Perspectives on the implementation of health informatics curricula frameworks.

BACKGROUND: The COVID-19 pandemic highlighted the necessity of equipping health professionals with knowledge and skills to effectively use digital technology for healthcare delivery. However, questions persist about the best approach to effectively educate future health professionals for this. A workshop at the 15th Nursing Informatics International Congress explored this issue. OBJECTIVE: To report findings from an international participatory workshop exploring pre-registration informatics implementation experiences. METHODS: A virtual workshop was held using whole and small group interactive methods aiming to 1) showcase international examples of incorporating health informatics into pre-registration education; 2) highlight essential elements and considerations for integrating health informatics into curricula; 3) identify integration models of health informatics; 4) identify core learning objectives, resources, and faculty capabilities for teaching informatics; and 5) propose curriculum evaluation strategies. The facilitators' recorded data and written notes were content analysed. RESULTS: Fourteen participants represented seven countries and a range of educational experiences. Four themes emerged: 1) Design: scaffolding digital health and technology capabilities; 2) Development: interprofessional experience of and engagement with digital health technology capabilities; 3) implementation strategies; and 4) Evaluation: multifaceted, multi-stakeholder evaluation of curricula. These themes were used to propose an implementation framework. DISCUSSION: Workshop findings emphasise global challenges in integrating health informatics into curricula. While course development approaches may appear linear, the learner-centred implementation framework based on workshop findings, advocates for a more cyclical approach. Iterative evaluation involving stakeholders, such as health services, will ensure that health professional education is progressive and innovative. CONCLUSIONS: The proposed implementation framework serves as a roadmap for successful health informatics implementation into health professional curricula. Prioritising engagement with health services and digital health industry is essential to ensure the relevance of implemented informatics curricula for the future workforce, acknowledging the variability in placement experiences and their influence on informatics exposure, experience, and learning.

Sleep deprivation and medication administration errors in registered nurses-A scoping review.

AIM: To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs). BACKGROUND: Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived-anecdotal reports suggest that this could result in an increased risk of error occurring. DESIGN: A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors. METHODS: A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies. RESULTS: Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used. CONCLUSION: Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption. NO PATIENT OR PUBLIC CONTRIBUTIONS: Patient or public contributions were not required for this scoping review. RELEVANCE TO CLINICAL PRACTICE: Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.

Systematic reviews and meta-analysis with sub-groups - A commentary.

As the outcomes of systematic reviews and meta-analysis are used to inform clinical practice it is imperative that the review and meta-analysis conducted is accurate and rigorous. In this commentary the authors wish to review the recommended approaches to be used when conducting a meta-analysis of quantitative data in a systematic review and outline the common errors and risks. The authors of this commentary aim to highlight the consequence of potential errors when conducting a meta-analysis using sub-groups with an example from a systematic review published in Research in Social and Administrative Pharmacy in 2019.

Baseline evaluation of nursing students' informatics competency for digital health practice: A descriptive exploratory study.

Introduction: The healthcare system is increasingly technology-dependent and proficiency in informatics skills is essential for health professionals to efficiently operate in the contemporary clinical environment. Nurses are major users of digital health technologies and graduates need to be well-prepared and confident to use the different available clinical systems competently as they transition from education to practice. Aim: To explore undergraduate nursing students' self-perceptions of informatics competence, set within a larger research project. Method: Descriptive, exploratory cross-sectional research design, with online self-assessment survey of undergraduate nursing students (n = 142). Data were analysed with descriptive, correlation and comparative statistics. Results: Participants' perceived overall mean informatics competency was at the level of somewhat competent, with only 40.84% (n = 58) at the level of competent. The highest mean value was in foundational information and communication skills and the lowest in information and knowledge management. Formal informatics education within curriculum was limited and lacked uniformity, as was prior exposure to important simulated informatics tools in preparation for practice. Factors including academic year level, computer experience and previous experience using clinical systems had a significant impact on participants' perceived informatics competency. Conclusion: Even though informatics competence is vital for clinical practice, with technology becoming pervasive within healthcare, nursing students' preparedness for digital health was sub-optimal. There were gaps in students' critical informatics practice knowledge with implications for work readiness of future graduates and nurse education practice.

Nursing Students' Experiences of a Student-Led Collaborative Online International Learning Program.

AIM: The aim of the study was to explore undergraduate nursing and midwifery students' perspectives of participating in a student-led collaborative online international learning (COIL) program. BACKGROUND: Research on COIL programs is limited. This program, developed across three global universities, was implemented to provide an internationalization-at-home experience for students during the COVID-19 pandemic. METHOD: An exploratory descriptive qualitative design was employed using nursing students' reflections and interviews. RESULTS: Data analysis revealed four key themes: student-led learning experiences, personal gains, influence on professional practice, and becoming a global citizen. Students' experiences offer insights into positive aspects of the program and highlight challenges to overcome. CONCLUSION: The student-led COIL experience increased nursing students' understanding of the dynamics of culture and nursing practices across different countries. Students' personal growth and professional gains will potentially prepare them to work in multicultural environments and develop global citizenship attributes.

Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial.

BACKGROUND: Adherence Therapy is a candidate intervention to promote consistent medication taking in people with type 2 diabetes. The aim of this study was to establish the feasibility of conducting a randomized controlled trial of adherence therapy in people with type 2 diabetes who were non-adherent with medication. METHODS: The design is an open-label, single-center, randomized controlled feasibility trial. Participants were randomly allocated to receive either eight sessions of telephone-delivered adherence therapy or treatment as usual. Recruitment occurred during the COVID-19 pandemic. Outcome measures-adherence, beliefs about medication, and average blood glucose (sugar) levels (HbA1c)-were administered at baseline and after 8 weeks (TAU group) or at the completion of the treatment (AT group). Feasibility outcomes included the number of people approached to participate in the trial and the numbers that consented, completed study measures, finished treatment with adherence therapy, and dropped out of the trial. Fieldwork for this trial was conducted in the National Guard Hospital, a tertiary care provider, in the Kingdom of Saudi Arabia. RESULTS: Seventy-eight people were screened, of which 47 met eligibility criteria and were invited to take part in the trial. Thirty-four people were excluded for various reasons. The remaining thirteen who consented to participate were enrolled in the trial and were randomized (AT, n = 7) (TAU, n = 6). Five (71%) of the seven participants in the adherence therapy arm completed treatment. Baseline measures were completed by all participants. Week 8 (post-treatment) measures were completed by eight (62%) participants. Dropout may have been linked to a poor understanding of what was involved in taking part in the trial. CONCLUSIONS: It may be feasible to conduct a full RCT of adherence therapy, but careful consideration should be given to developing effective recruitment strategies, consent procedures, rigorous field testing, and clear support materials. TRIAL REGISTRATION: The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000827134, on the 7th of June 2019.

Undergraduate paramedicine students' experiences of feedback during clinical placement on-road: A scoping review.

Feedback on performance enhances student confidence and clinical skills and promotes safe clinical practice. Experiences of feedback are well documented across many health disciplines; however, less is known about paramedicine students' experiences of feedback on-road in an emergency ambulance. The aim of this scoping review was to identify what is known about paramedicine students' experiences of feedback during clinical placement on-road in an emergency ambulance. A review of studies between 2000 and 2021 was undertaken, guided by the Joanna Briggs Institute Methodology for JBI Scoping Reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. Databases included CINAHL, EMBASE, EBSCO, MEDLINE, Web of Science, Cochrane, ERIC (ProQuest), ProQuest (Nursing and Allied Health), Trove, and Open Accessd Theses and Dissertations. Three studies were identified. Feedback is valued by paramedicine students; however, it can be personal and destructive in nature. Paramedics are enthusiastic and supportive and provide clear feedback. Paramedics face challenges supervising students and may lack preparation to provide feedback. There is limited evidence on paramedicine students' experiences of feedback during clinical placement. Further exploration is needed to gain further understanding.

Factors in integrating academic electronic medical records in nursing curricula: A qualitative multiple case studies approach.

BACKGROUND: Academic electronic medical records are useful simulation-based educational tools that assist health professional students develop their skill sets for digital health practice. Despite this, their utilisation in pre-registration nursing curricula is uncommon in Australia and New Zealand. AIM: To explore factors surrounding integration of academic electronic medical records into pre-registration nursing curricula in Australia and New Zealand. DESIGN: Exploratory qualitative multiple case studies approach with purposive sampling set within a larger research project. METHODS: Semi-structured interviews conducted with course leaders from six nursing schools. Data were analysed in an iterative content-driven deductive and inductive process using open-coding and categories. Case analysis involved within case and cross-case analysis. RESULTS: Findings revealed different factors that impacted the utilisation of academic electronic medical records in nursing curricula including factors influencing adoption, barriers and challenges with implementation, enablers for integration and perceived benefits for students' clinical practice preparation. Reasons for not using academic electronic medical records, barriers for implementation, and preparation of students for clinical practice in the absence of these simulation tools were also highlighted. CONCLUSION: Our findings suggest that use of academic electronic medical records in nursing curricula is still evolving and that their adoption and application within programs is not straightforward. While there are many factors unique to the schools using such resources, factors including decisions around curriculum incorporation, optimising available resources to support students' learning, and developing faculty capability to teach with academic electronic medical records were common considerations. Lack of funding and access to local educational tools were ongoing barriers for adoption. Further research examining curriculum timing and preparation, possibilities of partnerships to share resources, and evaluation in meeting students' needs is necessary.

Informatics Competency Measurement Instruments for Nursing Students: A Rapid Review.

Digital transformation in healthcare impacts curricula preparation and work readiness of future health professionals. Informatics capabilities are essential practice attributes. Therefore, measurement of these competencies is important as students transition from education to practice. This rapid review, conducted according to Cochrane and World Health Organization guidelines, examined validity and reliability measurements of existing instruments used to self-assess nursing informatics competencies. MEDLINE, CINAHL, EMBASE, and PubMed databases were searched. Empirical studies with the primary aim of measuring informatics competencies reporting psychometric assessment were included. Methodological quality appraisal involved predetermined criteria based on COnsensus-based Standards for the selection of health Measurement INstruments taxonomy. Data extraction and critical appraisal of six studies from four countries identified five instruments. Study characteristics, constructs measured, population, instrument type, and psychometric properties of interest were examined. There were some similarities and differences with instrumentation. Two important measurement properties, content validity and reliability, were underreported. Gaps in key measurement properties were identified, which require further research. Selection of a practical evaluative instrument to implement should also consider the constructs measured, and practicality and feasibility of the instrument for its suitability in different settings. A larger investigation comparing more informatics competency assessment instruments is necessary for an exhaustive analysis.

Maintaining reflexivity in qualitative nursing research.

AIMS: Reflexivity is central to the construction of knowledge in qualitative research. This purpose of this paper was to outline one approach when using reflexivity as a strategy to ensure quality of the research process. DESIGN: In this exploratory research, reflexivity was established and maintained by using repeated questionnaires, completed online. Using the approach presented by Bradbury-Jones (2007) and Peshkin's I's, the aim of the research was to identify the researcher's values, beliefs, perspectives and perceptions prevalent in the research. METHODS: Qualitative data were collected in online reflexive questionnaires, completed monthly by the researcher from January 2017 to December 2018. Data analysis used interpretive and reflective reading and inductive processes. RESULTS: Seventeen questionnaires were analysed. Data indicated use of questionnaires enabled and detailed development of specific strategies to ensure trustworthiness. Importantly, reflexivity, supported by questionnaires, brought about transformation through self-awareness and enlightenment.

Use of academic electronic medical records in nurse education: A scoping review.

BACKGROUND: Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment. Reported practice benefits include skills for electronic documentation, health informatics, point-of-care clinical decision support systems, as well as preparation for information technology-enabled clinical settings, while challenges include lack of access to simulation software, faculty-related barriers, limited finances and educational software costs. However, little is known about best practices related to its use within pre-licensure or entry-to-practice nursing curricula and impact on clinical practice outcomes. OBJECTIVE: This review sought to explore how academic electronic medical records are used in entry-to-practice nursing curricula. DESIGN: A scoping review guided by the Joanna Briggs Institute three-step search strategy, exploring existing publications and grey literature. INCLUSION CRITERIA: Quantitative and qualitative studies related to use of academic electronic medical records in pre-licensure nurse education. INFORMATION SOURCES: A range of databases were searched including CINAHL, Medline, Proquest Central, ERIC, ScienceDirect, PubMed, IOS Press, as well as grey literature, reference lists and handsearching. REVIEW METHODS: The search yielded 580 articles, from which inductive thematic analysis of 34 included studies was conducted. RESULTS: Included articles were nine qualitative, 21 quantitative and five mixed methods studies. Most originated from the USA. Academic electronic medical records are mainly used to teach documentation, safe use of health technology, and for clinical preparation. Most are used for fundamental or junior levels courses, with problem-based learning and simulation embedded. Institution's technology resources and faculty capability are essential to implementation. CONCLUSIONS: There is a need for more research that examines optimal timing and duration of use of academic electronic medical records in curricula, and their impact on critical thinking and clinical performance. Finally, there is a need to explore greater academic-clinical partnerships in the education process.

Effectiveness of Adherence Therapy in Adults with Type 2 Diabetes: A Systematic Review.

Adherence therapy has been shown to be an effective adjunct treatment in long-term conditions including hypertension. The purpose of this study is to review and critically appraise evidence on the effectiveness of adherence therapy as an intervention in adults with type 2 diabetes. A systematic search of clinical trials published between 2005 and January 2020 in databases was undertaken in October 2018 and updated in August 2020. Inclusion criteria were any clinical trials where the population under investigation was adults with type 2 diabetes and the experimental intervention was adherence therapy. Version 2 of the Cochrane risk of bias was used to determine the quality of the included studies. No studies met our inclusion criteria. However, four studies that we excluded at full text screening tested some of the components (e.g., problem solving) of adherence therapy. As is recommended when reporting empty reviews, those studies were synthesized to determine if useful information can be extracted. That no trials of adherence therapy have been reported in type 2 diabetes establishes a potentially important gap in knowledge. This review was registered in PROSPERO (registration number: CRD42019115216) after the initial searches were completed.

A study protocol for a feasibility trial of telephone-delivered Adherence Therapy for adults with type 2 diabetes.

AIMS: Adherence therapy is a candidate intervention to improve medication adherence and clinical outcomes in patients with type 2 diabetes. The feasibility of conducting a trial of adherence therapy in this population has not been established. The objective of this study is therefore to test the feasibility of conducting a randomized controlled trial of adherence therapy in a Middle Eastern context. DESIGN: A single-centre randomized controlled feasibility trial of adherence therapy in patients with type 2 diabetes. METHODS: We will undertake an initial cultural adaptation of a telephone-delivered form of adherence therapy in four patients in a Middle Eastern context. Our subsequent feasibility trial will aim to recruit 40 non-adherent diabetic patients that will be randomly allocated to receive eight weekly 30-min telephone adherence therapy sessions delivered by a diabetes educator versus treatment as usual. Key outcomes of interest include the number of patients invited to take part in the trial that consent to participate and then go on to complete treatment. RESULT: The findings of this study will determine the feasibility of undertaking a full randomized controlled trial of adherence therapy in patients with type 2 diabetes.

Preliminary report of a simulation community of practice needs analysis.

AIM: To understand the current needs related to education and training, and other investment priorities, in simulated learning environments in Australia following a significant period of government funding for simulation-based learning. METHODS: A mixed methods study, comprising qualitative focus groups and individual interviews, followed by a quantitative cross-sectional survey informed by themes emerging from the qualitative data. FINDINGS: Two focus groups and 22 individual interviews were conducted. Participants included simulation educators, technical users and new adopters. Survey data were collected from 152 responses. Barriers at the introduction and maintenance stages of simulated learning included irregular staff training resulting in inconsistent practice, and lack of onsite technical support. Educators lacked skills in some simulation and debriefing techniques, and basic education and research skills were limited, while technicians raised concerns regarding the maintenance of equipment and managing budgets. DISCUSSION AND CONCLUSION: Despite its effectiveness as an education tool, barriers remain at the introduction and maintenance stages of simulated learning environments. Efforts to improve the integrity and sustainability of simulation training should be informed by a comprehensive needs analysis. The resulting data should be used to address barriers in a way that maximises the limited resources and funding available for this important learning tool.

Exploring undergraduate nursing student interactions with virtual patients to develop 'non-technical skills' through case study methodology.

BACKGROUND: Virtual patients are a recent addition to the educational arsenal to develop non-technical skills in undergraduate health professionals. The Virtual Simulated Patient Resource (www.vspr.net.au) is a web-based resource that uses branching, narrative virtual patients to develop knowledge, attitude and practice of all categories of non-technical skills in undergraduate health professionals. However, there is limited literature exploring how the interaction with a virtual patient influences the development of knowledge, attitude and practice of non-technical skills in undergraduate nursing students. METHODS: An intrinsic case study method, using focus groups and individual interviews, enabled exploration of the experience of undergraduate nursing students when interacting with a virtual patient to develop non-technical skills. Purposive sampling identified participants to address the research question. Framework analysis supported by a codebook enabled deductive and inductive data analysis. RESULTS: Forty-five first-year and 31 third-year students consented to participate. Findings indicated that the different years interacted differently with the virtual patients. Four themes were recognised in the data: how the virtual patients enabled learning non-technical skills, learning surrounding the virtual patient encounter, changing the way students perceive practice and potential limitations to learning. CONCLUSIONS: Interactions with virtual patients influence learning knowledge, attitudes and practice of non-technical skills in undergraduate nursing students via authenticity in the virtual patient interaction, socialisation to the professional role, vicarious learning and learning by making mistakes. Potential limitations to learning from virtual patient interactions include fear, overconfidence, groupthink and confusion. To manage limitations to learning, facilitation approaches, opportunities for reflection, constructive feedback and debriefing may be key. This study demonstrates learning non-technical skills via interactions with virtual patients can change the way students perceive practice, with learning transferable to the clinical setting to support safe and competent patient care.

Development of non-technical skills through virtual patients for undergraduate nursing students: An exploratory study.

INTRODUCTION: Non-technical skills (NTS) are fundamental requirements for health professional graduates for safe and competent practice. Technology enhanced simulation, including virtual patients (VPs), is suggested to be effective in developing NTS. PURPOSE: The purpose of this paper is to explore what participants learnt about NTS following interactions with the VPs in the case study. DESIGN: Case study methodology was used to explore learning by undergraduate nursing students related to NTS following interactions with VPs. First- (n = 40) and third-year (n = 31) undergraduate nursing students from two universities in Victoria, Australia agreed to participate in focus groups and interviews. These were audio-recorded, transcribed and then underwent framework analysis. A priori codes in the framework used NTS categories including communication, situation awareness, teamwork, decision-making skills, leadership, managing stress and coping with fatigue. FINDINGS: Overall, students in both years and universities reported that interactions with VPs developed knowledge and skills across all categories of NTS to varying degrees. Third-year students suggested that interactions with VPs enabled development of knowledge and skills, as well as practise of selected NTS in the clinical setting. CONCLUSION: Interactions with VPs across the curriculum may assist undergraduate nursing students in developing knowledge, skill and practice of NTS categories including communication, situation awareness, teamwork, decision-making skills and duty, advocacy and empathy.

Participant perceptions of virtual simulation to develop non-technical skills in health professionals.

BACKGROUND: Research has identified that virtual simulations may be effective in developing non-technical skills including communication, teamwork and decision making. However, little is known about how participants perceive learning non-technical skills via engagement in virtual simulation. AIMS: The aim of this research was to investigate participant perceptions and the learning experiences when engaging in virtual simulations focused on developing non-technical skills. METHOD: A descriptive exploratory approach was used. An online voluntary survey collected qualitative extended responses from participants after each virtual simulation. Ethics approval was obtained for the research and guidelines adhered to throughout the study. RESULTS: A total of 675 responses were obtained. Participants perceive that engaging with the virtual simulation made them aware of non-technical skills including communication, teamwork, decision making, critical thinking and problem solving, and, to a lesser extent, situational awareness. Additional categories of learning, clinical practice and limitations were identified. CONCLUSIONS: Engaging in virtual simulation can develop awareness of non-technical skills, as well as confidence and vigilance in practice and mindfulness of a person-centred approach to healthcare. Engaging in virtual simulation may support change in the professional performance of the participants through role modelling and learning through error.

What non-technical skills competencies are addressed by Australian standards documents for health professionals who work in secondary and tertiary clinical settings? A qualitative comparative analysis.

OBJECTIVES: At minimum, safe patient outcomes are recognised as resulting from a combination of technical and non-technical skills. Flin and colleagues provide a practical framework of non-technical skills, cognitive, social and interpersonal, that complement technical skills, with categories identified as situational awareness, communication, team working, decision-making, leadership, coping with stress and managing fatigue. The aim of this research was to explore the alignment of categories and elements of non-technical skills with those in the published standards documents of several health professions in Australia. DESIGN: A qualitative comparative analysis using document analysis and deductive coding examined, extracted and interpreted data from competency standards documents focusing on non-technical skills categories and elements. PARTICIPANTS: A purposive sample of 11 health professions competency standards documents required for registration in Australia. FINDINGS: The 11 competency standards documents contained 1616 statements. Although standards documents addressed all non-technical skills categories, there was limited reporting of managing stress and coping with fatigue. Of the 31 elements included in the non-technical skills framework, 22 were not common to all health professions and 3 elements were missing from the standards documents. Additionally, the documents were composed differently with no common taxonomy and multifaceted statements. CONCLUSION: While commonalities identified in the standards documents related to non-technical skills categories are likely to support patient safety, gaps in associated elements may undermine their effectiveness. The notable lack of reference to stress and fatigue requires further attention for health professional well-being in Australia. A shared taxonomy with clear statements may offer the best support for collaborative practice and positive patient outcomes. Competency standards need to be flexible to respond to the emerging demands of current healthcare practice along with consumer and health service needs.