Hospital Based Violence Intervention Programs Using Peer Support Specialists: A Concise Review.

BACKGROUND: Interpersonal violence remains a significant public health problem in the United States. The toll of violence has spurred the development of hospital-based violence intervention programs that use peer support specialists or navigators. Yet, their effectiveness remains uncertain. This study aims to concisely review the recent literature on the effectiveness of hospital-based violence intervention programs using the peer support specialist role. METHODS: A systematic search of articles from PubMed, OVID, and Google Scholar was performed for this review. Peer reviewed studies addressing hospital-based violence intervention programs using peer support specialists between 2017 and 2022 were selected. Key data points were extracted and analyzed by consensus of the authors. RESULTS: Eight of the 232 studies reviewed met eligibility requirements. Across these studies, the recidivism rate was reduced between 43% and 95% in victims participating in hospital-based violence intervention programs with peer support specialists. CONCLUSION: The peer support specialist (navigator) role is central to the success of the violence intervention programs. This role guides and coordinates health services for victims of violence, extending after discharge into the community. Programs showed the most success with helping victims reach short-term goals focused on immediate basic needs but are more challenged meeting longer-term goals, such as education or relocation. This review reveals that hospital-based violence intervention programs using peer support specialists (navigators) lead to the achievement of meeting victim goals and reduce recidivism rates.

An Educational Module to Teach Interprofessional Learner Feedback Skills for Trauma Simulation Events.

BACKGROUND: Peer feedback, or feedback given by a learner to another learner, is an important active learning strategy. Hierarchy and stereotypes may affect interprofessional (IP) learner-to-learner feedback. The aim was to assess the efficacy of an educational module for IP learners in delivering effective feedback during trauma simulations. METHODS: Multiple simulation events designed to improve teamwork and leadership skills during trauma simulations included IP learners (residents and nurses). Participants completed a pre-course educational module on IP peer feedback. The Trauma Team Competence Assessment-24 tool structured feedback. Learners completed pre/post-assessments utilizing IP Collaborative Competencies Attainment Survey (ICCAS). RESULTS: Twenty-five learners participated in the trauma simulations (13 general surgery and 5 emergency residents, 3 medical students, 4 nurses). The majority of learners had either not received any previous training in how to effectively deliver peer feedback (40%) or had engaged in self-directed learning only (24%). Most learners (64%) had delivered peer feedback less than ten times. Learner knowledge and confidence in delivering feedback to fellow IP learners improved after simulations. All learners felt the feedback received was useful to their daily practice (68% agree, 32% strongly agree). All participants agreed that the simulation achieved each of the ICCAS competencies. CONCLUSIONS: Formal education on IP peer feedback is rare. This pilot work demonstrates educational modules with a foundation in validated tools can be effective in improving learner knowledge and confidence in the process. Engaging in IP peer feedback may also serve to flatten hierarchies that can challenge effective interprofessional teamwork.

The community of inquiry framework for virtual team-to-team debriefings during interprofessional trauma simulations.

Purpose: Psychological safety is key to effective debriefing and learning. The COVID-19 pandemic necessitated rapid adaption of simulation events to virtual/hybrid platforms. We sought to determine the effect of utilizing the Community of Inquiry framework (CoI) for debriefing virtually connecting interprofessional learner teams on the psychological safety experienced during trauma simulations. Methods: General surgery (GSR), emergency medicine (EMR) residents, trauma nurses/nurse practitioners and medical students participated in multiple simulation events designed to improve teamwork and leadership skills. Pre-course materials were provided before the event for learners to prepare. Briefings delineating expectations emphasized importance of and strategies employed to achieve psychological safety. Four unique clinical scenarios were run for each simulation event, with a debrief after each scenario. Virtual team-to-team debriefings were structured using the Community of Inquiry (CoI) conceptual framework. All learners completed pre-/post-assessments utilizing Inter-professional Collaborative Competencies Attainment Survey (ICCAS). Results: Twenty-five learners participated (13 GSR, 5 EMR, 3 medical students, 2 trauma APRNs and 2 trauma RNs). Learner assessment found 88% (22) "agreed"/"strongly agreed" that virtual team-to-team debriefing had social, cognitive and educator presence per the CoI domains. However, one GSR and two nurse learners "strongly disagreed" with these statements. Most learners felt the debriefing was effective and safe. All participants "strongly agreed"/"agreed" the simulation achieved ICCAS competencies. Conclusions: Debriefings utilizing a virtual platform are challenging with multiple barriers to ensuring psychological safety and efficacy. By structuring debriefings using the CoI framework we demonstrate they can be effective for most learners. However, educators should recognize the implications of social identity theory, particularly the effects of hierarchy, on comfort level of learners. Developing strategies to optimize virtual simulation learning environments is essential as this valuable pedagogy persists during and beyond the COVID-19 pandemic.

Evaluation of an Education Strategy versus Usual Care to Implement the STEADI Algorithm in Primary Care Clinics in an Academic Medical Center.

BACKGROUND: Although falls are the leading cause of morbidity and mortality in the US in the older adult population, there is little information regarding implementation of evidence-based fall prevention guidelines within primary care settings. The objective of this study was to address this gap in the literature by determining the effectiveness of the use of education and written materials as implementation strategies. METHODS: Using a prospective, mixed methods, controlled before-and-after study design, we studied the effect of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) education and written materials on knowledge and intention to use in primary care clinics as well as test the screening, assessment, and intervention behaviors. This manuscript details the quantitative findings of the study, using STEADI Knowledge Test, Continuing Professional Development (CPD) Reaction Questionnaire, and EMR Reports. We compared data between the study arms (usual implementation versus education implementation) using descriptive statistics, paired t-tests, and factorial ANOVAs. RESULTS: In total, data from 29 primary care staff, including physicians, APRNs, RNs, and medical assistants, were analyzed. Although we found a statistically significant difference within the education arm between immediate pretests and posttests/surveys mean scores, there was no statistically significant difference between the study arms' knowledge, intent to use STEADI, or use behaviors. The pre/immediate post education mean knowledge score increased by 1.19 (p= 0.02) and the pre/immediate post education intent to use mean increased by 0.64 (p 0.01). There was no statistically significant change between the study arms over time. CONCLUSION: Educational strategies, particularly written materials and an online module, did not increase the long-term use of the STEADI toolkit. Implementation research is needed to identify the strategies that are most effective for promoting the adoption of STEADI in primary care.

Plagued by Politics: Cuba's National Sanatorium Project, 1936-59.

In 1936, Fulgencio Batista, the head of the Cuban military (and the de facto ruler of Cuba), founded the National Tuberculosis Council (CNT) to lead a state-directed anti-tuberculosis campaign. While most national and colonial governments neglected tuberculosis until the postwar period, populist politics pushed Batista to prioritize a disease of poverty by the mid-1930s. However, national politics also undermined efforts to control the disease in Cuba. Authoritarianism facilitated Batista's considerable influence over tuberculosis policy, and he and his advisors pursued political objectives rather than following the technical advice offered by professional groups. As a result, the administration of the campaign was inefficient, nowhere more notably than in the CNT's premiere project, the Topes de Collantes National Sanatorium. Citizen and physician discontent with this project, the anti-tuberculosis campaign, and the state health sector fed into processes of political delegitimation and regime change in the 1950s.