Nursing workforce allocation in the intensive care units of COVID-19-designated hospitals: A nationwide cross-sectional survey in China.

AIM: To explore the nursing workforce allocation in intensive care units (ICUs) of COVID-19-designated hospitals during the epidemic peak in China. DESIGN: A nationwide cross-sectional online survey. METHODS: A total of 37 head nurses and 262 frontline nurses in 37 ICUs of COVID-19-designated tertiary hospitals located in 22 cities of China were surveyed. The self-reported human resource allocation questionnaire was used to assess the nursing workforce allocation. RESULTS: The average patient-to-nurse ratio was 1.89 ± 1.14, and the median working hours per shift was 5 h. The top four majors of front-line nurses in ICUs were respiratory (31.30%), lemology (27.86%), intensive care (21.76%) and emergency (17.18%). We also found that a smaller average patient-to-nurse ratio (odds ratio [OR]: 0.328, 95% CI: 0.108, 1.000), longer average weekly rest time per person (OR: 0.193, 95% CI: 0.051, 0.729) and larger proportion of 6-9 working years (OR: 0.002, 95% CI: 0.001, 1.121) decreased the occurrence of nursing adverse events.

Towards digitally mediated social work – the impact of the COVID-19 pandemic on encountering clients in social work

In the spring of 2020, the COVID-19 pandemic spread around the globe. The viral outbreak was followed by rapid changes in people's everyday and working lives. Because of the wide-scale societal restrictions that took place to prevent the pandemic, social work was forced to take a digital leap. In this article, we examine Finnish social workers' experiences of extending the use of digitally mediated social work (DMSW) in working with clients during the first wave of the pandemic, the spring of 2020. The data consist of 33 social workers' personal diaries, which are analysed using a qualitative theory-based content analysis. Henri Lefebvre's theory of spatial triad will be utilised in theorising how social workers represent DMSW through three dimensions of space, that is, how they perceive, conceive and live digital spaces when encountering their clients and how physical, mental and social spaces are embodied in the representations. The results suggest that the three dimensions of space 1) basis of, 2) conceived and 3) lived DMSW intertwine closely together. The results reveal how the physical space, including IT infrastructure, its functionality and applicability, along with the organisational contexts, form a bedrock for the social workers' DMSW practice and had a decisive impact on their experiences. Second, the conceived space consists of workers' cognitive and emotional elements, such as competencies, preconceptions and attitudes towards ICT. Finally, the third dimension of spatiality concludes with the social and relational aspects of the user experiences and encounters between clients and social workers.

High-fidelity simulation and nurse clinical competence-An integrative review.

AIM: The aim of this review was to synthesise current knowledge of high-fidelity simulation practices and its impact on nurse clinical competence in the acute care setting. BACKGROUND: There is no consensus or standardisation surrounding best practices for the delivery of high-fidelity simulation in the acute care setting. This is an understudied area. DESIGN: An integrative review using Johns Hopkins Nursing Evidence-Based Practice Model. METHODS: Medical subject heading terms 'Clinical Competence', AND 'High Fidelity Simulation Training', AND 'Clinical Deterioration' were systematically searched in PubMed, CINAHL and Embase databases for peer-reviewed literature published through September 2020. The current study was evaluated using PRISMA checklist. RESULTS: Seven studies met the inclusion criteria. Three main concepts were identified: modes of delivery, approach to learner participation and outcome measurement. CONCLUSIONS: This review substantiated the use of high-fidelity simulation to improve acute care nurses' early identification and management of clinical deterioration. Global variations in course design and implementation highlight the need for future approaches to be standardised at the regional level (i.e., country-centric approach) where differing scopes of practice and sociocultural complexities are best contextualised. RELEVANCE TO CLINICAL PRACTICE: These findings add to the growing body of evidence of simulation science. Important considerations in course planning and design for nursing clinical educators were uncovered. This is especially relevant given the current COVID-19 pandemic and urgent need to train redeployed nurses safely and effectively from other units and specialties to acute care.

Correlation between moral distress and clinical competence in COVID-19 ICU nurses.

BACKGROUND: Nurses' clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs). METHODS: The study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS: The mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R2 = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R2 = 0.160, P < 0.001). CONCLUSION: Considering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.

Dental students and recent dental graduates' perceptions of preparedness in treating pediatric patients.

PURPOSE/OBJECTIVES: To survey potential applicants applying to advanced education in pediatric dental programs and evaluate their preparedness upon graduating from an accredited dental school. METHODS: Attendees of a virtual externship of a University program were recruited to participate in a web-based survey. The survey collected demographic data, current levels of confidence with various pediatric clinical procedures, predicted confidence with those procedures, and number of procedures completed. Chi-Square and analysis of variance statistics were performed on resulting data to determine statistical significance. RESULTS: Fifty-three participants completed the survey in its entirety (n = 53). Most respondents reported adequate didactic training, mean score of 3.6 (range 0-5) and a moderate to high impact of coronavirus disease 2019 on their overall training with a mean score of 4.9 (range 0-10). Current dental students reported that they are "not confident at all" (<2.0) for 15/24 (63%) of the procedures. Graduates reported "somewhat confident" (<3.0) for 13/24 (54%) of the categories. Both students and graduates report the lowest levels of confidence for managing dental trauma, invasive treatment of young patients (<4 years of age), and patients with special healthcare needs. Dental students self-reported the expectation to feel more confident throughout their matriculation; however, their clinical experience was still reported to be limited. Students did not report reaching the level of "confident" for 75% of the procedures. CONCLUSION: Dental students and recent dental graduates alike perceive themselves to be under prepared for practice and do not feel confident in performing pediatric dental procedures. This study can provide dental schools, program directors, recent graduates, and dental students with an understanding of areas where they are under prepared and could offer areas where curricula and clinical experiences could be updated or modified.

Using virtual methods to teach Clinical Communication Skills: a survey: Presenter(s): Panayiota Andreou, University of Nicosia, Cyprus

The COVID-19 pandemic presented the education community with an enormous challenge where educators were called to adjust and shift their teaching in most cases from onsite settings to online environments. This transition was abrupt and required adjustments, and in most cases without the necessary expertise or infrastructure. This study aimed to assess the impact of Covid-19 pandemic on the conventional Methods: of teaching clinical communication skills (CCS) as compared to virtual Methods: of teaching. A convenience sample of EACH members involved in medical student CCS education were invited to complete an online survey comprising of 34 quantitative and qualitative questions about the use of virtual Methods: of teaching CCS. The data was analyzed using frequencies and content analysis. Forty-six (46) participants from 19 countries and a range of disciplines completed the survey. For most participants, very little of the CCS education was conducted online prior COVID-19. Once the transition was done online, most of the teaching was delivered synchronously (happening in real time) as opposed to asynchronous (e.g. recorded lectures). Participants reported that the transition from onsite to online was relatively smooth;online consultations minimized class distractions and enabled greater focus on student-simulated patient interaction. Areas that did not work well included missing on non-verbal cues both from the role-plays and the group;online sessions were viewed as a second-best option to onsite teaching. Online CCS teaching was forced to scale up within a short space of time. This study provides valuable insight of the challenges educators faced in this transition, their reflection on the strengths and weakness of online teaching as well as about the adaptability of educators, students and simulated patients in this change. It is envisaged this work will highlight areas to strengthen the skills and infrastructure of online CCS teaching. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Comparability of Objective Structured Clinical Examinations (OSCEs) and Written Tests for Assessing Medical School Students' Competencies: A Scoping Review.

Objective Structured Clinical Examinations (OSCEs) and written tests are commonly used to assess health professional students, but it remains unclear whether the additional human resources and expenses required for OSCEs, both in-person and online, are worthwhile for assessing competencies. This scoping review summarized literature identified by searching MEDLINE and EMBASE comparing 1) OSCEs and written tests and 2) in-person and online OSCEs, for assessing health professional trainees' competencies. For Q1, 21 studies satisfied inclusion criteria. The most examined health profession was medical trainees (19, 90.5%), the comparison was most frequently OSCEs versus multiple-choice questions (MCQs) (18, 85.7%), and 18 (87.5%) examined the same competency domain. Most (77.5%) total score correlation coefficients between testing methods were weak (r < 0.40). For Q2, 13 articles were included. In-person and online OSCEs were most used for medical trainees (9, 69.2%), checklists were the most prevalent evaluation scheme (7, 63.6%), and 14/17 overall score comparisons were not statistically significantly different. Generally low correlations exist between MCQ and OSCE scores, providing insufficient evidence as to whether OSCEs provide sufficient value to be worth their additional cost. Online OSCEs may be a viable alternative to in-person OSCEs for certain competencies where technical challenges can be met.

Comparison of Instructor-Led and Video-Based Instruction in Teaching Suturing to Medical Students.

INTRODUCTION: We conducted a single-blind, prospective, randomized, 3-arm controlled trial to compare the efficacy of interactive and noninteractive video-based with instructor-led teaching in acquiring and retaining basic surgical skills. METHODS: Participants were pretested after providing written instruction using a simulator. After the pretest, students were randomized to three groups: noninteractive video-based instruction (NIVBI), instructor-led teaching with concurrent feedback, and interactive video-based instruction (IVBI). An immediate post-test and a retention test were performed 1 mo after the practice session's end to assess the efficacy of practice conditions. Two experts blinded to the experimental condition evaluated performance using expert-based assessment. Data were analyzed using SPSS. RESULTS: There were no differences in expert-based assessments between groups at the pretest. All three groups showed significant improvements in expert-based scores between the pretests and post-tests as well as between pretests and retention tests (P < 0.0001). Instructor-led teaching and IVBI were equally effective initially for teaching this skill to naive medical students and showed better performance than NIVBI (P < 0.0001 each). At retention, IVBI displayed superior performance compared to NIVBI and the instructor-led group (P < 0.0001 each). CONCLUSIONS: Our result showed that video-based instruction could be as effective as instructor-led teaching in acquiring basic surgical skills. These findings support the idea that with thoughtful incorporation into technical skill curricula, video-based instruction may efficiently use faculty time and serve as a helpful adjunct for basic surgical skills training.

Effectiveness of transition programs on new graduate nurses' clinical competence, job satisfaction and perceptions of support: A mixed-methods study.

AIM: To assess the effectiveness of two graduate nurse programs on new graduate nurses' overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses' job satisfaction at 12 months and explore their experiences of support. BACKGROUND: Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs. DESIGN: Longitudinal mixed-methods study. METHODS: The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines. RESULTS: Competence increased significantly at T1, with participants stating that they learned by "getting out" of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn. CONCLUSION: This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it. RELEVANCE: There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

Effective and respectful interaction with Māori: How the regulators of health professionals are responding to the Health Practitioners Competence Assurance Amendment Act 2019

AIMS: To ascertain the response of registered health professional regulators to the legislated requirement under the Health Practitioners Competence Assurance Amendment Act 2019 (HPCA Amendement Act) that practitioners are culturally competent and, specifically, enabling "effective and respectful interaction with Māori". METHOD: A document analysis of the extent to which the culturally competent requirement is indicated in information about professional competencies within publicly available information of the 17 responsible authorities (RAs) that govern health practitioners under the Health Practitioners Competence Assurance legislation. RESULTS: Three years after the amendment to the original Act (HPCA Act) requiring health professionals to be culturally competent specifically in relation to interacting with Māori, only four of the 17 RAs fully reference the amended requirement, and only two RAs link this specific cultural competence to the requirements of the amended Act (HPCA Amendment Act). The majority of the RAs have yet to integrate references to engaging with Māori in this way into their professional competencies. CONCLUSIONS: Culturally competent practice is only meaningful once it is enacted by individual practitioners in their interactions with others. It is imperative for RAs to include the cultural competence requirement into their published information about professional competencies as this would signal to the profession, practitioners, and wider community that effective and respectful interaction with Māori is a fundamental expectation of all health practitioners in this country. Other issues identified during the analysis suggest an emphasis on administration and bureaucracy. This presents an opportunity for consolidating the practice of RAs including how key functions are expressed and promulgated.

Dental student oral surgery training-Comparing the impact of COVID-19 and cohort sizes.

INTRODUCTION: The response to the COVID-19 pandemic potentially reduced the clinical experience and academic education of dental trainees through reduced supervised clinical sessions. Graduating dental students, future employers and regulators may be concerned over the level of clinical experience of graduates trained within the COVID-19 pandemic. The purpose of this study was to try and document the evidence for, and significance of, this impact. MATERIALS AND METHODS: From dental student data in the 2017, 2018, 2019 and 2020 cohorts attending the University of Sydney, Australia, the number of dental extractions and adjunct oral surgery procedures, as well as final end-of-year examination results, was recorded. Results were compared to determine whether differences in experience and final academic achievement existed between these cohorts. RESULTS: The smallest student cohort, 2017, demonstrated greater clinical experience than the 2018, 2019 and 2020 cohorts. The 2020 COVID-19-affected cohort demonstrated no statistically significant reduction in clinical experience in all measured clinical procedures when compared to the 2018 and 2019 cohorts. The decrease in city teaching hospital clinical experience was compensated by an increase in rural placements. The 2020 cohort achieved the lowest academic results, and this was statistically significant. CONCLUSION: The oral surgery clinical experience of the 2020 dental cohort at the University of Sydney was comparable to prior cohorts. Rural clinics were able to compensate for COVID-19 interruptions to clinical training. The number of students in a cohort, if all other variables remain constant, appeared to affect clinical exposure to a greater extent than COVID-19.

Objective structured clinical examination (OSCE) during the COVID-19 pandemic

Introduction: Objective Structured Clinical Examination (OSCE) allows simulation of the interaction between the pharmacist (or the pharmacy student) and the patient in a community pharmacy or at a hospital setting. Hence, OSCE is nowadays considered the gold-standard for competency-based assessments in clinical disciplines such as Pharmacy. As a result of the pandemic situation, conventional face to face OSCE presents with challenges related to health and safety. Accordingly, alternative clinical competence assessments with similar objectives and standards for pharmacy students were designed. Method(s): OSCE was conducted during the academic year 2020-21 for fifth-year students after the completion of six months of practical rotations. Students completed an exam with five stations consisting of two face-to-face stations with simulated standardised patients and three online stations developed through the online learning platform Blackboard, each one with a duration of five minutes. The stations tested student knowledge, patient counselling and communication and acquisition of technical and/or clinical skills. Result(s): A total of 49 fifth-year students and ten examiners were involved in this OSCE hybrid format. The analysis of results showed that the best average grade was obtained at live stations. Comparing the results with previous conventional OSCEs (before pandemic) shows higher average grades for the hybrid OSCE celebrated in 2020-21. Amongst the participants in the hybrid OSCE, 33% of them preferred the online stations. Conclusion(s): During the COVID-19 pandemic, online stations have been implemented in OSCE as an opportunity to assess clinical skills in pharmacy students. The online version was effective for evaluating knowledge. However, there were limitations in the assessment of some specific skills such as communication.

Effectiveness of Debriefing in Simulation-Based Education for Nursing Students: A Systematic Review and Meta-analysis

Purpose: This study aimed to determine the effect of debriefing interventions on clinical competence in nursing students. Methods: A systematic review with a meta-analysis was conducted. Korean and English studies were retrieved from eight databases: KERIS, KISS, KoreaMed, NDSL, CINAHL, Cochrane Library, EMbase, and PubMed through January 2022. Fifteen studies were selected for the meta-analysis based on the inclusion criteria and low risk of bias. The data was analyzed using RevMan 5.3. and R software 3.6.2. Results: Most studies had a low risk of bias. Debriefing intervention in simulation-based education were found to be significantly effective compared to the control groups on clinical competence(Hedges'g=1.06, 95% CI=0.73~1.39, p<.001). In addition, the length of the debriefing intervention influenced the heterogeneity in the meta-ANOVA. Conclusion: Debriefing intervention in simulation-based education help improve nursing students' clinical competence in nursing students. Futhermore, our findings suggest that nursing educators should consider the length of debriefing for nursing students to improve their clinical competence. © 2022 Korean Academy of Fundamentals of Nursing.

Examining Clinical Readiness and Performance of Students on Clinical Education Experiences: Is There an Influence From Virtual Learning?

Supplemental Digital Content is Available in the Text. Introduction.: Peer simulation is a mechanism to enhance clinical reasoning and determine clinic readiness of Doctor of Physical Therapy students. In 2020, coursework that was traditionally face-to-face (F2F) was conducted completely online at many universities. Therefore, the purpose of this study was to examine if students who completed a stand-alone virtual simulation course presented with the same readiness and performance on their first full-time clinical education experience (CEE) as compared with students who completed the course during the previous 2 years in the traditional F2F format. Review of Literature.: Prior to the COVID-19 pandemic, literature focused on virtual learning explored hybrid methods of delivering physical therapy education. There are limited studies exploring the impact of virtual learning on clinical performance of DPT students. Subjects.: One hundred eight students completed their first full-time CEE during this 3-year period, with 34 having a virtual preparation and 74 having F2F coursework. Twelve of the clinical instructors (CIs) who had supervised students both virtually and in the previous 2 years were included in survey data analysis to compare cohorts. Methods.: This study used final Clinical Performance Instrument (CPI) data to compare objective ratings of student performance from CIs as well as a standardized survey of student clinical readiness based on 22 items previously published. Both instruments were used to compare students from the class of 2022 (virtual cohort) to those from the previous 2 years (F2F cohort). Independent sample t tests were used to examine group differences in perceptions of student readiness and CPI data for compiled professional practice and patient management constructs. Results.: Clinical Performance Instrument data revealed lower mean scores of students in all areas of performance in the virtual cohort as compared with F2F, but none of the differences reached statistical significance. For the clinical readiness survey, CIs rated students from the virtual cohort lower than prior students in overall readiness, as well as psychomotor, cognitive, and affective skill domains, including safety and accountability. However, none of the mean score differences reached statistical significance. Discussion and Conclusion.: Although there was no statistical difference in scores on the CPI or perception of clinic readiness by CIs, students from the virtual cohort consistently scored lower on both instruments. Transition of students from F2F coursework for psychomotor skills to virtual formats should transpire with caution. As students transition back to traditional learning environments, programs should evaluate the effectiveness of various teaching methods to ensure excellence in physical therapist education.

Competence in Spiritual and Emotional Care: Learning Outcomes for the Evaluation of Nursing Students.

Spiritual and emotional care is an important part of the person, especially in situations such as changes in health or a community coping with a pandemic. However, nurses report scarce university training in this area of care. The aim of the study is to define a catalogue of learning outcomes for spiritual and emotional care for undergraduate nurses. The design used a mixed method for the development and validation of learning outcomes. The first phase designs the catalogue of learning outcomes through a coordinating group and uses a bibliographic search and nursing legislation. The second phase validates the proposal through a group of experts, with a questionnaire using the modified Delphi technique in two rounds. The initial proposal was 75 learning outcomes, of which 17 were eliminated, 36 changed their wording and the experts proposed 7 new ones. The experts validated 65 learning outcomes: 14 for Assessment and diagnosis; 5 for Planning; 17 for Intervention; 4 for Evaluation and quality; 8 for Communication and interpersonal relationship and 17 for Knowledge and intrapersonal development. In conclusion, the academic curriculum can include these learning outcomes to help undergraduate nurses in the process of acquiring knowledge, skills and attitudes in spiritual and emotional care.