Online Learning Challenges for Nursing Students in Appalachia.

ABSTRACT: It is known that nursing students in an online learning environment may experience challenges related to their quality of life and well-being. However, it is unknown what additional challenges students face in a resource-limited environment like Appalachia. This descriptive study surveyed 154 undergraduate nursing students from a single institution in the Appalachian region at the beginning of the COVID-19 pandemic. Results reveal that students experienced unique resource-related barriers specific to underserved communities that impacted their online learning experiences. Findings offer unique implications for nurse educators facilitating online learning. Specific ideas for those teaching in resource-limited areas are presented.

Using nominal group technique among resident physicians to identify key attributes of a burnout prevention program.

PURPOSE: To identify preferred burnout interventions within a resident physician population, utilizing the Nominal Group Technique. The results will be used to design a discrete choice experiment study to inform the development of resident burnout prevention programs. METHODS: Three resident focus groups met (10-14 participants/group) to prioritize a list of 23 factors for burnout prevention programs. The Nominal Group Technique consisted of three steps: an individual, confidential ranking of the 23 factors by importance from 1 to 23, a group discussion of each attribute, including a group review of the rankings, and an opportunity to alter the original ranking across participants. RESULTS: The total number of residents (36) were a representative sample of specialty, year of residency, and sex. There was strong agreement about the most highly rated attributes which grouped naturally into themes of autonomy, meaning, competency and relatedness. There was also disagreement on several of the attributes that is likely due to the differences in residency specialty and subsequently rotation requirements. CONCLUSION: This study identified the need to address multiple organizational factors that may lead to physician burnout. There is a clear need for complex interventions that target systemic and program level factors rather than focus on individual interventions. These results may help residency program directors understand the specific attributes of a burnout prevention program valued by residents. Aligning burnout interventions with resident preferences could improve the efficacy of burnout prevention programs by improving adoption of, and satisfaction with, these programs. Physician burnout is a work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment [1]. Burnout is present in epidemic proportions and was estimated to occur in over 50 percent of practicing physicians and in up to 89 percent of resident physicians pre-COVID 19. The burnout epidemic is growing; a recent national survey of US physicians reported an 8.9 percent increase in burnout between 2011 and 2014 [2]. Rates of physician burnout have also increased [3] during the COVID-19 pandemic with a new classification of "pandemic burnout" experienced by over 52 percent of healthcare workers as early as June of 2020 [4]. Physician burnout can lead to depression, suicidal ideation, and relationship problems that may progress to substance abuse, increased interpersonal conflicts, broken relationships, low quality of life, major depression, and suicide [5-7]. The estimated rate of physician suicide is 300-400 annually [8-10].

Quality Improvement for Outpatient COVID-19 Infection Control.

Background To stop the spread of COVID-19 in outpatient primary care clinics, infection control strategies were needed including social distancing and masking in Fall 2020. Studies show a significant decrease in COVID-19 transmission when healthcare professionals comply with preventive measures. We tested whether an educational video would improve compliance to infection control behaviors quickly. Objective To improve COVID-19 infection control compliance in clinical staff at an outpatient federally qualified health center (FQHC) family medicine residency clinic with quality improvement (QI) tools.  Methods On-line surveys assessed medical assistants' (MAs), residents', and attending physicians' before and after an educational video intervention to assess knowledge of and compliance with social distancing and masking guidelines. Independent observed compliance assessments before and after the educational video were used to confirm the self-reported compliance.  Results The pre- and post-intervention surveys were completed by 49% (37/76) and 62% (47/76) of participants, respectively. Self-reported knowledge and compliance showed no significant change over time. Observed compliance, however, from pre (n = 667) to post (n = 1132) intervention improved for both masking (p < 0.001) and social distancing (p < 0.001). Conclusion An educational video regarding COVID-19 infection control was effective in improving compliance in an outpatient clinic in an underserved, urban setting. While building these new behavioral habits, however, self-report may not be as accurate as observational assessments. Since this intervention was implemented prior to the COVID-19 fall surge and introduction of mass vaccinations, the educational intervention may have improved behavioral compliance with COVID-19 protocols later in the pandemic.