Creating Effective Post-Pandemic Psychiatric Nursing Clinical Experiences Using the Roy Adaptation Model.

Introduction: The COVID-19 pandemic significantly impacted students in psychiatric clinical rotations. Clinicals were frequently limited or canceled, restricting exposure of student nurses to this experience. Many modifications led to permanent changes in the psychiatric clinical setting. Objectives: The purpose of this manuscript is to provide a cohesive approach to serving student nurses in the post-pandemic psychiatric clinical setting. Methods: A theoretical exploration of the literature framed by the Roy Adaptation Model (RAM) was conducted. Discussion: Results are presented using the four modes of the theory: Physiological, Self-Concept, Role Function, and Interdependence. Conclusions: Findings include strategies to enhance student learning while supporting students' health and wellness. Educators and practitioners should provide high-quality, safe learning environments for student nurses.

Experiences related to the COVID-19 pandemic among U.S. physicians in office-based settings, 2020-2021

Objective-To assess final estimates of physician experiences related to COVID-19 and to compare preliminary estimates used in NCHS early-release dashboards with final estimates in this report. Methods-Physicians interviewed in periods 3 and 4 (December 15, 2020, through May 5, 2021) of the 2020 National Ambulatory Medical Care Survey (NAMCS) were asked a series of questions about experiences related to COVID-19 (n = 422). This report presents final nationally representative estimates for selected measures of COVID-19-related experiences among physicians in the United States and compares preliminary and final estimates for these measures. Results-Between September 2020 and May 2021, 31.1% of office-based physicians in the United States experienced shortages of personal protective equipment, and 38.4% of physicians had to turn away COVID-19 patients or refer them elsewhere for care. The percentage of physicians using telemedicine for patient care increased from 43.1% before the pandemic to 88.4% after the start of the pandemic. No statistically significant differences were seen between preliminary and final estimates for the measures assessed in this report. Conclusions-By making changes to NAMCS partway through the survey year, the National Center for Health Statistics was able to produce nationally representative estimates of physician experiences related to an emerging health threat, the COVID-19 pandemic. Additionally, the similarity between preliminary and final estimates for measures of interest provides evidence of the value of developing preliminary earlyrelease estimates.

Making the case for citizenship-oriented mental healthcare for youth in Canada

PurposeVarying stakeholders have highlighted how recovery-oriented mental health services such as youth mental health services have traditionally focused on supporting individual resources to promote recovery (e.g., agency) to the exclusion of addressing structural issues that influence recovery (e.g. poverty). One response to this criticism has been work helping people with mental health problems recover a sense of citizenship and sense of belonging in their communities. Work on citizenship has yet to influence youth mental healthcare in Canada's provinces and territories. This paper aims to highlight ways that youth mental healthcare can better help youth recover a sense of citizenship.Design/methodology/approachThe arguments described in this paper were established through discussion and consensus among authors based on clinical experience in youth mental health and an understanding of Canada's healthcare policy landscape, including current best practices as well as guidelines for recovery-oriented care by the Mental Health Commission of Canada.FindingsHere, this study proposes several recommendations that can help young with mental health problems recover their sense of citizenship at the social, systems and service levels. These include addressing the social determinants of health;developing a citizenship-based system of care;addressing identity-related disparities;employing youth community health workers within services;adapting and delivering citizenship-based interventions;and connecting youth in care to civic-oriented organizations.Originality/valueThis paper provides the first discussion of how the concept of citizenship can be applied to youth mental health in Canada in multiple ways. The authors hope that this work provides momentum for adopting policies and practices that can help youth in Canada recover a sense of citizenship following a mental health crisis.

The staff's perception of level of clinical competence of graduating dental students amid COVID-19: A qualitative research in one Saudi dental school

Introduction: The COVID-19 pandemic had a huge impact on dental education and assessment. This study focuses on the changes made to the delivery of teaching, assessment, and clinical competence of the final year students enrolled on the dentistry programme of the Faculty of Dental, Qassim University during the COVID-19 pandemic. Material and methods: This is a full qualitative study that uses semi-structured interviews to focus on the faculty members of one dental school in Saudi Arabia. The online interviews were performed using Zoom platform. The interviews were transcribed verbatim and analysed using thematic analysis. Themes were gathered and grouped into emerging topics. Purposive sampling method was adopted and continued until data saturation was achieved. Results: The change to online delivery of teaching proved to be a good solution for the cohort immediately affected by COVID, however, the online delivery of teaching placed significant amount of added pressure on faculty members. The work-life boundaries blurred and most staff complaint of long hours of working, mostly into the late evening. Despite the fact that the COVID graduating cohort achieved less clinical experience compared to typical graduates, a useful agreement between the University and college allowed newly graduated dentists to focus on the areas of low experience during their first rotation of their internship. Conclusion: Despite COVID's challenges and lockdowns and its effect on teaching and assessment, staff believed that students were graduating at a safe beginner level. With mitigating strategies in place, the newly graduated dentists achieved the same amount of experience as a typical graduate but over a slightly prolonged span of time. © 2022 The Authors

Measuring Training Disruptions Using an Informatics Based Tool.

OBJECTIVE: Training disruptions, such as planned curricular adjustments or unplanned global pandemics, impact residency training in ways that are difficult to quantify. Informatics-based medical education tools can help measure these impacts. We tested the ability of a software platform driven by electronic health record data to quantify anticipated changes in trainee clinical experiences during the COVID-19 pandemic. METHODS: We previously developed and validated the Trainee Individualized Learning System (TRAILS) to identify pediatric resident clinical experiences (i.e. shifts, resident provider-patient interactions (rPPIs), and diagnoses). We used TRAILS to perform a year-over-year analysis comparing pediatrics residents at a large academic children's hospital during March 15-June 15 in 2018 (Control #1), 2019 (Control #2), and 2020 (Exposure). RESULTS: Residents in the exposure cohort had fewer shifts than those in both control cohorts (P < .05). rPPIs decreased an average of 43% across all PGY levels, with interns experiencing a 78% decrease in Continuity Clinic. Patient continuity decreased from 23% to 11%. rPPIs with common clinic and emergency department diagnoses decreased substantially during the exposure period. CONCLUSIONS: Informatics tools like TRAILS may help program directors understand the impact of training disruptions on resident clinical experiences and target interventions to learners' needs and development.

The staff's perception of level of clinical competence of graduating dental students amid COVID-19: A qualitative research in one Saudi dental school

Introduction: The COVID-19 pandemic had a huge impact on dental education and assessment. This study focuses on the changes made to the delivery of teaching, assessment, and clinical competence of the final year students enrolled on the dentistry programme of the Faculty of Dental Medicine, Qassim University during the COVID-19 pandemic. Material and Methods: This is a full qualitative study that uses semi-structured interviews to focus on the faculty members of one dental school in Saudi Arabia. The online interviews were performed using Zoom platform. The interviews were transcribed verbatim and analysed using thematic analysis. Themes were gathered and grouped into emerging topics. Purposive sampling method was adopted and continued until data saturation was achieved. Results: The change to online delivery of teaching proved to be a good solution for the cohort immediately affected by COVID, however, the online delivery of teaching placed significant amount of added pressure on faculty members. The work-life boundaries blurred and most staff complaint of long hours of working, mostly into the late evening. Despite the fact that the COVID graduating cohort achieved less clinical experience compared to typical graduates, a useful agreement between the University and college allowed newly graduated dentists to focus on the areas of low experience during their first rotation of their internship. Conclusion: Despite COVID's challenges and lockdowns and its effect on teaching and assessment, staff believed that students were graduating at a safe beginner level. With mitigating strategies in place, the newly graduated dentists achieved the same amount of experience as a typical graduate but over a slightly prolonged span of time. Resumen Introducción: La pandemia de COVID-19 tuvo un gran impacto en la educación y evaluación dental. Este estudio se centra en los cambios realizados en la entrega de la enseñanza, la evaluación y la competencia clínica de los estudiantes de último año matriculados en el programa de odontología de la Facultad de Medicina Dental de la Universidad Qassim durante la pandemia de COVID-19. Material y métodos: Este es un estudio cualitativo completo que utiliza entrevistas semiestructuradas para centrarse en los miembros de la facultad de una escuela de odontología en Arabia Saudita. Las entrevistas en línea se realizaron utilizando la plataforma Zoom. Las entrevistas se transcribieron literalmente y se analizaron utilizando un análisis temático. Los temas se reunieron y agruparon en temas emergentes. Se adoptó y continuó el método de muestreo intencional hasta que se logró la saturación de datos. Resultados: El cambio a la entrega en línea de la enseñanza resultó ser una buena solución para la cohorte inmediatamente afectada por el COVID, sin embargo, la entrega en línea de la enseñanza ejerció una cantidad significativa de presión adicional sobre los miembros de la facultad. Los límites de la vida laboral se difuminaron y la mayoría del personal se queja de largas horas de trabajo, sobre todo hasta altas horas de la noche. A pesar del hecho de que la cohorte de graduados de COVID logró menos experiencia clínica en comparación con los graduados típicos, un acuerdo útil entre la Universidad y la facultad permitió a los dentistas recién graduados centrarse en las áreas de baja experiencia durante su primera rotación de su pasantía. Conclusión: A pesar de los desafíos y confinamientos de COVID y su efecto en la enseñanza y la evaluación, el personal creía que los estudiantes se estaban graduando a un nivel principiante seguro. Con las estrategias de mitigación en vigor, los dentistas recién graduados lograron la misma cantidad de experiencia que un graduado típico, pero durante un lapso de tiempo ligeramente prolongado.

Building Primary Preservice Teachers' Identity as Engineering Educators

The purpose of this qualitative case study was to investigate how two primary preservice teachers built their engineering education identities during a clinical field experience that emphasized engineering education. More specifically, we explored the development of their engineering education identities while facing unforeseen circumstances and unfamiliar engineering content. We used a nested qualitative case study approach that was bounded by a university practicum field experience that took place at the height of the COVID-19 pandemic. Data sources included preservice teacher interviews and reflective field notes. We found that the preservice teachers faced a series of contextual factors in the clinical experience that both afforded and constrained professional learning opportunities that influenced their identity development. The affordances made professional learning opportunities possible, while the constraints limited professional growth. We also found that it was the negotiation of the factors, where the preservice teachers worked to mitigate the effect of the constraints while maximizing the advantages of the affordances, that had the greatest influence on their engineering pedagogical knowledge and engineering teaching self-efficacy. Findings from this study could provide teacher educators with insight into preparing primary teachers for unexpected challenges when teaching engineering, as well as how to best prepare engineering-efficacious teachers.

Readiness for practice in undergraduate nursing students during the COVID-19 pandemic: a cross-sectional study.

Background: The Coronavirus disease 2019 (COVID-19) pandemic negatively impacted nursing students' opportunity to gain experience through clinical placement, potentially threatening their readiness for practice and their clinical competence. The aim of this study was to explore whether and to what extent the third-year undergraduate nursing students perceived that their readiness for practice was impacted by changes to clinical placement and classroom learning implemented in response to the COVID-19 pandemic. Study design: Cross-sectional study. Methods: The study was conducted in a university of North-western Italy that provides nursing education across five sites. All sites stopped in-person classroom learning at the beginning of March 2020, but each site was free to decide whether to continue in-person clinical placement based on the local epidemiological situation. All 228 third-year nursing students who completed their degree by June 2020 were invited to participate. Data were collected via online questionnaire, which included the question "What impact do you think that COVID-19 safety measures employed by your nursing programme had on your readiness for practice?" Answers were given on a 5-point Likert scale (none, minimal, moderate, major, and severe). Explanatory variables were collected at the individual, nursing programme, and university site levels. Results: A total of 126 (response rate 55.3%) nursing students completed the questionnaire. Overall, 84 (66.7%) perceived that COVID-19 safety measures had a moderate to severe impact on their readiness for practice. These students often had lower grade point averages (p=0.037) and received no clinical placement during the pandemic (72.6% vs 90.5% of students who reported no or minimal impact, p=0.022). Average duration of third-year clinical placement was also lower among these students, though it was not statistically significant. No differences emerged at the university site level. Conclusions: Despite important advances in technology-based educational activities, clinical placement remains the best educational strategy to allow nursing students to feel prepared to work effectively during a pandemic.

Trans-Inf-Net: COVID-19 Lung Infection Segmentation Based on Transformer

For the global health crisis COVID-19, the radio-logical imaging techniques CT have demonstrated effectiveness in both current diagnosis and evaluation of disease evolution. However, the manual delineation of lung infections is tedious and time-consuming work, and infection annotation by radiologists is a highly subjective task, often influenced by individual bias and clinical experiences. To address these challenges, we proposed a transformer learning method (Trans-Inf-Net) to automatically identify infected regions from chest CT slices. In our Trans-Inf-Net, a parallel partial decoder is used to aggregate the high-level features and generate a global map. Then, the implicit reverse attention and explicit edge-Attention are utilized to model the boundaries and enhance the representations. Moreover, to alleviate the shortage of labeled data, we present a segmentation framework based on a randomly selected propagation strategy and transformer, which only requires a few labeled images and leverages primarily unlabeled data. We apply attention in conjunction with convolutional networks, while keeping their overall structure in place. a pure transformer applied directly to sequences of image patches can perform very well on image segmentation tasks. Our framework can improve the learning ability and achieve a higher performance. Extensive experiments on COVID-SemiSeg and real CT volumes demonstrate that the proposed Trans-Inf-Net outperforms most cutting-edge segmen-Tation models and advances the state-of-The-Art performance. © 2022 IEEE.

The acquisition of clinical experience during GP training - how can we mitigate for the impact of COVID-19?

The COVID-19 pandemic has profoundly impacted the way general practice is run and this is expected to have had a knock-on effect upon GP training. A questionnaire-based study was designed to investigate what was happening to GP trainees 16 months into the pandemic in terms of opportunities to develop clinical experience and clinical decision-making. We also asked trainers and trainees for ideas on how we might mitigate for the effects of COVID-19. In particular, there has been decreased exposure to clinical examination during the pandemic and there appear to be gaps in opportunities to learn from urgent and unscheduled care settings and to develop skills in rapid clinical decision-making. It is interesting to consider what general practice will look like when the pandemic is over and how this will this affect the GP training curriculum going forwards. Although response rates were low, we were able to determine some emerging themes for national, local and educational review going forwards to help shape and improve GP training for the future.

Nursing students' reflections on vaccine administration during the COVID-19 global pandemic.

BACKGROUND: During the COVID-19 pandemic, many nursing schools limited in-person clinical instruction to lower the risk of student exposure to SARS-CoV-2. Some U.S. state boards of nursing authorized virtual learning experiences to attempt to fill this void. The effects of restricting such hands-on training are not fully understood, but we believed it could be detrimental to student development and saw partnering with local COVID-19 vaccination clinic as a promising alternative. Between January and April 2021, second semester pre-licensure nursing students assisted at the clinic and submitted reflections on the experience. The aim of this study was to assess the effectiveness of this educational encounter. METHODS: One hundred seventy-one students submitted reflections on their experience, which were de-identified and uploaded to a HIPAA- and FERPA-compliant cloud storage system using SAFE desktop and coded for thematic analysis. RESULTS: Analysis revealed five major themes: community, socializing, perceived confidence, impact, and professional role. CONCLUSION: This study demonstrated the viability of instruction at a COVID-19 vaccination clinic as an alternative learning experience for nursing students encountering restricted face-to-face clinical training. It suggests that schools can develop other novel clinical experiences to increase students' perceived confidence, provide opportunities to practice skills, and gain insights into nursing practice.

Opportunities from Covid-19 Pandemic: Strategies to Transform On-Site to Remote Community Clinical Experience

The Covid-19 pandemic continues to affect lives. This evidencebased strategy describes pathways to address the crisis and meet goals of undergraduate baccalaureate nursing education. Impact of the pandemic on clinical site availability provided opportunities to revise the maternity clinical course from direct on-site clinical to a clinical course with multiple modalities including small-group hospital clinical, faculty-facilitated remote clinical days, and written assignments. The design incorporated adult learning principles. This presentation illustrates transformation of the “Community Clinical Education Day” from on-site activities to remote virtual experiences. Teaching strategies that successfully fulfilled requirements of maternity clinical course, components of the eight-hour offering, and effectiveness of a multimodal clinical course compared to a traditional clinical course are described. Objectives: To identify mission, services, and population of community agencies and to develop education offerings for target population Format: Live remote faculty presentation on community-based health promotion;assessment, values, and beliefs;social and health-related issues affecting women;cultural competence in healthcare;and health literacy. Students independently review agency websites, and in small groups develop client education materials on assigned topics. Students reconvene remotely to present teaching projects. Implications: Changes from traditional methods of on-site community clinical education to remote model with multiple modalities of instruction reflect adult learning principles, enhance student engagement, and provide templates for educators. Evaluations of remote community clinical demonstrate completion of course objectives and positive student and faculty perceptions of the experience. The effectiveness of a remote multimodal course compared to traditional course provides a model for adaptation of clinical courses.

Assessment of the teaching on alcohol use and management in current health professional curricula in India. (Special Issue: Health systems strengthening.)

Alcohol consumption is globally a serious public health challenge, and it is rampant across all parts of India. The COVID-19 pandemic has added to the overall burden of alcoholism due to long working hours, increased mental stress, depression, and so on. Primary care physicians have an important role in assessing risk and providing counselling, intervention and treatment of alcohol misuse. Studies have demonstrated primary health care facilities to be ideally suited for alcohol prevention and cessation interventions as most patients with alcohol use disorders (AUDs) seek treatment from facilities in the primary care setting in India. Thus, the training of healthcare professionals is vital in addressing AUDs in India. The Indian government is setting up Health and Wellness Centres across the country intended to address long-term care and holistic health promotion. At the same time, healthcare providers have expressed their limited competence in cessation and counselling practices related to AUDs. One of the attributing factors for these limitations is the paucity of exposure during the formative years. With this background, a review was undertaken of the current prescribed undergraduate professional curricula (medical, nursing, dentistry and physiotherapy) in India to assess its current status and preparedness in addressing alcohol misuse. The study findings emphasise the need to bolster the continuing education of health professionals aimed at health promotion and preventive strategies by hands-on training, brief workshops, supervised clinical experience by extramural faculty such as addiction psychiatrists, use of standardised patients, role play, and other similar methods.

Implications of the COVID-19 pandemic: Virtual nursing education for delirium care.

BACKGROUND: Technology is increasingly used in nursing education, particularly during the SARS-CoV-2 (COVID-19) pandemic. COVID-19 also brought new challenges to patient care and limited access to in-person clinical experiences for nursing students. Pivoting to virtual simulation (VS) for clinical was necessary during the height of the pandemic. With students' return to clinical settings, VS experiences continue to be needed, due to quarantine of clinical settings and/or shortage of available clinical sites. VS clinical experiences have been successfully utilized over the past decade; however, the literature lacks resources on the use of VS for delirium care of patients. METHOD: In this article, the authors describe the creation and provision of a VS clinical day using interactive computer-based technology to educate nursing students to prevent, recognize, and manage delirium. The VS clinical was in conjunction with a Behavioral Health course. RESULTS: Evaluation of students demonstrated attainment of objectives. Students reported satisfaction with the VS experience. CONCLUSION: Technology in nursing education and use of VS clinical provide effective strategies for clinical learning when in-person clinical experiences are unavailable, either due to access limitations or lack of patients with specific health needs.

Australian critical care nurses' knowledge, preparedness, and experiences of managing SARS-COV-2 and COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has again highlighted the crucial role of healthcare workers in case management, disease surveillance, policy development, and healthcare education and training. The ongoing pandemic demonstrates the importance of having an emergency response plan that accounts for the safety of frontline healthcare workers, including those working in critical care settings. OBJECTIVES: The aim of the study was to explore Australian critical care nurses' knowledge, preparedness, and experiences of managing patients diagnosed with severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) and COVID-19. METHODS: An exploratory cross-sectional study of Australian critical care nurses was conducted between June and September 2020. An anonymised online survey was sent to Australian College of Critical Care Nurses' members to collect information about their knowledge, preparedness, and experiences during the COVID-19 pandemic. Descriptive statistics were used to summarise and report data. RESULTS: A total of 157 critical care nurses participated, with 138 fully complete surveys analysed. Most respondents reported 'good' to 'very good' level of knowledge about COVID-19 and obtained up-to-date COVID-19 information from international and local sources. Regarding managing patients with COVID-19, 82.3% felt sufficiently prepared at the time of data collection, and 93.4% had received specific education, training, or instruction. Most participants were involved in assessing (89.3%) and treating (92.4%) patients with COVID-19. Varying levels of concerns about SARS-CoV-2 infection were expressed by respondents, and 55.7% thought the pandemic had increased their workload. The most frequent concerns expressed by participants were a lack of appropriate personal protective equipment (PPE) and fear of PPE shortage. CONCLUSIONS: While most nurses expressed sufficient preparedness for managing COVID-19 patients, specific education had been undertaken and experiential learning was evident. Fears of insufficient or lack of appropriate PPE made the response more difficult for nurses and the community. Preparedness and responsiveness are critical to successful management of the COVID-19 pandemic and future outbreaks of emerging infectious diseases.

Managements of 13 emergency cardiac surgeries under COVID-19 pandemic in a Sentinel Hospital.

BACKGROUND: The pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) creates many challenges for the healthcare sector. Currently, little is known of how the pandemic has impacted patients with cardiovascular disease. The primary focus of this study was to determine whether emergency cardiovascular surgeries can be carried out safely during the COVID-19 pandemic. METHODS: Between 17 January 2020 and 11 February 2020, 13 patients were admitted to Wuhan Union Hospital for emergency cardiovascular surgery. During this time, Wuhan was a COVID-19 epicenter, and Wuhan Union Hospital is a sentinel hospital located in this area. These patients' epidemiological histories, clinical records, laboratory assessments, imaging findings, and surgical outcomes were retrospectively reviewed. Throat swabs were collected from some patients preoperatively and all patients postoperatively for reverse transcription polymerase chain reaction (RT-PCR) testing to determine whether these patients had COVID-19. RESULTS: This cohort included 5 cases of acute aortic dissection, 3 cases of congenital heart disease, 2 cases of dilated cardiomyopathy with end-stage heart failure, 1 case of aortocoronary fistula that had undergone previous surgery, 1 case of subacute infective endocarditis with cerebral infarction, and 1 case of multivessel coronary disease. Six patients were suspected COVID-19 cases (46.2%). There were no confirmed COVID-19 cases in this cohort. None of the patients in this cohort died and none developed severe acute respiratory syndrome, renal failure, or septic shock after surgery. No cross-infection occurred with other patients or medical staff who came into close contact with this cohort. CONCLUSIONS: Emergency surgery is crucial and unavoidable for many patients with acute and severe cardiovascular disease, regardless of the pandemic. Our study indicates that, with adequate preparation and the provision of appropriate treatment, satisfactory outcomes can be achieved for such patients.