Development of entrustable professional activities for advanced practice nurses education.

BACKGROUND: Entrustable professional activity (EPA) framework has gained popularity within competency-based healthcare education programmes across disciplines, professions, and countries. As opposed to traditional time-based approach, EPAs bridge the gaps between competency framework and clinical practice, however, limited information on nursing EPAs highlights a need to develop EPAs specific to graduate nursing education to promote patient safety and quality patient care. OBJECTIVES: This paper described comprehensively the four-stage approach used to develop and pilot test a set of core EPAs for advanced practice nurse (APN) education. METHOD: The four-stage approach used to develop and pilot the EPAs included: 1) team formation, 2) development of conceptual framework, 3) identifying and reviewing core EPAs, and 4) pilot testing the EPAs. Post pilot test and surveys were conducted for the EPA developers, APN preceptors and interns to explore their perceptions and experiences using the EPAs. RESULTS: A framework of nine core EPAs was developed for APN education, including: 1) perform an initial assessment and formulate management plans, 2) manage follow-up care for a clinical encounter, 3) plan, perform and evaluate care procedures, 4) recognise and manage patients requiring urgent care, 5) manage care transitions within and between health care organisations, 6) recognise and manage pharmacological needs of patients, 7) collaborate with patients, families, and community to improve health through disease prevention and health promotion, 8) participate in health quality improvement initiative, and 9) develop self and others for professional practice. CONCLUSION: Despite the stakeholders having generally positive attitudes towards the use of EPAs, it has its drawbacks. More research is needed to examine the psychometric properties of the EPA assessment tools and evaluate the effectiveness of EPAs in graduate nursing education. Additionally, the described set of core APN EPAs needs more refinement and rigorous testing before it can be implemented on a larger scale.

Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem.

This study aimed to: (i) determine the prevalence, socio-demographic and clinical correlates of internalized stigma and (ii) explore the association between internalized stigma and quality of life, general functioning, hope and self-esteem, among a multi-ethnic Asian population of patients with mental disorders. This cross-sectional, survey recruited adult patients (n=280) who were seeking treatment at outpatient and affiliated clinics of the only tertiary psychiatric hospital in Singapore. Internalized stigma was measured using the Internalized Stigma of Mental Illness scale. 43.6% experienced moderate to high internalized stigma. After making adjustments in multiple logistic regression analysis, results revealed there were no significant socio-demographic or clinical correlates relating to internalized stigma. Individual logistic regression models found a negative relationship between quality of life, self-esteem, general functioning and internalized stigma whereby lower scores were associated with higher internalized stigma. In the final regression model, which included all psychosocial variables together, self-esteem was the only variable significantly and negatively associated with internalized stigma. The results of this study contribute to our understanding of the role internalized stigma plays in patients with mental illness, and the impact it can have on psychosocial aspects of their lives.

The effectiveness of using non-traditional teaching methods to prepare student health care professionals for the delivery of mental state examination: a systematic review.

BACKGROUND: With the evolution of education, there has been a shift from the use of traditional teaching methods, such as didactic or rote teaching, towards non-traditional teaching methods, such as viewing of role plays, simulation, live interviews and the use of virtual environments. Mental state examination is an essential competency for all student healthcare professionals. If mental state examination is not taught in the most effective manner so learners can comprehend its concepts and interpret the findings correctly, it could lead to serious repercussions and subsequently impact on clinical care provided for patients with mental health conditions, such as incorrect assessment of suicidal ideation. However, the methods for teaching mental state examination vary widely between countries, academic institutions and clinical settings. OBJECTIVES: This systematic review aimed to identify and synthesize the best available evidence of effective teaching methods used to prepare student health care professionals for the delivery of mental state examination. INCLUSION CRITERIA: This review considered evidence from primary quantitative studies which address the effectiveness of a chosen method used for the teaching of mental state examination published in English, including studies that measure learner outcomes, i.e. improved knowledge and skills, self-confidence and learners' satisfaction. SEARCH STRATEGY: A three-step search strategy was undertaken in this review to search for articles published in English from the inception of the database to December 2014. An initial search of MEDLINE and CINAHL was undertaken to identify keywords. Secondly, the keywords identified were used to search electronic databases, namely, CINAHL, Medline, Cochrane Central Register of Controlled Trials, Ovid, PsycINFO and, ProQuest Dissertations & Theses. Thirdly, reference lists of the articles identified in the second stage were searched for other relevant studies. METHODOLOGICAL QUALITY: Studies selected were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute's Meta-Analysis of Statistics Assessment and Review Instrument embedded within the System for the Unified Management, Assessment and Review of Information. Any disagreements that arose between the reviewers were resolved through discussion between the reviewers. DATA EXTRACTION: Data was extracted using data extraction tools developed by the Joanna Briggs Institute Quantitative data was extracted from papers using standardized data extraction tools from the Joanna Briggs Institute's Meta-Analysis of Statistics Assessment and Review Instrument. DATA SYNTHESIS: The included studies were found to be heterogeneous in terms of participants and teaching methods. Moreover, a wide variety of instruments were used to determine impact and outcomes of the teaching methods. Hence, findings of the included articles were presented in a narrative summary. RESULTS: A total of 12 articles were included in this review with consensus from all reviewers. The evidence retrieved in this study suggests that non-traditional teaching methods, such as videotapes, virtual simulation, standardized patients and reflection, improve learners' understanding and skills of mental state examination as opposed to traditional teaching methods like lectures and provision of reading materials. However, studies that specifically compared the effectiveness of one method over another were limited to comparison between lectures with videotaped interviews and virtual simulations. It was shown that both videotaped interviews and virtual simulations were superior to lectures. In videotaped teaching, interactions between patients and learners performing mental state examination were shown for the learner's discussion while virtual simulations mimicked patient symptoms in computer applications. Virtual simulation was notably a unique learning opportunity for the learners as it allowed learning to take place without the use of diminishing real life resources. However, in view of the high cost and learners' difficulty in negotiating the virtual environment, videotaped teaching remained as the more commonly used method of teaching mental state examination. CONCLUSIONS: This systematic review study identified teaching strategies utilized in the teaching of mental state examination and their effectiveness. Videotapes was the most widely used and effective approach, that is, until the issue of high cost and ease of maneuver in virtual simulation could be overcome. There were also potential benefits of other teaching, such as reflection and use of standardized patients, and educators could consider these in the teaching of mental state examination. Future research could focus more on the comparison of various teaching methods to offer more evidence on the use of one teaching method over another.

Nursing inter-shift handover process in mental health settings: a best practice implementation project.

AIMS: Nursing inter-shift handover remains an important traditional ritual in nursing. Timely and effective handover of critical information ensure continuity of patient care and safe delivery. This project took place in a tertiary mental health institution in Singapore. The project aims to (i) examine existing handover practices/process in the tertiary mental health institution; (ii) determine the strengths and limitations of the existing handover practice/process; and (iii) identify, implement and evaluate an evidence-based nursing inter-shift handover process to enhance patient safety and service delivery. METHODS: This project was conducted in three phases using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programmes. It was implemented over a period of 4 months from end of August 2011 to beginning of December 2011. Evidence-based strategies such as town hall meetings and education sessions that reinforce proper handover techniques and its importance were implemented to enhance the handover processes and practices in four acute admitting wards. Pre- and post-audit data were observed and recorded for each case handover during each inter-shift handover session in four acute admitting wards. RESULTS: The handover processes for 212 cases for four acute admitting wards were observed using the seven audit criteria. Post-implementation audit findings show that compliance rate had improved significantly for the four criteria: an improvement of 49% compliance rate in the use of standardised documentation during shift handover session; an increase of 74% compliance rate in proper identification of patient at the start of each case report; a 31% increase in proper handing over of significant patient's history; and 18% increased compliance in providing detailed observation of patients. CONCLUSION: This project had shown that handover sessions can be made effective by translating evidence into practice through ongoing evidence-based audit. Continuous evidence-based evaluation, identification and implementation of nursing inter-shift handover process are imperative to enhance patient safety and service delivery.