Navigating COVID-19 Educational Challenges: Transitioning an In-Person Mentoring Program to a Virtual Learning Environment

Nursing professional development practitioners and leadership staff implemented a second Transitional Mentor Education Program. The pilot program was classroom based; however, with pandemic restrictions, a shift to deliver a hybrid mentoring program was needed. Learning needs, clinician well-being, and professional development were addressed. Regardless of the method of educational delivery, the nurses in Phase 2 achieved the same outcomes as the pilot program, including increased clinical confidence, communication, integration of stress reduction strategies, and reflective practice.

Interprofessional Use and Validation of the AACN Healthy Work Environment Assessment Tool

BACKGROUND

Health care work environments affect patient outcomes, staff satisfaction and retention, and organizational financial viability. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool (HWEAT) is a resource for patient care units and organizations to assess the work environment and track progress on their journey to excellence.

OBJECTIVE

To validate interprofessional use of the AACN HWEAT across a large free-standing children's hospital.

METHODS

The AACN HWEAT was administered to staff members across professional categories. Responses were averaged to achieve an overall score and a score for each standard included in the instrument. Nurses' and physicians' scores were further stratified. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating the AACN HWEAT and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (H-SOPS).

RESULTS

Of 2621 AACN HWEAT surveys, 1030 (39.3%) were returned for review. The organization-wide HWEAT mean overall score was 3.58 (3.87 for physicians vs 3.54 for nurses, P= .02). Test-retest reliability was indicated by Spearman correlation coefficients of 0.50 to 0.68. Internal consistency was shown by a Cronbach α of 0.77 overall (range for standards, 0.77-0.81). Convergent validity between AACN HWEAT standards and AHRQ H-SOPS items was shown by correlation coefficients of 0.30 to 0.52.

CONCLUSION

The AACN HWEAT was both reliable and valid, supporting its interprofessional use as an organizational measure. Active evaluation of health care environments is critical to achieving optimal patient outcomes.

Family Perspectives on Whiteboard Use and Recommendations for Improved Practices

OBJECTIVES

To explore pediatric family perspectives and preferences regarding whiteboard use, as well as recommendations for using whiteboards as tools for patient-centered communication and care.

METHODS

Semi-structured interviews were conducted with 29 families in a pediatric urban academic hospital inpatient surgical service, exploring whiteboard experiences and suggestions. Parent responses were manually recorded during interviews. Quantitative data were analyzed by using descriptive statistics.

RESULTS

Of all families, 66% reported using the whiteboard, and 52% were informed about it by staff. Among users, parents who were informed of the whiteboard used it actively (writing to share information) 6 times more often than those who used it passively (as a visual reference). Pictorial whiteboard analysis found that 42% of whiteboards had parent writing. Of these, 80% had contact information alone. Among reasons for whiteboard nonuse, 58% were modifiable, including not knowing about it, assuming it was intended for staff, believing no one would read it, or physical inaccessibility. Parents overwhelmingly identified nurses as whiteboard users (81%) compared with physicians (who families did not identify as users). The majority (76%) of families offered recommendations to improve whiteboard effectiveness.

CONCLUSIONS

Of all families, approximately one-half were not informed about whiteboards and one-third did not use them. Reasons for nonuse were largely modifiable. Parents made aware of their whiteboard by their care teams demonstrated increased likelihood of active whiteboard use, highlighting the importance of education and suggesting a gap in harnessing the full potential of whiteboards as communication tools. Families' recommendations can help inform whiteboard practices to strengthen communication and care.

Palliative and end-of-life care in pediatric solid organ transplantation

End-of-life care is a component of palliative care and takes a holistic, individualized approach to patients, focusing on the assessment of quality of life and its maintenance until the end of life, and beyond, for the patient's family. Transplant teams do not always make timely referrals to palliative care teams due to various clinician and perceived family barriers, an important one being the simultaneous, active care plan each patient would have alongside an end-of-life plan. Application of findings and further research specific to the pediatric solid organ population would be of significant benefit to guide transplant teams as to the most effective time to introduce end-of-life care, who to involve in ongoing discussions, and important ethical and cultural considerations to include in care planning. Attention must also be paid to clinician training and support in this challenging area of health care.

Lapatinib and trastuzumab in combination with an aromatase inhibitor for the first-line treatment of metastatic hormone receptor-positive breast cancer which over-expresses human epidermal growth factor 2 (HER2): a systematic review and economic analysis

BACKGROUND

Breast cancer is the uncontrolled, abnormal growth of malignant breast tissue affecting predominantly women. Metastatic breast cancer (mBC) is an advanced stage of the disease when the disease has spread beyond the original organ. Hormone receptor status and human epidermal growth factor 2 (HER2) status are two predictive factors that are taken into consideration when estimating the prognosis of patients with breast cancer.

OBJECTIVES

To review the clinical effectiveness and cost-effectiveness evidence base for lapatinib (LAP) in combination with an aromatase inhibitor (AI) and trastuzumab (TRA) in combination with an AI for the first-line treatment of patients who have hormone receptor-positive (HR+)/human epidermal growth factor 2-positive (HER2+) mBC.

DATA SOURCES

Relevant electronic databases and websites, including MEDLINE, EMBASE and the Cochrane Library, were searched until May 2010. Further data were derived from the manufacturers' submissions for LAP + AI and TRA + AI.

REVIEW METHODS

A systematic review of the clinical effectiveness and cost-effectiveness of LAP + AI and TRA + AI was undertaken. As it was deemed inappropriate to compare LAP + AI with TRA + AI, two separate assessments of cost-effectiveness versus AIs alone were undertaken.

RESULTS

Three trials were included in the systematic review [the patient populations of the efficacy and safety of lapatinib combined with letrozole (EGF30008) trial, the efficacy and safety of trastuzumab combined with anastrozole (TAnDEM) trial and the efficacy and safety of letrozole combined with trastuzumab (eLEcTRA) trial]. As a result of differences in the exclusion criteria and because one trial was halted prematurely, comparisons across trials were believed to be inappropriate and meta-analysis was not possible. Individually, however, the findings from the trials all suggest that LAP + AI or TRA + AI results in improved progression-free survival and/or time to progression when compared with AIs alone. The trials do not show a statistically significant benefit in terms of overall survival. Two separate economic analyses were conducted based on the completed trials; neither LAP + AI nor TRA + AI was found to be cost-effective when compared with AI monotherapy.

LIMITATIONS

Because of differences in the EGF30008 and the TAnDEM trials, the Assessment Group believes the indirect comparisons analyses conducted by the manufacturers are inappropriate and, for the same reason, chooses not to compare LAP + AI with TRA + AI in an economic evaluation.

CONCLUSIONS

LAP + AI and TRA + AI appear to be clinically more effective than AI monotherapy, but neither is cost-effective compared with AIs alone. It was not possible to compare LAP + AI with TRA + AI. Future research should include research into treating mBC in the HR+/HER2+ population who are not TRA (or LAP) naive and into comparing the clinical effectiveness of AIs as monotherapy in patients with HER2+ and human epidermal growth factor 2-negative breast cancer.

FUNDING

The National Institute for Health Research Technology Assessment programme.