Students' perceptions on their use of an EHR: pilot questionnaire study.

INTRODUCTION: Many clinical education programmes have not incorporated the use of the electronic health record (EHR) into their curriculum. It is important to incorporate technologies that will be used in real-world settings to better prepare students for clinical practice. OBJECTIVES: To undertake a review of literature to identify a training evaluation framework; to conduct a self-completion survey, pretraining and post-training, to determine students' perceptions on the benefit of using EHR training system. SETTING: Nursing School, University, North West England, UK; University Ethic Committee Approval Received. PARTICIPANTS: Registered nurses undertaking a validated return to practice course; 24 participants for the first cohort who completed pretraining questionnaire and 23 for the second post-training cohort. RESULTS: The statistical results show that the students perceived that the training improved their capability in employing digital systems with statistically significant difference in the assessed preproficiency and post proficiency in the use of digital clinical systems (premedians and post medians are 2 and 5 on 10-point Likert scale, p=0.041). There was also an indication of an improvement in the knowledge of EHR systems although not statistically significant. Most students perceived it increased their knowledge on digital systems. CONCLUSION: Students perceived an increase in proficiency with the EHR. There was evidence of improvement in confidence in the use of the EHR, but this confidence would be enhanced by additional use of the system. Some desire to increase confidence further and to develop knowledge of digital systems was expressed.

Carga de trabalho de enfermagem na consulta à pessoa com diabetes mellitus: estudo preliminar / Workload in the nursing consultationto the person with diabetes mellitus: preliminary study

Introduction and objectives: Evaluating the activities developed in the consultation and determining the associated workload becomes relevant insofar as it influences safety and the quality of care. The purpose of this study was to identify the assistance and non-assistance activities carried out within the scope of the consultation; determine the execution time of the performed activities and set the average time of the consultation. Methodology: An exploratory descrip-tive study of quantitative nature was carried out. 16 primary health care nurses of 3 health units participated in the study. The instrument evaluates three dimensions: sociodemographic characterization of the clients, nursing and non-care nursing activity that integrates the previously defined categories and actions and socio-professional characterization of the nurse. The study was carried out between February and May 2018. Data was processed using SPSS25(R). Results and discussion: 103 nursing consultations were performed. It was identified that the most accompli-shed assistance activities belonged to the evaluation and health education categories. The documented non-care activities were the reception of the patient; infection control procedures and documentation of the provided care. The mean time of consultation was 24 minutes, the maximum time was 76,6 m and the minimum time was 7, 91 m. Conclusion: Identifying what activities were carried out and determining the associated workload allows us to know what work is being done and its implications in the provided care

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Newly Qualified Nurses' Perception of Their Competency Achievement on Leaving University: A Qualitative Study.

Background: After implementing the Tuning Educational Structures in Europe Project, numerous efforts have been made to define, establish, and evaluate nursing competences. The European Federation of Nurses Association played a key role in enacting the nursing competences included in Directive 2013/55/EU. Nevertheless, assessing competences remains elusive, and there is little research into nurses' perceptions of the competency training provided by their universities. The purpose of the study was to explore the perceptions and experiences of newly qualified nurses about the competences they acquired during their university education. Methods: A qualitative research study was developed in a Spanish university. Twelve semi-structured interviews with newly qualified nurses were conducted, and two focus groups made up of twelve students were carried out in order to triangulate the results. Participants were recruited through email contact. Interviews focused on clinical training, theoretical content, and the reality of healthcare. Data was analyzed thematically. Results: Two main themes emerged: (1) improving theoretical content and (2) rethinking practical lessons and clinical training. A lack of knowledge about mental health, pharmacology, or critical care has been found; in addition, it was highlighted, among others, the need to improve communication skills in difficult and conflictive situations. Conclusions: Considering the participants' perception of deficiency in some aspects of most of the competences established by the European Federation of Nurses Association, further research has been suggested to include other stakeholders' views.

Effect of a Nurse-Managed Telemetry Discontinuation Protocol on Monitoring Duration, Alarm Frequency, and Adverse Patient Events.

Telemetry monitoring is a limited resource. This quality improvement project describes a nurse-managed telemetry discontinuation protocol aimed at stopping telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared with a preintervention time frame. There was a mean decrease in telemetry monitor usage and a decreased likelihood of remaining on a telemetry monitor until discharge. A nurse-managed telemetry discontinuation protocol was effective in decreasing overmonitoring and ensuring telemetry availability.

[How to quantify the qualitative aspects of nursing outcomes classification scales with psychosociocultural indicators]. / Cómo cuantificar los aspectos cualitativos en escalas de clasificación de resultados NOC para etiquetas psico-socioculturales.

Working necessarily with Likert scales to measure Nursing Outcomes Classification (NOC) outcomes has the advantage of unification, but also presents difficulty in reducing the rating from 1 to 5, especially when the research is qualitative and thus includes the use of words and expressions, as well as observations and perceptions. What exactly does a score of 2 or 3 mean with regard to the NOC Health beliefs? In this paper, we make a number of different proposals for operationalizing concepts and transforming them to numbers; however, it should be noted that such proposals always end in a quantitative analysis. Thus, we propose the use of emic/etic qualitative observations for psychosocial and cultural indicators, following ethnographic principles. Basic and applied research on nursing languages must have correct methodological foundations and seek to satisfy the same criteria of methodological suitability as any other research.

Effectiveness of a computer based medication calculation education and testing programme for nurses.

The aim of the study was to evaluate the effect of an on-line, medication calculation education and testing programme. The outcome measures were medication calculation proficiency and self efficacy. This quasi-experimental study involved the administration of questionnaires before and after nurses completed annual medication calculation testing. The study was conducted in two hospitals in south-east Queensland, Australia, which provide a variety of clinical services including obstetrics, paediatrics, ambulatory, mental health, acute and critical care and community services. Participants were registered nurses (RNs) and enrolled nurses with a medication endorsement (EN(Med)) working as clinicians (n=107). Data pertaining to success rate, number of test attempts, self-efficacy, medication calculation error rates and nurses' satisfaction with the programme were collected. Medication calculation scores at first test attempt showed improvement following one year of access to the programme. Two of the self-efficacy subscales improved over time and nurses reported satisfaction with the online programme. Results of this study may facilitate the continuation and expansion of medication calculation and administration education to improve nursing knowledge, inform practise and directly improve patient safety.

Persistence, how do they do it? A case study of Access to Higher Education learners on a U.K. Diploma/BSc nursing programme.

In 2006, the United Kingdom (U.K.) Department of Health (DoH) produced guidelines, requiring institutions to address the attrition rates for student nurses and midwives. This issue is not only a concern in the U.K. but has gained prominence in other Schools of Nursing including the U.S.A., Australia, and developing countries. Many Schools of Nursing have witnessed a change in their student population with a growing prominence of mature entrants (those over 21). Studies that focus on learner persistence, in particular mature students are relatively rare and very scarce on entrants with an Access to Higher Education (HE) qualification. This study, using focus group interviews, involved Access to HE learners who successfully progressed to a Diploma of Higher Education (DipHE)/Bachelor of Science (BSc) in Nursing at one U.K. University. The study findings indicated that Access to HE learners are able to develop a range of coping strategies in relation to academic demands and caring responsibilities, which are drawn upon in their DipHE/BSc programme. The findings have relevance for all Schools of Nursing as we face new and difficult challenges not least the global shortage of qualified nurses and the pressures placed on educators to retain student nurses.

Return on investment imperative: the cost of care calculator for an evidence-based practice program.

The key elements of the evaluation process of an evidence-based practice (EBP) program and the infrastructure needed as identified by a large health care organization. The EBP evaluation program has 2 major elements for measuring success. The first component for evaluation is the impact on the clinical outcomes of care and the second is the fiscal implications of implementing the EBP. This article focuses on the fiscal evaluation component and describes a process to calculate the cost of care compared to before and after implementation of the EBP. The literature to support the care calculations is examined and a cost algorithm is described.

Evaluation through research of a three-track career ladder program for registered nurses.

A descriptive study design was employed to survey registered nurse participants in a career ladder program comprising of three tracks: clinical, education, and management. Findings indicate that participation allows nurses of varying education preparation and roles to demonstrate professional development. Implications for staff development include efficacy of the online survey technique, provision of a reliable tool to evaluate a career ladder, and evaluation of a career ladder that includes the staff development educator.

The Brøset Violence Checklist: clinical utility in a secure psychiatric intensive care setting.

Violence towards health-care workers, especially in areas such as mental health/psychiatry, has become increasingly common, with nursing staff suggesting that a fear of violence from their patients may affect the quality of care they provide. Structured clinical tools have the potential to assist health-care providers in identifying patients who have the potential to become violent or aggressive. The Brøset Violence Checklist (BVC), a six-item instrument that uses the presence or absence of three patient characteristics and three patient behaviours to predict the potential for violence within a subsequent 24-h period, was trialled for 3 months on an 11-bed secure psychiatric intensive care unit. Despite the belief on the part of some nurses that decisions related to risk for violence and aggression rely heavily on intuition, there was widespread acceptance of the tool. During the trial, use of seclusion decreased suggesting that staff were able to intervene before seclusion was necessary. The tool has since been implemented as a routine part of patient care on two units in a 92-bed psychiatric centre. Five-year follow-up data and implications for practice are presented.

Pediatric nurse practitioners in the United States: current distribution and recent trends in training.

OBJECTIVE: To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). STUDY DESIGN: Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. RESULTS: PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. CONCLUSION: Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.

Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system.

A non-experimental longitudinal prospective study was conducted to examine the relationships between patient-centered nursing interventions (PCNIs), system characteristics, patient characteristics, and desired health outcomes (DHOs) for 173 hematology-oncology patients. Forty-nine nurse participants provided system characteristics data. Confirmatory factor analyses yielded parsimonious scales to operationalize the variables. In the path model, one PCNI-individualization-was positively related to three subsequent DHOs: authentic self-representation, optimism, and sense of well-being. Two additional PCNIs-responsiveness and proficiency-were positively related to subsequent trust in nurses. PCNIs did not vary with patient race, ethnicity, age, gender, or educational level. Patient-centeredness of care for cancer patients may be enhanced by quality improvement activities that measure and monitor these PCNIs and resultant outcomes.

[Some critical remarks on standardised assessment instruments in nursing]. / Einige kritische Anmerkungen zu standardisierten Assessmentinstrumenten in der Pflege.

The use of standardised instruments in nursing has rapidly grown and can be seen as a symptom of the necessary comprehensive nursing diagnostics. However, these instruments comprise the risk of misuse, if they are not critically evaluated. Published statements about tests of reliability and validity of an instrument are insufficient. First, the critical evaluation has to ask for the instrument's theoretical and content base: Is the instrument relevant for nursing, suitable for practice and leading to nursing actions? Two examples of well known instruments and different kinds of their utilization in nursing are discussed. Next, the instruments have to be questioned as "bodies with numbers". Studies on reliability and validity have to be as carefully evaluated as other empirical research. The sample, the suitability of agreement indicators (interraterreliability), kind and reason of tests have to be questioned. The same has to be done with tests of validity which comprise an even greater challenge. Methodological studies about these questions are missing; guidelines for test user qualifications need to be developed.

An Auckland regional audit of the nurse-led rheumatic fever secondary prophylaxis programme.

BACKGROUND: Rheumatic fever with ensuing rheumatic heart disease is considered to be a preventable chronic disease. AIM: To assess the compliance rates with the rheumatic fever secondary prophylaxis programme established through the Auckland Rheumatic Fever Register and managed by community nursing services in Auckland, New Zealand. METHODS: An audit of the 1998 and 2000 Auckland Rheumatic Fever Register data was undertaken to establish the compliance rates of patients with the rheumatic fever secondary prophylaxis programme. The sample included all patients on the Auckland Rheumatic Fever Register during this time. RESULTS: Results showed compliance rates across the three Auckland DHBs ranging from 79.9% to 100% for individual community nursing offices. CONCLUSION: A community-based nurse-led secondary prophylaxis programme for Rheumatic Fever heart disease is able to deliver excellent patient compliance levels. Secondary prophylaxis is the WHO-recommended cost effective first step to Rheumatic Fever/Rheumatic Heart Disease control. Community health workers have a key role to play in facilitating this compliance.

Currículo por competencias en la Universidad de La Sabana / Competence Curriculum at La Sabana University

La presente investigación tiene como objetivo analizar si el desarrollo de la práctica educativa de los profesores de las asignaturas de Cuidado de Enfermería corresponde a la formación por competencias, con relación a la planeación, ejecución y evaluación de los procesos de enseñanza y aprendizaje. El estudio, de tipo descriptivo cualitativo, se llevó a cabo durante el primer semestre de 2006 en la Facultad de Enfermería de la Universidad de La Sabana. Sus principales hallazgos son: con relación a la programación de las asignaturas se encontró que éstas tienen los elementos básicos de la educación por competencias, contemplando el saber ser, el conocer y el hacer propios de cada asignatura. Sin embargo, dentro de esta programación no se encuentra la metodología que se empleará en las clases. Tampoco hay una relación clara entre las estrategias didácticas, el proceso evaluativo y el logro de las competencias. En el desarrollo de las clases se encontró que los profesores manejan los temas en forma clara y concisa, pero hay diferencias entre el profesor novato, que se centra más en los contenidos, y el experto, que se ocupa de forma más natural por los procesos y por promover el análisis. La metodología más utilizada por los profesores durante las clases consiste en realizar y responder preguntas mientras se expone o se discute determinado tema. Con relación al proceso evaluativo, éste se centra principalmente en los contenidos, excepto en las prácticas donde se valora el saber, el hacer y el ser en forma integral. Falta evidenciar la autoevaluación y la coevaluación en todas las asignaturas, aspectos necesarios dentro de la formación por competencias. La recuperación es una herramienta valiosa que apunta a la educación por competencias, es aplicada en todas las asignaturas y permite valorar en forma individual los logros del alumno al establecer un plan de mejoramiento orientado por el profesor.

Educação em saúde: objeto de estudo em dissertações e teses de enfermeiras no Brasil / Health education: object of study in dissertations and theses by Brazilian nurses / Educación en salud: objeto de estudio en disertaciones y tesis de enfermeras em Brasil

Objetivou-se levantar o quantitativo de dissertações e teses produzidas por enfermeiras sobre educação em saúde, identificando e analisando seus passos metodológicos. Pesquisou-se nos 17 Catálogos de Informações sobre Pesquisas e Pesquisadores do CEPEn/ABEn, publicados de 1979 a 1999. A amostra constituiu-se de 105 dissertações e 15 teses sobre a temática. Destacaram-se como objeto: doenças crônicas, ciclo gravídico-puerperal, educação em saúde, gerenciamento e situação perioperatória. Foram populações: adultos, profissionais de enfermagem, mulheres, crianças e adolescentes. A entrevista foi a técnica mais utilizada. Os autores apontam necessidade de melhoria das práticas educativas e consideraram que educação em saúde motiva mudanças no estilo de vida. Concluiu-se haver necessidade de fortalecerem-se pesquisas sobre o cotidiano da Enfermagem no contexto histórico-social.

This study was aimed at surveying the quantity of dissertations and theses written by nurses on health education, identifying and analyzing their methodological steps. 17 Catalogs of Information about Research and Researchers from CEPEn/ABEn - published from 1979 to 1999 - have been examined. The sample comprises 105 dissertations and 15 theses about the theme. Chronic diseases, pregnancy-puerperal cycle, health education, management and perisurgery situation have stood out as objects of study. The populations were adults, nursing professionals, women, children and adolescents. Interviewing was the most used technique. Authors indicated the need to improve educative practices and considered that health education motivates changes in lifestyle. It was concluded that there is a need to strengthen research into the everyday of Nursing in a historical and social context.

Se ha objetivado conocer el cuantitativo de disertaciones y tesis producidas por enfermeras sobre educación en salud, identificando y analizando sus pasos metodológicos. Se ha investigado en los 17 Catálogos de Informaciones sobre Investigaciones e Investigadores del CEPEn/ABEn, publicados desde 1979 hasta 1999. El cuantitativo se constituyó de 105 disertaciones y 15 tesis sobre la temática. Se destacaron como objeto enfermedades crónicas, ciclo embarazo-puerperal, educación en salud, gerencia y situación perioperatoria. Fueron poblaciones: adultos, profesionales de enfermería, mujeres, niños, y adolescentes. La encuesta fue la técnica más utilizada. Los autores indican la necesidad de mejoras de las prácticas educativas y consideraron que educación en salud motiva cambios en el estilo de vida. Se concluyó que hay necesidad de fortalecer las investigaciones que exploren el cotidiano de la Enfermería en el contexto histórico y social.

[Health education: object of study in dissertations and theses by Brazillian nurses]. / Educação em saúde: objeto de estudo em dissertações e teses de enfermeiras no Brasil.

This study was aimed at surveying the quantity of dissertations and theses written by nurses on health education, identifying and analyzing their methodological steps. 17 Catalogs of Information about Research and Researchers from CEPEn/ABEn--published from 1979 to 1999--have been examined. The sample comprises 105 dissertations and 15 theses about the theme. Chronic diseases, pregnancy-puerperal cycle, health education, management and perisurgery situation have stood out as objects of study. The populations were adults, nursing professionals, women, children and adolescents. Interviewing was the most used technique. Authors indicated the need to improve educative practices and considered that health education motivates changes in lifestyle. It was concluded that there is a need to strengthen research into the everyday of Nursing in a historical and social context.

A profile of perianesthesia nursing patient outcome research, 1994-1999.

The purpose of this research was to profile the current body of perianesthesia nursing research and extend the findings of previous integrative reviews completed on research from 1982 to 1993. The tables of contents from 18 nursing journals were examined and 31 studies met inclusion criteria. Findings indicated that some improvements were made by perianesthesia nurse researchers in using the scientific method. No studies replicated previously published research before 1994. Pediatric and elderly studies were scarce. Free-standing ambulatory surgery continues to be an under-represented research setting.