scholarly journals Effects of environmental distractors on nurse emergency triage accuracy: a pilot study

2020 ◽  
Author(s):  
philippe delmas ◽  
Assunta fiorentino ◽  
matteo antonini ◽  
severine Vuilleumier ◽  
guy Stotzer ◽  
...  

Abstract Background: Patient safety is a top priority of the health professions. In emergency departments, the clinical decision making of triage nurses must be of the highest reliability. However, studies have repeatedly found that nurses over- or undertriage a considerable portion of cases, which can have major consequences for patient management. Among the factors that might explain this inaccuracy, workplace distractors have been pointed to without ever being the focus of specific investigation, owing in particular to the challenge of assessing them in care settings. Consequently, the use of a serious game reproducing a work environment comprising distractors would afford a unique opportunity to explore their impact on the quality of nurse emergency triage. Methods/Design : A factorial design will be used to test the acceptability and feasibility of a serious game created to explore the primary effects of distractors on emergency nurse triage accuracy. A sample of 80 emergency nurses will be randomised across three experimental groups exposed to different distractor conditions and one control group not exposed to distractors. Specifically, experimental group A will be exposed to noise distractors only; experimental group B to task interruptions only; and experimental group C to both types combined. Each group will engage in the serious game to complete 20 clinical vignettes in two hours. For each clinical vignette, a gold standard will be determined by experts. Pre-tests will be planned with clinicians and specialised emergency nurses to examine their interaction with the first version of the serious game. Discussion : This study will shed light on the acceptability and feasibility of a serious game in the field of emergency triage. It will also advance knowledge of the possible effects of exposure to common environmental distractors on nurse triage accuracy. Finally, this pilot study will inform planned large-scale studies of emergency nurse practice using serious games.

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Philippe Delmas ◽  
Assunta Fiorentino ◽  
Matteo Antonini ◽  
Séverine Vuilleumier ◽  
Guy Stotzer ◽  
...  

Abstract Background The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/design A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A, noise; B, task interruptions; C, noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within 2 h. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion Study results will inform the design of large-scale investigations and will help identify teaching, training, and research areas that require further development.


2020 ◽  
Author(s):  
philippe delmas ◽  
Assunta fiorentino ◽  
matteo antonini ◽  
severine Vuilleumier ◽  
guy Stotzer ◽  
...  

Abstract Background: The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/Design: A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A: noise, B: task interruptions, C: noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within two hours. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion: Study results will inform the design of large-scale investigations and will help identify teaching, training and research areas that require further development.


2020 ◽  
Author(s):  
philippe delmas ◽  
Assunta fiorentino ◽  
matteo antonini ◽  
severine Vuilleumier ◽  
guy Stotzer ◽  
...  

Abstract Background: The clinical decisions of emergency department triage nurses need to be of the highest accuracy. However, studies have found repeatedly that these nurses over- or underestimate the severity of patient health conditions. This has major consequences for patient safety and patient flow management. Workplace distractors such as noise and task interruptions have been pointed to as factors that might explain this inaccuracy. The use of a serious game reproducing the work environment during triage affords the opportunity to explore the impact of these distractors on nurse emergency triage accuracy, in a safe setting. Methods/Design: A pilot study with a factorial design will be carried out to test the acceptability and feasibility of a serious game developed specifically to simulate the triage process in emergency departments and to explore the primary effects of distractors on nurse emergency triage accuracy. Eighty emergency nurses will be randomized into four groups: three groups exposed to different distractors (A: noise, B: task interruptions, C: noise and task interruptions) and one control group. All nurses will have to complete 20 clinical vignettes within two hours. For each vignette, a gold standard assessment will be determined by experts. Pre-tests will be conducted with clinicians and certified emergency nurses to evaluate the appeal of the serious game. Discussion: Study results will inform the design of large-scale investigations and will help identify teaching, training and research areas that require further development.


2021 ◽  
Vol 28 (4) ◽  
pp. 458-469
Author(s):  
Eun Ju Lee ◽  
Min Jung Ryu

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.


Author(s):  
Nelson Ribeiro Jorge ◽  
Lina Morgado ◽  
Pedro J. S. Gaspar

This investigation aimed to verify if augmented reality (AR) increases students' motivation and enhances the development of clinical decision-making skills in wound diagnosis and treatment. A quasi-experimental study was carried out with a sample of 54 nursing students. A comparative analysis of the progress of the control and experimental group was made using the data extracted from the simulator and a questionnaire. First, both groups used e-FER, a virtual simulator that simulates the diagnosis and treatment of virtual clinical cases. In the second moment, the control group continued using only e-FER, while the experimental group used e-FER combined with an AR application to observe the chronic wounds. The results showed that AR enhanced student performance, particularly in wound diagnostic parameters, with highly statistically significant differences (p<0,001), and registering high levels of motivation and simulator usability, even with the introduction of an additional device in the activity.


2021 ◽  
Author(s):  
Samira Mehrabi ◽  
John Edison Muñoz ◽  
Aysha Basharat ◽  
Jennifer Boger ◽  
Shi Cao ◽  
...  

BACKGROUND Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter older adults’ engagement. Interactive virtual reality games that are combined with exercise (VR exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research regarding the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. OBJECTIVE The objectives of this pilot study are to i) estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; ii) examine the feasibility of the intervention and assessment protocols to use them in a future large-scale trial; and iii) provide pilot data on outcomes of interest including physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics. METHODS The pilot study will be a remote, 6-week intervention study consisting of an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both participant groups will follow the same study procedures and assessment methods. However, participants in the experimental group will engage with a co-designed VR exergame (Seas The Day) three times/week for approximately 20 minutes, using the Oculus Quest 2 VR headset. Those recruited for the control study will not have exposure to the exergame and instead they will read thrice/week for approximately 20 minutes over the 6-week period. A mixed-methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be analyzed pre- and post-acute as well as pre- and post-6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from post-intervention focus groups/interviews, as well as informal notes and reports from all participants, will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergame and explore perceived facilitators and barriers of uptaking VR systems among community-dwelling older adults. RESULTS The screening and recruitment process for the experimental group started in May 2021 and the data collection process will be ongoing until September 2021. Recruitment process for the control group has not started, however, data collection will be complete by December 2021. CONCLUSIONS This pilot study with an experimental and control group will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults’ well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepening the understanding of remote deployment and at-home use of VR for older adults exercise.


BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xin Huang ◽  
Lai Jiang ◽  
Shaojun Chen ◽  
Gang Li ◽  
Wanxi Pan ◽  
...  

Abstract Background Minimally invasive surgery has achieved good results in the treatment of cerebral haemorrhage.However, no large-scale clinical study has demonstrated that surgical treatment of cerebral haemorrhages less than 30 ml can improve the curative effect. Our study explored the efficacy and complication of stereotactic drainage based on the amount of cerebral hemorrhage (15-30 ml) in hypertensive basal ganglia. Method Sixty patients with hypertensive basal ganglia haemorrhages were divided into a control group and an experimental group with 30 patients in each group. Patients in the control group were treated conservatively. In contrast, those in the experimental group received stereotactic drainage, and urokinase was injected into the haematoma cavity after the operation. The haematoma volume at admission and 1, 3, 7 and 30 days after treatment and National Institute of Health stroke scale(NIHSS) score data were recorded. Complications after treatment in the two groups of data were compared and analysed. Result No significant differences in age, sex, time of treatment after onset, admission blood pressure, admission haematoma volume or admission NIHSS score were noted between these two groups (P > 0.05). After treatment, significant differences in haematoma volume were noted between the two groups on the 1st, 3rd, 7th and 30th days after treatment (P < 0.05). The amount of hematoma of patients in the experimental group was significantly reduced compared with that in the control group, and the NIHSS scores were significantly different on the 3rd, 7th and 30th days after treatment. The neurological deficit scores of patients in the experimental group were significantly reduced compared with those in the control group, and the incidence of pulmonary infection and venous thrombosis in the lower limbs of patients in the experimental group were significantly reduced (P < 0.05). ROC curve analysis showed that stereotactic drainage affected the early neurological function of patients with small and medium basal ganglia haemorrhages. Conclusion For patients with small and medium basal ganglia haemorrhages, stereotactic drainage can be used due to the faster drainage speed of haematomas after operation, which is beneficial to the recovery of neurological function and reduce complications.


2021 ◽  
Vol 28 (1) ◽  
pp. e100251
Author(s):  
Ian Scott ◽  
Stacey Carter ◽  
Enrico Coiera

Machine learning algorithms are being used to screen and diagnose disease, prognosticate and predict therapeutic responses. Hundreds of new algorithms are being developed, but whether they improve clinical decision making and patient outcomes remains uncertain. If clinicians are to use algorithms, they need to be reassured that key issues relating to their validity, utility, feasibility, safety and ethical use have been addressed. We propose a checklist of 10 questions that clinicians can ask of those advocating for the use of a particular algorithm, but which do not expect clinicians, as non-experts, to demonstrate mastery over what can be highly complex statistical and computational concepts. The questions are: (1) What is the purpose and context of the algorithm? (2) How good were the data used to train the algorithm? (3) Were there sufficient data to train the algorithm? (4) How well does the algorithm perform? (5) Is the algorithm transferable to new clinical settings? (6) Are the outputs of the algorithm clinically intelligible? (7) How will this algorithm fit into and complement current workflows? (8) Has use of the algorithm been shown to improve patient care and outcomes? (9) Could the algorithm cause patient harm? and (10) Does use of the algorithm raise ethical, legal or social concerns? We provide examples where an algorithm may raise concerns and apply the checklist to a recent review of diagnostic imaging applications. This checklist aims to assist clinicians in assessing algorithm readiness for routine care and identify situations where further refinement and evaluation is required prior to large-scale use.


Author(s):  
Brij Bhushan Singh ◽  
Shubi Mirja ◽  
Samiya Husain

The purpose of this study was to investigate the effects of yogic practices on cardio-vascular efficiency. Material and methods: Total Forty (40) subject’s boys/girls were selected as the sample of the study through the random sampling and their age ranged between 20 to 25 years from the Department of Physical Education, Aligarh Muslim University, Aligarh. The subjects were divided into two groups comprising 20 subjects in each group, namely group “A” (the experimental group) performs yogic practices (Asanas, Pranayamas and Kriyas) and group “B” (the control group) served as control. Statistical technique: for the assessment of the cardiovascular efficiency through Harvard step test pre and post-test was conducted and t-test was applied for the analysis. Result: revealed that there exist a significant difference between group A and group B, at .05 level of significance. On the basis of the pre and post-test among experimental and control group, experimental group found better than the control group on cardiovascular efficiency and significant result were found in this study.


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