Point Prevalence Survey of Acute Hospital Patients with Difficulty Swallowing Solid Oral Dose Forms.

The safe administration of solid oral dose forms in hospital inpatients with swallowing difficulties is challenging. The aim of this study was to establish the prevalence of difficulties in swallowing solid oral dose forms in acute hospital inpatients. A point prevalence study was completed at three time points. The following data were collected: the prevalence of swallowing difficulties, methods used to modify solid oral dose forms to facilitate administration, the appropriateness of the modification, and patient co-morbidities. The prevalence of acute hospital inpatients with swallowing difficulties was an average of 15.4% with a 95% CI [13.4, 17.6] across the three studies. On average, 9.6% of patients with swallowing difficulties had no enteral feeding tube in situ, with 6.0% of these patients receiving at least one modified medicine. The most common method of solid oral dose form modification was crushing, with an administration error rate of approximately 14.4%. The most common co-morbid condition in these patients was hypertension, with dysphagia appearing on the problem list of two (5.5%) acute hospital inpatients with swallowing difficulties. Inappropriate modifications to solid oral dose forms to facilitate administration can result in patient harm. A proactive approach, such as the use of a screening tool to identify acute hospital inpatients with swallowing difficulties, is required, to mitigate the risk of inappropriate modifications to medicines to overcome swallowing difficulties.

A European evaluation of the patients' role in clinical education: A six-country cross sectional study.

AIM: The aim of this study was to analyse the patients' role in clinical education in terms of facilitative student-patient relationship in Finland, Germany, Iceland, Ireland, Lithuania and Spain and factors promoting a more facilitative relationship in clinical education. BACKGROUND: Nursing students' bedside learning is reliant on patients and the establishment of a person-centred approach develops from the relationships with patients. DESIGN: A multi-country, cross-sectional design was implemented. METHODS: Survey data were collected from graduating nursing students and patients between May 2018 and March 2019. The survey consisted of a 13-item facilitative sub-scale of the Student-Patient Relationship Scale as the main outcome measure, which was identical for both populations. In addition, background factors were surveyed with single questions and other scales. Associations between facilitative relationship and background factors were studied with linear models. RESULTS: Altogether, 1796 students and 1327 patients answered the survey. Overall, both students and patients regarded their relationship as facilitative, but students' (median 4.23, 95% confidence interval 4.15-4.23) evaluations were higher than patients' (median 3.75, 95% confidence interval 3.69-3.77). The students' and patients' evaluations differed from each other significantly in all other countries except in Ireland and Lithuania. Corresponding associations for both populations were found in terms of the country and students' cultural confidence. CONCLUSIONS: Results signal favourable grounds for students' bedside learning and patient participation in clinical education with the potential to foster a person-centred approach.

Graduating nurse students' interest in older people nursing-A cross-sectional survey in six European countries.

BACKGROUND: Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence. AIM: To analyse graduating nurse students' interest in older people nursing and the factors associated with it. METHODS: A cross-sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non-probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub-scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables. RESULTS: Overall, students' interest in older people nursing was low (score 20.5, on a 0-100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p < .001), the length of work experience (p = .006), plans for further study (p = .007), competence (p < .001) and the extent that nursing is valued by society (p < .001). The students who were most interested in older people nursing had higher self-reported competence level (p < .001). CONCLUSION: In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent. IMPLICATIONS FOR PRACTICE: Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities.

Preceptors' experiences of using a competence assessment tool to assess undergraduate nursing students.

The purpose of this study was to explore Irish preceptors' experience of using a competence tool to assess undergraduate nursing students' clinical competence. This study used a mixed methods design. This study was conducted in two phases, the qualitative phase involved six focus group interviews to ascertain preceptors' experiences of using an assessment tool to assess clinical competence. The quantitative phase involved a descriptive survey measuring preceptors (N = 843) attitudes linked with the use of the assessment tool. The key themes that emerged from qualitative analysis were challenges of using the assessment tool, recognising competence and valuing adult learners. The challenges of using the tool included negotiating complex language and time constraints in completing assessments. Recognising competence revealed the use of intuition and subjectivity. While valuing adult learners acknowledged the reciprocal learning process between the preceptor and the learner. These findings reveal the inherent skills of preceptors to intuitively and subjectively recognise competence. The quantitative findings revealed merits and challenges for the preceptors using the assessment tool. In particular the complexity of the language was highlighted as an issue. A key recommendation from this research is the need to revise the assessment tool to support objective and subjective measurement of competence.

Back to the future: An online OSCE Management Information System for nursing OSCEs.

BACKGROUND: The Objective Structured Clinical Examination (OSCE) is an established tool in the repertoire of clinical assessment methods in nurse education. The use of OSCEs facilitates the assessment of psychomotor skills as well as knowledge and attitudes. Identified benefits of OSCE assessment include development of students' confidence in their clinical skills and preparation for clinical practice. However, a number of challenges exist with the traditional paper methodology, including documentation errors and inadequate student feedback. OBJECTIVES: To explore electronic OSCE delivery and evaluate the benefits of using an electronic OSCE management system. To explore assessors' perceptions of and attitudes to the computer based package. DESIGN: This study was conducted using electronic software in the management of a four station OSCE assessment with a cohort of first year undergraduate nursing students delivered over two consecutive years (n=203) in one higher education institution in Ireland. A quantitative descriptive survey methodology was used to obtain the views of the assessors on the process and outcome of using the software. METHODS: OSCE documentation was converted to electronic format. Assessors were trained in the use of the OSCE management software package and laptops were procured to facilitate electronic management of the OSCE assessment. Following the OSCE assessment, assessors were invited to evaluate the experience. RESULTS: Electronic software facilitated the storage and analysis of overall group and individual results thereby offering considerable time savings. Submission of electronic forms was allowed only when fully completed thus removing the potential for missing data. The feedback facility allowed the student to receive timely evaluation on their performance and to benchmark their performance against the class. CONCLUSIONS: Assessors' satisfaction with the software was high. Analysis of assessment results can highlight issues around internal consistency being moderate and examiners variability. Regression analysis increases fairness of result calculations.

Life with chronic obstructive pulmonary disease: striving for 'controlled co-existence'.

AIMS AND OBJECTIVES: To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. BACKGROUND: COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. DESIGN: Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. METHODS: Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. RESULTS: Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. CONCLUSION: The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. RELEVANCE TO CLINICAL PRACTICE: Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease.

Use of peer assessment as a student engagement strategy in nurse education.

This paper describes how peer assessment was implemented in an undergraduate nursing program in Ireland to enhance student engagement, and reports students' (n=37) experiences of the process. The process involved second year Bachelor of Nursing Science students developing marking criteria and marking two of their colleagues' assignments anonymously. A qualitative descriptive design using focus group interviews was used to collect data on students' experiences. Demographic data were collected through questionnaires. The analysis identified three themes: (i) impact on student engagement; (ii) challenges of peer assessment; and (iii) making it better. The findings revealed that most students enjoyed the process, and that peer assessment facilitates and enhances student engagement. The findings also provide evidence to support the self-regulation theory of learning. A detailed account of the methods used to implement peer assessment is also provided, which might be useful for other nurse educators seeking to implement peer assessment at an undergraduate level.