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To assess the emergency department practice context and identify strategies to improve outcomes of patients with acute pain. Effective treatment of acute pain in the emergency department depends upon clinicians adopting pain interventions into practice. However, it is well-recognized that acute pain is often undertreated. The local practice context strongly influences clinicians' adoption of interventions into their clinical practice. An assessment of this practice context can inform implementation interventions and strategies to improve outcomes for patients with acute pain. Chart audit, staff survey, and staff working groups were conducted from June 2020 to May 2021 Data were analyzed and synthesized across sources informed by assessment elements of the Ottawa model of research use (OMRU) implementation model and expert recommendations for implementing change strategies. The OMRU facilitated contextual assessment of pain treatment practice in the emergency department and the development of implementation strategies. Adoption of evidence-based pain interventions was low in the sample studied. Workflow and workload were the primary barriers to evidence-based pain practices by potential adopters, while positive beliefs and high awareness of evidence-based pain interventions were supportive factors. Implementation strategies were informed by assessment findings and mapped to the Ottawa model and expert recommendations for implementing change elements. The adoption of evidence into practice in the emergency department relies upon a comprehensive assessment of the local context. The use of the OMRU assessment process resulted in meaningful engagement with staff and a deeper understanding of local pain management practices. Clinicians view evidence-based pain management as important, however, there are competing priorities within the emergency department, such as patient flow and triage. This study provides an exemplar of utilizing an implementation framework to identify pain practices within the emergency department. Achieving impactful change in clinical practice to improve patient outcomes should start with the application of implementation methods that enable comprehensive analysis of the local practice context. The assessment should begin with collaboration with local clinicians that persist throughout the life of the study to ensure change is sustainable. [ABSTRACT FROM AUTHOR]

• Students are not well prepared to respond to patient deterioration. • Deliberate practice and mastery of learning principles may assist in skill acquisition. • An evidence base of best practices to prepare students is needed. • A feasibility study provides information on improvements for a future randomized trial. Patient assessment underpins recognition of deterioration. Simulation is frequently used to educate about deterioration, but the optimal simulation method is unclear. This study explored the feasibility of using a deliberate practice mastery learning approach (DPML) in a future larger randomized controlled trial (RCT) patient deterioration scenario. Seventy-four nursing students. Feasibility data was collected according to Tickle-Degnen's method of assessing study processes (recruitment and retention), resources (technology), collection and management of data, and science (acceptability and results of the method of simulation). Resources to support an RCT included simulators with data collection capability, student satisfaction, and results of a significantly higher number of intervention groups who completed key behaviors. Barriers include recruitment and retention and the DPML method being unfamiliar. Improved recruitment strategies, educating and upskilling a large teaching team to deliver DPML consistently are required for a future RCT. [ABSTRACT FROM AUTHOR]

Clinical simulation is a popular method of educating undergraduate student nurses, however it is currently unknown, which specific simulation approach is the most effective at optimizing student learning in the context of the deteriorating patient. This study piloted a novel form of simulation called Rapid Cycle Intentional Simulation, to evaluate undergraduate nurses' perception and performance in recognizing and responding to clinical deterioration, compared to the standard simulation approach. A two-phased, prospective, nonequivalent control group design study was implemented, recruiting a total of 138 second year undergraduate nursing students. Simulation groups were randomly assigned to the intervention or standard simulation approaches. The simulation evaluation included observations, student satisfaction and self confidence in learning scale and student knowledge test. There were no significant differences in knowledge, perceived confidence, or satisfaction between standard and Rapid Cycle Intentional Simulation. Qualitative observer reflections suggest regular interruptions of Rapid Cycle Intentional Simulation, facilitated critical thinking and willingness to engage in feedback. Findings suggests this novel simulation approach, where the facilitator intentionally interrupts the simulation scenario to realign students through real time feedback, improved student performance, engagement, challenged learning avoidance behaviors, and increased student confidence to critique their practice. [ABSTRACT FROM AUTHOR]

This scoping review aimed to explore the interprofessional curriculum content and teaching approaches specific to wound care education in baccalaureate health courses internationally. Interprofessional education is defined as occurring when future health practitioners learn with, from and about each other with the goal of improving health outcomes. The management of wounds is a global public health issue with the World Health Organization recognising wound care is best managed by an interprofessional team. The preparedness of health professional graduates to engage in interprofessional education is essential to design and deliver coordinated health services that are person-centred and improve health outcomes. There is a lack of evidence however about how to prepare baccalaureate students in an interprofessional context, specifically in wound care. A scoping review was conducted using the framework of Arksey and O'Malley and reported using the PRISMA checklist for scoping reviews. A comprehensive search of the literature was conducted in MEDLINE (via EBSCOhost), CINAHL PLUS (via EBSCOhost), Pubmed and Embase databases published between 2012 and October 2023. Reference lists of included studies were also searched. Studies which were peer reviewed, written in English with a focus on interprofessional education in wound care were included in the review. The process of reviewing titles and abstracts was conducted by two independent reviewers. Data were extracted, key characteristics mapped and a narrative analysis of findings was reported. Three studies were included in this review. All the reviewed papers reported collaborative learning activities between different health professional groups relating to wound care, although there was no consistent approach to what wound care content was delivered or how it was delivered. Only one study reported that the delivery of content was completed by staff from multiple professional groups. Evaluation of the included studies related to either the effectiveness of the interprofessional education or wound care rather than both concepts. Due to the limited number of studies included in this review, it was difficult to draw conclusions about the effectiveness of interprofessional approaches to wound care. It may be possible that interprofessional wound care is currently being undertaken but not formally evaluated. This itself is problematic. It is imperative to equip healthcare students with the knowledge and skills necessary to provide safe, effective interprofessional care. Evidence on the effectiveness of educational programs is urgently needed. to be included in abstract after acceptance. [ABSTRACT FROM AUTHOR]

• Nursing student performance in escalating patient deterioration needs improvement. • Comprehensive assessment, environmental scan in combination with clear and timely escalation are all areas for improvement. • Repeated practice simulation has been shown to improve student response to deteriorating patient simulation. Graduate nurses are unprepared to recognize and respond to patient deterioration. Simulation involving micro-debriefing with feedback and opportunities for repeated performance can improve simulated clinical practice. A prospective quasi-experimental design evaluating two simulation approaches (Standard simulation versus Rapid Cycle Intentional Simulation) recruited 138 second year undergraduate nursing students. During simulations the intervention groups demonstrated behaviors associated with situational awareness, in context of a deteriorating patient. Conversely control groups initiated incorrect clinical actions throughout the scenario, potentially harming the simulated patient. Simulation that involves interruptions and micro-debriefings has been shown to improve student performance in deteriorating patient simulations. [ABSTRACT FROM AUTHOR]

Nurse-initiated interventions potentially provide an opportunity for earlier response for time sensitive presentations to the Emergency Department, and may improve time-to-treatment, symptomatic relief and patient flow through the department. To determine the effectiveness of nurse-initiated interventions on patient outcomes in the Emergency Department. The review followed the JBI methodology for reviews of quantitative evidence. Each study was assessed by two independent reviewers and data were extracted from included papers using standardized data extraction tools. Outcomes of interest included time-to-treatment, relief of acute symptoms, waiting times and admission rates. Twenty-six studies were included in the final review, with a total of 9144 participants. Nine were randomized control trials, 17 had a quasi-experimental design. Twelve of the studies involved pediatric patients only and 14 included adult patients only. Interventions, protocols and outcomes were heterogeneous across studies. Overall, nurse-initiated interventions were effective in reducing time-to-analgesia, time-to-treatment for acute respiratory distress as well as improved pain relief and decreased admission rates. To achieve early intervention and timely relief of acute symptoms, nurses should seek to consistently implement nurse-initiated interventions into their care of patients in the Emergency Department. Several findings are made to inform practice, however future high-quality research with locally specific strategies is required to improve certainty and quality of findings. [ABSTRACT FROM AUTHOR]

• Authentic codesigned AV simulation were positively rated for relevance and feasibility, and enhanced compassion. • Featuring nurse: Patient interactions based on a social transaction framework highlighted how individualized empathic care can be achieved. • There is further scope and appetite for modelling practices on pain assessment and management. Appropriate management of pain remains a challenging issue. Surfacing nurses' inherent assumptions about pain may lead to better pain management. This study developed and evaluated new audio-visual (AV) simulations for nursing students showcasing patient characteristics that may influence pain assessment. Descriptive pre/post intervention study informed by the STROBE framework. Participants were drawn from two Australian universities. Three AV simulations were codesigned by clinicians, educators, and health consumers. Data included: demographics, previous experiences of pain assessment; compassion scale, feasibility, and relevance of AV simulations. Quantile regression and content analyses were applied. Full data sets of 491 participants (314 from Curtin University and 177 from Queensland University of Technology) were analyzed. Cohorts were equivalent except for age, country of birth, and stage within the program of study. Participants found the AV simulations easy to understand, relevant to practice, and beneficial in prompting reflection on patients' responses to pain and nurses' critical thinking. Compassion scores increased significantly following the intervention. AV simulations triggered participants' reflection on factors that can influence pain assessment and were considered valuable learning experiences. [ABSTRACT FROM AUTHOR]

A period of re-negotiation is expected when introducing a new teaching and learning approach in a Bachelor of Nursing course. This study, underpinned by a social constructivist framework, used action research to uncover the interactions, challenges and outcomes when implementing an inquiry-based learning approach to support the development of students' clinical reasoning and capability to think like a nurse. Data collection involved non-participant observation of 32 tutorial groups (600 first-year students and 8 teachers) over the first two weeks of semester. Analysis was informed by Charmaz's social constructivist approach. The findings revealed three interconnected constructs: Opting in and out (students), Driving and reframing (teachers) and Creating and realising new understandings (both students and teachers). Introducing a new approach necessitated conscious planning and deliberate behaviour change on behalf of the teacher and student. Use of an inquiry-based learning approach which embedded clinical reasoning, investigative prompts and learning scaffolds in the form of case exemplars assisted students to 'think like a nurse'. • The teacher role in inquiry-based learning is pivotal to facilitate active learning. • Use of consistent scaffolds and frameworks enhanced students' active learning. • Digital technologies facilitate learning but may detract from engagement. [ABSTRACT FROM AUTHOR]

Promoting student engagement in a student led environment can be challenging. This article reports on the process of design, implementation and evaluation of a student led learning approach in a small group tutorial environment in a three year Bachelor of Nursing program at an Australian university. The research employed three phases of data collection. The first phase explored student perceptions of learning and engagement in tutorials. The results informed the development of a web based learning resource. Phase two centred on implementation of a community of learning approach where students were supported to lead tutorial learning with peers. The final phase constituted an evaluation of the new approach. Findings suggest that students have the capacity to lead and engage in a community of learning and to assume greater ownership and responsibility where scaffolding is provided. Nonetheless, an ongoing whole of course approach to pedagogical change would better support this form of teaching and learning innovation. [ABSTRACT FROM AUTHOR]

This scoping review aimed to explore nursing students experience as simulation observers and their level of engagement in learning through use of clinical decision-making models and learning scaffolds. A gap continues to exist between the published empirical literature, the role and experiences of the simulation observer and teaching scaffolds that enhance learning outcomes, despite the increased understanding of simulation and its role in preparing nursing students for practice. Further, little is known about the nursing student's experience of clinical reasoning whilst observing simulation and the impact of scaffolding observations using clinical decision-making models. This scoping review was conducted using the methodological framework of Arksey and O'Malley (2005) and the PRISMA checklist for systematic reviews (Page et al., 2020). A comprehensive search of the literature published in Medline and CINAHL databases between 1999 and 2020 was undertaken in May 2019. The studies selected for this review (n = 18) were analyzed thematically. The validated Mixed-Methods Appraisal Tool assessed quality of the quantitative, qualitative and mixed methods studies. The role of the observer in simulation was explored and included observation to transform practice in self and observation to transform practice in others, namely peers in the nurse role in simulation. Application of the MMAT indicated that of the 18 studies included only 6 (33.3%) had a clear research question. Research aims or objectives were found in another six studies (33.3%). In this review 13 studies (72%) included answers to the research question or aim, three (17%) did not and in two (11%) it was impossible to tell. Results of this review indicate the paucity of research relating to nursing student's experience of clinical reasoning while observing simulation. Further, it highlights the value of nurse educators optimizing the observer role and maximizing learning by scaffolding observer activities within the simulation experience. • The observer role can enhance learning outcomes in simulation. • The observer role is undervalued. • Clinical reasoning models are a valuable learning tool to maximise nursing student learning. [ABSTRACT FROM AUTHOR]

This systematic review examines the effectiveness of undergraduate nursing students' using simulation to acquire clinical reasoning. Use of simulation to positively impact practice outcomes is an established method in nursing education. Clinical reasoning is a graduate capability that contributes to safe practice, so developing clinical reasoning requires explicit scaffolding in undergraduate contexts. While research has primarily evaluated specific clinical reasoning frameworks, variability in clinical reasoning definitions has obscured simulation efficacy for clinical reasoning acquisition. This review uses the Joanna Briggs Institute Systematic Reviews approach. An electronic database search was conducted to identify studies published from May 2009 to January 2020 using a three-step search strategy. Selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction. Ten studies using quasi-experimental designs involving 1532 students were included. Evidence regarding the effectiveness of simulation for undergraduate nursing students' acquisition of clinical reasoning was limited but of high quality. Review results showed no statistically significant gains in clinical reasoning with a single simulation exposure. Two emerging concepts, situation awareness and teamwork support the enhancement of clinical reasoning within simulation. In order to draw future conclusions on the efficacy of simulation to develop clinical reasoning, more research is warranted. New insights about team-based simulations and situation awareness were identified as integral for development of clinical reasoning in the context of simulation. More consistent use of terminology in the context of simulation research is also recommended. • Simulation efficacy is obscured by imprecise definitions of clinical reasoning and inconsistent terminology in research. • Multiple simulation exposures are recommended as single exposure showed no statistically significant gains in clinical reasoning. • Focus on situation awareness and team-based simulations enhances development of clinical reasoning. • Further research is needed to draw conclusions on the efficacy of simulation for development of clinical reasoning. [ABSTRACT FROM AUTHOR]

Summary: This Husserlian phenomenological study explored the lived experience of eight full-time agency nurses working in the environment of intensive care in London, United Kingdom. In-depth interviews were used to ascertain the participants’ experiences of full-time agency nursing in intensive care. Colaizzi''s [Colaizzi P. Psychological research as the phenomenologist views it. In: Vale R, King M, editors. Existential-phenomenological alternatives for psychology. London: Oxford University Press; 1978, p. 48–71] method of data analysis was utilised. Thematic analysis identified three cluster themes: the shared experience of lacking confidence; the shared experience of deskilling; and the shared experience of feelings of isolation. The theme of the shared experience of lacking confidence identified the importance of support and understanding of agency nurses’ needs in the ICU. The theme of the shared experience of deskilling illuminated participants concern at not having the opportunity to care for patients of higher acuity. The theme of the shared experience of feelings of isolation highlighted that often participants did not feel they “belonged to a team”. Study findings suggest the need to include: the implementation of protocols within the clinical setting; the provision of performance feedback to agency nurses; and the consideration of ongoing structured professional development and education for ICU agency nurses. [Copyright &y& Elsevier]

Abstract: Background: The migration of registered nurses as a response to a global nurse shortage has seen a growth in research interest in this area. Much of the research focuses on differences in language and culture which are posed as the attributes of the immigrant nurse. Objectives: In reporting on an analysis of data drawn from China-educated nurses working in the Australian health care system, this paper explores the social construction of difference and the related intersection of difference and racialisation. Design: A symbolic interactionist approach informed 46 in-depth interviews with 28 China-educated nurses. The method of analysis was initial and focused coding and constant comparison of data. The focus of interpretation was on human action and interaction as contextual and thus structural factors were critical to the analysis. Results: Two levels of meaning were depicted in this study: difference as “you are you and I am I” and difference as “incompetence”. Negative meanings were ascribed to difference which in turn legitimised inequality and held the potential to perpetuate racism. Conclusions: We argue that it is problematic to conceptualise difference as individual attributes. Difference needs to be contextualised and thus explored as a complex and socially constructed concept that in its application has social and political implications for immigrant nurses in Australia and elsewhere. [Copyright &y& Elsevier]