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Background Current team assessment instruments in healthcare tend to involve rater-based evaluations that are susceptible to well-known biases. Recent advances in technology include portable devices to measure team-based activities. Consequently, the possibility exists to move away from rater-based assessments of team function by identifying quantitative measures to replace them. Aim This article aims to provide potential approaches to developing quantitative measurement suites involving large amounts of data to address the challenges of assessment presented by the complex nature of teamwork. Conclusion By addressing construct, measurement, and context components, we provide a practical approach to developing a suite to capture quantitative measurements that, through incorporation of social network analysis and aggregated other values, aligns with the Team Strategies & Tools to Enhance Performance and Patient SafetyTM (TeamSTEPPSTM) dimensions for fostering teamwork.

Background Team debriefing is an important teamwork development intervention for improving team outputs in healthcare. Debriefing is a key component of experiential team training teamwork development interventions such as simulation-based training. Improving the quality of debriefing of healthcare teams, therefore, has multiple benefits. We investigated whether the quality of student-led debriefing improved using a shortened guide. Methods Senior medical students, nurse anesthesia students, and senior undergraduate nursing students participated in student operating room team training at a health sciences center in the southeastern United States. Student teams participated in a dual-scenario simulation-based training session with immediate after-action debriefings after each scenario. In 2018, student teams conducted the second debriefing using as a guide the teamwork assessment scale, an 11-item, 3-subscale, 6-point Likert-type instrument. In 2019, they used a shortened, revised, 5-item version of the teamwork assessment scale, the quick teamwork assessment scale. Trained observers rated the quality of the student-led debriefings using the Objective Structured Assessment of Debriefing, an 8-item, 5-point instrument. The Wilcoxon-Mann-Whitney test was used to compare the teamwork assessment scale-guided and the quick teamwork assessment scale-guided mean item debriefing scores. Results Two observers rated 3 student-led team debriefings using the teamwork assessment scales as a guide in 2018, and 6 such debriefings happened using the quick teamwork assessment scale as a guide in 2019. For each debriefing, observer scores were averaged for each Objective Structured Assessment of Debriefing item; these mean scores were then averaged with other mean scores for each year. The use of the quick teamwork assessment scale resulted in a statistically significant higher mean score for the Analysis Objective Structured Assessment of Debriefing item compared with the use of the teamwork assessment scale (4.92 [standard deviation 0.20] versus 3.83 [standard deviation 0.76], P = .023). Conclusion The use of a shortened teamwork assessment instrument as a debriefing guide for student teams in student operating room team training was more effective in analysis of actions than the original, longer tool. Next steps include determining the efficacy of the quick teamwork assessment scale in an actual clinical setting.

We investigated the impact of a health sciences centre-wide, high-fidelity, simulation-based interprofessional team training program on participants’ knowledge, skills and attitudes towards teams and teamwork. Senior medical, nurse anaesthesia and allied health profession students participated in dual-scenario, simulation-based, interprofessional team training sessions with immediate debriefings about team-based competencies (2015–2017). Pre- and post-intervention, students completed the Interprofessional Teamwork (IPT) questionnaire and the Readiness for Interprofessional Learning Scale (RIPLS). Observers and students rated team performance using the Teamwork Assessment Scales (TAS). Descriptive statistics were determined for IPT and RIPLS items and TAS subscales; student Students from five health professions participated ( A health sciences centre-wide high-fidelity, simulation-based, interprofessional team training program improves students’ team-based behaviours, teamwork attitudes and interprofessional learning attitudes. Widespread adoption of such large-scale team training programs has the potential to improve teamwork among healthcare providers over time.

Effective teamwork remains a crucial component in providing high-quality care to patients in today’s complex healthcare environment. A prevalent ‘us’ versus ‘them’ mentality among professions, however, impedes reliable team function in the clinical setting. More importantly, its corrosive influence extends to health professional students who model the ineffective behaviour as they learn from practicing clinicians. Simulation-based training (SBT) of health professional students in team-based competencies recognized to improve performance could potentially mitigate such negative influences. This quasi-experimental prospective study will evaluate the effectiveness and impact of incorporating a multi-year, health science centre-wide SBT curriculum for interprofessional student teams. It targets health professional students from the Schools of Medicine, Nursing and Allied Health at Louisiana State University (LSU) Health New Orleans. The intervention will teach interprofessional student teams key team-based competencies for highly reliable team behaviour using SBT. The study will use the Kirkpatrick framework to evaluate training effectiveness. Primary outcomes will focus on the impact of the training on immediate improvements in team-based skills and attitudes (Level 2). Secondary outcomes include students’ perception of the SBT (Level 1), its immediate impact on attitudes towards interprofessional education (Level 2) and its impact on team-based attitudes over time (Level 3). The Institutional Review Board at LSU Health New Orleans approved this research as part of an exempt protocol with a waiver of documentation of informed consent due to its educational nature. The research description for participants provides information on the nature of the project, privacy, dissemination of results and opting out of the research.

Objectives To determine whether high fidelity simulation-based training (SBT) of interprofessional teams involving trauma transfers has an immediate impact on participants’ team-based attitudes and behaviors. Design A quasi-experimental, pre-/postintervention comparison design examined high fidelity SBT of inter-professional teams using a 2 scenario format with immediate after action structured debriefing. Pre-/postsession Readiness for Inter-Professional Learning Scale (RIPLS, 19 items, Likert-type) surveys as well as Interprofessional Teamwork (IPT, 15 items, Likert-type) questionnaires, and postscenario participant- and observer-rated Teamwork Assessment Scales (TAS, 3 subscales, 11 items, Likert-type) were completed during each training session. Mean RIPLS, IPT, and TAS scores were calculated and matched pre-/postscore differences compared using paired t-test or analysis of variance with Bonferroni adjustment. Setting A large, urban, academic, state health sciences institution in the Southeastern United States during the 2014 to 2015 academic year. Participants General surgery residents, emergency medicine residents, and senior undergraduate nursing students comprising ten interprofessional teams. Results From approximately 48 participants, matched pre-/postsession IPT surveys were available for 42 individuals; 45 had an observer TAS evaluation for both scenarios; and 40 completed TAS peer evaluations for both scenarios. 47 participants had matched RIPLS surveys. Statistically significant improvements in matched pre-/postscore differences occurred for all 15 IPT items. Observer TAS scores significantly improved on 2 of the 3 subscales comparing the second to the first scenario. Peer evaluations statistically improved comparing the second to the first scenario. Two of the 19 RIPLS items demonstrated statistically significant improvement. Conclusions Interprofessional trauma team transfer training using SBT changes attitudes toward key team-based competencies and leads to learning them in the simulated environment. Such improvement in team-based skill and attitudes is an important first step in adopting team-based behaviors in the actual clinical environment and improving transfer care.

BackgroundThe evidence for the conventional wisdom that debriefing quality determines the effectiveness of learning in simulation-based training is lacking. We investigated whether the quality of debriefing in using simulation-based training in team training correlated with the degree of learning of participants.MethodsForty-two teams of medical and undergraduate nursing students participated in simulation-based training sessions using a two-scenario format with after-action debriefing. Observers rated team performance with an 11-item Teamwork Assessment Scales (TAS) instrument (three subscales, team-based behaviours (5-items), shared mental model (3-items), adaptive communication and response (3-items)). Two independent, blinded raters evaluated video-recorded facilitator team prebriefs and debriefs using the Objective Structured Assessment of Debriefing (OSAD) 8-item tool. Descriptive statistics were calculated, t-test comparisons made and multiple linear regression and univariate analysis used to compare OSAD item scores and changes in TAS scores.ResultsStatistically significant improvements in all three TAS subscales occurred from scenario 1 to 2. Seven faculty teams taught learners with all scores ≥3.0 (except two) for prebriefs and all scores ≥3.5 (except one) for debriefs (OSAD rating 1=done poorly to 5=done well). Linear regression analysis revealed a single statistically significant correlation between debrief engagement and adaptive communication and response score without significance on univariate analysis.ConclusionsQuality of debriefing does not seem to increase the degree of learning in interprofessional education using simulation-based training of prelicensure student teams. Such a finding may be due to the relatively high quality of the prebrief and debrief of the faculty teams involved in the training.

BACKGROUND: Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently. AIM: We aimed to determine commonalities in defined measurements among existing OR NTS tools. METHODS: We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects: teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selected describing specific instruments. Three reviewers then identified the common components measured among these assessment tools. Reviewers collated kin constructs within each instrument using frequency counts of similarly termed and conceptualized components. RESULTS: The initial PubMed search produced 119 articles of which 24 articles satisfied the inclusion criteria. Within these articles, 10 assessment tools evaluated OR NTS. Kin constructs were grouped into six NTS categories in the following decreasing frequency order: communication, situation awareness, teamwork, leadership, decision making, and task management/decision making (equal). CONCLUSION: NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.

Objective The objective of this review was to evaluate the effects of preoperative intrathecal morphine (ITM) in addition to patient-controlled analgesia with morphine (PCAM) versus PCAM without preoperative ITM on total morphine dose in the first 24 hours postoperatively in adult patients undergoing abdominal or thoracic surgery. Introduction Postoperative pain is a significant problem for patients undergoing major abdominal and thoracic surgery. Intrathecal morphine can reduce postoperative pain and reduce intravenous (IV) morphine requirements during the first 24 hours after surgery; however, the amount of IV morphine dose reduction achieved has not been well established. This knowledge could help anesthesia providers determine if ITM is an appropriate analgesic option for patients. Inclusion criteria This review included studies with participants 18 years of age or older receiving general anesthesia for abdominal or thoracic surgery. Studies were included that used the intervention of preoperative ITM in addition to PCAM versus PCAM without preoperative ITM. Total morphine dose in milligrams during the first 24 hours after surgery was the outcome of interest. Methods A search of PubMed and CINAHL was conducted for studies published between January 1984 and October 2018 using the key terms intrathecal, morphine, postoperative, pain, patient-controlled analgesia and general anesthesia. Index terms and keywords from identified articles were used to search CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, Ovid MEDLINE, ProQuest Dissertations and Theses/Nursing and Allied Health Databases, and Scopus. The reference lists of articles that underwent critical appraisal were searched for additional studies. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. Two independent reviewers assessed each selected article. Study results were pooled in statistical meta-analysis using the JBI System for the Unified Management, Assessment and Review of Information, and two studies were described in narrative form. Differences in IV morphine dose between the ITM plus PCAM and PCAM alone groups were calculated to produce the weighted mean difference (WMD) utilizing a 95% confidence interval (CI). Heterogeneity was assessed using χ and I values. Subgroup analysis was conducted on two studies that included IV non-opioid analgesia in addition to ITM and PCAM for postoperative analgesia. Results Seven RCTs with a total sample size of 352 patients were included in this review. Five studies that evaluated postoperative total morphine dose in milligrams with and without preoperative ITM were included for statistical meta-analysis, with 277 participants from four countries. Total morphine dose was significantly reduced in patients who received ITM (WMD = -24.44 mg, 95% CI -28.70 to -20.18 mg) compared to PCAM without ITM. Subgroup analysis of two studies involving 112 participants using IV acetaminophen in addition to ITM and PCAM indicated no additional benefit after ITM was already administered (WMD = -25.93, 95% CI -32.05 to -19.80 mg). Two studies with 75 participants were described narratively because total morphine dose was reported as median rather than mean values. Conclusions In this review, ITM provided a significant decrease in overall total morphine dose during the first 24 hours after surgery in abdominal surgery patients. The addition of IV non-opioids to the postoperative analgesia protocol showed no additional reduction in postoperative IV morphine dose between groups. Systematic review registration number PROSPERO CRD42018100613.

REVIEW QUESTION/OBJECTIVE The purpose of this systematic review is to describe the effect of preoperative intrathecal morphine (ITM) on postoperative intravenous (IV) morphine dosage during the first postoperative day. This systematic review will compare the postoperative IV morphine dosage of patients receiving ITM plus morphine morphine-based patient-controlled analgesia (PCA), to patients receiving PCA morphine without ITM. This will establish the magnitude of the postoperative morphine sparing effect of ITM.This review aims to answer the following specific question: In adult abdominal and thoracic surgery patients undergoing general anesthesia (GA), what is the effect of ITM plus PCA morphine, compared to PCA morphine alone, on total IV morphine dosage (in milligrams) during the first 24 hours after surgery?

Educação interprofissional baseada em simulação

Advances in healthcare have enabled clinicians to help increasingly sicker patients recover from illness and disease. As a result, the timely identification and treatment of critically ill individuals by specialized interprofessional teams within acute care hospitals and settings is now an essential feature of care. From rapid response teams intervening in the treatment of a deteriorating patient before the development of cardiopulmonary arrest to trauma teams treating accident and assault victims with serious physiologic disturbances, these interprofessional teams must function as cohesive units in order to adapt to the dynamic changes seen in these dire situations. Simulation-based training (SBT) is an ideal modality for honing the team interactions and function of such specialized interprofessional squads. This chapter will examine the role of interprofessional SBT in preparing healthcare providers in their treatment of critically ill patients and for mass casualty situations. In doing so, it will briefly discuss key interprofessional competencies needed by modern healthcare acute care teams. It will then review applications of interprofessional SBT currently used in such settings. It will close with a discussion of potential obstacles to conducting such training and strategies to overcome them.

Introduction Effective teamwork is critical for the delivery of safe, quality care of the surgical patient. Current surgical team members, however, often foster professional tribalism1 and a silo mentality2, impeding team interaction. Although several educational strategies, such as simulation-based training (SBT), can help improve surgical team function, their effectiveness requires a means to measure the team performance accurately, efficiently, and quickly, especially in the busy clinical environment. In order to enhance ease-of-use, we revised the Teamwork Assessment Scale (TAS), an 11-item instrument used to evaluate individual- and team-based performance containing three subscales: team-based behaviors (TBB, five items), shared mental model (SMM, three items), and adaptive communication and response (ACR, three items).3 Methods Refinement of the TAS occurred in three phases: 1) factor analysis of its three subscales using data from prior SBT sessions of inter-professional students; 2) a comprehensive literature review of recently published surgical team assessment tools; and 3) qualitative analysis of focus group interviews of practicing surgical team members. Revision and consolidation of the TAS using data from all three phases of analysis then occurred to improve ease-of-use without loss of scope. Results Upon completion of all three phases of analysis, the revision of the 11-item TAS resulted in the creation of a 5-item instrument, known as the Quick TAS (QTAS). The TBB subscale decreased from six to two items; the SMM decreased from three items to one item, and the ACR decreased from three to two items. This consolidation improved efficiency of completing the instrument. Conclusions We successfully consolidated the 11-item TAS into a 5-item QTAS that, due to its decreased number of items, will enhance its ease-of-use, especially in a busy clinical environment. Next steps include piloting its use in SBT in order to demonstrate its validity and reliability for targeted populations. This work was supported through a Southern Group on Educational Affairs (SGEA) Medical Education Scholarship, Research and Evaluation (MESRE) Grant. References Gillespie BM, Chaboyer W, Wallis M, Fenwick C. Why isn’t ‘time out’ being implemented? An exploratory study. Qual Saf Health Care 2010;19:103–106. Bleakley A. You are who I say you are: the rhetorical construction of identity in the operating theatre. J Workplace Learning 2006;18(7–8):414–425. Paige JT, Garbee DD, Kozmenko V, Yu Q, Kozmenko L, Yang T, Bonanno L, Swartz W. Getting a head start: high fidelity, simulation-based operating room team training of inter-professional students. J Am Coll Surg. 2014 18(1):140–9.

Interprofessional education (IPE) has become an important component of health professions curricula due to evidence that interprofessional collaborative practice improves health outcomes for patients. To increase opportunities for IPE for learners in our institutions, an IPE elective was developed for students in the schools within Louisiana State University Health Sciences Center and Xavier University College of Pharmacy in New Orleans, Louisiana. The IDEA framework, a published framework for IPE curriculum development, was utilized to design learning activities. To assess the effect of using the IDEA framework to target the Interprofessional Education Collaborative (IPEC) competency related to roles and responsibilities, the Readiness for Interprofessional Learning Scale (RIPLS) was administered to students before and after the course. Comparison of the results showed a significant positive difference on items within the roles and responsibilities subscale after participating in the course. Developing the curriculum using the IDEA framework likely contributed to this effect by intentionally providing ample time for interaction and designing learning activities aimed at helping students recognize one another's roles and contributions to health care.

High-fidelity simulation-based training is used increasingly for prelicensure student teams. Such sessions rely on faculty who are able to provide quality prebriefing and debriefing to foster learning among participants. We investigated how well faculty conducted prebriefing and debriefing as part of high-fidelity simulation-based training for interprofessional education.Two trained observers independently rated 38 video-recorded sessions of combinations of 4 faculty conducting prebriefings and debriefings of prelicensure student teams after high-fidelity simulation-based training. Assessment was undertaken using the Objective Structured Assessment of Debriefing, an 8-item tool using a 5-point Likert scale (1 as minimum and 5 as maximum). Mean scores for each item were calculated. Inter-rater agreement was determined using Cohen's kappa. A one-way between-subjects analysis of variance with post-hoc Tukey's studentized range procedure was conducted to compare the effect of team facilitator grouping on the quality of team performance of each Objective Structured Assessment of Debriefing element during a prebriefing or a debriefing. Trend analyses of teams with 4 or more observations were performed using Kendall's Tau coefficient test and linear regression analyses to identify whether teams showed improvement through time. Statistical significance was set at P.05.A total of 7 combinations of faculty conducted between 1 to 14 prebriefings or debriefings. In general, faculty combinations performed better during debriefings compared with prebriefings, with only 1 team having 1 mean item score3.50. Statistically significant differences between faculty combinations in mean item scores was more pronounced during the prebriefings (2 of 3 Objective Structured Assessment of Debriefing items rated) than during debriefings (1 of 8 Objective Structured Assessment of Debriefing items rated). Effect sizes were strong for all differences. Linear regression analysis revealed a statistically significant change through time for the 3 rated prebriefing items and for 7 of the 8 rated debriefing items.Interprofessional faculty combinations in this study tended to have good quality prebriefings and debriefings. The quality of the prebriefings and debriefings can, however, be influenced by the composition of the facilitator teams, most prominently for prebriefings, and team performance does appear to change through time, especially during the debriefing. Future work will focus on whether the quality of prebriefings and debriefings influences learning by trainees.

High-fidelity simulation (HFS) operating room (OR) inter-professional team training improves healthcare students' team-based attitudes and behaviours. Such improvements can diminish tribalism among the professions in the OR by overcoming entrenched perceptions of team members. We investigated whether simulation-based interprofessional student OR team training impacts students differently based on their professional background. From 2010 to 2013, HFS OR interprofessional student team training sessions were conducted involving senior medical students, senior undergraduate nursing students, and nurse anaesthesia students. The training involved a two-scenario format, each followed by a structured debriefing focusing on team-based competencies. Before and after each session, students completed a 15-item teamwork competencies self-efficacy survey as well as, from 2012-2013, the Readiness for Interprofessional Learning Scale (RIPLS). At the end of each session, they also completed a 6-item rating scale assessing overall team function during the session. Mean scores were calculated for each student professional group, post/pre mean differences were determined, and student t-test and ANOVA analyses were employed to compare within and between-group differences, respectively. Response rates were over 80% for each scale used. Medical students and undergraduate nursing students had significant improvements in team-based attitudes post- to pre-session. Medical students and nurse anaesthesia students had significant improvements in RIPLS scores. Statistically significant improvements from post- to pre-session were seen overall for both team-based attitudes (effect size = 0.83) and RIPLS (effect size = 0.37). The difference between the team-based scores between professions was significant; RIPLS differences were not. No significant difference existed between professions related to overall teamwork scores. HFS OR team training of healthcare students has beneficial but variable benefits for each professional group.

ObjectiveIn surgery, dysfunctional teamwork is perpetuated by a ‘silo’ mentality modelled by students. Interprofessional education using high-fidelity simulation-based training (SBT) may counteract such modelling. We sought to determine whether SBT of interprofessional student teams (1) changes long-term teamwork attitudes and (2) is an effective form of team training.DesignA quasiexperimental, pre/postintervention comparison design was employed at an academic health sciences institution. High-fidelity simulation-based training of 42 interprofessional teams of third year surgery clerkship medical students and senior undergraduate nursing students was undertaken using a two-scenario format with immediate after action debriefing. Pre/postintervention TeamSTEPPS Teamwork Attitudes questionnaires (5 subscales, 30 items, Likert type) were given to the medical student and undergraduate nursing student classes. Pre/postsession Readiness for Inter-Professional Learning (RIPL; 19 items, Likert type) surveys and postscenario participant-rated and observer-rated Teamwork Assessment Scales (3 subscales, 11 items, Likert type) were given during each training session. Mean TeamSTEPPS Teamwork Attitudes Questionnaire, RIPL and Teamwork Assessment Scales scores were calculated; matched pre/postscore differences and trained versus non-trained TeamSTEPPS Teamwork Attitudes Questionnaire scores were compared using paired t-test or analysis of variance.ResultsBoth student groups had 10 significantly improved RIPL items as well as TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) mutual support subscales. Medical students had a significantly improved TTAQ team structure subscale. Over a simulation-based training session, each observer-rated Teamwork Assessment Scales subscale and two self-rated Teamwork Assessment Scales subscales significantly improved. Trained students had significantly higher TTAQ team structure subscales than non-trained students.ConclusionsInterprofessional education using high-fidelity simulation-based training of students is effective at teaching teamwork, changing interprofessional attitudes and improving long-term teamwork attitudes.

Fungal infections are rare compared with bacterial infections, but they are on the increase in critical care units. Diagnosis can be difficult, resulting in increased mortality. Immunocompromised patients are at higher risk for fungal infections, including organ transplant, oncology, and HIV/AIDS patients. Fatigue and fever are common symptoms that require critical care nurses to remain vigilant in assessment to identify at-risk patients and promote use of timely cultures and appropriate treatments for fungal infections. Critical care nurses can contribute to decreasing risk for fungal infections by controlling glucose levels, decreasing the use of invasive lines, and preventing unnecessary antibiotic use.

Simulation-based training (SBT) is a powerful educational tool permitting the acquisition of surgical knowledge, skills, and attitudes at both the individual- and team-based level in a safe, nonthreatening learning environment at no risk to a patient. Interprofessional education (IPE), in which participants from 2 or more health or social care professions learn interactively, can help improve patient care through the promotion of efficient coordination, dissemination of advances in care across specialties and professions, and optimization of individual- and team-based function. Nonetheless, conducting SBT IPE sessions poses several tactical and strategic challenges that must be effectively overcome to reap IPE's benefits.

A growing body of evidence indicates interprofessional collaborative practice improves patient care. With this in mind, Louisiana State University Health Sciences Center formally committed to expanding interprofessional education (IPE) initiatives. Thirty-eight self-selected students enrolled in an IPE elective course during the fall of 2012. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-course and also completed a post-course survey. Results indicated a significant change in the roles and responsibilities scale of the RIPLS. Analysis of the data from the post-course survey demonstrated students were able to identify key terms of an IPE definition, as related to their learning experience. In addition, themes of communication, learning/increased knowledge, and collaboration/contribution of other health care professionals were noted across all questions in the post-course survey. Based on the results of this study, an elective course is a promising educational opportunity to increase awareness and knowledge of IPE within academic medical centers.

Perioperative nurses strive to provide a positive surgical environment and, thus, a positive surgical experience for all patients. Blending traditional medicine with complementary therapies is one way to accomplish this task. This article presents a brief review of literature about traditional and complementary interventions used successfully in health care settings, along with a case study illustrating how one facility integrated these therapies into surgical patient care. The facility's goal was to increase patient satisfaction and create a positive surgical experience. AORN J 74 (Sept 2001) 333–337.

Phacoemulsification procedures with topical anesthesia, performed with small corneal incisions and 4% lidocaine hydrochloride methylparaben-free eye drops, have very high patient satisfaction rates because patients do not experience intraoperative pain, do not require sutures or eye patches, and have immediate improvements in their vision. Phacoemulsification procedures with topical anesthesia are cost-effective for surgery departments because patients have shorter hospitalizations and require fewer chargeable items. The perioperative nursing role is essential to the success of phacoemulsification procedures with topical anesthesia.

AIM The purpose of this study was to evaluate the efficacy of using crisis resource management (CRM) principles and high-fidelity human patient simulation (HFHPS) for interprofessional (IP) team training of students from undergraduate nursing, nurse anesthesia, medical, and respiratory therapy. BACKGROUND IP education using simulation-based training has the potential to transform education by improving teamwork and communication and breaking down silos in education. METHOD This one-year study used a quasi-experimental design to evaluate students' acquisition and retention of teamwork and communication skills. A convenience sample consisted of 52 students in the fall semester, with 40 students returning in the spring. RESULTS Mean scores increased after training, and skills were retained fairly well. Any loss was regained with repeat training in the spring. CONCLUSION The results suggest that using CRM and HFHPS is an effective pedagogy for teaching communication and teamwork skills to IP student ...

Background Effective teamwork in the operating room (OR) is often undermined by the "silo mentality" of the differing professions. Such thinking is formed early in one's professional experience and is fostered by undergraduate medical and nursing curricula lacking interprofessional education. We investigated the immediate impact of conducting interprofessional student OR team training using high-fidelity simulation (HFS) on students' team-related attitudes and behaviors. Study Design Ten HFS OR interprofessional student team training sessions were conducted involving 2 standardized HFS scenarios, each of which was followed by a structured debriefing that targeted team-based competencies. Pre- and post-session mean scores were calculated and analyzed for 15 Likert-type items measuring self-efficacy in teamwork competencies using the t -test. Additionally, mean scores of observer ratings of team performance after each scenario and participant ratings after the second scenario for an 11-item Likert-type teamwork scale were calculated and analyzed using one-way ANOVA and t -test. Results Eighteen nursing students, 20 nurse anesthetist students, and 28 medical students participated in the training. Statistically significant gains from mean pre- to post-training scores occurred on 11 of the 15 self-efficacy items. Statistically significant gains in mean observer performance scores were present on all 3 subscales of the teamwork scale from the first scenario to the second. A statistically significant difference was found in comparisons of mean observer scores with mean participant scores for the team-based behaviors subscale. Conclusions High-fidelity simulation OR interprofessional student team training improves students' team-based attitudes and behaviors. Students tend to overestimate their team-based behaviors.

Background: Effective teamwork and communication among healthcare professionals are essential to ensure quality patient care and safety. The use of high-fidelity human patient simulation scenarios enhances learning and has been used in various health professions education. The purpose of this study was to evaluate the efficacy and retention of teaching team-based competencies to interprofessional student teams using high-fidelity simulation. Methods: Quasi-experimental, pre/post-test design was used. The study was a teaching intervention using high-fidelity human patient simulation with crisis resource management techniques to teach team based competencies. A convenience sample of students from medicine, nurse anesthesia, undergraduate nursing, and physical therapy participated. There were pre/post data collected for fall and spring simulations from both participants and observers. Key variables were the various teamwork competencies. Participants and trained observers rated teamwork behaviors, each using two measures. Mean scores on participant and observer rated tools were compared using paired samples t -tests. Results: A total of 35 students underwent training in the fall of 2009 and 25 of the students returned in the spring of 2010 for repeat training. Participant paired samples t -tests showed a significant increase from simulation scenario one to two ( p < .05) in both the fall and spring. Observer data showed significant improvements in mean scores on one measure. Conclusions: High-fidelity simulation appears to improve both perceived and actual team-based competencies with retention over time. Findings support the benefit to students of repeat training in a six month period and provide some validation for faculty time and effort in repeated simulations.

The current nursing faculty shortage makes understanding intent to stay in academia a step toward slowing the exodus of faculty. The purpose of this study was to discover a parsimonious set of predictor variables from the variables of job satisfaction, mentoring, organizational commitment, and leadership behaviors for intent to stay in nursing education. A random cluster sample consisted of 39 schools of nursing in states within the Southern Regional Education Board (SREB). There were 316 responses from 782 potential participants for a response rate of 40.4%. Stepwise multiple regression results indicated that organizational commitment explained 19.7% of the variance in intent to stay one year and 21.2% of the variance in intent to stay five years. Further, mentored faculty scored significantly higher on organizational commitment. Intent to stay three years was not significantly correlated to any predictor variables suggesting it is a time to intervene to influence decisions to stay.