Improving Adolescent Psychosocial Assessment through Standardized Patient Simulation: An Interdisciplinary Quality Improvement Initiative.

Adolescent suicide and mental illness have increased at alarming rates. Healthcare professionals report a lack of skill and confidence in obtaining adolescent histories and managing confidential care due to limited training in residency. Nursing professional development practitioners face challenges of adequately preparing interdisciplinary healthcare providers to assess, identify, and intervene at all points of contact with adolescents. To increase the confidence in clinical communication skills and clinical competency, and to increase the number of social work referrals related to modifiable risk factors for adolescent patients, a Texas pediatric tertiary care center utilized standardized patient (SP) methodology to supplement traditional clinical experiences with communication-focused education based on the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing. This quality improvement (QI) pilot demonstrated the benefits of utilizing standardized patient methodology in communication-focused education based on the HEEADSSS interviewing. Following the SP simulations, confidence in clinical communication skills increased by 13%, clinical competency in performing comprehensive psychosocial interviews increased by 11%, use of HEEADSSS increased by 64%, and social work referrals increased by 89%. This interdisciplinary SP interviewing simulation pilot was beneficial in improving the 36 physician and nursing residents' ability to conduct psychosocial assessments for risk factors of suicidality among adolescents.

Nursing Graduates' Preparedness for Practice: Substantiating the Call for Competency-Evaluated Nursing Education.

Practice readiness continues to be a challenge in healthcare. This was especially evident during the COVID-19 pandemic. This focused descriptive-correlational study examined nurses' perceived preparedness for practice during the pandemic. One hundred and eighty-four registered nurses (RN) responded to Qualtrics survey questions addressing the competencies they perceived they had and the competencies they felt they needed that would have better prepared them to care for patients during the COVID-19 pandemic. The results demonstrated that although these nurses felt competent in certain areas, they perceived that they needed more education in those same areas to feel better prepared. Bivariate correlations and linear regression analysis indicated that institutional competency development, education, and work experience influenced perceived competency.

Aesthetics and Technology Integration in a Community-Based Primary Care Nursing Curriculum.

BACKGROUND: Reconceptualized nursing education can prepare registered nurses to practice at the full scope of licensure on interprofessional teams across care continua while enhancing the quality of health care systems. PROBLEM: Traditional nursing programs minimally address primary care competencies. Rapidly changing managed care models demand nurses develop knowledge, skills, and attitudes to effectively deliver population health, primary care, care coordination, and disease prevention/management services across care continua. APPROACH: A faculty team built an innovative concept and competency-based accelerated bachelor of science in nursing primary care-focused curriculum integrating behavioral health, aesthetic knowing, and technology. OUTCOMES: The curriculum was implemented twice, with the third cohort mid-program. Program evaluation is ongoing. CONCLUSION: A paradigm shift in nursing education may improve population-based biobehavioral wellness, disease prevention, and chronic disease management. Future research should focus on how this innovative curricular approach builds essential nursing competencies and enhances digital fluency, observation, communication, empathy, and critical thinking skills.

Physician Residents Shadowing a Certified WOC Nurse to Develop Interprofessional Competencies: A Quality Improvement Project.

PURPOSE: The aim of this quality improvement (QI) project was to assess a shadowing experience with a certified WOC nurse (CWOCN) on 4 interprofessional collaborative practice domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice. PARTICIPANTS AND SETTING: Forty-nine physician residents in Family and Internal Medicine participated in this project set at a health system in Chicago, Illinois. APPROACH: Residents spent 16 hours shadowing a CWOCN and completed the Interprofessional Education Collaborative Competency Self-Assessment Tool (IPESAT) pre- and postshadowing that measured 4 interprofessional education (IPE) domains: interprofessional communication, role awareness and responsibilities, teams and teamwork, and values and ethics for interprofessional practice. Paired t tests were performed to determine differences in IPESAT scores before and after the shadowing experience. OUTCOMES: Residents demonstrated significant improvement in their overall knowledge of IPE (P = .000) as well as knowledge within each of the 4 domains (P = .000). After the shadowing experience, the overall ranking improved by 7.5%; the greatest gain (10.8%) occurred in the teamwork domain. IMPLICATIONS FOR PRACTICE: We found that even a comparatively brief shadowing experience with a CWOCN improved knowledge in IPE competencies. The shadowing experience is now permanently part of the Internal Medicine Residency program, and based on these IPE outcomes, other residency programs in our setting, such as the Rehabilitation and Family Medicine program, have increased their requests to shadow with the CWOCN.

Innovative Frontline Nurse Leader Professional Development Program.

Frontline nurse leaders direct staff and unit systems while ensuring that quality, safe patient care is provided. It is unknown if frontline nurse leaders oriented with only on-the-job-training are competent and if a professional development program will improve their competencies. This project's purpose was to measure self-assessed competencies, using the Nurse Manager Inventory Tool, of 38 frontline nurse leaders. This project used a quasi-experimental design and utilized pre- and postsurvey for evaluation purposes of a leadership development curriculum.

Applying art observation skills to standardized patients.

AIM: In this interprofessional education Art Applications Workshop, 104 medicine, nursing and psychology students apply skills developed through visual arts observations that enhance students' collaboration, communication, and observational skills to standardized patient encounters. Students observe two-dimensional images, write case reports on the paintings' subjects, and apply principles to complete assessment notes on standardized patients. This descriptive paper's goal is to disseminate this interprofessional curriculum and share experiences in implementing this workshop. BACKGROUND: Visual arts education in healthcare programs expand students' visual, tactile and oral expression, especially in collaborative team settings. METHODS: In session 1, student teams analyze paintings and learn visual assessment techniques. In session 2, student teams observe paintings in a museum setting and write observations in case notes. In session 3, student teams apply visual assessment techniques to standardized patient interviews, write patient histories, assessment notes, and finally, complete post-survey self-evaluations. RESULTS: In the standardized patient assessment 73% of students made accurate diagnosis with supporting evidence in patient histories and notes. In post-survey results, 91% of students agreed/strongly agreed they improved their visual observation skills, 92% agreed/strongly agreed they improved their communication skills in listening and encouraging the ideas and opinions of other team members, 91% agreed/strongly agreed they are more confident in communicating with students from different disciplines, and 97% agreed/strongly agreed they are more confident in collaborating with students from different disciplines. CONCLUSIONS: This Workshop demonstrates enhanced self-reported perceptions of collaboration, observation, and communication skills in case notes and standardized patient assessment notes.

Medical and pharmacy students shadowing advanced practice nurses to develop interprofessional competencies.

AIM: This article describes a job-shadowing project that partnered second-year medical and third-year pharmacy students with an advanced practice nurse (APN) for a four-hour job- shadowing experience. BACKGROUND: In order to address the Interprofessional Education Collaborative (IPEC) Expert Panel core competencies of interprofessional communication, teamwork, and roles/responsibilities, this project implemented a job-shadowing experience to increase students' knowledge of APN roles and interprofessional collaborative team practices. METHODS: Forty volunteer medical and pharmacy students were paired together and completed the job-shadowing activity with an APN. Assessment of knowledge was measured by pre- and post-project surveys. RESULTS: Pre- and post-job-shadowing differences demonstrated statistical significance in the interprofessional domains of role awareness, collaboration and communication. These results suggest that an APN job-shadowing experience is effective in developing medical and pharmacy students' competencies in interprofessional collaborative practice. CONCLUSION: Specific recommendations include creating enhanced job-shadowing experiences within the curriculums of medicine, pharmacy, and nursing students, and assessing for evidence of enhanced IPEC competencies as a result of these learning experiences.

Renal artery stenosis precipitates hyponatremic hypertensive syndrome and posterior reversible leukoencephalopathy.

BACKGROUND: Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder usually encountered in the adult population with unilateral renal artery stenosis and is under-recognized in the pediatric population. CASE DIAGNOSIS/TREATMENT: A 19-month-old male presented with new-onset status epilepticus associated with neurological sequelae, and hypertension to a high of 248/150 mmHg. Lab work revealed significant hyponatremia, elevated peripheral renin activity, and increase in aldosterone and ADH levels. A diagnosis of HHS was made. Initial analysis revealed a high-grade proximal renal artery stenosis by magnetic resonance imaging (MRI) and angiogram. Electroencephalogram and an MRI of the brain demonstrated characteristic abnormalities of the left temporal-parietal regions consistent with posterior reversible leukoencephalopathy syndrome (PRES). The patient responded to right renal artery balloon dilation and stent placement. Since intervention and close blood pressure control with Amlodipine, the patient has been free of seizures and is neurologically intact. CONCLUSION: We report a case of malignant hypertension in a 19-month-old male secondary to renal artery stenosis with associated HHS and PRES. Prognosis of PRES in children with renal disease is excellent. Prompt intervention may offer near complete resolution of physiologic and symptomatic effects of HHS and PRES due to high-grade renal artery stenosis. This report was written with parental consent for de-identified case presentation and radiographs for the educational benefit of other medical professionals.

Acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is commonly associated with severe sepsis. While the criteria for diagnosis have evolved since the first description in 1967, the characteristics of hypoxemia, tachypnea, rapidly progressing acute respiratory failure, and poor lung compliance continue. Scoring systems have been developed in an effort to quantify the severity of lung injury, with the most recent being the Berlin Definition. This system attempts to define acute lung injury (ALI) and ARDS with more precision in terms of timing of disease onset, severity of disease, and chest radiograph findings. The number of reported cases of ALI/ARDS per year is lower in pediatric patients vs. adults; however, mortality rates continue to be high. Sepsis-related ARDS has a generally higher disease severity and poorer recovery period from lung injury with an increased mortality rate. ARDS results from an initial insult (direct and/or indirect) which triggers a series of cell-mediated responses leading to damage to the capillary endothelium, alveolar epithelium, and impaired fluid removal from the alveolar space. There is, however, gradual resolution of hypoxemia, lung function, and radiographic abnormalities in survivors of ARDS. Management of ARDS is mainly supportive with specific mechanical ventilation strategies and goal-directed therapies. Prevention of ventilator-induced lung injury (VILI) has been demonstrated to have a positive impact on outcomes in patients with ARDS.

Impact of the Family Health Program on gastroenteritis in children in Bahia, Northeast Brazil: an analysis of primary care-sensitive conditions.

In seeking to provide universal health care through its primary care-oriented Family Health Program, Brazil has attempted to reduce hospitalization rates for preventable illnesses such as childhood gastroenteritis. We measured rates of Primary Care-sensitive Hospitalizations and evaluated the impact of the Family Health Program on pediatric gastroenteritis trends in high-poverty Northeast Brazil. We analyzed aggregated municipal-level data in time-series between years 1999-2007 from the Brazilian health system payer database and performed qualitative, in-depth key informant interviews with public health experts in municipalities in Bahia. Data were sampled for Bahia's Salvador microregion, a population of approximately 14 million. Gastroenteritis hospitalization rates among children aged less than 5 years were evaluated. Declining hospitalization rates were associated with increasing coverage by the PSF (P = 0.02). After multivariate adjustment for garbage collection, sanitation, and water supply, evidence of this association was no longer significant (P = 0.28). Qualitative analysis confirmed these findings with a framework of health determinants, proximal causes, and health system effects. The PSF, with other public health efforts, was associated with decreasing gastroenteritis hospitalizations in children. Incentives for providers and more patient-centered health delivery may contribute to strengthening the PSF's role in improving primary health care outcomes in Brazil.