Learning on the periphery: a modified Delphi study of a nursing student communities of practice model.

OBJECTIVES: To develop a contemporary student placement model to address current placement challenges, impact student learning, and alleviate supervisor burden. METHODS: A modified Delphi technique was used to seek opinions, insights, and creative solutions. RESULTS: A draft Communities of Practice placement model, based on a systematic literature review, was introduced to a heterogenous expert panel (n=12). A contemporary placement model was developed and refined via video conference and email over three rounds. CONCLUSIONS: Despite initial reluctance concerning a new model, participants became conversant with the concept of peer-to-peer learning, where incidental, albeit essential, learning and support occurs between students, which also supports supervising staff. Greater flexibly and student screening were also incorporated to enable greater learning, confidence building, and reflection. The model's success is contingent upon students working within their scope of practice and provides a contemporary approach to best responds to student, education provider, and health service needs.

Analysis of Outcomes for Robotic-assisted Lobectomy With an Enhanced Recovery After Surgery Protocol.

BACKGROUND: The impact on cost relative to clinical efficacy of enhanced recovery after surgery (ERAS) protocols for patients who undergo robotic-assisted lobectomy is currently unknown. The objective of this study was to compare cost and perioperative outcomes of robotic-assisted lobectomy before and after implementation of an ERAS protocol. METHODS: This was a retrospective analysis of 574 patients who underwent robotic-assisted lobectomy for primary lung carcinoma from May 1, 2017 to June 1, 2021. The ERAS protocol was implemented on October 17, 2019. Inverse probability of treatment weighting of propensity scores was used to balance baseline characteristics. The primary outcomes of the study were mean direct and indirect hospital costs, complication rates, and hospital length of stay. RESULTS: Three hundred fifteen patients underwent robotic-assisted lobectomy before implementation of the ERAS protocol, and 259 patients were enrolled on the protocol. A significantly higher percentage of patients were discharged home in less than 3 days after the ERAS protocol implementation (24.5% vs 9.8%, P = .001). There were significant decreases in the inverse probability of treatment weighting-adjusted mean direct hospital costs (P < .001) and mean indirect costs (P = .018) for the total hospital stay after ERAS protocol implementation. The mean initial discharge opioid medication dose (morphine equivalent dose) was significantly lower (P < .001) after the ERAS protocol. CONCLUSIONS: Increased early discharge and decreased hospital costs were observed for robotic-assisted lobectomy after implementation of an ERAS protocol. There was also an observed significant decrease in the discharge opioid medication doses prescribed.

Traversing the Funambulist's Fine Line between Nursing and Male Identity: A Systematic Review of the Factors that Influence Men as They Seek to Navigate the Nursing Profession.

Nursing has seen a dominance of women within the profession, and today, the presence of men in the role remains less understood and appreciated. Males considering or entering nursing face challenges concerning role misconception, marginalization, and gender bias. With a looming shortage of nurses on the horizon, it is more important now than ever before to find better ways of engaging males into nursing. The aim of the study was to examine the psychological constructs that influence male perceptions of nursing as they seek to navigate the profession, and what aspects influence men to consider nursing as a career. To achieve this, a systematic review and mixed research synthesis (integrated design) was conducted. English language research published between 1999 and 2019 was eligible. The methodological rigor of qualitative articles followed the Critical Appraisal Skills Program, while the Best Evidence Medical Education guided the quantitative review. Among the 24 publications identified, three sub-themes emerged from the overarching theme of the funambulist or tightrope walker. Sub-themes included societal, inner and collective voices that inform men's place in nursing or their decision making about entering the profession. There is a need to re-visit what it means to be a nurse in order to address the gendered stereotypes that impact men entering the nursing profession.

Improving patient engagement, adherence, and satisfaction in lung cancer surgery with implementation of a mobile device platform for patient reported outcomes.

BACKGROUND: Active patient engagement may improve their perioperative experience and outcomes. We sought to evaluate the use of a mobile device application (App) for patient engagement and patient reported outcomes (PROs) assessment following robotic lung cancer surgery. METHODS: Patients with suspected lung cancer undergoing robotic resection between January-May 2019, were offered the SeamlessMD App, which was customized to meet requirements of the thoracic enhanced recovery pathway. The App guided patients through preoperative preparation, in-hospital recovery, and post-op discharge care with personalized reminders, task lists, education, progress tracking, and surveys. RESULTS: Fifty patients participated in the study (22.1%). Of the 50 patients, 20 (40%) patients completed the preoperative compliance survey, and 31 (62%) completed the hospital satisfaction survey. A total of 62 inpatient recovery checks were completed, identifying non-compliance with incentive spirometer use in 2 (3.2%) and patient worries about self-care after discharge in 18 (29%) instances. Postoperative health-checks were completed by 27 (54%) patients with a median of 3 [0-17] completed surveys per patient. Patient reported symptom scores up to 30 days after surgery, demonstrating a significant decrease maximum pain level (P=0.002) and anxiety scores (P<0.001). The App enabled health-checks improved confidence and decreased worries in over 80% of patients. Nine patients (40.9%) reported the health-checks helped avoid 1+ calls and 4 (18.2%) reported the App helped avoid 1+ visits to the hospital. Over 74% of patients reported the App was very or extremely useful in each of the preoperative, inpatient, and post-discharge settings. CONCLUSIONS: A mobile device platform may serve as an effective mechanism to record perioperative PROs and satisfaction while facilitating patient-provider engagement in perioperative care.