Faculty perceptions of teaching clinical reasoning at the patient bedside

Nurse educators meet frequently in conference settings and peer groups seeking an answer to "How do you do clinical?". The purpose of this qualitative, phenomenological study was to explore faculty perceptions of clinical teaching experiences at the patient bedside at a level one or two associate's degree nursing program by faculty within the Virginia Community College System (VCCS) that teach a rural student population.Rural students struggle with work-life barriers that complicate their educational journey. This was compounded by the COVID-19 pandemic that presented new challenges to the way nursing education could be delivered creating a need for on line and blended learning environments. Many programs experienced a shutdown of clinical teaching facilities and were forced online. This new learning environment proved to be another educational challenge for rural healthcare communities. This study explored faculty perceptions with interview sessions addressing clinical teaching practice over the last five years at the patient bedside with eight nurse educators from VCCS rural community colleges. A literature review revealed gaps in the research;the utilization of a comprehensive clinical teaching model and an overall disagreement on any one "best" teaching method. Three research questions on the teaching of clinical reasoning, safe patient care outcomes, and the experiences of new teaching environments during the COVID -19 pandemic were developed. Following hermeneutic analysis, the primary themes of Collaborative Teaching Practices, Traditional Teaching Methods, and Pandemic Teaching emerged with secondary themes of Concept Based Curriculum and Blended Learning Environments. Academic nursing leaders and faculty should use this information to create a common clinical teaching model. Health care leaders should use this information to enhance bedside teaching practices to produce safe outcomes for patients in their care. Nursing educators should use this information to make strong clinical thinkers that will address the growing need for nurses in the United States in the wake of the most significant nursing shortage experienced in this profession. This hermeneutic phenomenology is the beginning of a much-needed change in clinical education. Nurse educators must develop critical reasoning skills in nurses that will care for an aging population using innovative methods for critical thought. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa.

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Faculty perceptions of teaching clinical reasoning at the patient bedside

Nurse educators meet frequently in conference settings and peer groups seeking an answer to "How do you do clinical?". The purpose of this qualitative, phenomenological study was to explore faculty perceptions of clinical teaching experiences at the patient bedside at a level one or two associate's degree nursing program by faculty within the Virginia Community College System (VCCS) that teach a rural student population.Rural students struggle with work-life barriers that complicate their educational journey. This was compounded by the COVID-19 pandemic that presented new challenges to the way nursing education could be delivered creating a need for on line and blended learning environments. Many programs experienced a shutdown of clinical teaching facilities and were forced online. This new learning environment proved to be another educational challenge for rural healthcare communities. This study explored faculty perceptions with interview sessions addressing clinical teaching practice over the last five years at the patient bedside with eight nurse educators from VCCS rural community colleges. A literature review revealed gaps in the research;the utilization of a comprehensive clinical teaching model and an overall disagreement on any one "best" teaching method. Three research questions on the teaching of clinical reasoning, safe patient care outcomes, and the experiences of new teaching environments during the COVID -19 pandemic were developed. Following hermeneutic analysis, the primary themes of Collaborative Teaching Practices, Traditional Teaching Methods, and Pandemic Teaching emerged with secondary themes of Concept Based Curriculum and Blended Learning Environments. Academic nursing leaders and faculty should use this information to create a common clinical teaching model. Health care leaders should use this information to enhance bedside teaching practices to produce safe outcomes for patients in their care. Nursing educators should use this information to make strong clinical thinkers that will address the growing need for nurses in the United States in the wake of the most significant nursing shortage experienced in this profession. This hermeneutic phenomenology is the beginning of a much-needed change in clinical education. Nurse educators must develop critical reasoning skills in nurses that will care for an aging population using innovative methods for critical thought. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Racial resentment and support for decriminalization of drug possession in the United States.

Drug criminalization creates significant barriers to prevention and treatment of substance use disorders and racial equity objectives, and removal of criminal penalties for drug possession is increasingly being endorsed by health and justice advocates. We present empirical data estimating the share of U.S. adults who support eliminating criminal penalties for possession of all illicit drugs, and examine factors associated with public support. Data from the Johns Hopkins COVID-19 Civic Life and Public Health Survey, a probability-based nationally representative sample of 1222 U.S. adults, was collected from November 11-30, 2020. Support for decriminalizing drug possession was assessed overall and by sociodemographic factors and attitudes towards politics and race. Correlates of support were examined using multivariable logistic regression. Thirty-five percent of adults supported eliminating criminal penalties for drug possession in the U.S. In adjusted regression models, respondents who were younger or identified as politically liberal were more likely to support decriminalization relative to other groups, and respondents who were Hispanic or identified strongly with their religious beliefs were less likely to support decriminalization. Among white respondents, greater racial resentment was strongly associated with reduced support for drug decriminalization. Support for drug decriminalization varies considerably by beliefs about politics and race, with racial resentment among white Americans potentially comprising a barrier to drug policy reform. Findings can inform communication and advocacy efforts to promote drug policy reform in the United States.

Exploring the impact of the COVID-19 pandemic on syringe services programs in rural Kentucky.

BACKGROUND: The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES: We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS: In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS: Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION: The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.

An initial evaluation of the safety of a disposable oscillating positive expiratory pressure device in patients with chronic obstructive pulmonary disease: a sort-term pilot study.

BACKGROUND: Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device-the 'UL-OPEP' (University of Limerick-Oscillating Positive Expiratory Pressure device)-was developed to mitigate the risk of contamination by pathogens. The device was previously evaluated successfully in a group of paediatric CF patients. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. Data on user experience of the device were also collected during post-study follow-up. METHODS: A sample of 50 volunteer participants were recruited from pulmonary rehabilitation clinics within the local hospital network. The patients were clinically stable, productive, and not current or previous users of OPEP devices. Participants were invited to use a prototype disposable OPEP device daily for a period of 1 month. Pre- and post-study lung function was assessed with standard spirometry, and exercise tolerance with the 6-min-walk-test (6MWT). Quality of life was assessed using the St. George's Respiratory Questionnaire (SGRQ), and user experience of the prototype device evaluated using a post-study questionnaire. RESULTS: 24 Participants completed the study: 9 were female. Overall median age was 67.5 years, range 53-85 years. Lung function, 6-min walk test, and SGRQ scores showed no significant change post-study. User feedback was positive overall. CONCLUSIONS: The results indicate that the UL-OPEP is safe to use in patients with COPD. No adverse events were recorded during the study or in the follow-up period of 2 weeks. The device did not negatively impact patients' lung function, exercise tolerance, or quality of life during short term use (1 month), and usability feedback received was generally positive. Larger, longer duration studies will be required to evaluate efficacy. Registration The study was approved as a Clinical Investigation by the Irish Health Products Regulatory Authority (CRN-2209025-CI0085).