow-up (p < .001), verified by a CO breath test. CONCLUSION: A nurse-managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients.

Introducing ACTFAiREST2 to implement online assessments amid COVID-19: a case study from a low resource setting.

BACKGROUND: Amid COVID-19, soon after the closure of academic institutions, academia was compelled to implement teaching and assessments virtually. The situation was not the same for all countries. This transition was much more challenging in low-resource settings like Pakistan, where the students were geographically distant with minimal connectivity. A private university in Pakistan instituted a systematic approach for ensuring quality assurance and reliability before launching online assessments amid the COVID-19. The purpose of this study was to reflect on the phased transition to online/remote assessments to facilitate continuous student learning through distance modalities during the pandemic. METHOD: To assist faculty in re-designing their assessments, a workshop was conducted which was based on the modified Walker's nine principles. The principles coded as "ACTFAiREST2" were introduced to ensure that the faculty understands and adapts these principles in designing online assessments. The faculty modified and re-designed their course assessments, from face to face to online modality and submitted their proposals to the Curriculum Committee (CC). To guide the process of approving modified and re-designed assessments, a checklist was adapted. All the pre and -post workshop assessment proposals were analyzed using a content analysis approach to ensure the alignment of course learning outcomes with the assessments. RESULTS: A total of 45 undergraduate courses' assessment proposals were approved by the CC after deliberations ensuring their applicability in a virtual environment. From the analysis of the course outlines and assessment proposals submitted to the CC, faculty made four key changes to their assessment tasks in the light of ACT FAiREST2 principles (a) alternative to performance exams; (b) alternative to knowledge exams; (c) change in the mode of assessment administration; and (d) minimizing the overall assessment load. CONCLUSION: This transition provided an impetus for the faculty from a low resource setting to build momentum towards improved and innovative ways of online teaching and assessments for future nursing education to adapt to the new normal situation. This development will serve as a resource in similar contexts with planned and evidence-based approaches for enhancing faculty readiness and preparedness for online/remote assessments.

The impact of COVID-19 safety interventions on creating a controlled environment on campus.

Objectives: During COVID-19 the re-opening of educational institutes was frequently debated, however with the decline in the number of COVID-19 cases, The Aga Khan University (AKU) in Karachi, Pakistan opened its campus for medical and nursing students after more than 6 months of closure. To ensure gradual resumption of activities on-campus, a combination of interventions was diligently deployed to minimize student infection rates. Scarce literature exists on students' perceptions regarding decisions implemented by university leadership. The aim of the study was to determine the efficacy of these interventions. Methods: We conducted a convergent, parallel, mixed-methods observational study targeting medical and nursing students. An online questionnaire was disseminated to elicit students' degree of (dis)agreement on a four-point Likert scale. Focused group discussions (FGDs) were conducted to comprehend reasons for (dis)agreement. Results: Total of 183 students responded to questionnaire (59.0% nursing, 67.8% female), 11 FGDs were conducted with 85 students. Interventions with highest agreement were mandatory face masks policy (94.54%), weekly mandated COVID-testing (92.35%) and students' Academic Bubble (91.26%); highest disagreement was for Sehat Check application (41.53%); and stay strong campaign (40.44%). Four themes emerged from FGDs: Effective safety interventions, Safety interventions with limited effectiveness, Utility of Sehat Check Application and Future recommendations for informing policy. Conclusion: It is paramount to seek student-feedback at forefront of university re-opening strategy. Clear communication channels are as important as an administrative response system's robustness. Bidirectional communication channels are fundamental and requisite during ever-changing policies and regulations. Engaging student representatives in decision making or implementation processes (such as "pilot" before "roll-out") would allow any potential issues to be managed early on. Gather real-time anonymous feedback and identify key areas that need further promulgation and those that need to be replaced with more effective ones.

Levels and Predictors of Self-Care Among Patients with Hypertension in Pakistan.

BACKGROUND: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan. METHODS: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol. RESULTS: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population. CONCLUSION: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.

Family-centered rounds in Pakistani pediatric intensive care settings: non-randomized pre- and post-study design.

BACKGROUND: Involvement of family in bedside rounds is one strategy to implement family-centered care to help families get clear information about their child, and be actively involved in decision-making about care. However in developing countries such as Pakistan, daily bedside rounds include the physician, residents, medical students and a nurse/technician. Parents are not currently a part of these rounds. OBJECTIVE: To assess whether family-centered rounds improve parents' and health care professionals' satisfaction, decrease patient length of stay, and improve time utilization when compared to traditional practice rounds in a population with a low literacy rate, socioeconomic status, and different cultural values and beliefs. DESIGN: A non-randomized before-after study design. SETTING: A private hospital in Karachi, Pakistan. PARTICIPANTS: A convenience sample of 82 parents, whose children were hospitalized for a minimum of 48h, and 25 health care professionals able to attend two consecutive rounds. METHODS: During the before phase, traditional bedside rounds were practiced; and during after phase, family-centered rounds were practiced. Parents and health care professionals completed a questionnaire on the second day of rounds. An observational form facilitated data collection on length of stay and time utilization during. RESULTS: Parents' ratings during the family-centered rounds were significantly higher for some parental satisfaction items: evidence of team work (p=0.007), use of simple language during the rounds (p=0.002), feeling of inclusion in discussion at rounds (p=0.03), decision making (p=0.01), and preference for family-centered rounds (p=<0.001). No significant differences were found in health care professionals' satisfaction between rounds. Patient length of stay was significantly reduced in the family-centered rounds group, while no significant difference was found in the duration of rounds. Family-centered rounds served as an opportunity for parents to correct/add to patient history or documentation. CONCLUSION: Parents were satisfied with both forms of rounds; however, they appeared to have a greater preference for family-centered rounds than health care professionals. Family-centered rounds were a resource for Pakistani parents, enabling direct communication with the medical team without impacting on the time required to complete rounds. Family-centered rounds may improve quality of care such as decreasing length of stay or preventing critical incidents.

Triage; a literature review of key concepts.

The emergency department (ED)--sometimes termed the emergency room (ER), or the accident & emergency (A&E) department--in a hospital or primary care facility that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening or requiring immediate attention. The earliest patients-physician encounter is the triage doctor/nurse who completes the preliminary evaluation before transferring care to another area of the ED or a different department in the hospital. A strong triage system is the backbone of an efficient ED. It indicates that the staff is capable of differentiating critically ill from the sick, and, consequently, of segregating patients who may need admission from those who will not. Thus it is essential for the health professionals to be well-versed with the concepts of triaging. This paper intends to review the basic definitions and the common types of triaging that is used commonly in hospitals.

Faculty practice in a private teaching institution in a developing country: embracing the possibilities.

AIM: This paper discusses a case study on implementing faculty practice in a private teaching institution in a developing country where direct 'hands-on' care is undervalued by nurses. BACKGROUND: In Pakistan, faculty practice is not well known and related to indirect care. In the institution studied, faculty practice has been a major consideration to strengthen relationships between clinical and academic sectors. DATA SOURCES: MEDLINE and CINHAL were searched (1979 to July 2009). A consultative process was used by the faculty practice committee members and involved open discussions with academic and clinical service faculty in the institution studied. DISCUSSION: There is no empirical evidence to identify effective models for implementing faculty practice. A formalized faculty practice plan was identified as an important organization factor to promote faculty practice. IMPLICATIONS FOR NURSING: Identifying a definition of faculty practice and scholarship was an important step to ensure conceptual clarity. Consistent with the literature, workload, remuneration and performance appraisal were identified as perceived threats. The hierarchy in nursing is a unique organizational factor that will need to be addressed. Given the lack of research on the effectiveness of faculty practice and its models, evaluation is imperative. CONCLUSION: Dissonance is an overall theme of the literature and stems from the perceived threats/risks of faculty practice. Faculty practice may fulfil institutional, personal and professional needs of individual faculty members. Faculty practice offers an opportunity to change attitudes, beliefs and values related to direct care in the institution studied and influence other institutions in Pakistan.