Scoping Review of Racial, Ethnic, and Sex Disparities in the Diagnosis and Management of Hemorrhagic Stroke.

BACKGROUND AND OBJECTIVES: In the United States, Black, Hispanic, and Asian Americans experience excessively high incidence rates of hemorrhagic stroke compared with White Americans. Women experience higher rates of subarachnoid hemorrhage than men. Previous reviews detailing racial, ethnic, and sex disparities in stroke have focused on ischemic stroke. We performed a scoping review of disparities in the diagnosis and management of hemorrhagic stroke in the United States to identify areas of disparities, research gaps, and evidence to inform efforts aimed at health equity. METHODS: We included studies published after 2010 that assessed racial and ethnic or sex disparities in the diagnosis or management of patients aged 18 years or older in the United States with a primary diagnosis of spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage. We did not include studies assessing disparities in incidence, risks, or mortality and functional outcomes of hemorrhagic stroke. RESULTS: After reviewing 6,161 abstracts and 441 full texts, 59 studies met our inclusion criteria. Four themes emerged. First, few data address disparities in acute hemorrhagic stroke. Second, racial and ethnic disparities in blood pressure control after intracerebral hemorrhage exist and likely contribute to disparities in recurrence rates. Third, racial and ethnic differences in end-of-life care exist, but further work is required to understand whether these differences represent true disparities in care. Fourth, very few studies specifically address sex disparities in hemorrhagic stroke care. DISCUSSION: Further efforts are necessary to delineate and correct racial, ethnic, and sex disparities in the diagnosis and management of hemorrhagic stroke.

Participant evaluation of team-based learning using one-off teams in a hospital setting.

BACKGROUND: Team-based learning (TBL) is a highly structured educational strategy that improves student engagement, promotes deeper learning and builds professional skills but has had limited use in nursing education. AIMS: To examine participant experiences of TBL using one-off teams in a hospital setting. METHOD: A prospective exploratory design was used in an urban district hospital in Melbourne, Australia. The sample was 49 registered nurses. The intervention was a TBL-based education program focused on assessment and management of adult patients with isolated distal limb injuries. Data were collected using two instruments that evaluated participant experiences of the narrated slide presentation and participant experiences of learning of using TBL. Quantitative data were analysed using descriptive statistics and thematic analysis was used to analyse the qualitative data. RESULTS: The results revealed two key themes: "quality of learning" and "positive team experience". The presentation was accessed twice or more by 51% of participants. Participants perceived a high quality of learning: 95.5% stated that their learning expectations were met or exceeded. Three quarters of participants (77.5%) commented about the contribution of their team members. CONCLUSION: Participants in this study thought TBL provided them a positive learning experience, as individuals and as teams. Education methodologies that focus on professional attributes and behaviours in addition to clinical skill are well suited to emergency nursing whereby nurses have to be theoretically prepared for practice and work well in teams. RELEVANCE TO CLINICAL PRACTICE: TBL has a natural synergy with the requirements of advanced nursing practice and offers a positive learning experience that enhances clinical outcomes.

Expanding nurse initiated X-rays in emergency care using team-based learning and decision support.

BACKGROUND: Triage nurse initiated X-rays (NIXRs) are safe and effective, however, little is known about the ability of other RNs, particularly those without postgraduate qualifications in emergency nursing, to order NIXRs. The aim of this study was to evaluate an innovative NIXR education programme for emergency nurses. METHOD: The education programme was multi-faceted, delivered using Team-Based Learning (TBL) and augmented by a decision support checklist. Using a prospective exploratory design, 276 NIXR requests from June to December 2011 were audited. Three groups were compared: (i) RNs with and without postgraduate qualifications irrespective of how they were educated in NIXR, (ii) RNs with and without postgraduate qualifications who undertook the NIXR education programme, and (iii) RNs who did and did not undertake the NIXR programme irrespective of postgraduate qualifications. RESULTS: There were 130 NIXRs by 28 RNs with postgraduate qualifications and 146 NIXRs by 12 RNs without postgraduate qualifications. Analysis of all RNs showed RNs without postgraduate qualifications had higher incidence of appropriate NIXRs (83.6% vs 66.2%, p=0.003) however when controlled for the NIXR education programme, statistical significance was lost (83.6% vs 67.5%, p=0.017). RNs who undertook the NIXR education programme had superior documentation of patient assessment findings and higher incidence of appropriate X-ray requests than RNs who did not undertake the NIXR education programme (80.4% vs 65.2%, p=0.042). CONCLUSIONS: With appropriate educational preparation, RNs without postgraduate qualifications in emergency nursing can safely engage in NIXR. Structured education using TBL and a decision support checklist produces superior assessment and X-ray requests when compared to ad hoc education and role modelling.

In pursuit of expertise. Toward an educational model for expertise development.

Firstly, the many characteristics of expertise are examined: they include aspects of pattern recognition, knowledge, skill, flexibility, metacognitive monitoring, available cognitive space and teaching abilities. Secondly, three educational models from different domains (Nursing, Surgical Education, Education) are analysed, compared and contrasted, in relation to both educational approach and the development of expertise. Thirdly, a new model for the development of expertise is proposed, incorporating aspects of each of the three previously discussed models. Within this new model, four phases of development are proposed, culminating in the achievement of expertise. Furthermore, it is noted that under certain circumstances performance can deteriorate, and that with appropriate support, there can be recursion back through earlier phases of development. Significant implications for both healthcare education and practice are discussed, in relation to concepts of expertise, potential educational approaches and the proposed model for the development of expertise.

Evaluating the impact of organizational learning initiatives.

This article describes the process used to develop an evaluation model for organizational learning in a healthcare environment. This model moves away from the traditional focus on learner satisfaction and places greater emphasis on performance and impact evaluation. The evaluation model is grounded in the work of Kirkpatrick (1998) and Phillips (1991) and can be applied to a variety of programs. Using a highly practical approach, the model enables educators to determine the most appropriate level of evaluation for a learning opportunity and to identify effective and efficient strategies. This model could be readily adopted by healthcare organizations interested in enhancing the evaluation of the learning initiatives.