Everyone Is Listening: Podcasts as an Innovative Educational Approach in Graduate Level Education.

BACKGROUND: Over the past decade, graduate level nursing education has transitioned from synchronous, classroom-based models to hybrid, asynchronous models. This change has increased the amount of screen-time for graduate learners and generated the problem of screen-fatigue. To reduce screen-based learning time, faculty transitioned a didactic critical care course to a podcast-based educational format. METHOD: This pilot study used a pre-course and post-course survey to evaluate the efficacy of podcasts in delivering course content, meeting course objectives, and understanding learners' perceptions of podcasts in education. RESULTS: Pre-course and post-course survey data demonstrated that podcasts successfully met course objectives and provided content that was equally or more engaging than screen-based lectures. CONCLUSION: Podcasts can be successfully incorporated into a didactic course as a content delivery modality and are an innovative strategy for engaging adult learners in an asynchronous, distance-friendly format while continuing to meet educational objectives. [J Nurs Educ. 2024;63(5):335-337.].

Perceptions of motivating factors and barriers to precepting.

BACKGROUND: Advanced practice registered nurses (APRNs) and physician assistants (PAs) are integral to health care delivery in the United States. However, the cultivation of APRNs and PAs relies heavily on the model of precepting. Advanced practice registered nurses and PAs frequently precept students or new hires, yet limited data are available to describe the motivations, incentives, and barriers associated with precepting. PURPOSE: The purpose of this mixed-method, cross-sectional study was to better understand APRN and PA preceptors' perceived levels of support during precepting, facilitating factors, and barriers to the precepting process. METHODS: An electronic survey was distributed via REDCap to a convenience sample of APRN and PA preceptors at an academic medical center. Data collected from the survey were analyzed using both descriptive statistics and qualitative thematic analysis. RESULTS: One hundred fifty-four participants completed the survey. Motivating factors for precepting included "giving back" to the profession, and barriers included inadequate time to precept while in the clinical role. Participants indicated that financial incentives, heightened communication, protected teaching time, preceptor training, meaningful recognition, and organizational support could enhance the precepting process. CONCLUSION: This study demonstrated that altruistic intentions frequently motivate APRN and PA preceptors, however, navigating multiple clinical responsibilities while precepting serves as a barrier to the precepting process. Preceptor training, ongoing education, dedicated time for precepting, enhanced communication, and organizational or professional incentives may optimize the APRN and PA precepting process. IMPLICATIONS: Further research should focus on how to optimally incorporate education, professional development, support, and incentives into the APRN and PA preceptor role.

Using a Standardized Rounding Tool to Improve the Incidence of Spontaneous Awakening and Breathing Trials.

BACKGROUND: Spontaneous awakening and breathing trials have been associated with shorter durations of mechanical ventilation and intensive care unit lengths of stay. LOCAL PROBLEM: Inconsistent spontaneous awakening trials and spontaneous breathing trials, mechanical ventilation weaning strategies, and interdisciplinary rounding processes contributed to prolonged mechanical ventilation duration and length of stay in a 44-bed adult medical intensive care unit. Methods A standardized rounding tool that focused on coordinating spontaneous awakening and breathing trials, and on their outcomes, was integrated into daily multidisciplinary rounds in a medical intensive care unit. Aggregated patient data from the 4-month project implementation phase were compared with historical data collected for 2 months before project implementation. RESULTS: During the 2-month preintervention phase, 613 adult patients were managed in the medical intensive care unit and 41 patients required mechanical ventilation, whereas during the 4-month intervention phase, 1271 patients were managed in the unit and 96 patients required mechanical ventilation. The project was associated with a 24% (0.89-day) reduction in the mean length of stay (3.72 vs 2.83 days) and a 46.3% (2.81 day) reduction in mechanical ventilation duration (6.06 vs 3.25 days) when comparing August 2019 to January 2020. DISCUSSION: A standardized rounding tool emphasizing a coordinated process for spontaneous awakening and breathing trials was associated with a shorter length of stay and duration of mechanical ventilation among patients in the medical intensive care unit. CONCLUSION: An evidence-based approach to weaning from mechanical ventilation and standardized rounding may be a cost-effective way to reduce mechanical ventilation duration and length of stay in a medical intensive care unit.

Improving Medical and Nurse Practitioner Student Confidence and Clinical Skill in Advance Care Plan Development: A Multidisciplinary Mentorship Model.

BACKGROUND: Advance care planning (ACP) is an integral aspect of patient-centered care, however medical (MD) and Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) students receive minimal education on how to facilitate ACP discussions and ultimately feel uncomfortable having these discussions with patients.1-4 The aim of this project was to increase MD and AGACNP students' perceived ability and confidence in leading ACP conversations through an ACP educational program called the Letter Project Pilot (LPP). METHODS: The LPP consisted of faculty-supervised interactions in the inpatient setting during which students were able to lead ACP discussions with patients by guiding them through an advance directive worksheet that was structured in the format of a letter. Student participants were recruited from the MD and AGACNP programs associated with the academic medical center. Patients were recruited from inpatient medicine and geriatrics units at the academic medical center. At the end of the 3-month pilot, a voluntary, anonymous REDCap survey was used to evaluate 2 primary outcomes of interest:1) the association of the LPP pilot on perceived ACP skills, and 2) the perceived impact of the LPP pilot on ACP in future practice. RESULTS: Students perceived that their experiences positively enhanced their current ACP skills and their ability to have ACP conversations in their future practice. CONCLUSION: The results support that the LPP is a scalable, cost-effective project that increases students' perceived ability and confidence in leading ACP conversations.

Advance Care Planning in Chronically Ill Patients With an Episodic Disease Trajectory in the Acute Care Setting: A Quality Improvement Project.

INTRODUCTION: Advance care planning (ACP) is a fluid discussion between patients and providers to define preferences for future medical care. In the acute care setting, ACP is limited due to lack of structured process for identifying persons who may benefit from ACP. This quality improvement (QI) project aimed to increase the frequency of ACP discussions and documentation of preferences by targeting geriatric patients with an episodic disease trajectory for ACP. METHODS: This project used an intervention and comparison group design to target English-speaking, geriatric adults at a large academic medical center with a diagnosis of NYHA class III/IV HF and/or GOLD criteria III/IV COPD for ACP discussions. The intervention group was compared to a group with a range of diagnoses who were approached in a non-systematic way. RESULTS: Thirteen (n = 13) participants completed all aspects of the QI project. Results showed a non-significant increase in the number of patients with a diagnosis of HF and/or COPD who participated in an ACP discussion when compared to the comparison group (n = 20, p = 0.131), as well as a non-significant increase in the number of ACP tools documented in the HER (53.8% compared to 30%) (x = 1.877, p = 0.171). CONCLUSION: While this project demonstrated non-significant statistical results in the incidence and documentation of an ACP tool, this project increased the number of ACP discussions had, which is clinically significant.

Critical Care Considerations in Adult Patients With Influenza-Induced ARDS.

TOPIC: Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE: Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE: To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED: This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

Platelet Inhibitors.

Antithrombotic medications have become standard of care for management of acute coronary syndrome. Platelet adhesion, activation, and aggregation are essential components of platelet function; platelet-inhibiting medications interfere with these components and reduce incidence of thrombosis. Active bleeding is a contraindication for administration of platelet inhibitors. There is currently no reversal agent for platelet inhibitors, although platelet transfusion may be used to correct active bleeding after administration of platelet inhibitors.