A qualitative case study of health-related baccalaureate and graduate web-based simulated clinical learning platforms

Simulation has been recognized as a teaching, learning, evaluation, and research strategy based on learning theories, that has come to play a significant role in healthcare education (Beal et al., 2017;La Cerra et al., 2019). Health-related academic programs in higher education have traditionally used simulation to fill gaps in learning and strengthen students' clinical and critical thinking skills in conjunction with didactic classroom content, laboratory practice, and clinical education in the community setting (Hayden et al., 2014). With the onset and unpredictability of COVID-19, there was almost an immediate need for health-related academic programs across the world to transition from face-to-face teaching and learning, to remote online delivery methods to ensure the academic progression of students. To manage this transition, many higher education health-related programs turned to web-based simulated clinical learning platforms to support health-related students' development of clinical skills, and clinical understanding in the absence of traditional forms of laboratory, simulation, and clinical education. The purpose of this qualitative case study was to develop an in-depth analysis focused on perceived experiences of students and faculty utilizing web-based simulated clinical learning platforms incorporated within the curriculum of nine different baccalaureate and graduate health-related programs at one Midwestern public university in the United States. The analysis and triangulation of data included;students' and faculty perceptions via survey of their satisfaction, value, and usage levels of the web-based simulated clinical learning platforms, field educators' perception of student preparedness for clinical education, as well as, a comparison of course syllabi pre and post implementation of the web-based simulated clinical learning platforms. In-depth faculty opinions were also gathered via a focus group interview and inductive thematic analysis used to examine the perspectives of each participant on the overall effectiveness on how well such platforms helped meet course learning objectives, the usefulness of specific platform components, and the utilization levels and value of the platforms in comparison the actual cost of the platform. Findings of this study were used to provide actionable information and recommendations for stakeholders and others in the future utilization of web-based simulated clinical learning platforms in health-related academic programs in higher education. In summary, it is recommended that web-based simulated clinical learning platforms be utilized in conjunction with in-person clinical education. Whereas, content from the web-based simulated clinical learning platforms is used to supplement or replace missed clinical education, deliver specific evaluative standardized experiences for students, or provide students access to patient care conditions that are hard to replicate or gain access to in the student role in the clinical setting. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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)

Determining newly licensed nurses' satisfaction of a clinical advancement program

Nurse retention is a concerning issue in healthcare organizations. Newly licensed nurses leave their jobs at a higher rate than experienced nurses. The impact of COVID-19 has resulted in increased numbers of nurses leaving the acute care, inpatient setting due to early retirement or transition to outpatient ambulatory settings. Clinical advancement programs are a recommended strategy that is strongly associated with nurse retention. The purpose of this scholarly practice project was to describe the development, implementation, and evaluation of a clinical advancement program for newly licensed nurses in a 171-bed community teaching hospital located in the Northeast United States. The objective of the project was to evaluate participant satisfaction with a clinical advancement program. The Career Achievement and Recognition of Excellence Survey was used to measure the newly licensed nurses' perceived satisfaction with the clinical advancement program. The conclusions of the project indicated that the participants agreed with the clinical advancement program in theory but found it too challenging to participate in the program outside of the residency program. The survey results also identified opportunities for improvement including embedding the program into the residency program with the goal of improving retention rates of newly licensed nurses at the project site. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Classification of COVID-19 Chest CT Images Using Optimized Deep Convolutional Generative Adversarial Network and Deep CNN

Coronavirus disease 2019 (COVID-19) pandemic has become a major threat to the entire world and severely affects the health and economy of many people. It also causes the lot of other diseases and side effects after taking treatment for COVID. Early detection and diagnosis will reduce the community spread as well as saves the life. Even though clinical methods are available, some of the imaging methods are being adopted to fix the disease. Recently, several deep learning models have been developed for screening COVID-19 using computed tomography (CT) images of the chest, which plays a potential role in diagnosing, detecting complications, and prognosticating coronavirus disease. However, the performances of the models are highly affected by the limited availability of samples for training. Hence, in this work, deep convolutional generative adversarial network (DCGAN) has been proposed and implemented which automatically discovers and learns the regularities from input data so that the model can be used to generate requisite samples. Further, the hyperparameters of DCGAN such as number of neurons, learning rate, momentum, alpha, and dropout probability have been optimized by using genetic algorithm (GA). Finally, deep convolutional neural network (CNN) with various optimizers is implemented to predict COVID-19 and non-COVID-19 images which assist radiologists to increase diagnostic accuracy. The proposed deep CNN model with GA optimized DCGAN exhibits an accuracy of 94.50% which is higher than the pre-trained models such as AlexNet, VggNet, and ResNet. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Clinical skills development in the virtual learning environment: Adapting to a new world

The rapid transition to distance learning in response to the unexpected SARS-CoV-2/COVID-19 pandemic led to disruption of clinical skills development, which are typically conducted face-to-face. Consequently, faculty adapted their courses, using a multitude of active learning modalities, to meet student learning objectives in the didactic and experiential settings. Strategies and considerations to implement innovative delivery methods and address potential challenges are elucidated. Furthermore, integration of a layered learning approach may allow for more broad perspectives and allow additional interactions and feedback, which is especially necessary in the virtual environment. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of the COVID-19 pandemic on nursing simulation use and the influence of simulation use on future admissions

Nursing simulations have been used for over 100 years to better prepare nursing students and equip them with the medical and social skills necessary to provide high quality patient care. The use of simulation in nursing programs has helped students better their clinical skills, increase their confidence with patients, and practice with rare and difficult medical and social scenarios. With states approving up to 50% replacement of clinical hours with simulation hours, many schools have taken this opportunity to provide their students with the technology. With the onset of the COVID pandemic, clinical placements were suspended, and nursing programs turned to virtual simulations. The California Board of Nursing (BON) increased their approval to 75% replacement of clinical hours (AB2288) and, based on the results of this study, the vast majority of California nursing programs increased their percent of simulation use by 100% on average. Simulation was used to replace a higher percent of clinical hours than ever before.This explanatory sequential mixed methods study included a survey, followed by an interview to understand how simulation use changed as a result of the COVID pandemic and explore ways in which simulation technology can impact nursing school admissions for the future. For the quantitative portion, surveys were sent to simulation leaders at 128 of the 149 nursing programs in California, and 43 completed the survey (a 34% response rate). The survey revealed that 90% of programs increased their simulation use overall during the pandemic, 92% of respondents stated that the increase was necessary to address a scarcity of clinical placements, and the percent of clinical hours replaced by simulation during the pandemic rose from an average of 16% to 40%. After the pandemic, 68% of respondents predicted that they would use more simulation than they did before the pandemic, which suggests that schools have increased their buy-in to the benefits of the technology. Lastly, 31% of respondents stated that they were able to increase admission offers in 2020 because of increased simulation use.From the survey data collected, I interviewed simulation leaders of 5 nursing programs at which simulation impacted enrollment in the past, currently or had a predicted impact on future enrollment. Interviews were conducted virtually and further confirmed that increasing simulation use for the replacement of clinical hours could allow the enrollment of more students. If each student requires fewer clinical placement hours because a higher percent of these hours can be replaced by simulation, then the available clinical placement hours can be spread across more students. However, all interview respondents stated the next biggest barrier of increasing enrollment, insufficient number of faculty, would stifle any hopes of enrolling more students.Program leaders reported highly positive perceptions of the effectiveness of simulation on student NCLEX scores as well as their clinical competence. Respondents noted that the top three motivators for increasing simulation use before the pandemic was to practice clinical skills, expose students to rare scenarios and assess students' clinical skills. During the pandemic, the top three motivators shifted;an overwhelmingly high percent of respondents (92%) stated that the top reason for increasing simulation was to address the scarcity of clinical placements.Although most nursing programs have increased their simulation substantially, there are still programs that are nowhere near the maximum allowable usage. The Diffusion of Innovation theory categorizes schools that have not fully integrated the innovation as being in the implementation stage. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Identifying SARS-CoV-2 Variants of Concern through Saliva-Based RT-qPCR by Targeting Recurrent Mutation Sites.

SARS-CoV-2 variants of concern (VOCs) continue to pose a public health threat which necessitates a real-time monitoring strategy to complement whole genome sequencing. Thus, we investigated the efficacy of competitive probe RT-qPCR assays for six mutation sites identified in SARS-CoV-2 VOCs and, after validating the assays with synthetic RNA, performed these assays on positive saliva samples. When compared with whole genome sequence results, the SΔ69-70 and ORF1aΔ3675-3677 assays demonstrated 93.60 and 68.00% accuracy, respectively. The SNP assays (K417T, E484K, E484Q, L452R) demonstrated 99.20, 96.40, 99.60, and 96.80% accuracies, respectively. Lastly, we screened 345 positive saliva samples from 7 to 22 December 2021 using Omicron-specific mutation assays and were able to quickly identify rapid spread of Omicron in Upstate South Carolina. Our workflow demonstrates a novel approach for low-cost, real-time population screening of VOCs. IMPORTANCE SARS-CoV-2 variants of concern and their many sublineages can be characterized by mutations present within their genetic sequences. These mutations can provide selective advantages such as increased transmissibility and antibody evasion, which influences public health recommendations such as mask mandates, quarantine requirements, and treatment regimens. Our RT-qPCR workflow allows for strain identification of SARS-CoV-2 positive saliva samples by targeting common mutation sites shared between variants of concern and detecting single nucleotides present at the targeted location. This differential diagnostic system can quickly and effectively identify a wide array of SARS-CoV-2 strains, which can provide more informed public health surveillance strategies in the future.

Prospective Study of the Performance of Parent-Collected Nasal and Saliva Swab Samples, Compared with Nurse-Collected Swab Samples, for the Molecular Detection of Respiratory Microorganisms.

Respiratory tract infections (RTIs) are ubiquitous among children in the community. A prospective observational study was performed to evaluate the diagnostic performance and quality of at-home parent-collected (PC) nasal and saliva swab samples, compared to nurse-collected (NC) swab samples, from children with RTI symptoms. Children with RTI symptoms were swabbed at home on the same day by a parent and a nurse. We compared the performance of PC swab samples as the test with NC swab samples as the reference for the detection of respiratory pathogen gene targets by reverse transcriptase PCR, with quality assessment using a human gene. PC and NC paired nasal and saliva swab samples were collected from 91 and 92 children, respectively. Performance and interrater agreement (Cohen's κ) of PC versus NC nasal swab samples for viruses combined showed sensitivity of 91.6% (95% confidence interval [CI], 85.47 to 95.73%) and κ of 0.84 (95% CI, 0.79 to 0.88), respectively; the respective values for bacteria combined were 91.4% (95% CI, 86.85 to 94.87%) and κ of 0.85 (95% CI, 0.80 to 0.89). In saliva samples, viral and bacterial sensitivities were lower at 69.0% (95% CI, 57.47 to 79.76%) and 78.1% (95% CI, 71.60 to 83.76%), as were κ values at 0.64 (95% CI, 0.53 to 0.72) and 0.70 (95% CI, 0.65 to 0.76), respectively. Quality assessment for human biological material (18S rRNA) indicated perfect interrater agreement. At-home PC nasal swab samples performed comparably to NC swab samples, whereas PC saliva swab samples lacked sensitivity for the detection of respiratory microbes. IMPORTANCE RTIs are ubiquitous among children. Diagnosis involves a swab sample being taken by a health professional, which places a considerable burden on community health care systems, given the number of cases involved. The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in the at-home self-collection of upper respiratory tract swab samples without the involvement of health professionals. It is advised that parents conduct or supervise swabbing of children. Surprisingly, few studies have addressed the quality of PC swab samples for subsequent identification of respiratory pathogens. We compared NC and PC nasal and saliva swab samples taken from the same child with RTI symptoms, for detection of respiratory pathogens. The PC nasal swab samples performed comparably to NC samples, whereas saliva swab samples lacked sensitivity for the detection of respiratory microbes. Collection of swab samples by parents would greatly reduce the burden on community nurses without reducing the effectiveness of diagnoses.

Generation of False-Positive SARS-CoV-2 Antigen Results with Testing Conditions outside Manufacturer Recommendations: A Scientific Approach to Pandemic Misinformation.

Antigen-based rapid diagnostics tests (Ag-RDTs) are useful tools for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. However, misleading demonstrations of the Abbott Panbio coronavirus disease 2019 (COVID-19) Ag-RDT on social media claimed that SARS-CoV-2 antigen could be detected in municipal water and food products. To offer a scientific rebuttal to pandemic misinformation and disinformation, this study explored the impact of using the Panbio SARS-CoV-2 assay with conditions falling outside manufacturer recommendations. Using Panbio, various water and food products, laboratory buffers, and SARS-CoV-2-negative clinical specimens were tested with and without manufacturer buffer. Additional experiments were conducted to assess the role of each Panbio buffer component (tricine, NaCl, pH, and Tween 20) as well as the impact of temperature (4°C, 20°C, and 45°C) and humidity (90%) on assay performance. Direct sample testing (without the kit buffer) resulted in false-positive signals resembling those obtained with SARS-CoV-2 positive controls tested under proper conditions. The likely explanation of these artifacts is nonspecific interactions between the SARS-CoV-2-specific conjugated and capture antibodies, as proteinase K treatment abrogated this phenomenon, and thermal shift assays showed pH-induced conformational changes under conditions promoting artifact formation. Omitting, altering, and reverse engineering the kit buffer all supported the importance of maintaining buffering capacity, ionic strength, and pH for accurate kit function. Interestingly, the Panbio assay could tolerate some extremes of temperature and humidity outside manufacturer claims. Our data support strict adherence to manufacturer instructions to avoid false-positive SARS-CoV-2 Ag-RDT reactions, otherwise resulting in anxiety, overuse of public health resources, and dissemination of misinformation. IMPORTANCE With the Panbio severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test being deployed in over 120 countries worldwide, understanding conditions required for its ideal performance is critical. Recently on social media, this kit was shown to generate false positives when manufacturer recommendations were not followed. While erroneous results from improper use of a test may not be surprising to some health care professionals, understanding why false positives occur can help reduce the propagation of misinformation and provide a scientific rebuttal for these aberrant findings. This study demonstrated that the kit buffer's pH, ionic strength, and buffering capacity were critical components to ensure proper kit function and avoid generation of false-positive results. Typically, false positives arise from cross-reacting or interfering substances; however, this study demonstrated a mechanism where false positives were generated under conditions favoring nonspecific interactions between the two antibodies designed for SARS-CoV-2 antigen detection. Following the manufacturer instructions is critical for accurate test results.