Economic evaluation of an integrated virtual care programme for people with chronic illness who are frequent users of health services in Australia.

OBJECTIVE: The MeCare programme is a tailored virtual care initiative targeted at frequent users of health services who have at least one chronic condition including cardiovascular disease, chronic respiratory disease, diabetes or chronic kidney disease. The programme aims to prevent unnecessary hospitalisations by helping patients to self-manage, improve their health literacy and engage in positive health behaviours. This study investigates the impact of the MeCare programme on healthcare resource use, costs and patient-reported outcomes. METHODS AND ANALYSIS: A retrospective pre-post study design was adopted. Data on emergency department presentations, hospital admissions, outpatient appointments and their associated costs were obtained from administrative databases. Probabilistic sensitivity analysis using Monte Carlo simulation was used to model changes in resource use and costs prior to, and following, participant enrolment on the MeCare programme. Generalised linear models were used to investigate the observed changes in patient-reported outcomes. RESULTS: The MeCare programme cost $A624 per participant month to deliver. Median monthly rates of ED presentations, hospital admissions and average length of stay post-MeCare reduced by 76%, 50% and 12%, respectively. This translated to a median net cost saving of $A982 per participant month (IQR: -1936; -152). A significant, positive trend in patient experience based on responses to the Patient Assessment of Care for Chronic Conditions Questionnaire was observed over the duration of programme enrolment. DISCUSSION: The MeCare programme is likely to result in substantial cost savings to the health system, while maintaining or improving patient-reported outcomes. Further research in multisite randomised studies is needed to confirm the generalisability of these results.

Digital Microcertification: An Interprofessional Simulation Experience for Undergraduate Nursing and Medical Laboratory Students.

ABSTRACT: Badges of merit, or microcertification, have increased in popularity to acknowledge achievement of skills or proficiency in a profession-specific competency and incentivize the learning experience. Outcome criteria are rigorously established by an academic institution to preserve the integrity of the microcredential or badge. On the premise that a microcredential may be favored by future employers, stakeholder involvement in the microcredential process strategically enhances employer awareness. This article describes use of a simulation experience with nursing and medical laboratory science students to demonstrate competencies in interprofessional communication to achieve a digital microcredential.

Exploring Relationships of Sleep Duration with Eating and Physical Activity Behaviors among Canadian University Students.

BACKGROUND: Students pursuing postsecondary education are a population described as vulnerable for sleep problems, poor dietary habits, weight gain, and reduced physical activity. The primary goal of this study was to examine relationships of sleep behaviors with eating and physical activity behaviors in a sample of undergraduate health sciences students. METHODS: Using a cross-sectional design, undergraduate health sciences students in a small Canadian university were recruited to complete an on-line questionnaire about their sleep, eating, and physical activity behaviors using valid and reliable instruments. Key sociodemographic characteristics and self-reported height and weight data were also captured. RESULTS: The participants (n = 245) were on average 23 years of age, female (86%), and the majority were full-time students (92%). The mean BMI was within a healthy range (mean 24.58 SD 5.55) with the majority reporting low physical activity levels (65%). Despite self-reports of very or fairly good (65%) sleep quality in the past month, the mean global sleep scores (scores > 5, mean 7.4, SD 3.3) indicated poor overall sleep quality. Poorer sleep quality was associated with higher BMIs (r = 0.265, p < 0.001). CONCLUSIONS: The findings highlight the need to expand the scope of on-campus wellness programs to promote healthy sleep habits in a vulnerable university population.

Speaking Up Against Hierarchy: A Simulation Geared Towards Nursing Students.

Background As simulation science continues to advance, the focus previously put on scenario creation and debriefing must now be applied to other components of the learning experience. There is a need to examine the effectiveness of pre-simulation activities and how they relate to the overall simulation experience and learning outcomes. However, few randomized controlled trials have been conducted comparing different approaches in the pre-simulation preparatory phase and the impact on learning outcomes. Methods A randomized controlled trial was conducted with undergraduate nursing students (n=83) who were randomized to a traditional paper case study (control group) or an interactive pre-simulation activity (intervention group). The use of the two-challenge rule and Satisfaction and Self Confidence in Learning (SSL) was evaluated. Results The proportion of students who utilized the two-challenge rule in the intervention group was significantly higher than the control group. Results from the two independent-samples Wilcoxon-Mann-Whitney test showed a significant difference in the median of the total score of the SSL W=2.5, p <0.001, satisfaction W=6.0, p <0.001, and self-confidence W=68.0, p <0.001 in learning between third-year nursing students in the control and intervention groups. Conclusion Our results showed significant differences in the use of the two-challenge rule by students who completed an interactive pre-simulation activity (intervention group) compared to those who completed the paper case study (control group). Additionally, students in the intervention group were more self-confident and satisfied with the entire simulation intervention than the control group. From a pedagogical perspective, this study also emphasizes the need to ground simulations in theory. Moreover, there is value in using progressive frameworks, i.e., revised Medical Research Council (2014) in simulation design and research to ensure high quality. More studies are required to examine the right dosage and type of pre-simulation activity and impact on learning outcomes.

Pre-simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to systematically examine the use and effectiveness of pre-simulation preparation and briefing practices for healthcare professionals and students. More specifically, the objectives are to identify characteristics/activities of pre-simulation preparation and briefing and their effects on knowledge, attitudes, self-confidence, self-efficacy, anxiety and skill performance in healthcare professionals and students.The review question is: What are the characteristics/activities of effective pre-simulation preparation and briefing?

Opening the black-box of person-centred care: An arts-informed narrative inquiry into mental health education and practice.

BACKGROUND: Nursing education has a history of encouraging students to know their patients and to negotiate the in-between of art/science, person/profession, and intuition/evidence. Nurse-teachers know that students may abandon some values and practices when they encounter practice environments that are complex and have competing agendas. We are concerned that nursing knowledge is black-boxed, invisible and taken-for-granted, in healthcare settings. OBJECTIVES: Our research explores how nursing students and nurses are constructing and enacting person-centred care in mental health education and practice. We want to understand the nursing standpoint on this significant ontological issue and to make nursing knowledge construction and utilization visible; illuminating how person-centred theory emerges from practice. DESIGN: The process involved four 3-hour group meetings and an individual follow-up telephone conversation. SETTINGS: Students and nurses met at a tertiary-care mental health organization. PARTICIPANTS: Fourteen nurses (Registered Nurses and Registered Practical Nurses) and nursing students (Bachelor of Science in Nursing and Practical Nursing) participated in our inquiry. METHODS: We used arts-informed narrative inquiry to explore experience through the arts such as metaphor, collage, poems, letters, and group conversations. RESULTS: The black-box is opened as the inquiry reveals how nursing knowledge is constructed, assumptions are challenged and new practices emerge. CONCLUSIONS: Our research is significant for education and for practice and is transferable to other populations and settings. Nurses are affirmed in person-centred values and practices that include partnership with those in their care, role modeling for colleagues and mentoring students and new nurses. Students participate in transferring their learning from school to practice, in the company of experienced colleagues; together they open the black-box to show how nurses conceptualize and enact person-centred care.

Trialing a contextual approach to academic honesty.

Concerns about academic honesty in higher education are widespread. To address this issue, faculty took part in a 3-year trial of a highly successful approach to academic honesty. Guiding this approach were an appreciation of student context, faculty orientation to student engagement, and available antiplagiarism technology.

The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey.

OBJECTIVES: The purpose of this investigation was to examine the relationship between psychosocial variables and working conditions, and nurses' coping methods and distress in response to the severe acute respiratory syndrome (SARS) crisis in Canada. PARTICIPANTS AND PROCEDURE: The sample consisted of 333 nurses (315 women, 18 men) who completed an Internet-mediated questionnaire that was posted on the Registered Nurses' Association of Ontario (RNAO) website between March and May 2004. The questionnaire was restricted to respondents who had to authenticate their RNAO membership with a valid username and password before accessing the questionnaire. This served a dual purpose: to ensure that only RNAO nurses completed the questionnaire and thereby safeguarding the generalizability of the findings; and second, to prevent any one nurse from contributing more than once to the overall sample. RESULTS: Correlational analysis yielded several significant relationships between psychosocial variables and working conditions, and the traditional correlates of burnout and stress. Three multiple regression analysis revealed that the model we evolved--including higher levels of vigor, organizational support, and trust in equipment/infection control initiative; and lower levels of contact with SARS patients, and time spent in quarantine--predicted to lower levels of avoidance behavior, emotional exhaustion, and state anger. CONCLUSIONS: By employing models of stress and burnout that combine psychosocial variables and working conditions, researchers can account for significant amounts of variance in outcomes related to burnout. These findings highlight the importance of vigor and perceived organizational support in predicting nurses' symptoms of burnout. For healthcare administrators, this means that a likely strategy for assuaging the negative outcomes of stress should address nurses' psychosocial concerns and the working conditions that they face during novel times of crisis.

The nurse-patient relationship in cancer care as a shared covenant: a concept analysis.

The concept of the nurse-patient covenant was explored using a multiple-method research design. Analysis of the literature (167 references) was the basis for 2 focus group interviews (12 nurses) and 8 semistructured patient interviews. Attributes, antecedents, and consequences were identified through an analysis of findings across all data sources. The nurse-patient covenant in cancer care is defined as an enduring relationship, embodying caring benevolence and contextually negotiated reciprocity. It is preceded by the demonstration of nursing competence as a manifestation of nursing tradition and leads to patients' trusting and entrusting nurses, the emergence of personhood and professionhood, and benefits and obligations.

Educating international nurses: curricular innovation through a bachelor of science in nursing bridging program.

A curricular innovation was designed to provide internationally educated nurses with access to nursing licensure and employment. Through a program that includes professionally relevant English language support, mentorship, academic upgrading, workplace experiences, and clinical skills support, a mechanism has been created for internationally educated nurses to earn a bachelor of science in nursing degree and overcome barriers to practicing their profession.