Cochlear implantation and partial deafness - A retrospective review on processor programming.

BACKGROUND: To decide what programming parameters to use for cochlear implants (CIs) in partial deaf patients can be challenging. OBJECTIVE: The processor programming form, categorised as electrical complement (EC), electro-acoustic-stimulation (EAS) or electric stimulation (ES), and difficulties switching programming form were investigated. METHODS: A retrospective investigation of medical records and audiograms was conducted in adult patients intended for EC and EAS. RESULTS: Eighty-four ears (80 patients) were included. Twenty ears were initially fitted with EC, 32 with EAS, 30 with ES and 2 with both EC and EAS. Sixty-four ears met the criteria to use EC or EAS at initial fitting, however only 54 ears were fitted with EC or EAS initially. Twenty-eight patients altered between at least two programming forms and six of those experienced difficulties to adapt to a new form when their low-frequency hearing deteriorated. Twenty-five percent of patients initially fitted with EC or EAS switched programming form within two years. DISCUSSION: Further studies on how to choose the most beneficial sound processor programming parameters for EC and EAS, and when to change between programming forms, are warranted as well as clear guidance on choosing the right candidates for EC and EAS.

Do Patients Aged 85 Years and above Benefit from Their Cochlear Implants?

The present study aims to investigate the usage and benefits of cochlear implants (CIs) in elderly patients aged ≥85 years, including their device-handling issues, follow-ups, and the influence on their well-being. The patients answered one questionnaire regarding quality of life, EQ5D-3L, and one questionnaire, obtained from the Swedish CI quality register, regarding usage, handling, satisfaction, remaining difficulties, etc. The medical records were searched for the implantation date, implant model, speech processor model, monosyllabic (MS) word scores, infections over the implant, and compliance regarding scheduled visits to the clinic. The results show that most elderly patients are satisfied full-time users of their implants. Even though most patients had no problems handling their CI, handling issues must be considered. Recurring guidance and training on device operation are needed. We suggest that follow-up visits are essentially needed for this group of patients on a regular basis. CI surgery is considered a safe treatment, even for the elderly. Upgrads to new external equipment (e.g., sound processors) should not be excluded because of their age. The results suggested that the CI positively affected their well-being. This study was approved by the Swedish Ethical Review Authority (5/10-2021, Dnr: 2021-04970).

Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study.

OBJECTIVE: This study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care. DESIGN: Retrospective cohort study. SETTING: Orthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011. PARTICIPANTS: Two cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1 day at the IPTW. MAIN OUTCOME MEASURES: Readmission at 90 days and 1-year mortality. RESULTS: We included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders. CONCLUSION: Interprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.

Peri-operative electrically evoked auditory brainstem response assessment of facial nerve/cochlea interaction at cochlear implantation.

OBJECTIVES: Dehiscence between the cochlear otic capsule and the facial nerve canal is a rare and relatively newly described pathology. In cochlear implantation (CI), this dehiscence may lead to adverse electric facial nerve stimulation (FNS) already at low levels, rendering its use impossible. Here, we describe an assessment technique to foresee this complication. METHODS: Pre- and postoperative computed tomography (CT) scans and intraoperative electrically evoked auditory brainstem response (e-ABR) measurements were analyzed in two patients with cochlear-facial dehiscence (CFD). RESULTS: Because of the relatively low resolution, the confirmation of CFD with a clinical CT was difficult. The e-ABR displayed a large potential with 6 and 7.5 ms latency, respectively, which did not occur otherwise. DISCUSSION: Potential strategies to resolve and manage FNS are described. CONCLUSION: Prediction of FNS by assessing the distance between the labyrinthine portion of the facial nerve and the cochlea is difficult using conventional CT scans. A large evoked late myogenic potential at low stimulation levels during intraoperative e-ABR measurement may foresee FNS at CI activation.

High-fidelity simulation: Assessment of student nurses' team achievements of clinical judgment.

Nursing educators have the challenge of preparing nursing students to handle complex patient care situations in real life, but much remains unknown about the ability to make clinical judgments. In this study, high-fidelity simulation (HFS) was used at a Swedish university to find answers about pre-licensure nursing students' success in clinical judgment in terms of team ability and relationships with theoretical achievements, and personal and scenario circumstances. The matrix Lasater Clinical Judgment Rubric (LCJR) was used to analyze and score the students' ability in teams to notice, interpret and respond to complex care situations. Overall, the results showed the student teams in their first meeting with HFS in a complex care situation achieved low clinical judgment points; most teams were in the stages of Beginning and Developing. For attaining high team achievements the majority of the students in the team should theoretically be "high performance". Being observers and having HFS experience before nursing education was significant too. However, age, health care experience, and assistant nurse degrees were of secondary importance. Further research at universities regionally, nationally, and internationally is needed.

A safe place with space for learning: Experiences from an interprofessional training ward.

Interprofessional learning in a real ward context effectively increases collaborative and professional competence among students. However, less is known on the processes behind this. The aim of this study was to explore medical, nurse, physiotherapy, and occupational therapy students' perspectives on the process of their own learning at an interprofessional training ward (IPTW). We performed a qualitative content analysis on free-text answers of 333 student questionnaires from the years 2004 to 2011. Two main themes emerged: first, students found that the IPTW provided an enriching learning environment--a safe place with space. It included authentic and relevant patients, well-composed and functioning student teams, competent and supportive supervisors, and adjusted ward structures to support learning. Second, they developed an awareness of their own development with faith in the future--from chaos to clarity. It included personal, professional, and interprofessional development towards a comprehensive view of practice and a faith in their ability to work as professionals in the future. Our findings are discussed with a social constructivist perspective. This study suggests that when an IPTW provides a supportive and permissive learning environment with possibilities to interact with one another--a safe place with space--it enables students to move from insecurity to faith in their abilities--from chaos to clarity. However, if the learning environment is impaired, the students' development could be halted.

Correlations Between Clinical Judgement and Learning Style Preferences of Nursing Students in the Simulation Room.

BACKGROUND: Health care educators account for variables affecting patient safety and are responsible for developing the highly complex process of education planning. Clinical judgement is a multidimensional process, which may be affected by learning styles. The aim was to explore three specific hypotheses to test correlations between nursing students' team achievements in clinical judgement and emotional, sociological and physiological learning style preferences. METHODS: A descriptive cross-sectional study was conducted with Swedish university nursing students in 2012-2013. Convenience sampling was used with 60 teams with 173 nursing students in the final semester of a three-year Bachelor of Science in nursing programme. Data collection included questionnaires of personal characteristics, learning style preferences, determined by the Dunn and Dunn Productivity Environmental Preference Survey, and videotaped complex nursing simulation scenarios. Comparison with Lasater Clinical Judgement Rubric and Non-parametric analyses were performed. RESULTS: Three significant correlations were found between the team achievements and the students' learning style preferences: significant negative correlation with 'Structure' and 'Kinesthetic' at the individual level, and positive correlation with the 'Tactile' variable. No significant correlations with students' 'Motivation', 'Persistence', 'Wish to learn alone' and 'Wish for an authoritative person present' were seen. DISCUSSION & CONCLUSION: There were multiple complex interactions between the tested learning style preferences and the team achievements of clinical judgement in the simulation room, which provides important information for the becoming nurses. Several factors may have influenced the results that should be acknowledged when designing further research. We suggest conducting mixed methods to determine further relationships between team achievements, learning style preferences, cognitive learning outcomes and group processes.

Nursing students at a university - a study about learning style preferences.

BACKGROUND: In most adult education, teachers use methods that assume all students learn in the same way. But knowledge of students' learning style preferences highlights the importance of adequate teaching and learning adaptation. OBJECTIVES: The aim of the study was to describe and compare final year nursing students' learning style preferences in two campuses during three semesters. A further aim was to identify differences between learning style preferences and personal characteristics. DESIGN: A descriptive cross-sectional study using the Productivity Environmental Preference Survey (PEPS) questionnaire was conducted at a Swedish rural university. Three semester groups with 263 nursing students participated in 2012-2013. RESULTS: The majority of the students were 'flexible' in their learning style preferences and had none or few strong preferences. Students with strong preferences preferred high structure (75%) and an authority figure present (40%). About a third were highly auditory, tactile and/or kinesthetic while 8% were highly visual. Few significant differences were revealed between the groups of campuses and the groups of semesters or between learning style preferences and upper secondary school and care experience. There were no significant differences between learning style preferences and age and assistant nurse graduation. More women than men were highly motivated, auditory, tactile and kinesthetic and preferred structure and mobility. CONCLUSIONS: The PEPS questionnaire provides nursing students with self-awareness regarding their strengths and shortcomings in learning and teachers with a valuable and practical basis for their selection of adapted individual and group teaching methods. The findings suggest the need for wide variation and interactive teaching approaches, conscious didactic actions between cooperating teachers and conscious learning strategies for nursing students.

Effects of interprofessional education on patient perceived quality of care.

BACKGROUND: Active patient-based learning by working together at an interprofessional clinical education ward (CEW) increases collaborative and professional competence among students. AIM: To assess the patients' perceptions of collaborative and communicative aspects of care when treated by interprofessional student teams as compared to usual care. METHOD: Patients treated by student teams (medical, nurse, physiotherapy and occupational therapy students) at a CEW comprised the intervention group. Patients treated at a regular ward were taken as controls. The patients answered a questionnaire representing collaborative and communicative aspects of care. Questionnaires from CEW (n = 84) and control (n = 62) patients were obtained (82% vs 73% response rates). RESULTS: CEW patients rated a significantly higher grade of own participation in decisions regarding treatment as compared to controls (p = 0.006). They did further rate a higher grade of satisfaction with information regarding need of help at home (p = 0.003) and perceived that the CEW staff had taken their home situation into account at a higher grade in the preparation of discharge (p = 0.0002). Finally, CEW patients felt better informed (p = 0.02). CONCLUSION: Patients perceived a higher grade of quality of care as compared to controls with no signs of disadvantages when treated and informed by supervised interprofessional student teams.

Preceptoring nursing students: registered nurses' perceptions of nursing students' preparation and study approaches in clinical education.

Preceptorship influences Registered Nurses' (RNs) daily work to different degrees depending on nursing students' knowledge, and willingness to learn. Consequently, it is of the utmost importance to investigate how RNs assess nursing students in clinical education. The aim of this study was to describe RNs' perceptions of nursing students' preparation and study approaches at hospital workplaces, and to explore relationships between RNs' perceptions and their personal/clinical characteristics. A cross-sectional design was used. In 2006, 142 of 196 RNs at a Swedish hospital answered a questionnaire (response rate 72.5%). The majority of RNs (63-84%) rated students' study approaches highly and thought students comprehended the outcomes of learning. Fewer (45-49%), rated students as having adequate theoretical knowledge highly and were of the opinion that they had acquired knowledge about the unit. Statistically, non specialist nurses rated significantly higher compared with specialist nurses. Significant positive correlations were found between the RNs' perceptions of nursing students and their interest in preceptoring. The extent to which preparation programmes, established in collaboration between a university and a hospital, had improved preceptors and nursing students was not graded. Further descriptive and intervention studies are therefore needed.

Being a personal preceptor for nursing students: Registered Nurses' experiences before and after introduction of a preceptor model.

AIM: This paper is a report of a study to compare Registered Nurses' experiences of acting as personal preceptors for nursing students in the year 2000 with the year 2006 and explores relationships between preceptors' experiences and personal/clinical characteristics. BACKGROUND: Preceptoring is experienced as stressful and challenging. How successful preceptors are in this role depends largely on the support they receive. Knowledge about preceptors' experiences over time and in relation to a preceptor model is limited. METHOD: Data were collected by questionnaire in 2000 (n=113) and 2006 (n=109) with preceptor groups in a hospital in Sweden before and after introduction of a preceptor model. Data were analysed with descriptive and correlational statistics using parametric and non-parametric methods. FINDINGS: Statistically significant improvements were noted in preceptors' experiences between 2000 and 2006. Statistically significantly more preceptors in 2006 reported that they felt prepared for their role and felt support from teachers, colleagues, chief nurses and enrolled nurses. Least improvement was seen in relation to the questionnaire items workload, constructive feedback and support in linking research results to practice. A strong positive relationship existed between preceptors' experiences of the preceptor role and the level of interest in preceptoring. CONCLUSION: The preceptor model offers a way to support and facilitate preceptors and to develop co-operation between university and hospital. Future research should focus on students' experiences, experiences of first-time preceptors, head preceptors and teachers from a longitudinal perspective.

Active interprofessional education in a patient based setting increases perceived collaborative and professional competence.

BACKGROUND: Interprofessional competence can be defined as knowledge and understanding of their own and the other team members' professional roles, comprehension of communication and teamwork and collaboration in taking care of patients. AIM: To evaluate whether students perceived that they had achieved interprofessional competence after participating in clinical teamwork training. METHOD: Six hundred and sixteen students from four undergraduate educational programs-medicine, nursing, physiotherapy and occupational therapy-participated in an interprofessional course at a clinical education ward. The students filled out pre and post questionnaires (96% response rate). RESULTS: All student groups increased their perceived interprofessional competence. Occupational therapy and medical students had the greatest achievements. All student groups perceived improved knowledge of the other three professions' work (p = 0.000000) and assessed that the course had contributed to the understanding of the importance of communication and teamwork to patient care (effect size 1.0; p = 0.00002). The medical students had the greatest gain (p = 0.00093). All student groups perceived that the clarity of their own professional role had increased significantly (p = 0.00003). Occupational therapy students had the greatest gain (p = 0.000014). CONCLUSIONS: Active patient based learning by working together in a real ward context seemed to be an effective means to increase collaborative and professional competence.

Registered Nurses' perceptions of their work and professional development.

AIM: This paper is a report of a study to elucidate Registered Nurses' perceptions of their work and professional development 6 years after graduation. BACKGROUND: Nursing education and health care has rapidly changed in the last two decades. Education and experience are important components in Registered Nurses' ability to promote a high quality of care, but a great deal depends on their work circumstances. This study emphasizes Registered Nurses' view of their work in health care, at a time in their career when they have several years of experience. METHOD: Data were collected in 2003 from in-depth interviews with 15 Registered Nurses 6 years after their graduation. The interviews were semi-structured and analysed with interpretive content analysis. FINDINGS: The findings revealed two themes and five sub-themes. The first theme, An appropriate but demanding profession, consisted of two sub-themes: 'having found one's niche' and 'growing old in nursing may be difficult'. The second theme, A profession with opportunities and obstacles, consisted of three sub-themes: 'being aware of Registered Nurses' potential', 'having knowledge that is seldom made use of' and 'attaining professional growth is no matter of course'. CONCLUSION: Keeping Registered Nurses' satisfied and avoiding their dissatisfaction is crucial for both educators and employers. It is essential that employers give priority to Registered Nurses' time with patients and to motivate and support them in professional development. Further intervention studies regarding a change of the balance between obstacles and opportunities are needed.

Registered nurses' experiences of daily work, a balance between strain and stimulation: a qualitative study.

BACKGROUND: The challenges in the health care have given rise to a highly stressful work situation and a more complicated role for registered nurses (RNs). Qualitative studies about daily work as a whole is limited. It is therefore vital for future development of nursing knowledge and nursing education to recurrently investigate RNs' experiences of their ability to grasp and manage their daily work situation and to promote a high quality of care. AIM: The aim of this study was to describe RNs' experiences of their daily work. METHODS AND PARTICIPANTS: This follow up study was carried out involving 15 Swedish RNs 6 years after their graduation. Interviews, conducted with conversational strategy, were chosen for the data collection and content analysis was used to handle the interview texts. RESULTS: The analysis resulted in a main theme 'to balance strain and stimulation', two themes and seven sub-themes. The first theme 'a stressful work situation' consisted of the sub-themes: 'to meet all demands', 'to be insufficient', 'to be unsure of oneself', and 'too little contact with patient'. The second theme 'a stimulating work situation' consisted of the sub-themes: 'to encounter patients and health care staff is enriching', 'to have the situation under control', and 'to have the skills necessary to be independent'. A pattern emerged throughout the themes, which showed that due to the increasing number of patients RNs' capacity for management, prioritising and planning out of team work, and performing exacting documentation diminished. CONCLUSION: The RNs' daily work has been illustrated as a scale of balance that oscillated between strain and stimulation; an oscillation towards strain could lead to a vicious circle. The RNs need support from the start through nursing education and continuously in profession. This is a crucial issue for nursing education and health care sector.