Clinical nursing handovers for continuity of safe patient care in adult surgical wards: a best practice implementation project.

OBJECTIVES: The objective of this evidence-based quality improvement project was to improve clinical nursing handovers between registered nurses. INTRODUCTION: Clinical nursing handovers transfer critical information about the patient's care to oncoming shift nurses. Nurses use structured handover tools to handover patient information. In three adult surgical wards of a Singapore tertiary hospital, a lack of consistency was found in the local handover process when shifts changed. These resulted in ineffective handovers and compromised the patient's safety. Thus, evidence-based interventions were needed so that patient handovers and continuity in safe patient care could improve. METHODS: This project was implemented in three phases from January 2017 to November 2017 at three adult surgical wards of a tertiary hospital, utilizing the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) module. The pre- and post-implementation audits were conducted using JBI PACES audit criteria. An evidence-based four-pronged approach was employed, including adequate human resource coverage during handovers, a structured and standardized handover, visual cues and a teaching video. RESULTS: The results of the post-implementation audit of nurses performing handovers (n = 33) showed that handovers using standardized documentation improved from 0% to 21.0% (p = 0.005), which was statistically significant. However, handovers of detailed observations of patients improved from 72.7% to 87.9% (p = 0.215) and handovers of relevant history of patients improved slightly from 93.9% to 97.0% (p = 1.000) but was not statistically significant. Medication error incidents related to handovers was reduced by 72% over a six-month period. CONCLUSION: The multi-modal approach improved the comprehensiveness and completeness of clinical nursing handovers. These strategies had a significant effect on reducing medication errors related to handovers.

Prevalence of depression among nursing students: A systematic review and meta-analysis.

OBJECTIVES: To examine the global prevalence of depression among nursing students and the variation in depression rates influenced by demographic and educational factors. BACKGROUND: Depression affects approximately 350 million people worldwide and is the world's leading cause of disability. Nursing students struggle to cope with not only stressors common in higher education institutions but also anxiety towards clinical placements. Evidence has suggested high prevalence of depression among them, but no reviews have been conducted to report a consolidated prevalence. DESIGN: Systematic review and meta-analysis. REVIEW METHODS AND DATA SOURCES: A search was conducted from November 2015 to January 2016 on CINAHL, EMBASE, Medline OVID, Medline ProQuest, PsycINFO, PubMed, ScienceDirect, and SCOPUS, using a combination of keywords "depression", "nursing students", "mood disorder", "affective disorder", 'undergraduate nursing', "nursing education", "nursing undergraduate", and "nursing diploma". RESULTS: A total of 27 cross-sectional studies were included. The sample comprised 8918 nursing students and the mean age ranged from 17.4 to 28.4 years. Among these studies, the proportion of female students ranged from 79.0% to 100.0%. A high pooled prevalence of depression of 34.0% was reported among nursing students. Significant differences in depression prevalence were noted for different subgroups of age, with a higher prevalence noted in younger students (41.0%), and for different geographical regions, with Asian nursing students experiencing a higher prevalence of depression (43.0%). No significant difference was noted between nursing and non-nursing students. CONCLUSION: The findings suggest a high prevalence of depression among nursing students. This serves as an impetus for educational reforms in nursing schools and proposes for further research to aid prospective nurses in safeguarding their psychological wellbeing. In the long run, it is imperative that competent nurses be nurtured to improve the standards of healthcare and patients' quality of life.

Educational efficacy of objective structured clinical examination on clinical training of traditional Chinese medicine - A qualitative study.

OBJECTIVE: We propose applying objective structured clinical examinations (OSCEs) and discuss the educational efficacy of such examinations regarding the clinical competence of traditional Chinese medicine (TCM) practitioners. DESIGN: TCM OSCEs were implemented for evaluation and instruction from 2011 to 2013. Trainees received feedback from clinician-educators and standardized patients. Trainees' survey data were extracted from post-OSCE questionnaires and interviews to analyze TCM OSCEs. RESULTS: Five TCM OSCEs were administered, and the educational backgrounds of the 37 participants were analyzed. According to analysis of the questionnaires, all trainees agreed OSCEs were beneficial. In interviews, trainees expressed appreciation for the direct, real-time feedback during the OSCE and felt it closely resembled actual clinical work. However, the simulation models of OSCEs must be upgraded. CONCLUSIONS: OSCEs can be used in evaluating, teaching, and certifying TCM clinical competencies to improve the quality of TCM practices. The patient-centered training aspect of TCM OSCEs is particularly helpful for participants.