Handoffs and transitions of care: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.

BACKGROUND: The Joint Commission reports that at least half of communication breakdowns occur during handovers or transitions of care. There is no consensus on how best to approach the transfer of care within acute care surgery (ACS). We conduct a systematic review and meta-analysis of the current data on handoffs and transitions of care in ACS patients and evaluate the impact of standardization and formalized communication processes. METHODS: Clinically relevant questions regarding handoffs and transitions of care with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. These centered around specific transitions of care within the setting of ACS, specifically perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and intensive care unit (ICU) interactions. A systematic literature review and meta-analysis were conducted using the Grading of Recommendations Assessment, Development, and Evaluation methodology. RESULTS: A total of 10 studies were identified for analysis. These included 5,113 patients in the standardized handoff group and 5,293 in the current process group. Standardized handoffs reduced handover errors for perioperative interactions and preventable adverse events for intra/interfloor and ICU interactions. There were insufficient data to evaluate outcomes of clinical complications and medical errors. CONCLUSION: We conditionally recommend a standardized handoff in the field of ACS, including perioperative interactions, emergency medical services and trauma team interactions, and intra/interfloor and ICU interactions. LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level III.

Longitudinal Assessment to Evaluate Continued Certification and Lifelong Learning in Healthcare Professionals: A Scoping Review.

The balance of lifelong learning with assessment for continued certification is a challenge faced by healthcare professions. The value of single-point-in-time assessments has been questioned, and a shift to longitudinal assessments (LA) has been undertaken to assess lifelong learning over-time. This scoping review was conducted to inform healthcare certifying organizations who are considering LA as an assessment tool of competence and lifelong learning in healthcare professionals. A search of 6 databases and grey literature yielded 957 articles. After screening and removal of duplicates, 14 articles were included. Most articles were background studies informing the underpinnings of LA in the form of progress testing, pilot studies, and process of implementation. Progress testing is used in educational settings. Pilot studies reported satisfaction with LA's ease of use, online format, and provision of lifelong learning. Implementation processes reveal that key aspects of success include stakeholder participation, phased rollout, and a publicly available content outline. Initial outcomes data affirm that LA addresses knowledge gaps, and results in improved performance on maintenance of certification exams. Future research is needed to substantiate validity evidence of LA and its correlation with high-stakes exam performance when assessing lifelong learning and continued competence of healthcare professionals over time.

Belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment: A scoping review.

AIM: The aim of this scoping review was to map the literature investigating belongingness in undergraduate/pre-licensure nursing students in the clinical learning environment. BACKGROUND: The concept of belongingness, which encompasses feelings of acceptance, connection and value alignment, has been tied to positive outcomes in undergraduate/pre-licensure nursing students including increased learning, participation, confidence and professional socialization. It is critical for educators and clinical staff to foster a sense of belongingness for nursing students to promote positive and effective clinical learning experiences. DESIGN: The scoping review strategy established by the Joanna Briggs Institute was followed. The databases searched were CINAHL Complete (EBSCO), Education Source, Medline Complete (EBSCO), APA PsycINFO (EBSCO) and Epistemonikos. METHODS: Following a search of the five databases, studies were screened by title and abstract by two independent reviewers for inclusion. Data including population, concept, context, methods and key findings relevant to the review question were extracted and synthesized using an instrument developed by the reviewers. RESULTS: A total of 47 articles with varying methodologies were critically appraised. Three overarching focus areas emerged: outcomes resulting from feelings of belongingness versus alienation, factors that contribute to a sense of belongingness in the clinical learning environment and interventions to promote a sense of belongingness while students are immersed in the clinical learning environment. CONCLUSIONS: Belongingness in the clinical learning environment is an important concept that lends itself to positive learning experiences and increased satisfaction of undergraduate/pre-licensure nursing students. Environmental, relational and experiential factors can be maximized and specific interventions employed to promote belongingness. This review identifies a lack of evidence on measured interventional effectiveness at the student, school and clinical unit level. Future research to address these gaps is recommended. TWEETABLE ABSTRACT: Scoping review suggests environmental, relational and experiential factors promote positive outcomes in belongingness of nursing students.

Learning outcomes of the observer role in nursing simulation: a scoping review protocol.

OBJECTIVE: The purpose of this study is to map the literature investigating learning outcomes that have been measured in the observer role in simulation. A scoping review will be completed to investigate the research question: What learning outcomes have been reported in nurses or nursing students participating in simulation while assigned to the observer role? INTRODUCTION: Simulation-based learning experiences (SBLE) are being utilized more frequently to support learning with increasing numbers of nurses. Despite SBLE becoming more popular, resources and manikin availability are not meeting the demand placed on simulation programs in nursing schools and health care facilities. Programs are placing more learners in observational roles without knowing what learning can be expected. INCLUSION CRITERIA: Studies will be considered if they investigated learning outcomes of any nursing population (e.g. pre-licensure nursing student, graduate nursing student, practicing nurse) placed in an observational role in simulation. Any simulation topic related to nursing care will be considered. The observer role may involve observing one's own or expert behavior. The SBLE may occur in a simulation lab, classroom, community, health care facility, or online setting. Studies that include health care professionals other than nurses will be excluded. Experimental, quasi-experimental, observational, and qualitative studies will be considered. METHODS: The JBI methodology for scoping reviews will be followed. A three-step search strategy will be used to identify potentially relevant articles. Two independent reviewers will screen titles and abstracts, assess full-text studies against the inclusion criteria, and extract data. Results will be presented in a manner that aligns with the objective of the review.

Effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication for chronic or refractory gastroesophageal reflux disease: a systematic review protocol.

REVIEW OBJECTIVE/QUESTION: The objective of this review is to determine which 270-degree fundoplication procedure has a better outcome in patients with chronic or refractory gastroesophageal reflux disease (GERD). This review will identify the fundoplication approach for chronic or refractory GERD that provides better reflux control with minimal post-procedure complications.The question of this review is: what is the effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication in adult patients with chronic or refractory GERD?

Syntax and reading comprehension: a meta-analysis of different spoken-syntax assessments.

BACKGROUND: Syntax is a language skill purported to support children's reading comprehension. However, researchers who have examined whether children with average and below-average reading comprehension score significantly different on spoken-syntax assessments report inconsistent results. AIMS: To determine if differences in how syntax is measured affect whether children with average and below-average reading comprehension score significantly different on spoken-syntax assessments. METHODS & PROCEDURES: Studies that included a group comparison design, children with average and below-average reading comprehension, and a spoken-syntax assessment were selected for review. Fourteen articles from a total of 1281 reviewed met the inclusionary criteria. The 14 articles were coded for the age of the children, score on the reading comprehension assessment, type of spoken-syntax assessment, type of syntax construct measured and score on the spoken-syntax assessment. A random-effects model was used to analyze the difference between the effect sizes of the types of spoken-syntax assessments and the difference between the effect sizes of the syntax construct measured. OUTCOMES & RESULTS: There was a significant difference between children with average and below-average reading comprehension on spoken-syntax assessments. Those with average and below-average reading comprehension scored significantly different on spoken-syntax assessments when norm-referenced and researcher-created assessments were compared. However, when the type of construct was compared, children with average and below-average reading comprehension scored significantly different on assessments that measured knowledge of spoken syntax, but not on assessments that measured awareness of spoken syntax. CONCLUSIONS & IMPLICATIONS: The results of this meta-analysis confirmed that the type of spoken-syntax assessment, whether norm-referenced or researcher-created, did not explain why some researchers reported that there were no significant differences between children with average and below-average reading comprehension, but the syntax construct, awareness or knowledge, did. Thus, when selecting how to measure syntax among school-age children, researchers and practitioners should evaluate whether they are measuring children's awareness of spoken syntax or knowledge of spoken syntax. Other differences, such as participant diagnosis and the format of items on the spoken-syntax assessments, also were discussed as possible explanations for why researchers found that children with average and below-average reading comprehension did not score significantly differently on spoken-syntax assessments.

Evaluation of Testing as a Method to Assess Continued Competency in Nurse Anesthesia Practice: A Systematic Review.

Competency in healthcare practice has become a priority for sustaining the goals of quality and safety in patient care delivery. Evaluating maintenance of competency for practitioners beyond their initial licensure and credentialing has become a topic of focus in recent years. A systematic review was conducted to evaluate testing as a method of assessing continued competency in nurse anesthesia practice. Using the Joanna Briggs Institute method for a comprehensive systematic review, a literature search followed by critical appraisal of included manuscripts was performed. Sixty-three published and unpublished manuscripts were included in this systematic review. Testing should be used solely for the purpose of assessing knowledge necessary for current practice unique to the individual test taker. Testing should reflect real life and should allow the test taker access to materials and resources normally available in the provision of patient care.