Remediation in clinical practice for student nurses - A scoping review

BACKGROUND

Clinical practice provides an opportunity for undergraduate nursing students to develop the professional attitudes, knowledge and skills required for the delivery of safe competent care. Some students, however, are challenged to consolidate learning in clinical practice and are therefore at risk of failing courses or programmes. Supporting these students requires remediation strategies specific to clinical practice. This is challenging, however, as remediation approaches frequently centre on supporting students in theoretical components of courses/programmes, rather than clinical practice.

OBJECTIVES

A scoping review was conducted to explore and summarise literature in undergraduate nurse education related to remediation support for clinical practice.

METHODS

The research question was developed using the Population/Concept/Context model. Following the identification of keywords, five databases (CINHAL Plus, MEDLINE, ProQuest, Scopus and Informit) were searched. Abstracts and full-text articles were independently screened by two authors. Data from included studies was extracted and then thematically analysed.

RESULTS

Twenty papers met inclusion/exclusion criteria (five literature reviews, one concept analysis, six commentary papers and eight original research studies). Research studies used qualitative, quantitative, or mixed methods research designs. Populations included nurse academics, mentors/preceptors, health professional students (including nursing students) and nursing students exclusively. Three themes were identified: pre-placement remediation strategies; on-placement remediation strategies and post-placement remediation strategies. All authors highlighted the importance of remediation for at-risk students in clinical practice.

CONCLUSIONS

This review identified several remediation strategies that may support undergraduate nursing students in clinical practice. Few, however, were well-defined or rigorously evaluated, highlighting the need for additional research on nursing student remediation in clinical practice. A partnership-based approach to remediation that engages students, educators, and healthcare providers and is underpinned by clear processes may be of further benefit to nursing students in clinical practice.

Characteristics and outcomes of emergency department presentations brought in by police with and without an emergency examination authority: A state-wide cohort study

BACKGROUND

The aim of this study was to describe and compare the demographic characteristics, clinical characteristics and patient and health service outcomes of emergency department (ED) presentations brought in by police with and without an emergency examination authority.

METHODS

A retrospective cohort study of adult (≥ 18 years old) presentations brought in by police to EDs in Queensland, Australia from 01 January 2018 to 31 December 2020. Routinely collected ED data were used to describe and compare the demographic characteristics, clinical characteristics, and outcomes of people brought in by police with and without an emergency examination authority.

RESULTS

A total of 42 502 adult ED presentations were brought in by police over the three-year period, of which 22 981 (44.7%) had an emergency examination authority. Compared with presentations brought in by police without an emergency examination authority, those brought in by police with an emergency examination authority had a higher proportion of presentations for mental health problems, were from major cities, and were allocated more urgent Australasian Triage Scale categories. Presentations brought in by police with an emergency examination authority were less likely to be seen within their Australasian Triage Scale timeframe and experienced a longer length of stay than those brought in by police without an emergency examination authority whether admitted (217 mins vs. 186 mins, p < 0.001) or discharged (212 mins vs. 97 mins, p < 0.001).

CONCLUSIONS

The characteristics and outcomes of people brought in by police with emergency examination authorities differed to those brought in by police without emergency examination authorities. Further research is required to enhance understanding of this relatively unexplored group of people and foster interagency collaborations.

People brought to the emergency department under involuntary assessment orders: A scoping review

BACKGROUND

Some people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs.

METHOD

A scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O'Malley framework.

RESULTS

In total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of staylonger than four hours.

CONCLUSION

This review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population.

Effect of jumping style on the performance of large and medium elite agility dogs

Dog agility is a rapidly progressing sport worldwide. Consequentially, research and methods to improve technique and performance are becoming highly sought after. Video data were collected of elite agility dogs during a training session, with downstream analysis examining differences in apparent topline angle and jumping speed of large and medium dogs as well as collie breeds and non-collie breeds. The study further examined any correlations between topline angle and jumping speed. Findings suggest that there is a difference between the jump kinematics of large and medium dogs (P=0.001) and between collie breeds and non-collie breeds (P<0.001) with collie breeds jumping faster than non-collie breeds (P=0.013). This information could be used to inform future training regimes and competitive strategies in a breed and size specific way, with the aim to improve long-term health and welfare of canine participants, whilst also ensuring that training and competitive expectations are within biological capabilities.

Self-responsibility and coping with pain: disparate attitudes toward psychosocial issues in recovery from work place injury

PURPOSE

To compare injured worker and health professional ratings of psychosocial variables as they relate to recovery.

METHOD

Seventy patients and 70 health care staff at an injured worker rehabilitation centre completed a 17-item checklist. Each subject selected five psychosocial variables believed to be most important to recovery. Group ratings were compared using chi-square with a Bonferroni adjustment.

RESULTS

In general, patients and health professionals agreed on the relative importance of 15 of 17 variables. However, the groups did differ significantly on two items--staff rated 'self-responsibility' higher than patients, while patients rated 'coping with pain' higher than staff.

CONCLUSIONS

The ratings reflect the occasionally divergent goals and expectations of the rehabilitation staff and patient groups. Consequently, some patients may be moved into inappropriate treatment modalities, resulting in non-compliance. Being aware of patient beliefs and expectations should assist health care professionals in generating improved rehabilitation outcomes by promoting better co-operation through shared perceptions and goals.

Hemispheric asymmetry in depression and mania. A longitudinal QEEG study in bipolar disorder

BACKGROUND

previous research has been inconclusive about the nature of hemispheric asymmetry in emotional processing.

METHOD

13 patients with DSM-IV bipolar disorder received repeated QEEGs over 2 years in different mood states. Z-score measures of asymmetry were assessed.

RESULTS

asymmetry in frontotemporal slow-wave activity appeared to be in opposite directions in depression compared to mania/hypomania.

CONCLUSIONS

mood change in bipolar disorder is associated with change in QEEG asymmetry.

LIMITATIONS

study of larger numbers of more homogenous patients under similar conditions is needed.

CLINICAL RELEVANCE

study of mood state-dependent asymmetry changes in bipolar disorder may lead to better understanding of hemispheric processing of emotion.

Can non-prosecutory enforcement of public health legislation reduce smoking among high school students?

BACKGROUND

Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents' access. METHODS/STRATEGY: A prospective study evaluating the impact of non-prosecutory enforcement of public health legislation involving 'beat police' was conducted in the Northern Sydney Health region. Secondary students, aged 12 to 17 years, from both intervention and control regions were surveyed about cigarette smoking habits by means of a self-completed questionnaire administered pre- and post-intervention.

RESULTS

12,502 anonymous questionnaires were completed. At baseline, 19.3% of male students and 21.2% of female students indicated they were current smokers. Age and sex stratified chi-squared analysis revealed significantly lower post-intervention smoking prevalence for year 8 and 10 females and year 7 males among the intervention group. Higher post-intervention smoking prevalences were demonstrated for year 7 and 9 females and year 8 males among the intervention group and in year 10 males and year 11 females among the control group. The analysis of combined baseline and follow-up data from coeducational schools with logistic regression techniques demonstrated that the intervention had a significant effect in reducing smoking prevalence among year 7 students only (OR = 0.54).

CONCLUSION

Our study demonstrates the difficulties in restricting high school students' access to cigarettes. Isolated non-prosecutory strategies are likely to only have a limited impact on reducing smoking prevalence among high school students.

Monitoring anticoagulant control in general practice: comparison of management in areas with and without access to hospital anticoagulant

BACKGROUND

Hospital anticoagulant clinics are available only in some areas. There is little information on the contribution of general practitioners to oral anticoagulant monitoring, and whether their management varies with access to hospital clinics.

AIM

A study was undertaken to compare general practice management of anticoagulant therapy in two health boards with contrasting access to hospital clinics.

METHOD

A postal questionnaire was sent to the senior partners in all 198 practices in Lothian and Fife, Scotland.

RESULTS

Lack of access to hospital clinics in Lothian health board resulted in more practices reporting taking sole responsibility for anticoagulant control than in Fife where there was access (P < 0.001). However, there was no significant difference in management policies. Overall, 93% of practices used a protocol for thrombotest target ranges, but 75% had no policy on review frequency and only 2% assessed complication or failure rates. Reduced access to hospital clinics was associated with a decreased likelihood of favouring hospital involvement. Sole responsibility for anticoagulant management was undertaken by 56% of general practices, although only 21% of doctors viewed this as ideal. Most general practitioners felt that they should monitor patients on anticoagulant therapy but should refer to hospital those with problematic control.

CONCLUSION

Access to hospital clinics affected the degree of involvement of general practitioners in oral anticoagulant monitoring, but did not considerably alter their management practice.

Comparison of anticoagulant control among patients attending general practice and a hospital anticoagulant clinic

Management of patients receiving oral anticoagulant therapy was assessed in general practice and a dedicated hospital anticoagulant clinic. The demographic characteristics of patients in both groups were similar, as were the indications for anticoagulation therapy and the duration of treatment. General practice patients were reviewed significantly more frequently, with a median interval of 16 days compared with 42 days for hospital patients (P < 0.001). Twenty four per cent of general practice visits and 26% of hospital attendances resulted in an alteration to the warfarin dosage. Overall, 52% of general practice thrombotest results lay within the ranges recommended by the British Society for Haematology, compared with 45% of hospital results (P < 0.001). There was no difference in the rate of complications in general practice and the hospital clinic. In this study, the anticoagulant control achieved in a general practice setting was superior to that in a dedicated hospital outpatient clinic, although control was far from ideal in either setting.

Courtship Feeding and Mate Choice in Thynnine Wasps (Hymenoptera, Tiphiidae)

Females of two species of thynnine wasps, Megalothynnus klugii and Macrothynnus sp., attract mates while perched upright on vegetation close to the ground. When given an experimental choice between two females of different sizes, males of M. klugii carry off and copulate with the larger female significantly more often than they do the smaller one. No such preference was exhibited by males of Macrothynnus sp. Females of both species resist being removed from their calling perches and large males succeed more often than small ones in carrying away very large females. Despite mechanisms allowing a preference for large partners by both males and females in M. klugii, there is no evidence, in nature, of positive assortative mating according to body weight in this species. Various conditions, especially a scarcity of fertilisable females, may severely limit the choice of mates by males of these wasps.