Nursing students' clinical judgment skills in simulation and clinical placement: a comparison of student self-assessment and evaluator assessment.

BACKGROUND: Clinical judgment is an important and desirable learning outcome in nursing education. Students must be able to self-assess their clinical judgment in both the simulation and clinical settings to identify knowledge gaps and further improve and develop their skills. Further investigation is needed to determine the optimal conditions for and reliability of this self-assessment. AIMS: This study aimed to compare the same group of students' self-assessment of clinical judgment with an evaluator's assessment in both simulation and clinical settings. The study further aimed to investigate whether the Dunning-Kruger effect is present in nursing students' self-assessment of clinical judgment. METHODS: The study applied a quantitative comparative design. It was conducted in two learning settings: an academic simulation-based education course, and a clinical placement course in an acute care hospital. The sample consisted of 23 nursing students. The Lasater Clinical Judgment Rubric was used to collect data. The scores were compared using a t-test, intraclass correlation coefficient, Pearson's correlation coefficient, and Bland-Altman plots. The Dunning-Kruger effect was investigated using linear regression analysis and a scatter plot. RESULTS: The results showed an inconsistency between student self-assessment and evaluator assessment of clinical judgment in both simulation-based education and clinical placement. Students overestimated their clinical judgment when compared to the more experienced evaluator's assessment. Differences between students' scores and the evaluator's scores were larger when the evaluator's scores were low, indicating the presence of the Dunning-Kruger effect. CONCLUSION: It is vital to acknowledge that student self-assessment alone may not be a reliable predictor of a student's clinical judgment. Students who had a lower level of clinical judgment were likely to be less aware that this was the case. For future practice and research, we recommend a combination of student self-assessment and evaluator assessment to provide a more realistic view of students' clinical judgment skills.

A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective.

Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.

Changes in nursing students' self-reported professional competence in simulation-based education and clinical placement: A longitudinal study.

BACKGROUND: A primary learning outcome for nursing students is to achieve the professional competence necessary to provide safe and high-quality care in complex and specialized health services. Simulation-based education (SBE) and clinical placement are two educational settings in which nursing students' professional competence can be facilitated as a learning outcome. OBJECTIVES: The study objectives were to investigate changes in nursing students' self-reported professional competence in SBE and clinical placement and the transfer of this competence from SBE to clinical placement. We also aimed to investigate which competence areas were highest and lowest rated. DESIGN: A quantitative longitudinal survey design was applied. SETTINGS: The study took place from May 2019 to January 2020 in a simulation center at a Norwegian university and clinical placement in hospital units. PARTICIPANTS: Bachelor nursing students (N = 38) in their second and third year of a four-year part-time Norwegian nursing bachelor's degree program. METHODS: The Nurse Professional Scale Short Form (NPC Scale-SF) consisting of six competence areas was used to measure nursing students' self-reported professional competence across four time points. Paired sample t-test and descriptive statistics were used to analyse data. RESULTS: For changes in the longitudinal perspective, students' self-reported professional competence increased significantly. In the transfer perspective, from SBE to clinical placement, four competence areas declined significantly. Value-based nursing care were scored highest, whilst Development, leadership, and organization of nursing care were scored lowest score at all time-points. CONCLUSIONS: Findings indicate that nursing students' self-reported professional competence increased in the longitudinal perspective. Supporting students in transfer of professional competence should be addressed in SBE and clinical placement, whilst nursing education should be strengthened concerning development, leadership, and organization of nursing care.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions.

BACKGROUND: High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators' guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator's role during simulated scenarios. METHODS: A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation. RESULTS: One main category, "Alternating between active and passive facilitation," emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students' understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator's presence in the simulation room during the simulated scenarios influenced students' emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed. CONCLUSIONS: The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old.

OBJECTIVE: To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. METHODS: This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. RESULTS: Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. CONCLUSION: The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.

A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward.

BACKGROUND: Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. METHODS: This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. RESULTS: After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention. CONCLUSION: These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context. TRIAL REGISTRATION NUMBER: ISRCTN13997367 (retrospectively registered).

An interprofessional team training intervention with an implementation phase in a surgical ward: A controlled quasi-experimental study.

Despite a growing awareness of the importance of interprofessional teamwork in relation to patient safety, many hospital units lack effective teamwork. The aim of this study was to explore if an interprofessional teamwork intervention in a surgical ward changed the healthcare personnel's perceptions of patient safety culture, perceptions of teamwork, and attitudes toward teamwork over 12 months. Healthcare personnel from surgical wards at two hospitals participated in a controlled quasi-experimental study. The intervention consisted of six hours of TeamSTEPPS team training and 12 months for the implementation of teamwork tools and strategies. The data collection was conducted among the healthcare personnel in the intervention group and the control group at baseline and at the end of the 12 month study period. The results within the intervention group showed that there were significantly improved scores in three of 12 patient safety culture dimensions and in three of five perceptions of teamwork dimensions after 12 months. When comparing between groups, significant differences were found in three patient safety culture measures in favor of the intervention group. The results of the study suggest that the teamwork intervention had a positive impact on patient safety culture and teamwork in the surgical ward.

A complex teamwork intervention in a surgical ward in Norway.

OBJECTIVES: Interprofessional team training has a positive impact on team behavior and patient safety culture. The overall objective of the study was to explore the impact of an interprofessional teamwork intervention in a surgical ward on structure, process and outcome. In this paper, the implementation of the teamwork intervention is reported to expand the understanding of the future evaluation results of this study. RESULTS: The evidence-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program was implemented in three phases according to the program's implementation plan, which are built on Kotter's organizational change model. In the first phase, a project group with the leaders and researchers was established and information about the project was given to all health care personnel in the ward. The second phase comprised 6 h interprofessional team training for all frontline health care personnel followed by 12 months implementation of TeamSTEPPS tools and strategies. In the third phase, the implementation of the tools and strategies continued, and refresher training was conducted. Trial registration Trial registration number (TRN) is ISRCTN13997367. The study was registered retrospectively with registration date May 30, 2017.

Collaboration and Satisfaction About Care Decisions in Team questionnaire-Psychometric testing of the Norwegian version, and hospital healthcare personnel perceptions across hospital units.

AIM: To translate "The Collaboration and Satisfaction About Care Decisions in Team" questionnaire (CSACD-T) into Norwegian and test it for psychometric properties. The further aim was to describe and compare healthcare personnel's collaboration and satisfaction about team decision-making (TDM) across hospital units. DESIGN: A cross-sectional study. METHODS: The questionnaire was translated into Norwegian. A total of 247 healthcare personnel at two hospitals responded to the questionnaire. An explorative factor analysis was performed to test the factor structure of the questionnaire, while a Cronbach's alpha analysis was used to test for internal consistency. A one-way ANOVA analysis and a Kruskal-Wallis test were applied to test for differences between hospital units. RESULTS: The results demonstrate that the Norwegian version of the CSACD-T has promising psychometric properties regarding construct validity and internal consistency. The mean score of the CSACD-T was significantly higher in the maternity ward group than in the emergency room group.