scholarly journals Nursing qualifications needed in municipal emergency inpatient units. A qualitative study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bodil J. Landstad ◽  
Torstein Hole ◽  
Aasta-Marie Sveino Strand ◽  
Marit Kvangarsnes
Keyword(s):  
Emergency Care ◽  
Hospital Admissions ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Holistic Approach ◽  
Older Individuals ◽  
Complex Needs ◽  
Emergency Situations ◽  
Interprofessional Cooperation ◽  
Inpatient Units

Abstract Background Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the municipalities. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities. The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. Method A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed. Results We synthesised three themes from the data: (1) broad medical knowledge; (2) advanced clinical skills; and (3) ethical qualifications and a holistic approach. The first theme is about knowledge, the second is about skills, and the third conveys the need for overall competence. Conclusions Nurses working in municipal emergency inpatient units need advanced ethical qualifications, which integrate broad medical knowledge, advanced clinical skills and the ability to take a holistic approach. They have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Establishing arenas for collaborative practice between physicians and nurses on clinical issues may be a way of strengthening patient safety and nurses’ clinical judgement.

scholarly journals Nursing Qualifications needed in Municipal Emergency Inpatient Units. A qualitative study

2021 ◽  
Author(s):  
Bodil J. Landstad ◽  
Torstein Hole ◽  
Aasta Marie Sveino Strand ◽  
Marit Kvangarsnes
Keyword(s):  
Emergency Care ◽  
Hospital Admissions ◽  
Medical Knowledge ◽  
Clinical Judgement ◽  
Continuous Learning ◽  
Complex Needs ◽  
Treatment Management ◽  
Family Perspective ◽  
Holistic Understanding ◽  
Inpatient Units

Abstract Background: Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the districts. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities.The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed.Results: The physicians highlighted broad medical knowledge, clinical judgement, skills in treatment management and communication, a holistic understanding, and continuous learning as relevant professional qualifications for nurses in municipal emergency inpatient units. Taking a holistic approach requires ethical judgement and teamwork. Interpersonal skills and adopting a family perspective were considered important in facilitating care in municipal emergency inpatient units.Conclusions: Nurses have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Nurses should adopt a family perspective when managing patients in municipal emergency inpatient units. Nursing education should prepare students to treat patients with complex needs and chronic illnesses. This requires an emphasis on broad medical knowledge, clinical judgement, and skills in communication, treatment management and continuous learning.

scholarly journals Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

2021 ◽  
Vol 38 (5) ◽  
pp. 371-372
Author(s):  
Rich Carden ◽  
Bill Leaning ◽  
Tony Joy
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Response Unit ◽  
Care Services ◽  
Vulnerable Patients ◽  
Palliative Care Services ◽  
Alternative Solutions ◽  
Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

scholarly journals Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jennifer Mann ◽  
Fintan Thompson ◽  
Robyn McDermott ◽  
A. Esterman ◽  
Edward Strivens
Keyword(s):  
Older People ◽  
Older Persons ◽  
Hospital Admissions ◽  
Community Dwelling ◽  
Trial Registration ◽  
Significant Finding ◽  
Complex Needs ◽  
Primary Practice ◽  
The Impact ◽  
Open Arch

Abstract Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

The Mount Sinai (New York) Visiting Doctors Program: Meeting the Needs of the Urban Homebound Population

2011 ◽  
Vol 12 (4) ◽  
pp. 139-143 ◽  
Author(s):  
Katherine Ornstein ◽  
Cameron R. Hernandez ◽  
Linda V. DeCherrie ◽  
Theresa A. Soriano
Keyword(s):  
New York ◽  
Social Work ◽  
Clinical Care ◽  
Older Individuals ◽  
Social Service Agencies ◽  
Complex Needs ◽  
Home Based ◽  
Major Teaching ◽  
Mount Sinai ◽  
Physician Availability

The Mount Sinai Visiting Doctors program, a joint program of Mount Sinai Medical Center’s Departments of Medicine and Geriatrics, is a large multidisciplinary teaching, research, and clinical care initiative serving homebound adults in Manhattan since 1995. Caring for more than 1,000 patients annually, the physicians of Visiting Doctors make more than 6,000 urgent and routine visits each year, making it the largest program of its kind in the country. Services include 24–hour physician availability, palliative care, social work case management, collaboration with nursing agencies, and in-home specialty consultation. The program serves many individuals who have previously received inadequate and inconsistent medical care. Patients are referred by social service agencies, local physicians, and hospitals and are primarily frail older individuals with complex needs. Funded by Mount Sinai and private support, the program serves as a major teaching site for medical, nursing, and social work trainees interested in home-based primary care.

scholarly journals A Mobile Medical Knowledge Dissemination Platform (HeadToToe): Mixed Methods Study

10.2196/17729 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e17729 ◽  
Author(s):  
Ido Zamberg ◽  
Olivier Windisch ◽  
Thomas Agoritsas ◽  
Mathieu Nendaz ◽  
Georges Savoldelli ◽  
...  
Keyword(s):  
Medical Students ◽  
User Experience ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Postgraduate Education ◽  
Third Party ◽  
University Hospital ◽  
Knowledge Dissemination ◽  
Easy Access ◽  
The University

Background Finding readily accessible, high-quality medical references can be a challenging task. HeadToToe is a mobile platform designed to allow easy and quick access to sound, up-to-date, and validated medical knowledge and guidance. It provides easy access to essential clinical medical content in the form of documents, videos, clinical scores, and other formats for the day-to-day access and use by medical students and physicians during their pre- and postgraduate education. Objective The aim of this paper is to describe the architecture, user interface, and potential strengths and limitations of an innovative knowledge dissemination platform developed at the University of Geneva, Switzerland. We also report preliminary results from a user-experience survey and usage statistics over a selected period. Methods The dissemination platform consists of a smartphone app. Through an administration interface, content is managed by senior university and hospital staff. The app includes the following sections: (1) main section of medical guidance, organized by clinical field; (2) checklists for history-taking and clinical examination, organized by body systems; (3) laboratory section with frequently used lab values; and (4) favorites section. Each content item is programmed to be available for a given duration as defined by the content’s author. Automatic notifications signal the author when the content is about to expire, hence, promoting its timely updating and reducing the risk of using obsolete content. In the background, a third-party statistical collecting tool records anonymous utilization statistics. Results We launched the final version of the platform in March 2019, both at the Faculty of Medicine at the University of Geneva and at the University Hospital of Geneva in Switzerland. A total of 622 students at the university and 613 health professionals at the hospital downloaded the app. Two-thirds of users at both institutions had an iOS device. During the practical examination period (ie, May 2019) there was a significant increase in the number of active users (P=.003), user activity (P<.001), and daily usage time (P<.001) among medical students. In addition, there were 1086 clinical skills video views during this period compared to a total of 484 in the preceding months (ie, a 108% increase). On a 10-point Likert scale, students and physicians rated the app with mean scores of 8.2 (SD 1.9) for user experience, 8.1 (SD 2.0) for usefulness, and 8.5 (SD 1.8) for relevance of content. In parallel, postgraduate trainees viewed more than 6000 documents during the first 3 months after the implementation in the Division of Neurology at our institution. Conclusions HeadToToe is an educator-driven, mobile dissemination platform, which provides rapid and user-friendly access to up-to-date medical content and guidance. The platform was given high ratings for user experience, usefulness, and content quality and was used more often during the exam period. This suggests that the platform could be used as tool for exam preparation.

scholarly journals NOVOSTI V OBRAVNAVI PLJUČNE BOLEZNI PRI OTROCIH IN MLADOSTNIKIH S CISTIČNO FIBROZO

2015 ◽  
Vol 84 (2) ◽  
Author(s):  
Marina Praprotnik ◽  
Ana Kotnik Pirš ◽  
Barbara Salobir ◽  
Majda Oštir ◽  
Matjaž Turel ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Transplantation ◽  
Lung Disease ◽  
Respiratory Insufficiency ◽  
Clinical Skills ◽  
Holistic Approach ◽  
Patient Registries ◽  
Recent Developments ◽  
Chronic Respiratory Insufficiency ◽  
Infection And Inflammation

Cystic fibrosis (CF) is a multi-organ disease,  affecting mostly lungs and gastrointestinal tract. Data from patient registries show that the survival of patients with CF has progressively improved over the past several decades, as a result of advances in antibiotic treatment, supplementation of pancreatic enzymes, better nutrition and a holistic approach to treatment in CF centres.The purpose of this review is to survey recent developments in the treatment of lung disease  in children and adolescents with CF.We describe newborn screening for CF.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue.Lung disease is the most common cause of morbidity and mortality in CF patients. Emerging new therapies are targeted at all points in the pathogenesis of lung disease, from drugs that treat infection and inflammation in the airways to gene transfer studies  and to drugs that augment airway surface liquid height. A number of antibacterial agents formulated for inhalation are at various stages of study and there are several anti-inflammatory candidate drugs in  clinical trials.  The most important development  in the recent years is  modulation of the abnormal protein that causes CF, the cystic fibrosis transmembrane regulator (CFTR), where drugs are targeted at specific defects in the transcription, processing or functioning.When chronic respiratory insufficiency occurs, lung transplantation becomes a very important issue. The role of the CF nurse, who has responsibilities in educating and teaching clinical skills to patients and families, is described.

scholarly journals Unmet goals of neonatal nursing - an observational study

2020 ◽  
Vol 7 (9) ◽  
pp. 1901
Author(s):  
Saikiran Deshabhotla ◽  
Sonnathi Sandeep ◽  
Baswaraj Tandur
Keyword(s):  
Intensive Care ◽  
Urban Areas ◽  
Neonatal Intensive Care ◽  
Clinical Skills ◽  
Neonatal Resuscitation ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Emergency Situations ◽  
Neonatal Nursing ◽  
Level 2

Background: Neonatal nurses are the backbone of any neonatal service, spending maximum time in the care of the sick New-borns in the Neonatal intensive care unit (NICU). Objective of the study was to know about the educational qualification and assess the self-reported confidence in various clinical skills among the nurses working in level 2 & 3 NICUs, preferred learning methodology and assess self-reported stressors among the nurses working in level 2 and level 3 NICUsMethods: This cross-sectional study was done across Level II and Level III Neonatal intensive care units in urban areas of the city of Hyderabad, India over one year from January 2019 to December 2019. Individual questionnaires were distributed to each registered nurse working in the NICU for a minimum duration of six months who were willing to participate.Results: A total of 217 respondents were enrolled. The majority of the nurses were having General Nursing and Midwifery (GNM) qualification 52% (n=112). Nearly 26% (n=58) of the nurses were not comfortable performing bag and mask ventilation. Learning from senior nurses/colleagues as the most preferred mode of learning 45% (n=98). Low salaries 45% (n=98) followed by absence of doctors in emergency situations 37% (n=81) and high documentation (paperwork) 36% (n=78) were most frequently reported stressors.Conclusions: Most of the nursing participants qualified as GNM. Lacking skills of neonatal resuscitation. Mentor based learning needs to be facilitated by raising a cadre of neonatal nursing tutors in various nursing colleges. Paperless monitoring systems and other automation methods should be developed to reduce the documentation work of the staff. 

Osteomyelitis, diabetic foot ulcers and the role of the community nurse

2021 ◽  
Vol 26 (Sup6) ◽  
pp. S6-S9
Author(s):  
Melanie Lumbers
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Holistic Approach ◽  
Diabetic Patients ◽  
Positive Outcomes ◽  
Community Nurse ◽  
Complex Needs ◽  
Health And Wellbeing

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

Flipping the Medical School Classroom

2018 ◽  
pp. 5800-5809
Author(s):  
Kristina Kaljo ◽  
Laura Jacques
Keyword(s):  
Medical Education ◽  
Medical Student ◽  
Medical Students ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Hybrid Learning ◽  
Teaching Methodologies ◽  
Face To Face ◽  
Content Acquisition ◽  
Hybrid Learning Environment

The preparation of today's physicians is a tremendous responsibility. For medical students to be successful, they must experience a multitude of opportunities to develop appropriate clinical skills, problem solving acumen, and medical knowledge. Due to various barriers, medical students may develop gaps in critical and foundational knowledge. The use of flipped lectures has the capacity to “mobilize” education and ensure for versatility and improved content acquisition through the implementation of both online and face-to-face teaching methodologies. This hybrid learning environment has the capacity to also address the increasingly diverse needs of today's matriculating medical student. This article identifies tools and strategies of how to incorporate flipped lectures into medical education.

scholarly journals The “Zing Factor”—How Do Faculty Describe the Best Pediatrics Residents?

2014 ◽  
Vol 6 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Glenn Rosenbluth ◽  
Bridget O'Brien ◽  
Emily M. Asher ◽  
Christine S. Cho
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Knowledge Integration ◽  
Clinical Skills ◽  
Medical Knowledge ◽  
Residency Programs ◽  
Graduate Medical ◽  
Trained Interviewer ◽  
And Behaviors ◽  
Assessment Strategies

Abstract Background Faculty in graduate medical education programs may not have uniform approaches to differentiating the quality of residents, and reviews of evaluations suggest that faculty use different standards when assessing residents. Standards for assessing residents also do not consistently map to items on evaluation forms. One way to improve assessment is to reach consensus on the traits and behaviors that are (or should be) present in the best residents. Methods A trained interviewer conducted semistructured interviews with faculty affiliated with 2 pediatrics residency programs until content saturation was achieved. Interviewees were asked to describe specific traits present in residents they identify as the best. Interviews were recorded and transcribed. We used an iterative, inductive approach to generate a coding scheme and identify common themes. Results From 23 interviews, we identified 7 thematic categories of traits and behaviors: personality, energy, professionalism, team behaviors, self-improvement behaviors, patient-interaction behaviors, and medical knowledge and clinical skills (including a subcategory, knowledge integration). Most faculty interviewees focused on traits like passion, enthusiasm, maturity, and reliability. Examination score or intelligence was mentioned less frequently than traits and behaviors categorized under personality and professionalism. Conclusions Faculty identified many traits and behaviors in the residents they define as the best. The thematic categories had incomplete overlap with Accreditation Council for Graduate Medical Education (ACGME) and CanMEDS competencies. This research highlights the ongoing need to review our assessment strategies, and may have implications for the ACGME Milestone Project.

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