The effectiveness of using non-traditional teaching methods to prepare student health care professionals for the delivery of mental state examination: a systematic review.

BACKGROUND: With the evolution of education, there has been a shift from the use of traditional teaching methods, such as didactic or rote teaching, towards non-traditional teaching methods, such as viewing of role plays, simulation, live interviews and the use of virtual environments. Mental state examination is an essential competency for all student healthcare professionals. If mental state examination is not taught in the most effective manner so learners can comprehend its concepts and interpret the findings correctly, it could lead to serious repercussions and subsequently impact on clinical care provided for patients with mental health conditions, such as incorrect assessment of suicidal ideation. However, the methods for teaching mental state examination vary widely between countries, academic institutions and clinical settings. OBJECTIVES: This systematic review aimed to identify and synthesize the best available evidence of effective teaching methods used to prepare student health care professionals for the delivery of mental state examination. INCLUSION CRITERIA: This review considered evidence from primary quantitative studies which address the effectiveness of a chosen method used for the teaching of mental state examination published in English, including studies that measure learner outcomes, i.e. improved knowledge and skills, self-confidence and learners' satisfaction. SEARCH STRATEGY: A three-step search strategy was undertaken in this review to search for articles published in English from the inception of the database to December 2014. An initial search of MEDLINE and CINAHL was undertaken to identify keywords. Secondly, the keywords identified were used to search electronic databases, namely, CINAHL, Medline, Cochrane Central Register of Controlled Trials, Ovid, PsycINFO and, ProQuest Dissertations & Theses. Thirdly, reference lists of the articles identified in the second stage were searched for other relevant studies. METHODOLOGICAL QUALITY: Studies selected were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute's Meta-Analysis of Statistics Assessment and Review Instrument embedded within the System for the Unified Management, Assessment and Review of Information. Any disagreements that arose between the reviewers were resolved through discussion between the reviewers. DATA EXTRACTION: Data was extracted using data extraction tools developed by the Joanna Briggs Institute Quantitative data was extracted from papers using standardized data extraction tools from the Joanna Briggs Institute's Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: The included studies were found to be heterogeneous in terms of participants and teaching methods. Moreover, a wide variety of instruments were used to determine impact and outcomes of the teaching methods. Hence, findings of the included articles were presented in a narrative summary. RESULTS: A total of 12 articles were included in this review with consensus from all reviewers. The evidence retrieved in this study suggests that non-traditional teaching methods, such as videotapes, virtual simulation, standardized patients and reflection, improve learners' understanding and skills of mental state examination as opposed to traditional teaching methods like lectures and provision of reading materials. However, studies that specifically compared the effectiveness of one method over another were limited to comparison between lectures with videotaped interviews and virtual simulations. It was shown that both videotaped interviews and virtual simulations were superior to lectures. In videotaped teaching, interactions between patients and learners performing mental state examination were shown for the learner's discussion while virtual simulations mimicked patient symptoms in computer applications. Virtual simulation was notably a unique learning opportunity for the learners as it allowed learning to take place without the use of diminishing real life resources. However, in view of the high cost and learners' difficulty in negotiating the virtual environment, videotaped teaching remained as the more commonly used method of teaching mental state examination. CONCLUSIONS: This systematic review study identified teaching strategies utilized in the teaching of mental state examination and their effectiveness. Videotapes was the most widely used and effective approach, that is, until the issue of high cost and ease of maneuver in virtual simulation could be overcome. There were also potential benefits of other teaching, such as reflection and use of standardized patients, and educators could consider these in the teaching of mental state examination. Future research could focus more on the comparison of various teaching methods to offer more evidence on the use of one teaching method over another.

Nursing inter-shift handover process in mental health settings: a best practice implementation project.

AIMS: Nursing inter-shift handover remains an important traditional ritual in nursing. Timely and effective handover of critical information ensure continuity of patient care and safe delivery. This project took place in a tertiary mental health institution in Singapore. The project aims to (i) examine existing handover practices/process in the tertiary mental health institution; (ii) determine the strengths and limitations of the existing handover practice/process; and (iii) identify, implement and evaluate an evidence-based nursing inter-shift handover process to enhance patient safety and service delivery. METHODS: This project was conducted in three phases using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programmes. It was implemented over a period of 4 months from end of August 2011 to beginning of December 2011. Evidence-based strategies such as town hall meetings and education sessions that reinforce proper handover techniques and its importance were implemented to enhance the handover processes and practices in four acute admitting wards. Pre- and post-audit data were observed and recorded for each case handover during each inter-shift handover session in four acute admitting wards. RESULTS: The handover processes for 212 cases for four acute admitting wards were observed using the seven audit criteria. Post-implementation audit findings show that compliance rate had improved significantly for the four criteria: an improvement of 49% compliance rate in the use of standardised documentation during shift handover session; an increase of 74% compliance rate in proper identification of patient at the start of each case report; a 31% increase in proper handing over of significant patient's history; and 18% increased compliance in providing detailed observation of patients. CONCLUSION: This project had shown that handover sessions can be made effective by translating evidence into practice through ongoing evidence-based audit. Continuous evidence-based evaluation, identification and implementation of nursing inter-shift handover process are imperative to enhance patient safety and service delivery.

Effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients: A systematic review.

BACKGROUND: Patient fall is among the top five sentinel events in hospitals due to the resultant functional loss and injury sustained. Precise fall risk assessment and prevention strategies are important components of a fall prevention program. Due to psychiatric conditions and medications, these patients may require a different fall management program compared to other patient populations. OBJECTIVE: The objective of this review was to identify the best available evidence for the effectiveness of nursing fall risk assessment tools, interventions to reduce incidence of falls, and common risk factors of adult psychiatric patients who fall. INCLUSION CRITERIA: Adults (19 to 64 years) diagnosed with mental illnessEvaluation of nursing fall risk assessment tools in adult psychiatric settings, and interventions, which minimised fall risk or fall rates.Number of patient falls during hospitalisation was the main outcome.Primary quantitative studies published in English language. SEARCH STRATEGY: The literature search sought published studies, and was limited to English language reports. There were no date restrictions applied to the search. Electronic databases searched included:CINAHLPubMedCochrane Central Register of Controlled TrialsPsycINFOScienceDirectScopusWeb of ScienceWiley-InterScienceProQuestMedNar METHODOLOGICAL QUALITY: Studies retrieved were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI). DATA EXTRACTION: Data including specific details about the methods, settings, purposes, populations, interventions, and outcomes significant to the review's objectives were extracted by two independent reviewers using standardised data extraction tools from JBI-SUMARI. RESULTS: Eleven studies were included in this review: three before-and-after studies, four descriptive studies, two case control studies and two cohort studies. Evidence with regards to the effectiveness of fall risk assessment tools and prevention strategies was inconclusive. Certain risk factors which were more frequently associated with falls included diagnoses of depression, bipolar disorder, and dementia / Alzheimer's disease, altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, polypharmacy, and taking of certain medications such as sedatives, antidepressants and mood stabilisers, particularly lithium. CONCLUSION: Evidence on the effectiveness of fall risk assessment tools and prevention strategies in psychiatric setting was inconclusive due to a paucity of studies. However, certain risk factors were found to be more commonly associated with falls in adult psychiatric patients (Level III Evidence).Constant observation of the side effects of medications, particularly orthostatic hypotension, and review of patients' medical profile by doctors or pharmacists may be helpful in preventing falls in psychiatric patients. Findings on common risk factors can better aid healthcare professionals in identifying psychiatric patients who are at risk for falls.More research is needed on the evaluation of fall risk assessment tools and fall prevention strategies, specifically for the adult psychiatric patients. More prospective and better quality studies examining fall risk factors in psychiatric patients are needed.