Effects of Handover Education Using the Outcome-Present State Test (OPT) Model and SBAR in Nursing Students: A Quasi-Experimental Design.

Background: Since most of nursing students lack clinical reasoning competency, for effective handover education, it is necessary to include a strategy to improve the clinical reasoning competency in the practical training course of the nursing department. Methods: This study used a quasi-experimental research design using a non-equivalent control group pretestposttest design to verify the effectiveness of the practice education program using the OPT model and SBAR. The subjects were 73 third-year students participating in clinical practice or clinical alternative practice in Korea. Results: The experimental group showed significantly better communication clarity (t=-12.262, P<.001), communication confidence (t=-12.486, P<.001), problem-solving processes (t=-13.100, P<.001), and team efficacy (t=-6.197, P<.001) compared to before the intervention. However, there was no significant difference between the pre- and post-intervention scores of the control group. Conclusion: In a situation where clinical practice is difficult for nursing students, the handover education program using the OPT model and SBAR can helps improve their communication clarity, communication confidence, problem-solving process, and team efficacy.

Factors Affecting the Length of Stay in the Emergency Department in Psychiatric Emergency Patients in the COVID-19 Pandemic Context.

To reduce overcrowding in emergency departments (ED), which is a serious international problem, it is important to reduce the length of ED stay (ED LOS) of emergency patients. In particular, due to the COVID 19 pandemic, psychiatric emergency patients spent much longer in ED. This study was conducted to identify the characteristics of psychiatric emergency patients who visited the ED during the COVID-19 pandemic and to identify factors affecting ED LOS. This retrospective study was conducted on adult patients aged 19 years or older who visited a psychiatric emergency center operated by an ED from 1 May 2020 to 31 April 2021 because of the COVID-19 pandemic. In this study, the average ED LOS of psychiatric emergency patients was 7.8 h. Factors affecting ED LOS for over 12 h were isolation (OR = 2.39, CI = 1.409-4.052), unaccompanied police officers (OR = 2.106, CI = 1.338-3.316), night-time visits (OR = 2.127, CI = 1.357-3.332), use of sedatives (OR = 1.671, CI = 1.030-2.713), and restraints (OR = 1.968, CI = 1.172-4.895). The ED LOS of psychiatric emergency patients is longer than that of general emergency patients, and a long ED LOS causes ED overcrowding. To reduce the ED LOS of psychiatric emergency patients, they must be accompanied by a police officer when visiting the ED, and the treatment process should be reorganized so that a psychiatrist can promptly intervene. Furthermore, it is necessary to reorganize the isolation guidelines and admission criteria for mental emergency patients.

Effect of problem-based learning on severity classification agreement by triage nurses.

BACKGROUND: Differences in the classification results among triage nurses in the emergency room can be improved by training or applying an algorithm. This study aimed to confirm whether the agreement among triage nurses could be improved through learner-led problem-based learning. METHODS: This study had a single-group time series design to investigate the effect of problem-based learning led by triage nurses on the agreement of Korean Triage and Acuity Scale classification results for patients who visited the emergency department. We extracted 300 patients each in May and August 2018 before learning began and 300 patients each in May and August 2019 after learning. RESULTS: After problem-based learning was applied, the self-efficacy of triage nurses for emergency patient classification increased statistically significantly compared to before learning (7.88 ± 0.96, p < .001), and the weighted kappa coefficient was also found to be almost perfectly agreement (0.835, p < .001). CONCLUSIONS: In this study, problem-based learning improved the inter-rater agreement of Korean Triage and Acuity Scale classification results and self-efficacy of triage nurses. Therefore, problem-based learning can contribute to patient safety in the emergency department by enhancing the expertise of triage nurses and increasing the accuracy of triage classification.

Development and validity of the Korea psychiatric triage algorithm.

BACKGROUND: Psychiatric emergencies require timely intervention because of the risk of harm to individuals and society, including others. The aim of the present study was to test the content validity of a psychiatric triage algorithm developed for use in South Korea. METHODS: The initial algorithm was developed through systematic literature review. Its validity was then verified by 10 experts. Based on results of expert validity, the algorithm was modified and the final algorithm was developed. RESULTS: Its clinical validity was then verified by 37 emergency room nurses who had used triage. Four questions of expert validity results with a CVI of 0.8 or less were revised to reflect expert opinion. The usefulness, adequacy, and convenience of the final modified algorithm was 2.98 ~ 3.53. CONCLUSION: After sufficiently validated by follow-up studies, it is expected that the use of psychiatric classification algorithms in emergency room nurses will not only improve the quality of care, but also can improve patient outcomes and experience.

Effectiveness of self-re-learning using video recordings of advanced life support on nursing students' knowledge, self-efficacy, and skills performance.

BACKGROUND: Nurses are presumably the first to see an in-hospital cardiac arrest patient. This study proposed measuring nursing students' knowledge, self-efficacy, and skills performance in advanced life support (ALS), 6 months after training, by sending videos taken during their final skills test after the ALS training. METHODS: This is an experimental study using a randomised control group design. This study was conducted from June to December 2018, and the subjects of the study were 4th year students, recruited through a bulletin board at a nursing university. The participants' knowledge, self-efficacy, and skill performance in ALS were evaluated immediately after the training, and participants were videotaped during the final skills test. Thereafter, the videos were sent to the experimental group through a mobile phone messenger application, once a month, from the third month after training. Approximately six months after training day, a follow-up test was conducted for the measured variables using a blinded method. The paired t-test and Wilcoxon signed-rank test were used to compare the two groups pre-and post-intervention. The statistical significance level was set at p < .05. RESULTS: Six months after the ALS training, knowledge scores decreased significantly in both groups (p < 0.001). Self-efficacy decreased by about 3 points from 50.55 to 47.18 in the experimental group (p = 0.089), while it decreased by 10 points in the control group, from 50.67 to 39 (p < 0.001). The skills performance decreased from 27.5 to 26.68 in the experimental group, while it decreased significantly from 27.95 to 16.9 in the control group (p < 0.001). CONCLUSION: Self-study with videos taken during an ALS skills test helps enhance the sustainable effects of training such as knowledge, self-efficacy, and skills performance.

Time point of blood pressure drop in patients with orthostatic hypotension in the emergency department.

OBJECTIVE: The purpose of this study was to identify the time of blood pressure (BP) drop in the orthostatic hypotension test, and to propose a realistic and appropriate duration in the orthostatic hypotension test. METHODS: A total of 879 consecutive patients (61-year-old and 44% women) with positive on the orthostatic hypotension test in the emergency department were retrospectively reviewed. Orthostatic hypotension was defined as drop in standing SBP of at least 20 mmHg or standing DBP of at least 10 mmHg from their supine values after standing for 5 min. BP measurements was made at 1, 3, and 5 min after standing. RESULTS: Six hundred and eighty-four (77.8%), 152 (17.3%) and 43 (4.9%) patients had BP drop meeting orthostatic hypotension criteria at 1, 3, and 5 min, respectively. In multivariable analysis, older age (≥60 years) and higher blood urea nitrogen (BUN) (≥15.5 mg/dl) were independently associated with early BP drop at 1 min, and younger age (<40 years) was independently associated with later BP drop at 5 min even after controlling for potential confounders. CONCLUSION: To measure orthostatic BP for orthostatic hypotension diagnosis at emergency department, older patients (≥60 years) with high BUN (≥15.5 mg/dl) should be monitored carefully as BP can drop quickly within 1 min. On the contrary, in younger people (<40 years), BP drop occurred slowly after 3 min, suggesting that clinicians measure BP for a longer time.

Additional Value of Brachial-Ankle Pulse Wave Velocity to Single-Photon Emission Computed Tomography in the Diagnosis of Coronary Artery Disease.

AIM: The aim of this study was to investigate whether information on arterial stiffness can improve the value of single-photon emission computed tomography (SPECT) in the detection of obstructive coronary artery disease (CAD). METHODS: A total of 233 patients (age: 62.2±10.8 years, 60.3% males) with detected ischemia on SPECT undergoing invasive coronary angiography (ICA) and brachial-ankle pulse wave velocity (baPWV) measurement within a month was retrospectively reviewed. RESULTS: Of the 233 patients, 190 (81.5%) had obstructive CAD (≥50% luminal stenosis). The difference in baPWV according to the presence of obstructive CAD was significant in patients in the mild ischemia group [summed stress score (SSS): 4-8] (1,770±364 cm versus 1,490±328 cm, p＜0.001) but not in the moderate (SSS: 9-13) or severe (SSS: ≥14) ischemia groups (p＞0.05 for each). Receiver operating characteristic curve analyses showed that the diagnostic value of baPWV for obstructive CAD was significant only in patients in the mild ischemia group (area under curve: 0.714; p=0.001) but not in the moderate or severe ischemia groups (p＞0.05 for each). Adding information on baPWV to SPECT results and clinical parameters significantly increased diagnostic accuracy in the detection of obstructive CAD in patients with mild ischemia (integrated discrimination improvement p=0.006) but not in those with moderate or severe ischemia on SPECT (p＞0.05 for each). CONCLUSIONS: The results of this study suggest that baPWV may have additional value to SPECT for the detection of obstructive CAD, especially in patients with mild ischemia on SPECT.