1
|
Chua WL, Rusli KDB, Aitken LM. Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2005-2018. [PMID: 38379353 DOI: 10.1111/jocn.17061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
AIM The early warning scores (EWS), quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria have been proposed as sepsis screening tools. This review aims to summarise and compare the performance of EWS with the qSOFA and SIRS criteria for predicting sepsis diagnosis and in-hospital mortality in patients with sepsis. DESIGN A systematic review with meta-analysis. REVIEW METHODS Seven databases were searched from January 1, 2016 until March 10, 2022. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, likelihood ratios and diagnostic odd ratios were pooled by using the bivariate random effects model. Overall performance was summarised by using the hierarchical summary receiver-operating characteristics curve. This paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. RESULTS Ten studies involving 52,474 subjects were included in the review. For predicting sepsis diagnosis, the pooled sensitivity of EWS (65%, 95% CI: 55, 75) was similar to SIRS ≥2 (70%, 95% CI: 49, 85) and higher than qSOFA ≥2 (37%, 95% CI: 20, 59). The pooled specificity of EWS (77%, 95% CI: 64, 86) was higher than SIRS ≥2 (62%, 95% CI: 41, 80) but lower than qSOFA ≥2 (94%, 95% CI: 86, 98). Results were similar for the secondary outcome of in-hospital mortality. CONCLUSIONS Although no one scoring system had both high sensitivity and specificity, the EWS had at least equivalent values in most measures of diagnostic accuracy compared with SIRS or qSOFA. IMPLICATIONS FOR THE PROFESSION Healthcare systems in which EWS is already in place should consider whether there is any clinical benefit in adopting qSOFA or SIRS. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review did not directly involve patient or public contribution to the manuscript.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leanne M Aitken
- School of Health & Psychological Sciences, City University of London, London, UK
| |
Collapse
|
2
|
Quek LH, Tan AJQ, Sim MJJ, Ignacio J, Harder N, Lamb A, Chua WL, Lau ST, Liaw SY. Educational escape rooms for healthcare students: A systematic review. Nurse Educ Today 2024; 132:106004. [PMID: 37924674 DOI: 10.1016/j.nedt.2023.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/02/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To synthesize evidence on the implementation and evaluation of educational escape rooms for healthcare students. DESIGN A systematic review. DATA SOURCES A search of seven databases including PubMed, Scopus, Web of Science, Cochrane, EMBASE, CINAHL, and Education Resources Information Center was conducted for published studies from inception to January 2023. The selected articles were assessed by two independent researchers for meeting the inclusion criteria and methodological quality. The data was narratively synthesised. RESULTS Fifty-two studies were included in the review. Escape rooms were employed as learning and assessment strategies for the delivery of diverse topics within dentistry, medical, nursing, pharmacy and physiotherapy pre-registration healthcare education. Most were conducted on nursing students with learning topics focusing on the development of knowledge related to patient care management. Virtual escape rooms became more prevalent following the COVID-19 pandemic. The specific design features of escape rooms were based on the elements of game-based learning including team learning with appropriate size, time limit and sequential path-design of puzzles. Applying the experiential learning approach, the facilitators played a pivotal role in pre-briefing, facilitating the gameplay, and debriefing. Escape rooms were evaluated to be enjoyable and have an impact on students' cognitive, psychomotor, non-technical and affective skills learning outcomes. However, the learning outcomes compared with conventional learning strategies were inconclusive due to lack of randomised controlled trials. CONCLUSION Escape rooms are increasingly being used as experiential and game-based learning in healthcare education. It will continue to evolve with virtual technology advancement and is a promising tool to provide virtual team training within interprofessional education for the development of teamwork and communication skills. While more rigorous research using a randomised controlled trial design is needed to evaluate the effectiveness of escape rooms and their design features, qualitative studies, particularly on the perspective of facilitators are needed to unravel the learning process.
Collapse
Affiliation(s)
- Lin Hui Quek
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Marcia J J Sim
- Nursing Department, Ng Teng Fong General Hospital, Singapore
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Aimee Lamb
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
3
|
Tan AJQ, Chua WL, McKenna L, Tan LLC, Lim YJ, Liaw SY. Interprofessional collaboration in telemedicine for long-term care: An exploratory qualitative study. J Nurs Scholarsh 2023; 55:1227-1237. [PMID: 37482951 DOI: 10.1111/jnu.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/22/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations. AIMS To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations. METHODS A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed. RESULTS Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse-physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians. CONCLUSION Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse-physician collaborative practice. CLINICAL RELEVANCE Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.
Collapse
Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Laurence Lean Chin Tan
- Division of Palliative and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore, Singapore
- GeriCare@North, Yishun Health, Singapore, Singapore
| | - Yu Jun Lim
- GeriCare@North, Yishun Health, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Rusli KDB, Chua WL, Ang WHD, Ang SGM, Lau Y, Liaw SY. A hybrid systematic narrative review of instruments measuring home-based care nurses' competency. J Adv Nurs 2023. [PMID: 37849066 DOI: 10.1111/jan.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/21/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim of the study was to identify and synthesize the contents and the psychometric properties of the existing instruments measuring home-based care (HBC) nurses' competencies. DESIGN A hybrid systematic narrative review was performed. REVIEW METHODS The eligible studies were reviewed to identify the competencies measured by the instruments for HBC nurses. The psychometric properties of instruments in development and psychometric testing design studies were also examined. The methodological quality of the studies was evaluated using the Medical Education Research Study Quality Instrument and COSMIN checklist accordingly. DATA SOURCES Relevant studies were searched on CINAHL, MEDLINE (via PubMed), EMBASE, PsychINFO and Scopus from 2000 to 2022. The search was limited to full-text items in the English language. RESULTS A total of 23 studies reporting 24 instruments were included. 12 instruments were adopted or modified by the studies while the other 12 were developed and psychometrically tested by the studies. None of the instruments encompassed all of the 10 home-based nursing care competencies identified in an earlier study. The two most frequently measured competencies were the management of health conditions, and critical thinking and problem-solving skills, while the two least measured competencies were quality and safety, and technological literacy. The content and structural validity of most instruments were inadequate since the adopted instruments were not initially designed or tested among HBC nurses. CONCLUSION This review provides a consolidation of existing instruments that were used to assess HBC nurses' competencies. The instruments were generally not comprehensive, and the content and structural validity were limited. Nonetheless, the domains, items and approaches to instrument development could be adopted to develop and test a comprehensive competency instrument for home-based nursing care practice in the future. IMPACT This review consolidated instruments used to measure home-based care nurses' competency. The instruments were often designed for ward-based care nurses hence a comprehensive and validated home-based nursing care competency instrument is needed. Nurses, researchers and nursing leaders could consider the competency instruments identified in this review to measure nurses' competencies, while a home-based nursing care competency scale is being developed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required in this review.
Collapse
Affiliation(s)
- Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seng Giap Marcus Ang
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Ying Lau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Chua WL, Wee LPC, Lim JYG, Yeo MLK, Jones D, Tan CK, Khan FA, Liaw SY. Automated rapid response system activation-Impact on nurses' attitudes and perceptions towards recognising and responding to clinical deterioration: Mixed-methods study. J Clin Nurs 2023; 32:6322-6338. [PMID: 37087695 DOI: 10.1111/jocn.16734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/12/2023] [Accepted: 04/05/2023] [Indexed: 04/24/2023]
Abstract
AIM To explore general ward nurses' attitudes and perceptions towards recognising and responding to clinical deterioration in a hospital with automated rapid response system activation. BACKGROUND There is growing interest in deploying automated clinical deterioration notification systems to reduce delayed or failed recognition and response to clinical deterioration of ward patients. However, little is known about its impact on ward nurses' perspectives and work patterns. DESIGN A mixed-methods study. METHODS Online survey of 168 registered nurses and individual interviews with 10 registered nurses in one acute hospital in Singapore. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. RESULTS Many nurses (38.1%) rarely performed patient assessments or observations other than vital signs assessment to assess for early signs of clinical deterioration. About 30% were worried about being criticised for calling the primary team doctors. Four themes emerged from the qualitative analysis: automated rapid response system activation as a safety net, being more cautious with vital signs monitoring, the NEWS2 alone is inadequate, and ward nurses as the 'middleman' between the intensive care unit outreach nurse and primary team doctors. CONCLUSIONS Although nurses value the automated rapid response system activation as a safety net to minimise delays in accessing urgent critical care resources, it does not address the sociocultural barriers inherent in escalation of care. Although the automated system led nurses to be more cautious with vital signs monitoring, it does not encourage them to perform comprehensive patient assessments to detect early signs of deterioration. RELEVANCE TO CLINICAL PRACTICE Nurse education on assessing for clinical deterioration should focus on the use of broader patient assessment skills other than vital signs. Sociocultural barriers to escalation of care remain a key issue that needs to be addressed by hospital management. NO PATIENT OR PUBLIC CONTRIBUTION No patients, service users, care-givers or members of the public were involved in the study.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li-Phing Clarice Wee
- Department of Nursing Administration, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Jia Ying Germaine Lim
- Department of Nursing, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Min Li Kimberly Yeo
- Department of Nursing, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Daryl Jones
- Intensive Care Unit, Austin Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Chee Keat Tan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Faheem Ahmed Khan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
6
|
Hong JQY, Chua WL, Smith D, Huang CM, Goh QLP, Liaw SY. Collaborative practice among general ward staff on escalating care in clinical deterioration: A systematic review. J Clin Nurs 2023; 32:6165-6178. [PMID: 37154497 DOI: 10.1111/jocn.16743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
AIM To understand the issues surrounding collaborative practice and collaboration experiences among general ward staff in the escalation of care for clinically deteriorating patients. DESIGN A systematic synthesis without meta-analysis. REVIEW METHODS Seven electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, Scopus and ProQuest Theses and Dissertations) were searched from their inception to 30 April 2022. Two reviewers independently screened titles, abstracts and full text for eligibility. The critical appraisal skill programme, Joanna Briggs Institute checklist for analytical cross-sectional studies and mixed methods appraisal tool were used to appraise the quality of the included studies. Both quantitative and qualitative research data were extracted, analysed and then synthesised using the data-based convergent qualitative synthesis approach. This review adhered to the Synthesis without meta-analysis (SWiM) reporting guidelines. RESULTS A total of 17 studies were included. Two themes and six sub-themes were generated: (1) intraprofessional factors-inadequate handover, workload and mutual support, raising and acting on concerns, and seeking help from seniors and (2) interprofessional factors-differences in communication styles, and hierarchical approach versus interpersonal relationships. CONCLUSIONS This systematic review highlights the need to address the intra- and interprofessional issues surrounding collaborative practice in escalation of care among general ward staff. IMPLICATIONS FOR THE PROFESSION Findings from this review will inform healthcare leaders and educators on the development of relevant strategies and multi-disciplinary training to foster effective teamwork among nurses and doctors, with the goal of improving the escalation of care for patients with clinical deterioration. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review did not directly involve patient or public contribution to the manuscript.
Collapse
Affiliation(s)
- Jordan Qi Yang Hong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Duncan Smith
- Department of Nursing, School of Health and Psychological Sciences, City University of London, London, UK
- Patient Emergency Response & Resuscitation Team (PERRT), University College London Hospitals, NHS Foundation Trust, London, UK
| | - Chi Ming Huang
- Nursing Service, National Healthcare Group, Tan Tock Seng Hospital, Singapore, Singapore
| | - Qin Ling Pearlyn Goh
- Department of Nursing, National Healthcare Group, Khoo Teck Puat Hospital, Yishun Health Campus, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
7
|
Liaw SY, Tan JZ, Bin Rusli KD, Ratan R, Zhou W, Lim S, Lau TC, Seah B, Chua WL. Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training: Randomized Controlled Study. J Med Internet Res 2023; 25:e47748. [PMID: 37494112 PMCID: PMC10413090 DOI: 10.2196/47748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/04/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Interprofessional communication is needed to enhance the early recognition and management of patients with sepsis. Preparing medical and nursing students using virtual reality simulation has been shown to be an effective learning approach for sepsis team training. However, its scalability is constrained by unequal cohort sizes between medical and nursing students. An artificial intelligence (AI) medical team member can be implemented in a virtual reality simulation to engage nursing students in sepsis team training. OBJECTIVE This study aimed to evaluate the effectiveness of an AI-powered doctor versus a human-controlled doctor in training nursing students for sepsis care and interprofessional communication. METHODS A randomized controlled trial study was conducted with 64 nursing students who were randomly assigned to undertake sepsis team training with an AI-powered doctor (AI-powered group) or with medical students using virtual reality simulation (human-controlled group). Participants from both groups were tested on their sepsis and communication performance through simulation-based assessments (posttest). Participants' sepsis knowledge and self-efficacy in interprofessional communication were also evaluated before and after the study interventions. RESULTS A total of 32 nursing students from each group completed the simulation-based assessment, sepsis and communication knowledge test, and self-efficacy questionnaire. Compared with the baseline scores, both the AI-powered and human-controlled groups demonstrated significant improvements in communication knowledge (P=.001) and self-efficacy in interprofessional communication (P<.001) in posttest scores. For sepsis care knowledge, a significant improvement in sepsis care knowledge from the baseline was observed in the AI-powered group (P<.001) but not in the human-controlled group (P=.16). Although no significant differences were found in sepsis care performance between the groups (AI-powered group: mean 13.63, SD 4.23, vs human-controlled group: mean 12.75, SD 3.85, P=.39), the AI-powered group (mean 9.06, SD 1.78) had statistically significantly higher sepsis posttest knowledge scores (P=.009) than the human-controlled group (mean 7.75, SD 2.08). No significant differences were found in interprofessional communication performance between the 2 groups (AI-powered group: mean 29.34, SD 8.37, vs human-controlled group: mean 27.06, SD 5.69, P=.21). However, the human-controlled group (mean 69.6, SD 14.4) reported a significantly higher level of self-efficacy in interprofessional communication (P=.008) than the AI-powered group (mean 60.1, SD 13.3). CONCLUSIONS Our study suggested that AI-powered doctors are not inferior to human-controlled virtual reality simulations with respect to sepsis care and interprofessional communication performance, which supports the viability of implementing AI-powered doctors to achieve scalability in sepsis team training. Our findings also suggested that future innovations should focus on the sociability of AI-powered doctors to enhance users' interprofessional communication training. Perhaps in the nearer term, future studies should examine how to best blend AI-powered training with human-controlled virtual reality simulation to optimize clinical performance in sepsis care and interprofessional communication. TRIAL REGISTRATION ClinicalTrials.gov NCT05953441; https://clinicaltrials.gov/study/NCT05953441.
Collapse
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Jian Zhi Tan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | | | - Rabindra Ratan
- Department of Media & Information, Michigan State University, East Lansing, MI, United States
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Siriwan Lim
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Tang Ching Lau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Betsy Seah
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| |
Collapse
|
8
|
Yasser NBM, Tan AJQ, Harder N, Ashokka B, Chua WL, Liaw SY. Telesimulation in healthcare education: A scoping review. Nurse Educ Today 2023; 126:105805. [PMID: 37062239 DOI: 10.1016/j.nedt.2023.105805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/15/2023] [Accepted: 03/26/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To provide a comprehensive overview on the utilization and effectiveness of telesimulation in healthcare education. DESIGN A scoping review. DATA SOURCES A search of five databases including PubMed, Web of Science, Cochrane, EMBASE and ProQuest was conducted between 2000 and 2022. REVIEW METHODS Arksey and O' Malley's scoping review framework was utilised. Data were narratively synthesised. RESULTS 29 articles were included. More than half of the publications on telesimulation were borne out of need during the COVID-19 pandemic. Innovation reports were the most prevalent publications followed by descriptive studies. Telesimulation was applied for the delivery of diverse learning content including patient care management, procedural skills and team training. A variety of videoconferencing software and simulation modalities have been used for telesimulation. Telesimulation was generally well-received, despite its technical challenges. Learning effectiveness of telesimulation was evident in quasi-experimental studies. CONCLUSION Telesimulation has been gaining acceptance as a distance-based simulation education modality. It will continue to evolve and potentially blend with in-person simulation. More rigorous research is warranted to evaluate learning outcomes and establish best practices in telesimulation.
Collapse
Affiliation(s)
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Canada
| | - Balakrishnan Ashokka
- Department of Anaesthesia, National University Hospital, Singapore; Centre for Medical Education, CenMED, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
9
|
Liaw SY, Tan JZ, Lim S, Zhou W, Yap J, Ratan R, Ooi SL, Wong SJ, Seah B, Chua WL. Artificial intelligence in virtual reality simulation for interprofessional communication training: Mixed method study. Nurse Educ Today 2023; 122:105718. [PMID: 36669304 DOI: 10.1016/j.nedt.2023.105718] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Virtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training. OBJECTIVES To describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor. METHODS A mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences. RESULTS The participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of "human-like" feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: "relate to the real world", "artificial intelligence versus human intelligence" and "complement with face-to-face learning". CONCLUSIONS This study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.
Collapse
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Jian Zhi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Yap
- NUS Information Technology, National University of Singapore, 2 Engineering Drive 4, 117584, Singapore
| | - Rabindra Ratan
- Department of Media & Information, Michigan State University, Address: 404 Wilson Rd, Communication Arts and Sciences Building, East Lansing, MI, USA
| | - Sim Leng Ooi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shu Jing Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
10
|
Chua WL, Teh CS, Basri MABA, Ong ST, Phang NQQ, Goh EL. Nurses' knowledge and confidence in recognizing and managing patients with sepsis: A multi-site cross-sectional study. J Adv Nurs 2023; 79:616-629. [PMID: 36069994 PMCID: PMC10087790 DOI: 10.1111/jan.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 01/26/2023]
Abstract
AIMS (1) To examine registered nurses' knowledge and confidence in recognizing and managing to patients with sepsis and (2) identify nurse and workplace factors that influence their knowledge on sepsis. DESIGN A multi-site, cross-sectional survey. METHODS An online survey was developed and content validated. Data was collected from registered nurses working in the inpatient wards and emergency departments of three hospitals of a single healthcare cluster in Singapore during August 2021. Statistical analyses of closed-ended responses and content analysis of open-ended responses were undertaken. RESULTS A total of 709 nurses completed the survey. Nurses possessed moderate levels of knowledge about sepsis (mean score = 10.56/15; SD = 2.01) and confidence in recognizing and responding to patients with sepsis (mean score = 18.46/25; SD = 2.79). However, only 369 (52.0%) could correctly define sepsis. Nurses' job grade, nursing education level and clinical work area were significant predictors of nurses' sepsis knowledge. Specifically, nurses with higher job grade, higher nursing education level or those working in acute care areas (i.e. emergency department, high dependency units or intensive care units) were more likely to obtain higher total sepsis knowledge scores. A weak positive correlation was observed between sepsis knowledge test scores and self-confidence (r = .184). Open comments revealed that participants desired for more sepsis education and training opportunities and the implementation of sepsis screening tool and sepsis care protocol. CONCLUSION A stronger foundation in sepsis education and training programs and the implementation of sepsis screening tools and care bundles are needed to enhance nurses' knowledge and confidence in recognizing and managing patients with sepsis. IMPACT The findings of this study are beneficial to administrators, educators and researchers in designing interventions to support nurses in their role in recognizing and responding to sepsis.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Chin Shim Teh
- Nursing Department, Alexandra Hospital, National University Health System, Singapore City, Singapore
| | | | - Shi Ting Ong
- Nursing Department, National University Hospital, National University Health System, Singapore City, Singapore
| | - Noel Qiao Qi Phang
- Nursing Department, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Ee Ling Goh
- Department of Emergency Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| |
Collapse
|
11
|
Qi Tan AJ, Chua WL, McKenna L, Chin Tan LL, Lim YJ, Liaw SY. Enablers and barriers to nurse-facilitated geriatric teleconsultations in nursing homes: a qualitative descriptive multi-site study. Age Ageing 2022; 51:6936403. [PMID: 36580553 DOI: 10.1093/ageing/afac268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/25/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses' role in teleconsultations allows for more support in the provision of patient care through this modality. OBJECTIVE This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes. METHODS A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke's thematic analysis approach. RESULTS Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses' acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses' sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses' lack of confidence in physical assessment and communication competencies, role conflict due to nurses' perceived inability to meet physicians' expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges. CONCLUSION The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses' telemedicine competencies and optimising digital infrastructure are warranted.
Collapse
Affiliation(s)
- Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Laurence Lean Chin Tan
- Division of Palliative and Supportive Care, Department of Geriatric Medicine, Yishun Health, Singapore.,GeriCare@North, Yishun Health, Singapore
| | - Yu Jun Lim
- GeriCare@North, Yishun Health, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
12
|
Nguyen PT, Liaw SY, Tan AJQ, Rusli KDB, Tan LLC, Goh HS, Chua WL. “Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore. Collegian 2022. [DOI: 10.1016/j.colegn.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
Thangavelu DP, Tan AJQ, Cant R, Chua WL, Liaw SY. Digital serious games in developing nursing clinical competence: A systematic review and meta-analysis. Nurse Educ Today 2022; 113:105357. [PMID: 35429749 DOI: 10.1016/j.nedt.2022.105357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes. RESULTS 22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care. CONCLUSION The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.
Collapse
Affiliation(s)
| | - Apphia J Q Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Robyn Cant
- School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
14
|
Chua WL, Smith D, Wee LC, Ting KC, Yeo MLK, Mordiffi SZ, Liaw SY. Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale. J Clin Nurs 2022; 32:2684-2699. [PMID: 35527356 DOI: 10.1111/jocn.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To develop and evaluate the psychometric properties of an instrument that measures nurses' Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND). BACKGROUND General ward nurses play an important role in recognising patient deterioration. However, their attitudes towards early recognition of clinical deterioration have not been adequately explored due to the lack of a valid and reliable scale. DESIGN An instrument development and validation study. METHODS A three-phase structure that followed the STROBE checklist was used: (1) item generation, (2) content and face validity assessment and (3) psychometric properties evaluation. The scale items were developed based on a comprehensive literature review and content validity assessment by 15 international experts from five countries. The psychometric properties of the ATREND scale were tested on 434 registered nurses, with retest evaluations (n = 100) at two hospitals. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale. The scale was also evaluated for its internal consistency, test-retest reliability and convergent validity. RESULTS The scale's content validity was 0.95. A 3-factor solution was identified from the final 11 items: (1) beliefs about importance of patient observation, (2) use of broader patient assessment skills and (3) confidence in recognising clinical deterioration. The internal consistency reliability of the scale was supported with an acceptable Cronbach's alpha value of 0.745. Test-retest reliability of the scale was excellent, with an intraclass correlation coefficient of 0.825. The ATREND scale shows evidence of good convergent validity. CONCLUSION The final 11-item ATREND scale demonstrates adequate initial evidence of reliability and validity for use in acute ward settings. RELEVANCE TO CLINICAL PRACTICE Nursing educators and clinicians may use this scale to assess ward nurses' attitudes and practices towards early recognition of clinical deterioration and then enhance their competencies and behaviours in the recognition of clinical deterioration.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Duncan Smith
- School of Health Sciences City University of London London UK
- Patient Emergency Response & Resuscitation Team (PERRT) NHS Foundation Trust University College London Hospitals London UK
| | - Li‐Phing Clarice Wee
- Department of Nursing Administration Ng Teng Fong General Hospital National University Health System Singapore City Singapore
| | - Kit Cheng Ting
- Nursing Department National University Hospital National University Health System Singapore City Singapore
| | - Min Li Kimberly Yeo
- Department of Nursing Ng Teng Fong General Hospital National University Health System Singapore City Singapore
| | - Siti Zubaidah Mordiffi
- Nursing Department National University Hospital National University Health System Singapore City Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| |
Collapse
|
15
|
Chua WL, Ooi SL, Chan GWH, Lau TC, Liaw SY. The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study. J Med Internet Res 2022; 24:e35058. [PMID: 35436237 PMCID: PMC9062715 DOI: 10.2196/35058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. OBJECTIVE This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students' sepsis knowledge, team communication skills, and skill use in clinical practice. METHODS A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants' sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants' sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. RESULTS Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other's roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education-particularly the use of virtual telesimulation-fostered participants' understanding and appreciation of each other's interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. CONCLUSIONS Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Sim Leng Ooi
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Gene Wai Han Chan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Rheumatology, Department of Medicine, National University Health System, Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| |
Collapse
|
16
|
Liaw SY, Ooi SL, Mildon R, Ang ENK, Lau TC, Chua WL. Translation of an evidence-based virtual reality simulation-based interprofessional education into health education curriculums: An implementation science method. Nurse Educ Today 2022; 110:105262. [PMID: 35063778 DOI: 10.1016/j.nedt.2021.105262] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The development of interprofessional competencies through an evidence-based program is paramount to nurture a collaborative practice-ready workforce for patient-centered care and safety. AIMS To describe an implementation science approach for translation of an evidence-based virtual reality simulation-based interprofessional education (VR-Sim-IPE) program into medical and nursing curriculums, and to evaluate the implementation outcomes. METHODS Implementation strategies from the "Expert Recommendations for Implementing Change" were used to support implementation of the VR-Sim-IPE program. This included recruiting and training 28 practicing clinicians as facilitators to deliver the program to 599 medical and nursing students. Proctor's conceptual framework for implementation outcomes was applied with multiple data collection methods to evaluate the VR-Sim-IPE program. An online survey was administered to measure the levels of acceptability, appropriateness, feasibility, and adoption. Forty-four sessions of structured observations were carried out to examine the facilitators' implementation fidelity. Individual interviews were conducted with 15 facilitators to identify the facilitators and barriers to the program implementation. An implementation cost analysis was also conducted. RESULTS Both facilitators and students had positive perceptions of the acceptability, adoption, appropriateness, and feasibility of the VR-Sim-IPE program. Facilitators were observed to implement the program with high fidelity, including program adherence, dosage, quality of delivery, and student responsiveness. While opportunities to contribute and learn, as well as receiving training and support, were identified as facilitators to implementation, the lack of familiarity with the virtual environment, varying levels of student participation, and facilitating interprofessional groups were reported barriers. The implementation costs amounted to USD45,648.50. CONCLUSION The evaluation of implementation outcomes identifies strategies for future implementation that could potentially enhance program acceptance, reduce implementation cost, improve penetration, and achieve program sustainability. These include increasing facilitation group size, preparing students to be active participants, and incorporating interprofessional facilitation skills in facilitators' training.
Collapse
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sim Leng Ooi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Robyn Mildon
- Centre for Evidence and Implementation, University of Melbourne, Australia.
| | - Emily Neo Kim Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Tang Ching Lau
- National University Hospital, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
17
|
Choy CL, Liaw SY, Goh EL, See KC, Chua WL. Impact of sepsis education for healthcare professionals and students on learner and patient outcomes: A systematic review. J Hosp Infect 2022; 122:84-95. [PMID: 35045340 DOI: 10.1016/j.jhin.2022.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sepsis is an important global healthcare problem that is a key challenge faced by healthcare professionals face worldwide. One key effort aimed at reducing the global burden of sepsis is educating healthcare professionals about early identification and management of sepsis. AIM To provide a comprehensive evaluation of sepsis education among healthcare professionals and students. METHODS Six databases (PubMed, CINAHL, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, and Scopus) were searched. We included studies that described and evaluated any form of education or training on sepsis delivered to healthcare professionals and students. Study outcomes were summarised according to the adapted Kirkpatrick model of training evaluation. RESULTS Thirty-two studies were included in the review. The learning contents were reported to be in accordance with the Surviving Sepsis Campaign guidelines. Seven studies included the topic of interprofessional teamwork and communication in their sepsis education content. Most educational programs were effective and reported positive effects on immediate knowledge outcomes. Interventions that were delivered through an active learning approach such as simulation and game-based learning generally produced greater gains than didactic teaching. Improvements in patient care processes and patient outcomes were associated with the concomitant existence or implementation of a hospital sepsis care bundle. CONCLUSION Incorporating active learning strategies into sepsis education interventions has the potential to improve learners' long-term outcomes. In addition, sepsis education and protocol-based sepsis care bundle act in synergy to augment greater improvements in care processes and patient benefits.
Collapse
Affiliation(s)
- C L Choy
- Nursing Department, National University Hospital, Singapore
| | - S Y Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - E L Goh
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Singapore
| | - K C See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore
| | - W L Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
18
|
Tan J, Ramazanu S, Liaw SY, Chua WL. Effectiveness of Public Education Campaigns for Stroke Symptom Recognition and Response in Non-Elderly Adults: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 31:106207. [PMID: 34844126 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106207] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The incidence of stroke is on the rise among younger adults. Stroke educational campaigns are often used to raise public knowledge of stroke warning signs and response actions, but their effectiveness in non-elderly adults is unclear. This study investigated the effectiveness of stroke campaigns in improving stroke symptom recognition and intention to call emergency medical services in adults aged < 65 years, and described the characteristics of public stroke education in this demographic group. MATERIALS AND METHODS Seven databases (Cochrane Library, CINAHL, Embase, Medline, PsycINFO, Scopus, and ProQuest Dissertations and Theses) were searched from inception to 24 January 2021. A meta-analysis was conducted to synthesize the effects of stroke education campaigns on stroke symptom recognition and intention to call emergency medical services in adults < 65 years. A narrative synthesis approach was used to explore the types of educational content and campaign best suited to this demographic group. RESULTS Thirteen studies from 2001 to 2019 were included in this review. Out of the thirteen studies, five were included in the meta-analysis to synthesize the effects of stroke education campaigns on symptom recognition and four were included for synthesizing the effects on intention to call emergency medical services. The estimated pooled risk ratio for post-campaign compared with pre-campaign in stroke symptom recognition and intention to call emergency medical services was 1.20 (95% CI: 1.07-1.36, p = 0.002) and 1.19 (95% CI: 1.11-1.28, p < 0.00001), respectively. Usage of acronyms in broadcast and digital media campaigns appears promising in enhancing recognition of and responsiveness to stroke symptoms. CONCLUSIONS Public stroke education campaigns were found to have a significant impact on stroke symptom recognition and intention to call emergency medical services. The evidence generated from this review could be applied to inform future campaigns targeted at younger adults.
Collapse
Affiliation(s)
- Jiayi Tan
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606
| | - Sheena Ramazanu
- Research Fellow, National University of Singapore, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Sok Ying Liaw
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Wei Ling Chua
- Research Fellow, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| |
Collapse
|
19
|
Heng WAM, Lin YP, Chua WL, Chan EY. The early stages of caregiving: A qualitative study into the caregiving experiences of Asian family caregivers of persons with newly-diagnosed dementia. Geriatr Nurs 2021; 42:1517-1524. [PMID: 34735998 DOI: 10.1016/j.gerinurse.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
In Asian societies, the responsibility of caring for persons with dementia often falls upon an immediate family member. However, little attention has been paid to the early stages of caregiving, as well as their transition into a more experienced caregiver. Thus, a qualitative descriptive study involving a purposive sample of 11 main family caregivers of a person with newly diagnosed dementia was recruited from a tertiary hospital in Singapore. Three themes emerged from the data analysis: (1) Suspicions to seeking confirmation of dementia, (2) Grappling with dementia diagnosis, and (3) Making adjustments for the future. Areas of needs and support identified during the early caregiving journey suggest the need for caregivers to be prepared for the practical and emotional challenges. Unique to the Asian culture, our findings put forth the advocacy of engaging persons with dementia in the discussions of their long-term care and options.
Collapse
Affiliation(s)
| | | | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ee-Yuee Chan
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore; Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
20
|
Chua WL, Rahim NRBA, McKenna L, Ho JTY, Liaw SY. Intraprofessional collaboration between enrolled and registered nurses in the care of clinically deteriorating ward patients: A qualitative study. Aust Crit Care 2021; 35:81-88. [PMID: 33926789 DOI: 10.1016/j.aucc.2021.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Nurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. OBJECTIVES The aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. METHODS A qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. FINDINGS Three main themes emerged from the data analysis. The first, "reaching a collective understanding of patients' conditions', identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, "role expectations of each other", describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, "lacking in shared decision-making", depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. CONCLUSIONS A less-than-optimal collaborative EN-RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN-RN collaborative practice. Nurse managers and educators are instrumental in fostering EN-RN collaboration and providing ongoing education on nursing teamwork skills and competencies.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | | | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Dr, Bundoora (Melbourne), Victoria, 3086, Australia
| | - Jasmine Tze Yin Ho
- National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| |
Collapse
|
21
|
Tan MW, Lim FP, Siew AL, Levett-Jones T, Chua WL, Liaw SY. Why are physical assessment skills not practiced? A systematic review with implications for nursing education. Nurse Educ Today 2021; 99:104759. [PMID: 33540350 DOI: 10.1016/j.nedt.2021.104759] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Physical assessment skills are taught in pre-registration nursing programs to equip nurses with the competencies to provide holistic nursing care. However, only a fraction of the skills they acquired during training are routinely performed in clinical practice thus highlighting a disconnect between learning and practicing. OBJECTIVE To better understand the issues surrounding the teaching and practice of physical assessment skills among nurses as described in the literature. DESIGN A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used. REVIEW METHOD A search of databases including PubMed, EMBASE, CINAHL and Scopus was conducted from January 1970 to December 2019. Two independent researchers performed the methodological quality assessment using the Joanna Briggs Institute's Critical Appraisal Checklists. Twenty-one papers, including two qualitative studies, 17 quantitative studies and two mixed methods study, were selected in this review. Data were synthesised narratively. RESULTS The review identified six overarching themes: (1) role ambiguity, (2) reliance on technology, (3) collegial support and culture, (4) practice variations across specialties, (5) a lack of confidence and knowledge, and (6) over-teaching using biomedical model. CONCLUSION This review identified the need to improve the teaching of the physical assessment skills. There is also a need to evaluate the physical assessment content taught within nursing curricula, with emphasis on depth rather than breadth of skills. The ability to interpret physical assessment observations and develop clinical judgement need to be incorporated into the curriculum. To aid in the development of an effective care plan, the physical assessment framework should move away from a biomedical framework to include nursing models such as nursing process and clinical reasoning model. This revised framework can be used in future studies in the development and testing of teaching and evaluation tools for physical assessment skills.
Collapse
Affiliation(s)
| | - Fui Ping Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Tracy Levett-Jones
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
22
|
Chua WL, Tee A, Hassan NB, Jones D, Tam WWS, Liaw SY. The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale. Aust Crit Care 2020; 34:340-349. [PMID: 33250402 DOI: 10.1016/j.aucc.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking. OBJECTIVES This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses. METHODS The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n = 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n = 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test-retest reliability, convergent validity, and known-group validity of the scale were also analysed. RESULTS A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent test-retest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics. CONCLUSIONS The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597.
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
| | - Norasyikin Binte Hassan
- Nursing Education and Research, Changi General Hospital, 2 Simei Street 3, Singapore, 529889
| | - Daryl Jones
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care Unit, Austin Hospital, 145 Studley Road PO Box 5555, Heidelberg, Victoria, Australia, 3084
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore, 117597
| |
Collapse
|
23
|
Liaw SY, Ooi SW, Rusli KDB, Lau TC, Tam WWS, Chua WL. Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes. J Med Internet Res 2020; 22:e17279. [PMID: 32267235 PMCID: PMC7177432 DOI: 10.2196/17279] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training. Objective This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes. Methods In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions. Results The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points. Conclusions Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education. Trial Registration ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924
Collapse
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Sim Win Ooi
- National University Hospital, Singapore, Singapore
| | | | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| |
Collapse
|
24
|
Chua WL, Legido-Quigley H, Jones D, Hassan NB, Tee A, Liaw SY. A call for better doctor–nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients. Aust Crit Care 2020; 33:54-61. [DOI: 10.1016/j.aucc.2019.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
|
25
|
Chua WL, Legido-Quigley H, Ng PY, McKenna L, Hassan NB, Liaw SY. Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study. Int J Nurs Stud 2019; 95:56-64. [DOI: 10.1016/j.ijnurstu.2019.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
|
26
|
Liaw SY, Tee A, Carpio GAC, Ang SBL, Chua WL. Review of systems for recognising and responding to clinical deterioration in Singapore hospitals: a nationwide cross-sectional study. Singapore Med J 2019; 61:184-189. [PMID: 31197374 DOI: 10.11622/smedj.2019050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Rapid Response System for recognising and responding to clinically deteriorating patients has been progressively implemented in acute care hospitals across the globe. This study sought to review the implementation of this system in acute public hospitals in Singapore. METHODS A cross-sectional study using a face-to-face survey questionnaire was conducted. RESULTS Five out of seven invited hospitals completed the questionnaire and rated the Rapid Response System as either high priority or essential, and indicated its importance over other patient safety indicators. Sensitivity and specificity of the triggering criteria and non-adherence to the escalation protocol were highlighted issues. Only two hospitals had a dedicated response team for providing emergency help to deteriorating ward patients. Limited manpower resources, unclear roles between the primary and response teams, and the potential deskilling of ward staff were reported barriers that inhibited the uptake of a response team. All hospitals had a committee that oversaw its system operation, provided training to ward staff, and used information technology to support the implementation. CONCLUSION A variety of approaches have been taken to support the system of recognising and responding to clinical deterioration. This calls for a national approach to enable the standardisation of clinical processes, sharing of educational resources and multi-site evaluation.
Collapse
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Guiller Augustin C Carpio
- Centre for Learning Environment and Assessment Development (CoLEAD), Singapore Institute of Technology, Singapore
| | | | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
27
|
Chua WL, See MTA, Legio-Quigley H, Jones D, Tee A, Liaw SY. Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review. Int J Qual Health Care 2018; 29:981-998. [PMID: 29177454 PMCID: PMC6216047 DOI: 10.1093/intqhc/mzx149] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 10/26/2017] [Indexed: 12/28/2022] Open
Abstract
Purpose To synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians. Data sources Nine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals. Study selection Published primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included. Data extraction Data on design, methods and key findings were extracted and collated. Results of data synthesis Thirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation. Conclusion This review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.
Collapse
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Min Ting Alicia See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Helena Legio-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,London School of Hygiene and Tropical Medicine, London, UK
| | - Daryl Jones
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Augustine Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
28
|
Chua WL, See MTA, Legido-Quigley H, Jones D, Tee A, Liaw SY. Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review. Int J Qual Health Care 2018; 30:492. [PMID: 29548028 DOI: 10.1093/intqhc/mzy040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Indexed: 11/13/2022] Open
|
29
|
Liaw SY, Chng DYJ, Wong LF, Ho JTY, Mordiffi SZ, Cooper S, Chua WL, Ang ENK. The impact of a Web-based educational program on the recognition and management of deteriorating patients. J Clin Nurs 2017; 26:4848-4856. [DOI: 10.1111/jocn.13955] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | | | - Lai Fun Wong
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | | | | | - Simon Cooper
- Faculty of Health; Federation University Australia; Mount Helen Vic. Australia
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| | - Emily Neo Kim Ang
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore City Singapore
| |
Collapse
|
30
|
Chua WL. Simulation training appears to improve nurses' ability to recognise and manage clinical deterioration. Evid Based Nurs 2017; 20:ebnurs-2017-102742. [PMID: 28794005 DOI: 10.1136/eb-2017-102742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| |
Collapse
|
31
|
Tan AJQ, Lee CCS, Lin PY, Cooper S, Lau LST, Chua WL, Liaw SY. Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial. Nurse Educ Today 2017; 55:38-44. [PMID: 28521248 DOI: 10.1016/j.nedt.2017.04.027] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/27/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preparing nursing students for the knowledge and skills required for the administration and monitoring of blood components is crucial for entry into clinical practice. Serious games create opportunities to develop this competency, which can be used as a self-directed learning strategy to complement existing didactic learning and simulation-based strategies. AIM To describe the development and evaluation of a serious game to improve nursing students' knowledge, confidence, and performance in blood transfusion. METHOD An experiential gaming model was applied to guide the design of the serious game environment. A clustered, randomized controlled trial was conducted with 103 second-year undergraduate nursing students who were randomized into control or experimental groups. After a baseline evaluation of the participants' knowledge and confidence on blood transfusion procedure, the experimental group undertook a blood transfusion serious game and completed a questionnaire to evaluate their learning experience. All participants' clinical performances were evaluated in a simulated environment. RESULTS The post-test knowledge and confidence mean scores of the experimental group improved significantly (p<0.001) after the serious game intervention compared to pre-test mean scores and to post-test mean scores of the control group (p<0.001). However, no significance difference (p=0.11) was found between the experimental and control groups on the post-test performance mean scores. The participants evaluated the serious game positively. CONCLUSION The study provided evidence on the effectiveness of a serious game in improving the knowledge and confidence of nursing students on blood transfusion practice. The features of this serious game could be further developed to incorporate additional scenarios with repetitive exercises and feedback to enhance the impact on clinical performance. Given the flexibility, practicality, and scalability of such a game, they can serve as a promising approach to optimize learning when blended with high-fidelity simulation.
Collapse
Affiliation(s)
| | - Cindy Ching Siang Lee
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Simon Cooper
- Faculty of Health, Federation University, Australia
| | - Lydia Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
32
|
Abstract
We present a case of a lower limb compartment syndrome associated with the use of an intra-osseous line inserted into the proximal tibia in an adult patient. An unconscious 59-year old male with multiple injuries presented to our Emergency Department after a road traffic accident. Bilateral proximal tibial intra osseous-lines were inserted due to poor venous access. After resuscitation his left leg was noted to be tense and swollen with absent pulses. Acute compartment syndrome was diagnosed both clinically and with compartment pressure measurement. Two incision fasciotomy on his left lower leg was performed. Intra osseous-lines in the proximal tibia are increasingly used in adult patients in the pre-hospital setting by paramedics and emergency physicians. Their use, along with the possible complications of these devices, such as the development of compartment syndrome or osteomyelitis leading to amputation, is well reported in the paediatric literature. To the best of our knowledge, there have not been any previous reports of complications in the adult patient. We present a case of lower leg compartment syndrome developing from the use of an intra-osseous line in the proximal tibia in an adult patient. With the increasing use of intra-osseous lines in adult patients, clinicians should be aware of the possibility of developing compartment syndrome which may lead to disability or amputation in severe cases.
Collapse
Affiliation(s)
- R Malhotra
- Department of Orthopaedics, National University Hospital Singapore, Singapore
| | - W L Chua
- Department of Orthopaedics, National University Hospital Singapore, Singapore
| | - G O'Neill
- Department of Orthopaedics, National University Hospital Singapore, Singapore
| |
Collapse
|
33
|
Affiliation(s)
- Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
34
|
Lin PY, Chua WL, Mok WQ, Liaw SY. Using a case-based animation on physiological compensatory mechanism to remediate nurses' misconceptions about changes in patient vital signs. J Clin Nurs 2016; 25:566-8. [PMID: 26818381 DOI: 10.1111/jocn.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Wen Qi Mok
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
35
|
Laverick R, Wulff M, Honisch JJ, Chua WL, Wing AM, Rotshtein P. Selecting object pairs for action: Is the active object always first? Exp Brain Res 2015; 233:2269-81. [PMID: 25929555 DOI: 10.1007/s00221-015-4296-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
Perception is linked to action via two routes: a direct route based on affordance information in the environment and an indirect route based on semantic knowledge about objects. The present study explored the factors modulating the recruitment of the two routes, in particular which factors affecting the selection of paired objects. In Experiment 1, we presented real objects among semantically related or unrelated distracters. Participants had to select two objects that can interact. The presence of distracters affected selection times, but not the semantic relations of the objects with the distracters. Furthermore, participants first selected the active object (e.g. teaspoon) with their right hand, followed by the passive object (e.g. mug), often with their left hand. In Experiment 2, we presented pictures of the same objects with no hand grip, congruent or incongruent hand grip. Participants had to decide whether the two objects can interact. Action decisions were faster when the presentation of the active object preceded the presentation of the passive object, and when the grip was congruent. Interestingly, participants were slower when the objects were semantically but not functionally related; this effect increased with congruently gripped objects. Our data showed that action decisions in the presence of strong affordance cues (real objects, pictures of congruently gripped objects) relied on sensory-motor representation, supporting the direct route from perception-to-action that bypasses semantic knowledge. However, in the case of weak affordance cues (pictures), semantic information interfered with action decisions, indicating that semantic knowledge impacts action decisions. The data support the dual-route account from perception-to-action.
Collapse
Affiliation(s)
- Rosanna Laverick
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK,
| | | | | | | | | | | |
Collapse
|
36
|
Lukman H, Kiat JE, Ganesan A, Chua WL, Khor KL, Choong YF. Negative social reaction to strabismus in school children ages 8-12 years. J AAPOS 2011; 15:238-40. [PMID: 21683635 DOI: 10.1016/j.jaapos.2011.01.158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 12/24/2010] [Accepted: 01/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate children's willingness to sit next to a child with noticeable exotropia as a measure of social alienation. METHODS This was a cross-sectional, mixed-design study. Children in primary grades 3-6 (8-12 years old) were asked to view 8 digitally modified images of exotropic or orthotropic children in classroom settings and rate their willingness to sit next to the child in each image. RESULTS A total of 157 children participated. A 4 × 2 × 2 mixed-design analysis of variance revealed a significant main effect for primary level (F [3, 151] = 4.06, P = .01, partial η(2) = .08) and for image type, exotropic versus orthotropic, (F [1, 151] = 108.45, P = .00, partial η(2) = .42). The results of the main effects were qualified by a significant primary level X image type interaction (F [3, 151] = 4.00, P = .01, partial η(2) = .08). Children were less willing to sit next to a person with noticeable exotropia. Although this phenomenon was consistent across all primary levels, the magnitude of the effect diminished in strength for children in higher primary levels. CONCLUSIONS This study further strengthens existing evidence for strabismus-related prejudice that suggests that children with noticeable strabismus may be subjected to social alienation by other children.
Collapse
Affiliation(s)
- Hera Lukman
- Department of Psychology, Faculty of Behavioural Sciences, HELP University College, Kuala Lumpur, Malaysia.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND In terms of clinical outcomes, women with schizophrenia seem to fare better then men, but appear more vulnerable to psychotic illness in the period after birth and menopause. As these vulnerable periods to psychosis are associated with estrogen withdrawal, this hormone has been proposed as a treatment for schizophrenia. OBJECTIVES To evaluate the clinical effects of estrogens alone or in combination with progesterone, as a sole treatment or as an adjunctive therapy, for the treatment of schizophrenia or schizophrenia-like illnesses. SEARCH STRATEGY Electronic searches of the Cochrane Schizophrenia Group's Register (October 2003) was supplemented with manual reference inspection of all identified studies. Authors of trials were contacted for further material and archive information. SELECTION CRITERIA All randomised clinical trials comparing estrogens with or without progesterone, as a sole or adjunctive treatment for people with schizophrenia or other similar serious, non-affective psychotic illness. DATA COLLECTION AND ANALYSIS We evaluated data independently and analysed on an intention to treat basis. For binary data we calculated the fixed effect relative risk (RR) and its 95% confidence interval (CI). For continuous non-skewed data, we calculated weighted mean differences. MAIN RESULTS All available evidence relates to women. Four studies (n=108) compared estrogen only with placebo. Short-term scores for general mental state showed no significant difference between groups (n=24, 1 RCT, WMD PANSS for 100mcg comparison -2.26 CI -15.4 to 10.9). Data from all four studies showed overall loss from the studies was low ( 5%), with no significant differences between groups (n=96, 4 RCTs, RR 0.95 CI 0.2 to 6.1). Skewed continuous data from two studies showed no clear differences in ratings of movement disorders. One medium-term unpublished study (n=14) compared estrogen and progesterone with placebo. Data at six months showed no difference between groups for total scores (n=9, WMD PANSS -25.3 CI -51 to 0.1). For negative symptoms, results favoured the estrogen and progesterone group (n=9, WMD PANSS negative subscale -9.0 CI -17 to -0.9). For loss to follow up there was no difference between groups (n=10, RR 0.33 CI 0.02 to 6.7). This trial used many cognitive tests and one visual retention test showed statistically significant differences favouring the treatment group: total scores (n=8, WMD -3.5 CI -5.7 to -1.3). AUTHORS' CONCLUSIONS Adjunctive estrogen with or without progesterone does not appear to offer convincing advantages over placebo. Before any more research is undertaken in this area, all completed and unpublished work should be made available in order to ensure that more trials are justified.
Collapse
Affiliation(s)
- W L Chua
- Bradford District Care Trust, City Mental Health Team, Horton Park Centre, 99 Horton Park Avenue, Bradford, West Yorkshire, UK BD7 3 EG.
| | | | | | | |
Collapse
|
38
|
Chua WL, Ng ASB. A defective endotracheal tube. Singapore Med J 2002; 43:476-8. [PMID: 12568427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Routine inspection and testing of endotracheal tubes prior to use may fail to detect certain manufacturing defects. We describe a case of endotracheal tube kinking at the junction where the inflation tube for the pilot balloon is attached to the endotracheal tube. This case report highlights the importance of maintaining an awareness that airway obstruction or leak due to structural defects can still occur even with high quality, prepacked single use plastic endotracheal tubes. It also emphasises the need to have a systematic approach when dealing with such critical events.
Collapse
Affiliation(s)
- W L Chua
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
| | | |
Collapse
|
39
|
Abstract
BACKGROUND AND OBJECTIVES Most studies in Asia exclude freelance female sex workers because of difficulties in access and the illegality of their work. Data are lacking on their risk behaviors. GOAL To compare sexually transmitted disease (STD) rates, condom use, and health screening behavior between freelance and brothel-based sex workers in Singapore. STUDY DESIGN This is a cross-sectional survey of 111 free-lance sex workers arrested from November 1996 to March 1997 for illicit prostitution and 333 randomly selected brothel-based sex workers. All were tested for STDs. RESULTS STDs were significantly more prevalent among freelance than brothel-based sex workers (34.8% vs. 24.0%). Inconsistent condom use was significantly higher among freelance than brothel-based sex workers and was significantly associated with younger age, decreasing number of clients, and perception of non-condom use among peers. CONCLUSION Educational programs to promote condom use should target freelance sex workers and their clients.
Collapse
Affiliation(s)
- M L Wong
- Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore.
| | | | | | | |
Collapse
|