Disseminated Tele-OSCE During a Pandemic: One University's Experience.

BACKGROUND: Due to coronavirus disease 2019 (COVID-19), in-person educational activities were suspended across the globe throughout 2020. In health care education, this required a swift, creative response to maintain the flow of trained clinicians into the workforce without compromising the integrity of core learning outcomes. Early during the pandemic, remote synchronous simulation emerged as a compelling focus of the overall strategy. METHOD: At one large health sciences university in the northwestern United States, family nurse practitioner faculty worked closely with the Simulation Operations team to plan, deliver, and assess a pilot tele-OSCE (objective structured clinical examination). RESULTS: In postevent debriefs and surveys, both standardized patients and students affirmed that the activity was generally safe, accessible, and high value. CONCLUSION: With appropriate planning, consensus building, and technology readiness assessment, tele-OSCEs can play a critical role in sustaining the flow of health care students into the workforce during a pandemic. [J Nurs Educ. 2022;61(2):107-110.].

Rural Telehealth Team Education for Baccalaureate and Nurse Practitioner Students.

BACKGROUND: Rural areas face health care workforce shortages. Nursing students seeking rural employment require instruction and clinical experience in using telehealth to work in health care teams. METHOD: An innovative telehealth consultation simulation paired nurse practitioner (NP) students with prelicensure baccalaureate nursing degree (BSN) students. The simulation aimed to enhance NP student proficiency and confidence in telehealth consultation skills and to foster professional role development through exposure to telehealth nursing roles for RNs and NPs. On-campus BSN students assumed the role of the RN in a rural clinic and consulted with off-campus NP students using telehealth technology in the care of a standardized patient. RESULTS: Participants demonstrated level-appropriate proficiency and reported confidence in telehealth consultation and favorable attitudes toward intraprofessional communication. CONCLUSION: An intraprofessional educational model allowing BSN and NP students to develop telehealth consultation skills successfully addressed a gap in preparing nursing students to meet rural health care workforce needs. [J Nurs Educ. 2020;59(5):274-277.].

Communicating acute coronary syndrome risk to women in primary care: A scoping review of the literature.

OBJECTIVES: Delay from symptom onset to hospital arrival drives poor outcomes in acute coronary syndrome (ACS), particularly for women. Primary care clinicians can discuss ACS with high-risk women, potentially reducing delay. We conducted a scoping review to assess what is known about ACS risk communication to women in primary care. METHODS: We used Arksey and O'Malley's framework. The PubMed, CINAHL, PsycINFO, and Embase databases were searched for relevant articles from inception through September, 2018. No restrictions on study methodology were applied. At least two reviewers assessed each article. Articles addressing risk communication, coronary heart disease, and ACS, related to primary care settings, and including women were retained. RESULTS: Eleven articles met inclusion criteria. Cardiovascular disease (CVD) risk communication is common in primary care; however, ACS symptoms are rarely discussed. Structured risk calculators are used to frame discussions. Communication styles include patient-centered discussions, paternalistic orders, and "scare tactics;" no single style is more effective. Analysis of gender differences in risk communication is extremely limited. CONCLUSION: There is scant evidence that primary care clinicians communicate effectively about ACS risk, symptoms, and appropriate symptom response. PRACTICE IMPLICATIONS: Interventions are needed to improve communication about ACS to at-risk women in the primary care setting.

Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome.

BACKGROUND: Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking. OBJECTIVES: The aim of this study was to identify common trajectories of symptom severity in the 6 months after an ED visit for potential ACS. METHODS: This was a secondary analysis of data from a larger observational, prospective study conducted in five U.S. EDs. Patients (N = 1005) who had electrocardiogram and biomarker testing ordered, and were identified by the triage nurse as potentially having ACS, were enrolled. Symptom severity was assessed in the hospital after initial stabilization and by telephone at 30 days and 6 months using the validated 13-item ACS Symptom Checklist. Growth mixture modeling was used for the secondary analysis. The eight most commonly reported symptoms (chest discomfort, chest pain, chest pressure, light-headedness, shortness of breath, shoulder pain, unusual fatigue, and upper back pain) were modeled across the three study time points. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. RESULTS: The sample was 62.6% male with a mean age of 60.2 years (SD = 14.17 years), and 57.1% ruled out for ACS. Between two and four distinct trajectory classes were identified for each symptom. The seven different types of trajectories identified across the eight symptoms were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset, "and "severe/improving." Trajectories differed on age, gender, and diagnosis. DISCUSSION: Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.

Symptom clusters in patients presenting to the emergency department with possible acute coronary syndrome differ by sex, age, and discharge diagnosis.

OBJECTIVES: To identify classes of individuals presenting to the ED for suspected ACS who shared similar symptoms and clinical characteristics. BACKGROUND: Describing symptom clusters in undiagnosed patients with suspected ACS is a novel and clinically relevant approach, reflecting real-world emergency department evaluation procedures. METHODS: Symptoms were measured using a validated 13-item symptom checklist. Latent class analysis was used to describe symptom clusters. RESULTS: The sample of 874 was 37% female with a mean age of 59.9 years. Four symptom classes were identified: Heavy Symptom Burden (Class 1), Chest Symptoms and Shortness of Breath (Class 2), Chest Symptoms Only (Class 3), and Weary (Class 4). Patients with ACS were more likely to cluster in Classes 2 and 3. Women and younger patients were more likely to group in Class 1. CONCLUSIONS: Further research is needed to determine the value of symptom clusters in the ED triage and management of suspected ACS.

A patient-focused framework integrating self-management and informatics.

PURPOSE: This article introduces a framework to (a) guide chronic illness self-management interventions through the integration of self-management and nursing informatics, (b) focus self-management research, and (c) promote ethical, patient-empowering technology use by practicing nurses. METHODS: Existing theory and research focusing on chronic illness, self-management, health-enabling technology, and nursing informatics were reviewed and examined and key concepts were identified. A care paradigm focusing on concordance, rather than compliance, served as the overall guiding principle. FINDINGS: This framework identifies key relationships among self-management (patient behaviors), health force (patient characteristics), and patient-defined goals. The role of health-enabling technology supporting these relationships is explored in the context of nursing informatics. CONCLUSIONS: The Empowerment Informatics framework can guide intervention design and evaluation and support practicing nurses' ethical use of technology as part of self-management support. CLINICAL RELEVANCE: Nurses worldwide provide support to patients who are living with chronic illnesses. As pressures related to cost and access to care increase, technology-enabled self-management interventions will become increasingly common. This patient-focused framework can guide nursing practice using technology that prioritizes patient needs.