Nurses, midwives and students' reports of effective dedicated education units in five European countries: A qualitative study.

AIM: To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment. DESIGN: A multi-country, phenomenological, qualitative study. METHODS: Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives. RESULTS: Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment. CONCLUSIONS: A close educational-service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment. IMPLICATIONS FOR THE PROFESSION: It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population. IMPACT: Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes. PUBLIC CONTRIBUTION: Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement.

Implementing dedicated education units in 6 European undergraduate nursing and midwifery students clinical placements.

BACKGROUND: Undergraduate students' clinical experience, working directly with patients and the healthcare team is essential to ensure students acquire the necessary competence for practice. There are differences in the quality of clinical environments and in students' clinical placement experiences and not all clinical sites are optimal learning environments. The Dedicated Education Unit clinical education model allows students to develop the practical knowledge, skills and professionalism they will need as nurses/midwives. METHODS: We employed the Consolidated Framework for Implementation Research to identify and compare barriers and facilitators in the implementation of the Dedicated Education Unit in 6 European undergraduate nursing/midwifery student clinical placement settings and to describe the experience of nurses/midwives involved in the Dedicated Education Unit model implementation and evaluation. A pre-post implementation interpretive assessment was based on participants' responses to the Consolidated Framework for Implementation Research construct questions. RESULTS: Although Dedicated Education Unit model implementation in our project was heterogeneous, no main implementation barriers were perceived. Qualitative data showed that educational-service collaboration, including a focus on mutual goals, organizational communication and networking, satisfaction of educational and healthcare professionals, and the establishment of a safe space for professional discussion and feedback, were considered facilitators. CONCLUSIONS: This study describes the key elements guiding educational and healthcare stakeholders in Dedicated Education Unit implementation, engaging participants in the entire process, and offering other organizations the opportunity to consider the benefits of this clinical education model.

Effective academic-practice partnership models in nursing students' clinical placement: A systematic literature review.

OBJECTIVES: This systematic review examines the effectiveness of academic-practice partnership models which include clinical faculty and clinical mentor roles in improving nursing students' clinical learning when compared with traditional models. REVIEW METHODS: PubMed, CINAHL, PsycINFO and Cochrane Library were searched to locate Randomized Control Trials and quasi-experimental studies published from 1999 to 2020. The Joanna Briggs Institute critical appraisal tools were used to ensure methodological quality. RESULTS: Fourteen studies were included in the review. The Collaborative Teaching Model and the Dedicated Education Unit model were tested in randomized controlled trials. Dedicated Education Unit, Dedicated Education Centre, Clinical Education Units, Education Partnership model, Collaborative educational-practice model and Collaborative clinical practicum model were evaluated in four experimental studies and ten quasi-experimental studies. Studies did not include patient participation, and staff and faculty had anecdotal presence. CONCLUSION: There is limited evidence on the effectiveness of academic-practice partnership models. However, the complementary roles of clinical faculty and clinical mentor, in addition to education and health institutions managers commitment could successfully facilitate students' clinical learning.

Perceived usefulness of data entry tools in medical encounters: a survey.

Electronic Health Records allows direct data entry and is an important factor for accurate diagnosis. However, two drawbacks of this system is the time needed to create them, which can reduce health care professional productivity, and the fact that it is error prone. It is important, therefore, to select the most appropriate methods and tools for data entry by the health care providers at the point of care in order to minimize a loss of productivity. The study aims to understand health care professionals' perceptions of the data entry process, and determine the appropriate methods, tools and functions that would facilitate the process, minimize loss of productivity and improve quality. A questionnaire which consisting of 18 basic questions (including demographic data) was posted on a web site which hosts questionnaires, on an established online community space and also mailed to health care professionals who are working in various hospitals for a duration of 10 months. Totally, 533 medical care professionals who are primarily from Turkey participated in the survey, of which 284 were medical doctors, 127 were nurses and the rest, other medical professionals. While the clear majority of participants involved in data entry use keyboard and mouse, most expressed a preference for more convenient methods, such as voice recognition or touch screen. Furthermore, physicians reported rarely spending more than 15 min for each consultation and conducting 21-30 examinations a day. The main motivation for creating an efficient direct data entry is to increase time allowed for patient examination, and to improve accuracy of diagnosis. Despite a heavy workload, health care professionals are very receptive to the idea of using a convenient data entry tool and keeping electronic patient records. Emergent data entry technologies in health sector can improve the quality of examinations, physicians' productivity and can decrease the percentage of medical misdiagnosis.

Attitudes toward the elderly among the health care providers: reliability and validity of Turkish version of the UCLA Geriatrics Attitudes (UCLA-GA) scale.

The population of above 65 years of age is increasing fast in societies, as the life expectancy is increasing and it leads to high demands for health care service. Health care service for the elderly should be provided by trained team in this field. Success of health care service to be rendered is related to knowledge, skill and attitudes of team members in different profession group (doctor, nurse, social worker, psychologist, etc.) about health of elderly. The aim of this study is to establish the Turkish validity and reliability of 14-question UCLA-GA scale, validity and reliability of which was proven and used the most frequently among the scales that assess attitudes of health care providers toward elderly. A total 256 people, 150 of them were post-graduates, 106 of them were pre-graduates were involved in the study at Ege University, medical faculty between the dates of December 2010 and February 2011. Majority of the participants (63.67%) were women and in the age group of 18-29 (58.3%). The ratio of the ones undergoing geriatric education is 38.2%. It was found out that the Kaiser-Meyer-Olkin (KMO) sampling adequacy test presented high correlation among the items in both single adult households of 14 items of the scale was 0.72. Cronbach alpha value of the scale was found as 0.67 and satisfying. As a result of examination with Tukey's test of additivity, it was seen that items of the scale have additive quality (F=85.25, p<0.0001). When we calculated the correlation of each item with total score, it was found that correlation coefficient varied between 0.32 and 0.68. Test-retest reliability was defined by use of Pearson correlation analysis. It was determined that test-retest consistency of correlation scale between two measurements was r=0.51. As a result of test-retest application, the correlation between the first and second application scores of each item was analyzed to determine the internal consistency of each item of the scale. Based on this analysis it was found as p<0.01 between r=0.22 and 0.65. As a conclusion, Turkish validity and reliability of UCLA-GA scale was demonstrated in this study. Since Turkish version of UCLA-GA scale is short and clear, it is recommended to use it for determining attitudes of health care providers toward elderly in geriatrics.

[Evaluation of anxiety and depression levels in patients with myocardial infarction]. / Miyokart enfarktüslü hastalarda anksiyete ve depresyonun incelenmesi.

OBJECTIVES: Patients with myocardial infarction (MI) may experience anxiety and depression. This study was designed to determine anxiety and depression levels in patients with MI. STUDY DESIGN: The study included 506 patients (199 women, 307 men; mean age 55.7+/-6.9 years) who were admitted to the cardiology department for MI. Data were collected using a questionnaire to identify patient characteristics and the Hospital Anxiety and Depression Scale (HADS). The HADS has been validated as a sensitive screening tool for anxiety and depression in MI patients in the Turkish population. RESULTS: Clinically severe anxiety was found in all the patients (100%). Depression scores showed a clinically normal level in 45 patients (8.9%), borderline level in 289 patients (57.1%), and severe level in 172 patients (34%). The mean HADS score was 11.4+/-2.9, being 12.2+/-4.1 and 10.6+/-4.1 for anxiety and depression, respectively. Among patient characteristics, age was significantly associated with both anxiety and depression subscales (p<0.001), and education level (p<0.05), total family income (p<0.01), health insurance (p<0.05), and the number of myocardial infarctions (p<0.05) were significantly associated with the depression subscale. In regression analysis, age (beta=-0.128), education level (beta=0.082), and working status (beta=-0.79) independently affected both anxiety and depression, and total family income (beta=-0.128) and health insurance (beta=-0.086) significantly affected depression. CONCLUSION: Our data suggest that planning nursing interventions to decrease anxiety and depression levels and implementation of cardiac rehabilitation programs are of particular importance in patients with MI.

Health promotion lifestyle and cancer screening behavior: a survey among academician women.

Breast self examination (BSE), screening mammography and Pap smear screening can significantly reduce mortality from breast and cervical cancer. In an effort to understand the factors that influence BSE, mammography, and Pap smear behavior of woman academicians, we here explored the relation between health promotion life-style and women's cancer screening practice. A total of 750 woman academicians working in a university were enrolled, 350 of them responding to the survey. The study instruments used were the Health Promotion Life-Style Profile (HPLP) scale and a questionnaire of demographic data. There was a significant relationship between age-group, marital status, presence of cancer in the family, history of cervical erosion and doing BSE, having mammography and a Pap smear. Additionally, both the general mean and nearly all domains of HPLP were significantly related to BSE, mammography, and Pap smear behavior. This study demonstrated strong relationships between breast and cervical cancer screening behavior and health promoting lifestyle in this subgroup of women, making an important contribution to understanding the factors influencing women's health behavior.

Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients.

BACKGROUND: Exercise-based cardiac rehabilitation improves exercise capacity and reduces cardiac risk factors. The purpose of this pilot study was to examine the effects of a home-based cardiac exercise program (HBCEP) on exercise tolerance, serum lipids, and self-efficacy in coronary heart disease patients in Turkey. Self-efficacy theory provided the framework for this study's intervention. DESIGN: The study design was a pre-test and post-test experimental, randomized assignment. METHOD: The study included 30 participants in a home-based cardiac exercise program (HBCEP; mean age=54.7+/-7.8) and 30 in control (C; mean age=52.7+/-6.5). The Phase II cardiac exercise program included three 45-60-min sessions per week for 12 weeks, and the enhancement of self-efficacy through educational sessions and the use of goal setting, modelling, and physiological feedback strategies. Both groups were comparable in their medical regimen, exercise capacity, and other measured variables pre-intervention. At baseline and after 12 weeks, exercise capacity was evaluated by exercise testing using the Bruce Protocol, self-efficacy was measured with the Cardiac Exercise Self Efficacy Index, and serum lipid values were measured. RESULTS: At the completion of the 12-week exercise program, the exercise capacity (P<0.001), total cholesterol (P=0.004), triglycerides (P=0.048), high-density lipoprotein-cholesterol (P=0.001), low-density lipoprotein-cholesterol (P=0.039), and self-efficacy (P<0.001) of the HBCEP Group were significantly improved compared to the control group. CONCLUSION: These results suggest that a first-time HBCEP in Turkey can be successful in having patients adhere to a prescribed exercise program and reduce risk factors. Enhanced self-efficacy may have mediated the improved behavioural outcomes.

Evaluation of the shortened Cholesterol-Lowering Diet Self-Efficacy Scale.

Specificity in the self-efficacy construct requires that instruments assess domain-specific behaviors. The objectives of the study were to (1) reexamine and shorten the original 57-item Cholesterol-Lowering Diet Self-Efficacy Scale (CLDSES), (2) estimate reliability and validity of the short form CLDSES (CLDSES-SF), (3) examine the dimensionality of the CLDSES-SF, (4) examine discriminant validity of the scale by its ability to differentiate between adherence and nonadherence to saturated fat intake guidelines, and (5) examine the CLDSES-SF's sensitivity and specificity. A sample of 238 patients being treated for hypercholesterolemia completed three instruments: the CLDSES, the Connor Diet Habit Survey (DHS) and a Three-Day Food Record. Internal consistency for the CLDSES-SF was .95. The inter-correlation coefficients among the seven sub-scales ranged from .28 to .62, and for the total to sub-scales .58 - .87, significant at p < .001. Evidence for criterion validity was shown in the correlations between the CLDSES-SF and the Connor DHS scores and between the CLDSES-SF and the Three-Day Food Record. Factor analysis showed a one-factor model that fits the data with a sufficient amount of total variance explained among the seven subscale items in each subscale, providing evidence of the uni-dimensionality of each subscale. Sensitivity (76%) and specificity (63%) for the CLDSES-SF were good with 88% positive predictive value for adherence. The shortened CLDSES retained its good psychometric properties and remains comprehensive in its assessment of self-efficacy for adherence to a cholesterol-lowering diet.