Remediation practices for health profession students and clinicians: An integrative review.

BACKGROUND: The current state of practices in health care remediation is not well known. The purpose of this review is to characterize, assess, and present synthesized results of current student and professional remediation practices described in the literature. METHODS: This study used an integrative review process including article extraction and review, descriptive characterization and statistics, classification of levels of evidence, assessment of risk of bias, and examination of relationships between factors and types of remediation. Articles were located in a search of PubMed (MEDLINE) and EBSCO (CINAHL Complete) last accessed in May 2022. INCLUSION CRITERIA: Full text journal articles and Briefs published between January 2001 and May 2022, English language, focus on remediation in health science education programs and professionals, identified key words in title, abstract, or article. EXCLUSION CRITERIA: Published outside the date range; focus of study or article outside health sciences; main focus not on remediation process or program (defined above), books, presentations and abstracts. RESULTS: 97 articles were included. Design rigor clustered around Level 6 (case-controlled studies, case series, case reports). All programs and activities were reported as successful. There was a statistically significant relationship (p < 0.01) between healthcare discipline and type of remediation. CONCLUSIONS: A variety of remediation methods for health care students and professionals are reported to be successful. Higher level studies are needed to help define best practices for remediation activities in health care professional knowledge and skill.

Assessing EHR Data for Use in Clinical Improvement and Research.

ABSTRACT: Data from electronic health records (EHRs) are becoming accessible for use in clinical improvement projects and nursing research. But the data quality may not meet clinicians' and researchers' needs. EHR data, which are primarily collected to document clinical care, invariably contain errors and omissions. This article introduces nurses to the secondary analysis of EHR data, first outlining the steps in data acquisition and then describing a theory-based process for evaluating data quality and cleaning the data. This process involves methodically examining the data using six data quality dimensions-completeness, correctness, concordance, plausibility, currency, and relevance-and helps the clinician or researcher to determine whether data for each variable are fit for use. Two case studies offer examples of problems that can arise and their solutions.

Teaching the concept curricula: theory and method.

Conceptual teaching in nursing education offers benefits over traditional content and fact-laden curricula, including the development of cognitive skills necessary for knowledge transfer across contexts and the ability to transform students into lifelong learners. The recent focus on active and learner-centered teaching techniques does not equate to learning conceptually, although it is a positive move away from teacher-centered techniques. A paucity of educational nursing literature exists that delineates both the theory and methods used to teach conceptually. We present a semiotic framework for teaching conceptually, in addition to outlining three core components necessary for conceptual learners: addressing misconceptions, developing enduring understandings, and acquiring metacognitive skills. Five teaching methods that are particularly fitting for concept-based curricula and useful across all program levels are described and outlined. Active and learner-centered activities can also be designed and adapted to develop the mindset necessary to learn conceptually.

Assessing responsiveness of cancer-related fatigue instruments: distribution-based and individual anchor-based methods.

BACKGROUND: The aims of the study were to examine the responsiveness of Chinese versions of the Cancer Fatigue Scale (C-CFS), the Schwartz Cancer Fatigue Scale-revised (C-SCFS-r), and the Fatigue Symptom Inventory (C-FSI) based on effect sizes and patient perceptions of change. METHOD: Convenience sampling was used to recruit subjects at a chemotherapy treatment center for outpatients in Taiwan. Data were collected twice: on the day cancer patients were receiving chemotherapy treatment (T1) and 2 days post-treatment (T2). RESULTS: Questionnaires were complete at T2 by 148 subjects (60.9%). The differences between T1 and T2 were statistically significant for all three scales. The effect sizes, ranging from a medium to a large change for the C-CFS, C-SCFS-r, and C-FSI were reported based on four groups (self-reported no increase, small increase, moderate increase, and large increase). Generalized estimating equations were used to compare the fatigue scores based on the four groups by controlling for the fatigue level at baseline and the time effect. The results indicate that the fatigue scores after 2 days of treatment in the three "change" groups were statistically significantly larger than in the "no increase" group. In addition, the pretreatment fatigue level in the "large increase" group was significantly higher than in the other three groups. CONCLUSION: Results indicate that the three scales are sensitive to change over 2 days. However, the three scales may not effectively discriminate between a moderate and large change. Therefore, further testing on cancer patients with severe fatigue to examine responsiveness to detect minimal important differences for the three scales is recommended.

Redundancy in a computer-generated order list: meeting the needs of nurses at various levels of practice expertise.

Paper-based clinical practice standards usually pertain to a single diagnosis or clinical condition. When a computerized provider order entry system applies multiple paper-based practice standards to one patient, it generates an order list containing redundant orders. Nurses respond to redundant orders on the basis of their level of nursing expertise with clinical care, computers, and practice standard domains. In this project, orders from three practice standards were manually combined to create a single order list, resulting in 15 duplicate and overlapping orders. A relational database was developed to test the automated removal of redundant orders. As expected, the automatically evaluated order list contained only one of each duplicate order and only the parent of each overlapping order group. Orders were then grouped by related system or function for readability. It is possible to automate the removal of duplicate and overlapping orders from an order list before display to the nurse.

Exploratory case method to determine the frequency of redundant orders within manually consolidated order lists.

A computerized provider order entry (CPOE) system can provide an efficient means of retrieving and consolidating order lists from multiple electronic clinical practice standards and protocols. However, the consolidated order list may contain exact duplicate or overlapping orders. Benner's framework for levels of nursing expertise can be used to explicate the variability of the nurse's responses to redundancies in order lists and the potential compromise to patient safety. An exploratory case method was performed to consolidate 74 orders from 11 sources. The consolidated order list contained 35% fewer orders after the redundant orders were removed. Our work has shown that many redundant orders may arise by consolidating order lists from multiple electronic standards. It is imperative that consolidated electronic order lists be manageable by the nurse according to their level of clinical and computer expertise, and that redundant orders are resolved before being displayed to the nurse.

Prevalence of sleep disturbance and its relationship to pain in adults with chronic pain.

The study examined the prevalence and relationship between sleep disturbance and chronic pain. Research questions were: (1) What is the prevalence of sleep disturbance in adults with chronic pain, and how does this prevalence compare with healthy and insomniac adults? (2) What is the relationship between sleep disturbance and chronic pain? (3) What is the relationship of patient characteristics to sleep? This descriptive, correlational field study was done at an interdisciplinary pain clinic, sampling 99 adults, and using an 11-point pain scale and a visual analog sleep scale. For every disturbance item, more than 47% of subjects reported a score of 50 or higher, twice as high as those for healthy adults, indicating disrupted sleep. For every effectiveness item, more than 54% of subjects reported a score of 50 or less, significantly lower than for healthy adults, indicating poor sleep quality. For every supplementation item, more than 60% reported mean scores of 10 or less, indicating minimal napping, yet scores were higher than for healthy adults. For all three scales, scores were similar to the mean scores for insomniacs. Soundness of sleep showed a small but significant positive (r <.30) correlation with years of pain. Supplementation scale items were not correlated with either years of pain or pain intensity. Fragmentation was significant on the basis of gender, with men having higher scores than women. Age was a negative predictor of sleep latency. Education and age were negative predictors of the quality of sleep.