Enhancing primary healthcare nurses' preparedness for climate-induced extreme weather events.

BACKGROUND: Climate Change is causing frequent and sever extreme weather events globally, impacting human health and well-being. Primary healthcare (PHC) nurses' are at the forefront of addressing these challenges and must be prepared. PURPOSE: This scoping revieww explored literature on the preparedness of the PHC nursing workforce for extreme weather events and identify gaps in knowledge and practice. METHODS: Using Arksey and O'Malley's framework, a comprehensive search was conducted across PubMed, Scopus, CINHAL, Web of Sciences, and ProQuest, on studies from 2014-2024, addressing PHC nurses' preparedness. DISCUSSION: Nine studies were identified and highlighted a need for preparedness training and facility-based preparedness plans. Key themes included prioritizing regional networks, clinical leadership, service delivery, health information, health workforce, medical products and technologies, and financing. CONCLUSION: Strengthening PHC nurses' resilience against extreme weather requires targeted professional development, mental health support, comprehensive planning, and collaborative efforts. Future strategies should enhance PHC nurses' capacity through training, support, and policy development.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study.

AIM: To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. DESIGN: A cross-sectional survey design. METHODS: An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices. RESULTS: There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively. CONCLUSION: Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health. IMPLICATIONS FOR THE PROFESSION: All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence. REPORTING METHOD: We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Achieving consensus on the essential knowledge and skills needed by nursing students to promote planetary health and sustainable healthcare: A Delphi study.

AIM: To achieve consensus on the knowledge and skills that undergraduate/pre-licensure nursing students require to steward healthcare towards a more sustainable future. DESIGN: A two-phase real-time Delphi study. METHODS: Phase 1 included the generation of Planetary Health, climate change and sustainability knowledge and skill statements based on a review of relevant literature. Phase 2 consisted of a real-time Delphi survey designed to seek consensus on the proposed statements from a panel of 42 international experts. RESULTS: Of the 49 survey statements, 44 (90%) achieved ≥75% consensus and 26 (53%) achieved ≥80% consensus. Three were removed and 32 were modified to improve clarity of language. CONCLUSION: The knowledge and skills statements that emerged through this Delphi study can serve as a guide for incorporating Planetary Health, climate change and sustainability into nursing education programs. IMPLICATIONS FOR THE PROFESSION: Incorporating Planetary Health and climate change education into nursing programs has the potential to produce more environmentally conscious and socially responsible nurses. IMPACT: The absence of consensus on the essential knowledge and skills expected of nursing students has hindered the advancement of curricula and impacted educators' confidence in teaching Planetary Health and climate change. This study has resulted in a meticulously crafted framework of knowledge and skill statements that will be beneficial to educators, the future nursing workforce, and, ultimately, the individuals and communities whom nurses serve. REPORTING METHOD: This paper adheres to the Conducting and REporting DElphi Studies (CREDES) reporting guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Improving Distress Screening for People with Prostate Cancer: Evaluation of an E-Learning Course to Increase Healthcare Professionals' Knowledge.

OBJECTIVES: Psychological distress can occur following diagnosis and treatment for prostate cancer, compromising psychosocial wellbeing. Improved recognition and management of distress by healthcare professionals can enhance clinical practice and promote evidence-based prostate cancer care. This paper explores the effectiveness and feasibility of the online Distress Screening for Prostate Cancer course, designed to improve healthcare professionals' understanding of screening for prostate cancer-related distress. It aims to evaluate whether this e-learning course increases learners' knowledge of distress screening for prostate cancer. METHODS: Healthcare professionals were invited to enroll in the online course and complete optional evaluation questions. The pretest posttest design identified changes in learners' knowledge about distress screening for people with prostate cancer, including prevalence, risk factors, assessment and management strategies for distress (n = 149). Learners also rated satisfaction in a cross-sectional survey (n = 116). Most respondents were nurses, including Prostate Cancer Specialist Nurses. RESULTS: Learners' knowledge of distress screening was higher after course completion. Improvement between pre- and posttest results was statistically significant for four of ten items, including risk of prostate cancer-related distress, and suicidality, and the purpose of distress screening. Learners reported high satisfaction with course content, structure, engagement, relevance, and approach. They particularly valued the narrative-based approach and interactivity. Small numbers encountered technological problems and some offered suggestions to improve learner feedback. CONCLUSIONS: The course improved healthcare professionals' knowledge of distress among people affected by prostate cancer. Learners found the e-learning format feasible and acceptable. IMPLICATIONS FOR NURSING PRACTICE: Deeper understanding of the psychological implications of diagnosis and treatment of prostate cancer can help healthcare professionals respond to and manage distress among men and their families, and provide supportive care to improve health-related quality of life. Access to an online course can offer effective, feasible education on distress screening.

Celebrating Australian nurses who are pioneering the response to climate change: a compilation of case studies.

BACKGROUND: Nurses, the largest healthcare workforce, are well placed to provide leadership in initiatives that promote planetary health. Yet, few practical examples of nurse leadership in the health sector's response to climate change are evident in the scholarly literature. AIM: The aim of this discussion paper is to profile Australian nurses who are leading initiatives designed to champion planetary health and promote sustainable practice. METHODS: The paper presents a series of case studies derived from interviews conducted in October and November 2023. FINDINGS: The nurses' experiences and insights, along with the challenges they have encountered, are presented as evidence of Kouzes and Posner's five practices of exemplary leadership. CONCLUSION: The case studies demonstrate that appointment of more nurses with climate and sustainability expertise will accelerate the implementation of responsive strategies that target waste management, emissions reduction and climate resilience across healthcare organisations.

Chaplaincy and spiritual care in Australian ambulance services: an exploratory cross-sectional study.

Ambulance staff wellbeing programs aim to support the bio-psycho-social and sometimes spiritual needs of paramedics. While evidence demonstrates strong connections between spirituality and/or religion to wellbeing outcomes, little is known about spiritual care in ambulance services or its impact. The aim of this study was to investigate paramedics' perspectives on the role and value of Australian ambulance chaplains. A cross-sectional online study of registered paramedics in Australia was conducted between November and December 2022. Analysis of the 150 responses identified that paramedics viewed the chaplain's role as one built on professional caring relationships that provided proactive and reactive care in paramedic workplaces. Chaplains were perceived to promote wellbeing by incorporating emotional, psychological, social and spiritual care, and assisting paramedics to access additional support. Perceived religiousness of chaplains and organisational factors were barriers to paramedics accessing chaplains, while pre-existing relationships and shared experiences positively influenced paramedics decision to seek chaplain support.

Nursing students' knowledge of and attitudes towards pain management: An integrative review.

OBJECTIVES: The objectives of this review were to appraise the available literature regarding nursing students' knowledge of and attitudes towards pain management; and secondly, to examine the instruments currently used to measure students' knowledge of and attitudes towards pain management. DESIGN: This review was conducted using Whittemore and Knafl's five-stage framework for integrative reviews. DATA SOURCES: A comprehensive search to retrieve relevant studies published in English between 1978 and 2022 was conducted using the databases: CINAHL, MEDLINE, Embase and Scopus databases. An updated search of the same databases was performed to identify studies published in 2023-2024. REVIEW METHODS: The initial search located 558 articles. One more relevant article was identified from an updated search test. Total of 244 duplicated records were removed. The remaining 315 studies were eligible for screening. After screening and checking for eligibility, 29 included articles were critically appraised using the Joanna Briggs Institute critical appraisal tools. RESULTS: Synthesis of the findings of the 29 included studies indicated that, internationally, nursing students have limited knowledge and often hold negative attitudes towards pain. Various instruments have been used to measure students' knowledge and attitudes towards pain. Most studies used true/false or multiple-choice questions and Likert-type scales. The validity and reliability of most of the tools were reported to be acceptable. The most commonly used instrument was the Knowledge and Attitudes Survey Regarding Pain. CONCLUSION: The findings from this review suggest the need for refinement of pain education programs to improve nursing students' knowledge of and attitudes towards pain management. Future research should focus on understanding the personal and environmental factors that impact students' level of knowledge and attitudes so as to inform curriculum development and ultimately the quality of the care graduates provide.

Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review.

BACKGROUND: The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning. AIM: The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic. METHODS: This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google. RESULTS: Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication. DISCUSSION: Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment. CONCLUSION: There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.

Use and effectiveness of the arts for enhancing healthcare students' empathy skills: A mixed methods systematic review.

OBJECTIVE: To identify, critically appraise and synthesise evidence of the use and effectiveness of the arts for enhancing pre-registration/prelicensure healthcare students' empathy skills. DESIGN: A systematic review of mixed methods literature. DATA SOURCES: A search of six electronic databases was conducted. REVIEW METHODS: Articles describing English language, peer-reviewed, primary research studies reporting empathy as an outcome of an arts-based intervention with pre-registration/prelicensure healthcare students (years 1-7) and published between 2000 and 2024 were eligible for inclusion. The JBI Manual for Evidence Synthesis guided the review and a convergent segregated methodology was used to synthesise the results. Methodological rigour of included studies was examined using the Mixed Methods Appraisal Tool. RESULTS: Twenty studies from 12 countries described the use of the arts to develop empathy, with visual arts being the most common approach (n = 8). Other modalities included film, drama, digital stories, literature, creative writing, music, poetry, photography and dance. Studies included nursing, medicine and dental, pharmacy and/or health sciences students. Ten studies used quantitative methods, three qualitative, and seven used mixed methods designs. Of the studies that presented pre-post outcome measures, nine reported significant gains in empathy scores at post-test and two reported non-significant gains in empathy. In eight studies, empathy scores demonstrated a significant intervention effect with effect sizes ranging from moderate (d = 0.52) to large (d = 1.19). Findings from qualitative studies revealed that arts pedagogies support students to better understand the perspectives of people with a lived experience of suffering but that these approaches are sometimes perceived negatively by students. CONCLUSIONS: Arts interventions generally have a positive effect on healthcare students' empathy levels and enable a nuanced conceptual understanding of empathy. Arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection, tend to be most effective.

The measured impact of the COVID-19 pandemic on nursing students' wellbeing, clinical placement and learning experiences: a cross sectional study.

Background: The epidemiological patterns of COVID-19 varied across Australia and differed from most other countries. Few studies describe the impact that the pandemic had on nursing student wellbeing, education and career.Aim: This study aimed to investigate how the COVID-19 pandemic impacted on nursing students' well-being, clinical placement and learning.Design: Cross-sectional survey.Setting: Sydney, Australia.Participants: Second- and third-year nursing students.Methods: Second- and third-year nursing degree students were asked to participate in an ethically approved study during March to May 2021. The de-identified on-line survey consisted of 63 closed end question and one open ended question. On completion, the dataset was exported from Redcap and imported into SPSS for analysis. Open ended text data were analysed by two researchers.Results: Of the 105 participating nursing students, a third (n = 26/83, 31%) thought about changing their degree to a non-nursing degree. The acknowledged risk of caring for a COVID-19 patient incrementally increased stress (ß-coefficient = 0.6, p value = 0.009, 95% CI 0.2-0.9). Conversely students who intended to complete their degree were less likely to report stress. Students who had prior nursing experience were three times more likely to report an increased generalised anxiety level (OR 3.8, p-value = 0.02, 95% CI 1.2-12.2), yet they were less likely to experience personal accomplishment burnout compared to other students. Nursing students who contemplated a change of degree to a non-nursing degree were 15.7 times more likely to experience emotional exhaustion and were 3.5 times more likely to be report a risk of depersonalisation (p = 0.03, 95% CI, 1.3-11.5).Conclusion: The COVID-19 pandemic compromised nursing student well-being, and theoretical and practical learning. Findings have implications for healthcare and academic staff who teach nursing students. Implementation of student-centred evidence-based strategies to manage stress, burnout and anxiety, and to sustain a healthy student cohort is essential to retain the future nursing workforce.

Promoting sustainability in nursing and midwifery clinical laboratories: Strategies for resource reduction, reuse, and recycling.

BACKGROUND: The impacts of climate change on planetary health are multifaceted and threaten public health gains made since World War II. Healthcare is the fifth largest global emitter of greenhouse gas emissions, demanding significant efforts to transition to an environmentally sustainable future. Addressing these issues will require collective societal action. In this regard, universities have a dual responsibility - (1) to tackle complex social, economic, and environmental challenges by championing sustainability initiatives designed to positively impact planetary health; and (2) to ensure that graduates are equipped with the knowledge, attitudes and skills needed to steward planetary health towards a more sustainable future. The future nursing and midwifery workforce must be educated to mitigate the health sector's impact on the environment, advocate for action on climate change, prepare for ongoing health impacts of unpredictable climate and environmental changes, and help communities and healthcare systems become more climate resilient. WHAT THIS PAPER CONTRIBUTES: To help increase nursing and midwifery educators' and students' capacity to support planetary-health related interventions, the overarching purpose of this paper is to provide a series of exemplars that illustrate sustainability initiatives used in four university-based clinical skills laboratories. These initiatives each demonstrate a commitment to the United Nation's Sustainable Development Goals and can be used to help embed the importance of planetary health in student learning.

Pre-assessment judgement framework for judging nursing students' performance in clinical placements: A qualitative case study.

AIM: This study aims to better understand and articulate the pre-assessment judgement processes commonly used by experienced clinical facilitators when assessing nursing students undertaking clinical placement. BACKGROUND: In the Australian context, clinical facilitators are registered nurses who primarily educate, monitor, support and assess groups of nursing students on clinical placements without carrying a patient load. The duties and scope of clinical facilitators may differ across international and institutional contexts. However, the core concepts of this paper will be relevant despite these differences as the importance of facilitators' confidence in making pre-assessment judgements of individual nursing student performance while on placement is universally acknowledged. Nursing students are often assessed on their provision of safe practice, patient task-orientated outcomes and professional behaviour. Clearly articulating performance judgements prior to formal assessment is vital to ensure progressive learning of students. Literature reports that many clinical facilitators lack confidence in the art of making performance judgements and call for targeted professional training and support in the clinical assessment of nursing students. To better understand and address this problem, clinical facilitators need a shared understanding of how individual nursing students' pre-assessment performance judgements are reached during placement experiences. DESIGN: A qualitative case study was used, with data collected via semi-structured interviews. Fifteen Australian clinical facilitators participated, each with over six months of experience. METHODS: Interview transcripts were analysed through an interpretive-constructivist paradigm. Thematic analysis revealed themes that were then deductively described through the application of the Cognitive Continuum Theory. RESULTS: Six modes of pre-assessment judgement emerged from the data synthesis process: 1) Recognising patterns, 2) Acknowledging uncertainty, 3) Understanding key players, 4) Verifying or refuting the information, 5) Benchmarking performance and 6) Contextualising information. Each mode is validated through the deductive application of the Cognitive Continuum theory. CONCLUSIONS: Understanding how experienced clinical facilitators make pre-assessment performance judgements has the potential to increase confidence in performance judgement decisions. In turn, confidence in judgements will increase clinical facilitator's capacity to give nursing students feedback that can be explained and justified. The pre-assessment judgement framework also provides a preliminary model for teaching the art of reaching accurate performance judgements to clinical educators in disciplines beyond nursing.

Modifying the clinical reasoning cycle to enhance forensic mental health nursing utility.

Forensic mental health nursing is a specialty area of practice requiring specific knowledge and skills to work collaboratively with consumers. The Clinical Reasoning Cycle has been recognised as a potential framework to support nursing practice; however, it has been identified that adaptations are required to enhance utility in a forensic mental health services. The aim of this study was to explore and finalise a version of the cycle for forensic mental health nursing practice. Focus groups and interviews were used to explore adaptations with staff from a state-wide forensic service and forensic mental health nursing academics. Data were thematically analysed. Four main themes were interpreted: (1) allegiance to the Nursing Process, (2) moving the cycle from page to practice, (3) working as a team, or not, and (4) implementation will be a marathon and not a sprint. While nursing academics were more in favour of updating the Nursing Process to ensure contemporary practice is captured, staff from the service were supportive of the adapted cycle but emphasised the need to ensure collaboration with the consumer and their supporters. The adapted cycle was seen to articulate the contribution of forensic mental health nursing care, and support for a nursing-specific cycle was embraced by other disciplines, despite some hesitation from nurses. Prior to implementation there is a need to ensure the merits of the cycle are clearly articulated, along with a range of resources and specific contextual information to ensure the cycle can be successfully applied to enhance nursing practice and consumer care.

Patient's views of empathic and compassionate healthcare interactions: A scoping review.

BACKGROUND: Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients. OBJECTIVE: The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions. METHOD: This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion. RESULTS: Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare. CONCLUSION: Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.

Healthcare professionals' experiences of interprofessional collaboration in patient education: A systematic review.

OBJECTIVES: This study explores interprofessional collaboration amongst healthcare professionals in patient education. METHODS: A systematic review was conducted. A search in seven databases was conducted from 2011 to 2022 and screened against the inclusion criteria. Quality appraisal was done independently by two reviewers. Studies were extracted and synthesised using the data-based convergent synthesis design. RESULTS: Twenty-one studies were included. Five themes on factors affecting interprofessional collaboration in patient education emerged: 1) role clarification, 2) communication infrastructure, 3) shared space for collaboration, 4) interprofessional trust, and 5) organisational support. CONCLUSION: Findings highlighted the importance of developing trustful relationships within the multidisciplinary team in delivering patient education. Channels for additional infrastructural support, guidelines and training in patient education delivery is required. Future research could explore patients' perspectives on how their learning needs in patient education may be optimised through a multidisciplinary approach. PRACTICE IMPLICATIONS: Healthcare leaders could promote shared goals within the team by facilitating a common space and time for interprofessional team rounding, and by developing shared patient education resources and documentation processes. Interprofessional education focusing on the delivery of team-based patient education could be implemented to foster understanding of the interdependent role of multidisciplinary healthcare professionals.

Examining the impact of virtual reality on clinical decision making - An integrative review.

BACKGROUND: Clinical decision making is an essential cognitive skill in nursing. It is a process undertaken daily by nurses as they make judgements about patient care and manage complex issues as they arise. Virtual reality is an emerging technology that is increasingly being used pedagogically to teach non-technical skills including CDM, communication, situational awareness, stress management, leadership, and teamwork. OBJECTIVE: The objective of this integrative review are to synthesise the research findings regarding the impact of virtual reality on clinical decision making in undergraduate nurses. DESIGN: An integrative review using Whittemore and Knafl's framework for integrated reviews. DATA SOURCES: An extensive search was conducted of healthcare databases including CINAHL, Medline and Web of Science between 2010 and 2021 using the terms virtual reality, clinical decision and undergraduate nursing. REVIEW METHODS: The initial search located 98 articles. After screening and checking for eligibility, 70 articles were critically reviewed. Eighteen studies were included in the review and were critically appraised using the Critical Appraisal Skills Program checklist for qualitative papers and McMaster's Critical appraisal form for quantitative papers. RESULTS: Research in the use of VR has demonstrated its potential to improve undergraduate nurses' critical thinking, clinical reasoning, clinical judgement and clinical decision-making skills. Students perceive these teaching modalities to be beneficial to the development of their clinical decision-making ability. There is lack of research related to the use of immersive virtual reality in developing and enhancing undergraduate nursing students' clinical decision-making skills. CONCLUSION: Current research on the impact of virtual reality on the development of nursing CDM has demonstrated positive results. VR is one pedagogical approach that could further assist, however, there are no identified studies that focus on its impact in developing CDM, therefore further studies are required to address this gap in the literature.

Patient perspectives of positive messages from clinicians: a qualitative secondary analysis and conceptual model.

Background: A review and meta- analysis of empathic communication and patients' expectations of interventions has shown that if positive messages are delivered there is a small but measurable reduction of pain and anxiety and some improvements in physical outcomes. Aim: To identify elements of health messages that may have a positive impact on patient health outcomes to guide effective nurse-patient- communication. Methods: Data were extracted from each study in a qualitative analysis of a systematic review investigating the health effects of positive messages, and analysed following the principles of thematic analysis. Findings: Central to effective positive messages were good communication skills. Five key features were identified. Discussion: The non-treatment care categories such as cognitive care and emotional care can significantly influence health outcomes across a range of interactions. Conclusion: Strategies to facilitate positivity can be incorporated into nursing education programs designed to improve patient outcomes.

Desktop Virtual Reality Versus Face-to-Face Simulation for Team-Training on Stress Levels and Performance in Clinical Deterioration: a Randomised Controlled Trial.

BACKGROUND: Simulation-based education can equip healthcare providers with the ability to respond to and manage stressors associated with rapidly deteriorating patient situations. However, little is known about the benefits of using virtual reality (VR) for this purpose. OBJECTIVE: To compare between desktop VR and face-to-face simulation in stress responses and performance outcomes of a team-based simulation training in managing clinical deterioration. DESIGN: A randomised controlled study METHOD: The study was conducted on 120 medical and nursing students working in interprofessional teams. The teams were randomly assigned to participate in a 2-h simulation using either the desktop VR or face-to-face simulation with simulated patient (SP). Biophysiological stress response, psychological stress, and confidence levels were measured before and after the simulation. Performance outcomes were evaluated after the simulation using a deteriorating patient scenario. RESULTS: The systolic blood pressure and psychological stress response were significantly increased among participants in VR and SP groups; however, no significant differences were found between the groups. There was also no significant difference in confidence and performance outcomes between participants in the VR and SP groups for both medical and  nursing students. Although the psychological stress response was negatively correlated (r = -0.43; p < 0.01) with confidence levels, there was no association between stress response and performance score. CONCLUSION: Despite being less immersive, the desktop VR was capable of inducing psychological and physiological stress responses by placing emotional, social, and cognitive demands on learners. Additionally, by ensuring close alignment between the simulation tasks and the clinical tasks (i.e. functional fidelity), the desktop VR may provide similar performance outcomes as conventional simulation training. This evidence is timely given the rise in the use of virtual learning platforms to facilitate training during the COVID-19 pandemic where face-to-face training may not be feasible. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov NCT04330924.

Exploring adaptations to the clinical reasoning cycle for forensic mental health nursing: A qualitative enquiry.

Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to 'own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team.