Using a design-based research framework to refine a desirable difficulties activity for sterile compounding in a skills-based laboratory course.

BACKGROUND AND PURPOSE: Design-based research (DBR) processes aim to connect educational research with instructional techniques by focusing on the development and evaluation of multiple iterations of learning activities for systematic improvement within learning environments. Desirable difficulties (DD) are purposeful challenges introduced to facilitate deeper learning of material. The purpose of this work was to evaluate a second iteration of a sterile compounding DD study in the context of DBR in order to allow for the identification and refinement of the educational methods. EDUCATIONAL ACTIVITY AND SETTING: In this second iteration, doctor of pharmacy students in their second professional year were exposed to both a mechanical and mathematical difficulty in sterile compounding training. Afterwards, students completed a questionnaire to rate their change in confidence and reflect on the activity. FINDINGS: An increase in confidence in sterile compounding skills was seen by the majority (97.9%) of students. Students' reflections highlighted gains in strategic knowledge, split between internal and external strategies. SUMMARY: Course instructors saw value in the refinement of a DD sterile compounding activity and plan to continue incorporating DBR processes in order to allow for the further improvement of this educational method. Faculty at other institutions could apply these processes to further refine a variety of educational activities.

A Kangaroo Care Pathway for NICU Staff and Families: The Proof Is in the Pouch.

BACKGROUND: Kangaroo care (KC) improves bonding and neonatal health outcomes worldwide. However, concerns for patient safety, interrupted workflow, and parent readiness continued to impede KC in a level IV neonatal intensive care unit (NICU). Its current policy did not recommend using more than 1 staff member during patient transfer. In addition, NICU staff and parents lacked skills training and education regarding the feasibility of routine KC. PURPOSE: A KC pathway was developed and integrated within a multifaceted, champion-based, simulated educational training program for NICU staff and families to promote earlier and more frequent KC by increasing their knowledge and comfort with this practice. METHODS: Patient data collected before and after the study determined the frequency, timing, and mode of respiratory support during KC. Pre- and posttest surveys evaluated nurses' knowledge and comfort level with KC. RESULTS: The frequency of KC occurred 2.4 times more after the intervention. The percentage of KC episodes for intubated patients nearly doubled. The posttest survey scores for nursing knowledge and comfort level also markedly improved. IMPLICATIONS FOR PRACTICE: The KC pathway ameliorated feelings of discomfort by depicting criteria and instructions for safe practice. Multidisciplinary champions were invaluable in assisting the nursing staff with patient transfer during KC. IMPLICATIONS FOR RESEARCH: More dose-response studies are needed to maximize the clinical benefits of KC in developed countries.

Lessons learned from an investigation exploring association between grit and student performance in a pharmacy skills laboratory course.

BACKGROUND: A challenge for many pharmacy educators is early identification of students who may struggle with various aspects of the pharmacy curriculum. While grade point average, demographic factors, and personality traits may be helpful considerations, we felt there was a need to further explore methods for readily identifying at-risk students who may benefit from early intervention. The Grit Scale has recently been explored, presented, and published in academic pharmacy. The goal of this study was to determine if there was an association between students' grit scores and performance on a laboratory practical examination. However, it became apparent that there were substantial limitations leading to difficulties analyzing and interpreting our study data and results. IMPACT: The interpretation of data was confounded due to study design limitations, including use of the Grit-O scale (rather than Grit-S), low response rate, and lack of validation evidence for laboratory practical assessments. RECOMMENDATIONS: Thoughtful consideration during the design of the study may have produced better data for analysis. Psychometric considerations are paramount, both for the instrument (Grit-O) and the dependent/outcome variable (laboratory practical assessment). DISCUSSION: While this study did not yield meaningful results for interpretation, it highlighted important lessons for investigators at the college to use moving forward. We hope that the lessons learned from this investigation might support the academy in improving design and rigor of educational research.

Neonatal Transport: Current Trends and Practices.

Since the inception of organized neonatal transport in the 1940s, advances in clinical care and technology have made the neonatal intensive care unit even more mobile in terms of care delivery. There currently exists an emphasis on quality metrics and simulation-based training for transport team members to achieve high levels of individual and team competence. Emerging therapies such as active cooling for neuroprotective hypothermia and high-frequency ventilation provide evidence-based care in the transport environment to enhance clinical outcomes. Accreditation of neonatal transport programs is now embraced as an indicator of competency and compliance with transport standards.

Utilizing desirable difficulties for sterile compounding training in a skills-based laboratory course.

BACKGROUND AND PURPOSE: Sterile compounding skills are essential components of a professional pharmacy curriculum. The theory of desirable difficulties has been used to facilitate deeper learning of material in other disciplines, but has not been described in pharmacy sterile compounding instruction. The purpose of this work was to evaluate whether challenges introduced in sterile compounding would act as desirable difficulties and result in greater student confidence in their sterile compounding competency. EDUCATIONAL ACTIVITY AND SETTING: Students in the fourth semester of Pharmacy Skills and Applications, a laboratory-based skills course, were presented with challenges in sterile compounding and were asked to complete a questionnaire rating their confidence and describing their experience. FINDINGS: The majority (92.8%) of students reported that the activity increased their confidence in their sterile compounding skills. Students' open-ended responses suggested that most of the knowledge gained was strategic in nature. DISCUSSION: The results of this activity met the instructors' initial goals by positively impacting students' confidence in their ability to overcome challenges with sterile products compounding. Course instructors may explore additional skills in which to introduce desirable difficulties in order to build student confidence. SUMMARY: Course instructors were pleased with the implementation and results of this desirable difficulties activity and plan to continue its use again in future semesters. Incorporating more real-world challenges throughout the skills-lab course may be beneficial to student learning and confidence. With thoughtful planning, faculty at other institutions can readily incorporate similar activities within their own courses.

Comparison of faculty and student self-assessment scores of aseptic technique skills and the impact of video review on self-awareness for second-year pharmacy students.

BACKGROUND AND PURPOSE: Educating students about aseptic technique presents many challenges. Students at Drake University have limited exposure to this skill outside of the classroom setting, and students have previously shown a lack of awareness related to their own aseptic technique skills. One approach to developing self-awareness in this area may be the incorporation of activities involving video viewing and self-reflection. EDUCATIONAL ACTIVITY AND SETTING: Second-year pharmacy students in the Intermediate Pharmacy Skills and Applications 2 course completed four total aseptic technique activities, each of which was assessed by faculty using a standardized assessment tool. Each student was video-recorded during one of these aseptic technique activities. Students were asked to self-reflect on their performance immediately after the activity and again after viewing the video recording of their performance (using the same criteria included in a standardized faculty assessment tool). Student self-reflection scores before and after video viewing were then compared to faculty scores. FINDINGS: One-hundred six students participated in the video recording and self-reflection activity. Compared to faculty assessment scores, there was no significant difference between the self-reflections before or after video viewing (p = 0.571). DISCUSSION: Video self-reflection had no significant impact on the ability to accurately self-assess aseptic technique skills, but this study did reveal several other opportunities for future teaching and research. SUMMARY: Future efforts to impact student self-awareness should include additional self-reflection instruction, repeated self-reflection activities conducted over the course of a semester, and improved video recording technology.

A Multifaceted Nursing Role to Comply With Neonatal Transport Regulations in Maryland: The TR/DR Nurse.

BACKGROUND: The Maryland Regional Neonatal Transport Program performs 800 transports annually. Historically transports utilized a neonatal nurse practitioner or neonatal transport nurse and 2 medics. A regulatory ruling at the state level mandated change in team composition. This institution elected to educate neonatal intensive care unit (NICU) staff nurses to become the providers for transports and to respond to deliveries requiring the NICU team. These nurses became the transport-delivery room nurse. PURPOSE: To implement a transport care delivery model in response to the new regulatory ruling and measure the impact of the change on care indices. METHODS/SEARCH STRATEGY: The new care delivery model involved the creation and implementation of a new role for the NICU nurse. NICU nurses were queried regarding their interest and 35 nurses received educational training. Two metrics were tracked to evaluate the success of the model for 1 full year prior to and monthly after implementation. The 2 metrics were axillary temperature on admission to the NICU from the delivery room and mean length of time of stabilization of the neonate at the referral hospital. RESULTS: The length of time to stabilize the neonate at the referring hospital was reduced by a mean of 7 minutes. Percentages of newborns admitted to the NICU from labor and delivery with an axillary temperature of greater than 36.3°C increased from 65% to 77%. IMPLICATIONS FOR PRACTICE AND RESEARCH: Nurses with specialized skill sets positively impact neonatal outcomes. Further investigations should involve the impact this role has on nurse and community satisfaction.