The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan

Background Shared decision-making (SDM) is significantly associated with promoting the quality of end-of-life (EOL). The attitude of nurses toward the end of life can affect EOL care, but there are few SDM-related clinical learning programs focused on EOL. In this study, therefore, we evaluated the effectiveness of an EOL-simulation education program on attitudes toward SDM among nurses, using an objective structured clinical examination (OSCE). Methods We used a quasi-experimental study design to evaluate nurses working at a medical center in Taiwan. We recruited 100 nurses and assigned them to an experimental group (n = 50) and a control group (n = 50). The experimental group received the SDM attitude (SDMA) cultivation program, and the control group did not. After the intervention, all participants were examined in an OSCE to assess the efficacy of their learning. A p value of.05 was considered statistically significant. Results The average score of the experimental group was higher than that of the control group in the dimensions “empathic communication” and “mastery learning”, but these differences were not significant. SDMA score is significantly and positively correlated with SDMA global score, standardized patient survey (SPS) score, and SPS global score (r = .92, .56, and .50, respectively; p < .01). Conclusions Simulations concerning EOL care that incorporate SDM components would be effective for training clinical nurses. This study can serve as a reference for nursing-administration managers who may consider designing SDM-related education programs to improve the quality of clinical nursing care.

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Optimizing patient adherence to stroke rehabilitation: A mixed method telerehabilitation trial (Preprint)

10.2196/preprints.32134 ◽

2021 ◽

Author(s):

Isabelle Gaboury ◽

Michel Tousignant ◽

Hélène Corriveau ◽

Matthew Menear ◽

Guylaine Le Dorze ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Stroke Rehabilitation ◽

Patient Adherence ◽

Interprofessional Collaboration ◽

Interdisciplinary Collaboration ◽

Control Group ◽

Shared Decision ◽

The Impact

BACKGROUND Strong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. OBJECTIVE Objective: The aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration to normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration to normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured on clinicians. METHODS In this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will entail 220 patients to receive stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation) versus face-to-face, standard of care (n = 110 patients). RESULTS Results: Our Research Ethics Board has approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. CONCLUSIONS This study will contribute to minimize both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practices guidelines regarding telecare services and the provision of telerehabilitation, including recommendations regarding effective interdisciplinary collaboration regarding stroke rehabilitation. CLINICALTRIAL ClinicalTrials.gov NCT04440215

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Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—results of the cluster-randomised controlled DEBATE trial

BMC Family Practice ◽

10.1186/s12875-021-01436-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Anja Wollny ◽

Christin Löffler ◽

Eva Drewelow ◽

Attila Altiner ◽

Christian Helbig ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Decision Making ◽

Type 2 Diabetes Mellitus ◽

Shared Decision Making ◽

Intervention Group ◽

Control Group ◽

Shared Decision ◽

Patient Centeredness

Abstract Background We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus? Methods We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline. Results Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups. Conclusions The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness. Trial registration The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.

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Improving the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic

Journal of Doctoral Nursing Practice ◽

10.1891/jdnp-d-20-00078 ◽

2021 ◽

pp. JDNP-D-20-00078

Author(s):

Sybilla Myers ◽

Christopher Kennedy

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Shared Decision Making ◽

Cognitive Theory ◽

Well Being ◽

Mobile App ◽

Shared Decision ◽

Patient Centered ◽

The Social

BackgroundPerceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.Local ProblemNo standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual’s likelihood of long-term success.MethodsDuring the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.InterventionsThe four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.ResultsAmong 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.ConclusionsThe SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.

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General & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II (MP39)

The Journal of Urology ◽

10.1097/01.ju.0000558591.08352.29 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Shared Decision Making ◽

Practice Patterns ◽

Shared Decision ◽

Epidemiological Trends

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General & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP33)

The Journal of Urology ◽

10.1097/01.ju.0000558579.57665.1d ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Shared Decision Making ◽

Practice Patterns ◽

Shared Decision ◽

Epidemiological Trends

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Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

Irish Journal of Paramedicine ◽

10.32378/ijp.v3i2.145 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Eamonn Byrne ◽

Sasha Selby ◽

Paul Gallen ◽

Alan Watts

Keyword(s):

Decision Making ◽

Patient Care ◽

Shared Decision Making ◽

Vital Signs ◽

Ambulance Service ◽

Guidance Document ◽

Shared Decision ◽

Clinical Guidance ◽

Decision Making Model

IntroductionEvery patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.AimFor patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.MethodsAll NAS incidents closed with a refusal of treatment or transport, from 1st Jan 2017 to 9th November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.Results31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.ConclusionClinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.

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Development and Effects of a Nursing Education Program Using Virtual Reality for Enhancing Clinical Decision-Making Ability in Respiratory Disease Nursing Care

Journal of Korean Academy of Fundamentals of Nursing ◽

10.7739/jkafn.2021.28.4.458 ◽

2021 ◽

Vol 28 (4) ◽

pp. 458-469

Author(s):

Eun Ju Lee ◽

Min Jung Ryu

Keyword(s):

Decision Making ◽

Virtual Reality ◽

Nursing Education ◽

Respiratory Disease ◽

Nursing Care ◽

Clinical Decision Making ◽

Clinical Decision ◽

Control Group ◽

Simulation Education ◽

Experimental Group

Purpose: This study was conducted to develop and examine the effects of a nursing education program using virtual reality to enhance clinical decision-making ability in respiratory disease nursing care by assessing students’ confidence in performance, clinical decision-making ability, practice flow, class evaluations, and simulation design evaluations.Methods: This study was developed based on the Jeffries simulation model and 5E learning cycle model, blending a virtual reality simulation and high-fidelity simulation. The participants were 41 third-year nursing students with no virtual reality and simulation education experience. The experimental group (n=21) received the virtual reality program, while the control group (n=20) received traditional simulation education. Data were collected from March 8 to May 28, 2021 and analyzed using SPSS version 27 for Windows.Results: Statistically significant differences were found between the experimental group and the control group post-intervention in confidence in performance (F=4.88, p=.33) and clinical decision-making ability (F=18.68, p＜.001). The experimental group showed significant increases in practice flow (t=2.34, p=.024) and class evaluations (t=2.99, p=.005) compared to the control group.Conclusion: Nursing education programs using virtual reality to enhance clinical decision-making ability in respiratory disease nursing care can be an effective educational strategy in the clinical context.

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