Assemble it like this! - Is AR- or VR-based training an effective alternative to video-based training in manual assembly?

AR- and VR-based training is increasingly being used in the industry to train workers safely and effectively for new tasks. In this study, we investigated and compared the effects of AR-, VR- and video-based training on short- and long-term objective performance measures and subjective evaluations in a manual assembly task. Our results showed that there was no difference between AR-, VR- and video-based training concerning the objective performance measures task completion time and error count. However, in the subjective evaluations VR-based training showed a significantly higher perceived task load and a lower usability rating than the AR- and video-based training regimes. An exploratory analysis additionally revealed partially better results for AR than for VR after adjusting the data for the age of the participants. Future research should further investigate the advantage of AR- and video-based methods over VR when the age and technology experience of participants are taken into account.

Onboarding New Graduate Nurses Using Assessment-Driven Personalized Learning to Improve Knowledge, Critical Thinking, and Nurse Satisfaction.

Effective onboarding is key to new nurse success; however, many programs lack evidence-based support. The current study compared knowledge, critical thinking, and nurse satisfaction between cohorts before and after implementation of personalized learning for onboarding. Results showed better knowledge, critical thinking, and nurse satisfaction in the personalized learning cohort compared to prior cohorts. Nurse educators should use evidence-based personalized learning for onboarding to fully support new nurses as they transition from the classroom to practice.

Survey of New Jersey K-12 Professionals on Work-Based Learning During COVID-19: A Preliminary Study and Future Implications.

BACKGROUND: The New Jersey Safe Schools Program (NJSS) offers an online professional development certification course, titled "Designing and Implementing Student Training Plans," for NJ high school (HS) teachers developing secondary school student work-based learning (WBL) programs. WBL provides students opportunities to engage in career-related field tasks, aligned to curricular instruction. METHODS: In January-July 2021, during 7 cohorts of trainings, questions in the training's assignment gauged teacher and student concerns regarding worksite placements during the COVID-19 pandemic, learning delivery format preferences, and alternative activities for WBL credit. RESULTS: In January-July 2021, 68 of 134 HS teachers (51%) were concerned placing students in WBL and indicated "no" and "I don't know" (37% and 31%, respectively) about employer willingness to offer virtual mentorship during the pandemic. CONCLUSIONS: This preliminary study presents insights of newly credentialed WBL supervisory HS teachers regarding impacts of COVID-19 on student health and workplace safety, preferred WBL formats, and potential implementation of COVID-19 safety trainings.

Treinamento mediado pela prática supervisionada à beira-leito para enfermeiros durante a pandemia de COVID-19: estudo observacional / Capacitación mediada por la práctica supervisada a pie de cama para enfermeros durante la pandemia de COVID-19: estudio observacional / Mediated training by bedside supervised practice for nurses during the COVID-19 pandemic: an observational study

Resumo Objetivos descrever estratégia de treinamento mediado pela prática supervisionada à beira-leito para enfermeiros na pandemia de COVID-19 e identificar a percepção dos enfermeiros quanto à contribuição do treinamento na aquisição de conhecimentos e habilidades para o atendimento ao paciente crítico. Método estudo observacional, longitudinal, retrospectivo, descritivo e quantitativo, realizado em hospital de grande porte (São Paulo). Dados foram coletados no primeiro semestre de 2021 após aprovação pelo Comitê de Ética em Pesquisa do Hospital Israelita Albert Einstein, sob Parecer 5.423.393. Foram selecionados dez procedimentos para supervisão, como aspiração traqueal, sondagem nasogástrica, punção venosa, paramentação, curativo e manuseio de equipamentos. Resultados dos 72 participantes, 87,5% eram mulheres, com idade e tempo médio de atuação de 33 anos a nove meses, respectivamente. Inicialmente, o profissional participou do treinamento institucional padrão de 26 horas e, posteriormente, ao mediado pela prática supervisionada. O tempo médio por procedimento foi de 45 minutos. A mediana de proficiência em oito dos procedimentos foi oito. A maioria dos profissionais se autoavaliou como confiante (98,9%) e satisfeitos com o treinamento (99,4%). Conclusão e implicações para a prática o treinamento possibilitou um processo estruturado de identificação e acompanhamento da prática assistencial, permitindo uma estratégia efetiva para prover profissionais preparados e atuando com segurança.

Resumen Objetivos describir estrategia de formación mediada por la práctica supervisada de cabecera para enfermeros durante la pandemia de COVID -19 y identificar la percepción de los enfermeros sobre la contribución de la formación de cabecera en la adquisición de conocimientos y habilidades para la práctica asistencial en la atención a pacientes críticos. Método estudio observacional de carácter longitudinal, retrospectivo y descriptivo, con enfoque cuantitativo, realizado en un hospital privado de gran porte en São Paulo. Los datos recopilados se refieren al período de abril a junio de 2021. La investigación fue aprobada por el por el Comité de Ética en Investigación del Hospital Israelita Albert Einstein, bajo el Dictamen 5.423.393. Se seleccionaron diez procedimientos para supervisión, como aspiración traqueal, sonda nasogástrica, venopunción, batas, vendajes y manejo de equipos. El análisis de los datos se basó en estadística descriptiva y pruebas estadísticas. Resultado de los 72 participantes, el 87,5% era mujer, de 33 años de edad promedio y un tiempo promedio de nueve meses de trabajo (50%). Inicialmente, los profesionales participaron de la formación institucional estándar de 26 horas y, posteriormente, de la formación mediada por la práctica supervisada. El tiempo medio por procedimiento fue de 45 minutos. La mediana de competencia en ocho de los procedimientos fue ocho. La mayoría de los profesionales se calificaron como confiados (98,9%) y satisfechos con la formación (99,4%). Conclusión e implicaciones para la práctica la capacitación posibilitó un proceso estructurado de identificación y seguimiento de la práctica asistencial, posibilitando una estrategia eficaz para brindar profesionales preparados que trabajen con seguridad.

Abstract Objective to describe a strategy of mediated training by bedside supervised practice for nurses during the COVID-19 pandemic and to determine nurses' perception about contribution of bedside training for the acquisition of knowledge and skills for healthcare practice in critical care settings. Methods this was an observational, longitudinal, retrospective and descriptive study that used a quantitative approach, conducted at a large private health care facility in the city of São Paulo, Brazil. The data collected refer to the period from April to June 2021. The research was approved by the Research Ethics Committee of Hospital Israelita Albert Einstein, under Protocol 5.423.393. Ten procedures were selected for supervision, such as tracheal aspiration, nasogastric tube, venipuncture, donning, dressing and equipment handling. Data obtained were analyzed using descriptive analyses and statistical tests. Results of the participants (72), 87.7% were women with mean age of 33 years and their mean work experience was 9 months (50%). Initially, professionals participated in the standard 26-hour institutional training and, later, in supervised practice-mediated training. The mean time per procedure was 45 minutes. The median proficiency in eight of the procedures was eight. Most professionals rated themselves as confident (98.9%) and satisfied with the training (99.4%). Conclusion and implications for practice the training enabled a structured process of identification and monitoring of care practice, allowing for an effective strategy to provide prepared professionals who work safely.

Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision.

Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.

Immunisation program training needs in 9 countries in the African Region.

INTRODUCTION: regular in-service training of healthcare workers within the immunization program is critical to address the program needs created by the introduction of new vaccines and technologies, as well as the expanding scope of immunisation programmes beyond infant immunization and towards a life-course approach. National immunization programs conduct in-service training of health workers depending on program needs and particularly when new program elements are introduced. METHODS: we conducted a survey of national and provincial level immunization program staff in 9 countries in the World Health Organization (WHO) African Region to determine the perceived needs and preferred training methods for capacity building in immunisation. RESULTS: nearly all of the respondents (98.3%) stated that there are skill gaps at their respective levels in the immunization program which require training, with 88% indicating that mid-level program management (MLM) training was needed to train new program staff, while 78% indicated program performance gaps and 60% of the respondents stated that refresher training is needed. Program areas identified as top priorities for training included immunisation monitoring and data quality, sustainable immunization financing, adverse events monitoring and community mobilization. More than three quarters of the respondents (78%) think that online MLM training is adequate to address program gaps. Only four of the 9 immunization program managers indicated that they regularly monitor the number of MLM trained staff within their national program. CONCLUSION: there is a strong need for in-service training of immunization program officers in the countries surveyed, especially at the subnational levels. Program managers should conduct regular monitoring of the training status of staff, as well as conduct detailed training needs assessments in order to tailor the training approaches and topics. Online training provides an acceptable approach for capacity building of immunization program staff.

Ateneo General de la Residencia de Psicopedagogía: Huellas de las promesas incumplidas: el devenir del aprendizaje en contextos violentos / Atheneaum Psychopedagogic Residence: Traces of unfulfilled promises: the evolution of learning in violent contexts

Ateneo del Equipo de Psicopedagogía del Centro de Salud Nº 13, del Área Programática del Hospital General de Agudos P. Piñero, de la Ciudad de Buenos Aires, centrado en la problemática de la violencia en la clínica psicopedagógica con niños/as, y en cómo se verán atravesados los procesos de aprendizaje de los/as niños/as víctimas o testigos de violencia con los/as que trabaja el Equipo. Se realiza un breve recorrido histórico del concepto de violencia, para intentar una posible conceptualización de la misma, y se analiza la dimensión socio-cultural e histórica de la violencia, enmarcada en el sistema patriarcal e influida por las relaciones de poder. Se hace hincapié en la violencia familiar y, más particularmente en la violencia de género y se profundiza en las distintas formas de maltrato infantil.

The Power of an Active Shooter Simulation: Changing Ethical Beliefs.

INTRODUCTION: During a hospital-based active shooter (AS) event, clinicians may be forced to choose between saving themselves or their patients. The Hartford Consensus survey of clinicians and the public demonstrated mixed feelings on the role of doctors and nurses in these situations. Our objective was to evaluate the effect of simulation on ethical dilemmas during a hospital-based AS simulation. The objective was to determine whether a hospital-based AS event simulation and debrief would impact the ethical beliefs of emergency physicians relating to personal duty and risk. METHODS: Forty-eight emergency physicians and physicians-in-training participated in this cohort study based in an urban academic hospital. Simulation scenarios presented ethical dilemmas for participants (eg, they decided between running a code or hiding from a shooter). Surveys based upon the Hartford Consensus were completed before and after the simulation. Questions focused on preparedness and ethical duties of physicians to their patients during an AS incident. We evaluated differences using a chi-squared test. RESULTS: Preparedness for an AS event significantly improved after the simulation (P = 0.0001). Pre-simulation, 56% of participants felt that doctors/nurses have a special duty like police to protect patients who cannot hide/run, and 20% reported that a provider should accept a very high/high level of personal risk to protect patients who cannot hide/run. This was similar to the findings of the Hartford Consensus. Interestingly, post-simulation, percentages decreased to 25% (P = 0.008) and 5% (P = 0.041), respectively. CONCLUSION: Simulation training influenced ethical beliefs relating to the duty of emergency physicians during a hospital-based AS incident. In addition to traditional learning objectives, ethics should be another important design consideration for planning future simulations in this domain.

Operating room team training using simulation: Hope or hype?

BACKGROUND: This study sought to determine the long-term impact of multidisciplinary simulated operating room (OR) team training. METHOD: Two-wave survey study (immediate post-training survey 2010-2017, follow-up 2018). Differences across time, specialty, and experience with adverse events were assessed using chi-square and t -tests. RESULTS: Immediately after training, more than 90% of respondents found simulation scenarios realistic and reported team training would provide safer patient care. However, follow-up participants reported less enthusiasm toward training, with 58% stating they would like to take similar training again. A majority of participants (77%) experienced adverse events after training; those reporting adverse events reported more positive long-term evaluations. CONCLUSIONS: Simulated OR team training is initially highly valued by participants and is perceived as contributing to patient safety. Diminution of participant enthusiasm over time suggests that repeat training requirements be reconsidered, and less costly, alternative methods (such as asynchronous learning or virtual reality) should be explored.

Self-compassion training for certified nurse assistants in nursing homes.

BACKGROUND/OBJECTIVES: Certified nursing assistants (CNAs) who work in nursing homes (NHs) face significant work and personal stress. Self-compassion training has been shown to decrease stress postintervention in previous studies among healthcare providers and those in helping professions. This study examines the feasibility, acceptability, and preliminary outcomes of self-compassion training to address CNA stress and well-being. DESIGN: Pre-post intervention. SETTING: Three mid-size, nonprofit NHs in North Carolina. PARTICIPANTS: Thirty CNAs, with a mean age of 49, 96% of whom were female, and 83% black/African American. INTERVENTION: In one NH, participants received an 8-week, 2.5-h/session (20 h total) group intervention. At the time of recruitment for NHs 2 and 3, a briefer format (6-week, 1-h/session; 6 h total) became available and was preferred by CNAs, thus both NHs 2 and 3 participants received a 6-h group intervention. All interventions occurred in meeting rooms within participating NHs during shift changes. MEASUREMENTS: Intervention attendance, retention, and acceptability; self-compassion, stress, burnout, depression, and attitudes toward residents with dementia, and job satisfaction pre-, post-, 3-month post-, and 6-month postintervention were assessed. RESULTS: Attendance and program satisfaction were high, and attrition was low for both training formats. Self-compassion was significantly improved at all time periods (p < 0.001), and stress and depression improved significantly through 3 months (p < 0.05), but not 6 months. No statistically significant change in job satisfaction was noted. CONCLUSION: Self-compassion interventions are feasible and acceptable for CNAs working in NHs and show promise for managing stress and improving well-being and compassion toward residents. The briefer 6-h format may maximize participation, while still providing benefits.

CE: Nursing Orientation to Data Science and Machine Learning.

ABSTRACT: Nurses collect, use, and produce data every day in countless ways, such as when assessing and treating patients, performing administrative functions, and engaging in strategic planning in their organizations and communities. These data are aggregated into large data sets in health care systems, public and private databases, and academic research settings. In recent years the machines used in this work (computer hardware) have become increasingly able to analyze large data sets, or "big data," at high speed. Data scientists use machine learning tools to aid in analyzing this big data, such as data amassed from large numbers of electronic health records. In health care, predictions for patient outcomes has become a focus of research using machine learning. It's important for nurses and nurse administrators to understand how machine learning has changed our ways of thinking about data and turning data into knowledge that can improve patient care. This article provides an orientation to machine learning and data science, offers an understanding of current challenges and opportunities, and describes the nursing implications for nurses in various roles.

Pregnancy Risk Screening and Counseling for Women Veterans: Piloting the One Key Question in the Veterans Healthcare Administration.

OBJECTIVES: Women veterans have a high prevalence of comorbidities that increase the risk of adverse pregnancy outcomes. Screening for pregnancy desires in primary care provider (PCP) visits offers an opportunity to optimize preconception health. This pilot quality improvement initiative sought to assess Veterans Healthcare Administration provider preferences on One Key Question (OKQ) implementation, identification of veterans' reproductive needs, and the effect of training on documentation in a women's primary care clinic in Salt Lake City, Utah. METHODS: We hosted OKQ training sessions for providers and staff, audio recorded group discussions on implementation barriers, and explored themes. Women veterans presenting for a PCP visit in July 2018 self-completed a paper OKQ screening tool. We calculated summary statistics on responses. We conducted a pre-post analysis, with respect to training sessions, to measure for changes in family planning documentation during PCP visits. RESULTS: Nineteen providers and staff completed the training. They acknowledged the importance, but believed that the screening tool should be completed by veterans and not be provider prompted. Forty-two women veterans completed the screening tool: 21% desired pregnancy in the next year and 26% desired contraceptive information. Chart reviews found a nonsignificant increase in current contraceptive method documentation between periods (20% vs 37%; P = 0.08), a decline in documentation of reproductive goals (22% vs 3%; P = 0.02), and no significant change in counseling. CONCLUSIONS: Veterans identify reproductive needs via the OKQ screening tool, but provider documentation did not reflect changes in care following training. Further study is necessary to develop an optimal, patient-centered tool and implementation plan to support women veterans in their reproductive goals.

Varying perceptions of the role of "nurse as teacher" for medical trainees: A qualitative study.

INTRODUCTION: The informal curriculum-an essential complement to the formal curriculum-is delivered to medical trainees through learning outside the classroom. We sought to explore nurse-mediated aspects of trainee education in the informal curriculum in obstetrics and gynecology (OBGYN), as well as nursing perceptions of their role in medical trainee education. METHODS: Naturalistic, non-participant observations (40 h) were performed on a tertiary care birthing unit (BU) to document teaching and learning interactions. Insights gleaned from observations informed subsequent semi-structured interviews with BU nurses (n = 10) and focus group discussions with third-year medical students who had completed an OBGYN rotation (n = 10). Thematic analysis was conducted across data sets. RESULTS: Conceptions of nurse-mediated education differed considerably between nurses and trainees. Nurses were widely acknowledged as gatekeepers and patient advocates by both groups, although this role was sometimes perceived by trainees as impacting on learning. Interest and engagement were noted as mediators of teaching, with enhanced access to educational opportunities reported by trainees who modelled openness and enthusiasm for learning. Nurse-driven education was frequently tailored to the learner's level, with nurses feeling well positioned to share procedural knowledge or hard skills, soft skills (i.e. bedside manners), and clinical insights gained from bedside practice. DISCUSSION: Nurses are instrumental in the education of medical trainees; however, divergence was noted in how this role is enacted in practice. Given the valuable teaching resource BU nurses present, more emphasis should be placed on interprofessional co-learning and the actualization of this role within the informal curriculum.

VALIDA: A Validation Therapy-Training Program for Staff of a Residential Care Facility.

Behavioral and psychological symptoms of dementia are a major reason for institutionalization, and high demanding for staff in Residential Care Facilities. This article reports the design, implementation, and evaluation of a Validation Therapy pilot-training program (VALIDA) for staff members of a residential care facility in Aveiro, Portugal. This pilot study involved 22 members of the staff, including qualified professionals and nonqualified direct care workers, who were involved in the design. The pilot-training program comprises two components: training sessions in group and individual monitoring between those sessions. The evaluation indicates that the structure of the pilot-program was well accepted, and participants reported positive impacts in professional (better skilled to deal with residents with dementia) and personal (better trained to deal with elderly relatives) lives. This pilot-training program shows potential to be used in residential care facilities and needs to be replicated.

Using In Situ Simulations to Improve Pediatric Patient Safety in Emergency Departments.

PROBLEM: Given the complex interaction among patients, individual providers, health care teams, and the clinical environment, patient safety events with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments (EDs). With low-frequency, high-risk events such as pediatric resuscitations, health care teams working in EDs may not have the clinical opportunity to identify deficiencies, review and reinforce knowledge and skills, and problem solve in authentic clinical conditions. Without creating opportunities to safely practice, hospitals run the risk of having health care teams and environments that are not prepared to provide optimal patient care. APPROACH: Researchers employed a case series design and used a train-the-trainer model for in situ simulation. They trained health care professionals (instructors) in 3 general, nonacademic EDs in the San Francisco Bay area of California to perform pediatric resuscitation in situ simulations in 2018-2019. In situ simulations occur in the clinical work environment with simulation participants (teams) who are health care professionals taking care of actual patients. OUTCOMES: Teams made up of physicians, nurses, and ED technicians were evaluated for clinical performance, teamwork, and communication during in situ simulations conducted by instructors at baseline, 6 months, and 12 months. Debriefing after the simulations identified multiple latent safety threats (i.e., unidentified potential safety hazards) that were previously unknown. Each ED's pediatric readiness-its ability to provide emergency care for children-was evaluated at baseline and 12 months. NEXT STEPS: The authors will continue to monitor and examine the impact and sustainability of the pediatric in situ simulation program on pediatric readiness scores and its possible translation to other high-risk clinical settings, as well as explore the relationship between in situ simulations and patient outcomes.

Emerging practices in onboarding programs for PAs: Strategies for onboarding.

OBJECTIVE: This is the final article in a series that examines the role of onboarding programs for new physician assistants (PAs) and NPs. On-the-job learning is highly relevant for this workforce. Here we examine the strategies organizations use to impart information and skills in onboarding programs. METHODS: In 2018, we interviewed 13 administrators of onboarding programs. Interviews were transcribed and analyzed for themes by a team of researchers, with feedback from interviewees. RESULTS: Seven strategies were identified and are described in this article: Clinical mentoring, personal and professional mentoring, meeting with/shadowing other professionals, checking in by administrators, delivering didactic content, tailoring content or ramp-up, and assessing/ensuring competency. CONCLUSIONS: This article describes commonly used strategies in onboarding programs for PAs and NPs and can provide guidance to those designing their own onboarding programs. The programs we examined relied heavily on mentoring and other strategies appropriate for adult learners. Future work should evaluate the effectiveness of onboarding programs.