Improving handover competency in preclinical medical and health professions students: establishing the reliability and construct validity of an assessment instrument

Background As part of the worldwide call to enhance the safety of patient handovers of care, the Association of American Medical Colleges (AAMC) requires that all graduating students “give or receive a patient handover to transition care responsibly” as one of its Core Entrustable Professional Activities (EPAs) for Entering Residency. Students therefore require educational activities that build the necessary teamwork skills to perform structured handovers. To date, a reliable instrument designed to assess teamwork competencies, like structured communication, throughout their preclinical and clinical years does not exist. Method Our team developed an assessment instrument that evaluates both the use of structured communication and two additional teamwork competencies necessary to perform safe patient handovers. This instrument was utilized to assess 192 handovers that were recorded from a sample of 229 preclinical medical students and 25 health professions students who participated in a virtual course on safe patient handovers. Five raters were trained on utilization of the assessment instrument, and consensus was established. Each handover was reviewed independently by two separate raters. Results The raters achieved 72.22 % agreement across items in the reviewed handovers. Krippendorff’s alpha coefficient to assess inter-rater reliability was 0.6245, indicating substantial agreement among the raters. A confirmatory factor analysis (CFA) demonstrated the orthogonal characteristics of items in this instrument with rotated item loadings onto three distinct factors providing preliminary evidence of construct validity. Conclusions We present an assessment instrument with substantial reliability and preliminary evidence of construct validity designed to evaluate both use of structured handover format as well as two team competencies necessary for safe patient handovers. Our assessment instrument can be used by educators to evaluate learners’ handoff performance as early as their preclinical years and is broadly applicable in the clinical context in which it is utilized. In the journey to optimize safe patient care through improved teamwork during handovers, our instrument achieves a critical step in the process of developing a validated assessment instrument to evaluate learners as they seek to accomplish this goal.

Closing the Virtual Gap in Health Care: A Series of Case Studies Illustrating the Impact of Embedding Evaluation Alongside System Initiatives

Early decisions relating to the implementation of virtual care relied on necessity and clinical judgement, but there is a growing need for the generation of evidence to inform policy and practice designs. The need for stronger partnerships between researchers and decision-makers is well recognized, but how these partnerships can be structured and how research can be embedded alongside existing virtual care initiatives remain unclear. We present a series of case studies that illustrate how embedded research can inform policy decisions related to the implementation of virtual care, where decisions are either to (1) discontinue (red light), (2) redesign (yellow light), or (3) scale up existing initiatives (green light). Data were collected through document review and informal interviews with key study personnel. Case 1 involved an evaluation of a mobile diabetes platform that demonstrated a mismatch between the setting and the technology (decision outcome: discontinue). Case 2 involved an evaluation of a mental health support platform that suggested evidence-based modifications to the delivery model (decision outcome: redesign). Case 3 involved an evaluation of video visits that generated evidence to inform the ideal model of implementation at scale (decision outcome: scale up). In this paper, we highlight the characteristics of the partnership and the process that enabled success and use the cases to illustrate how these characteristics were operationalized. Structured communication included monthly check-ins and iterative report development. We also outline key characteristics of the partnership (ie, trust and shared purpose) and the process (ie, timeliness, tailored reporting, and adaptability) that drove the uptake of evidence in decision-making. Across each case, the evaluation was designed to address policy questions articulated by our partners. Furthermore, structured communication provided opportunities for knowledge mobilization. Structured communication was operationalized through monthly meetings as well as the delivery of interim and final reports. These case studies demonstrate the importance of partnering with health system decision-makers to generate and mobilize scientific evidence. Embedded research partnerships founded on a shared purpose of system service provided an effective strategy to bridge the oft-cited gap between science and policy. Structured communication provided a mechanism for collaborative problem-solving and real-time feedback, and it helped contextualize emerging insights.

Learning Activities of the of Students in Peer-Jury Practices in the Architecture Design Studio

<p>The students learn through critical thinking and commenting on the design works of other students. This paper aims to demonstrate the students' learning process in a peer-jury activity through both mind engagement and practical activities in the architecture design studio. The methodology of the research was based on qualitative methods with the application of semi-structured observation, photography, sketching, and graphical analysis techniques. The findings of the analysis reveal that the students participated in the peer-jury activity with five attitudes including passive, reactive, active, interactive, and engaged. The peer-jury groups’ applied four approaches to comment on the peer presenters' design outputs, including the design process, task response, idea of the design, and design outputs. In conclusion, the students learn through peers effectively to enhance their skills and abilities in a structured communication. The students improve critical thinking skills through practice, personalization, and communication. </p>

Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager

Background Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective We seek to identify whether the structure of the collected communication data provides insights into hospitals’ workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff.

PENINGKATAN KEMAMPUAN TIMBANG TERIMA PASIEN DENGAN BUDAYA KOMUNIKASI SBAR DI RUMAH SAKIT “X”BEKASI

ABSTRAKKomunikasi tidak efektif dalam timbang terima pasien dapat meningkatkan kejadian medication error, membahayakan pasien, memperpanjang proses perawatan, menurunkan kepuasan pasien, memperpanjang hari rawat pasien, yang akan berdampak pada kurangnya mutu asuhan keperawatan yang diberikan pada pasien. Komunikasi dengan alur Situation, Background, Assessment, Recommendation (SBAR) adalah salah satu metode komunikasi efektif yang jelas, fokus, dan terstruktur. Tujuan penelitian adalah untuk mengidentifikasi perbedaan pengetahuan dan kemampuan perawat setelah pelatihan, desain penelitian dengan pre-eksperiment dengan pre-post tanpa kelompok kontrol, sampel penelitian seluruh Perawat Primer dan Penanggung Jawab shift (n= 17), analisis data dengan uji t berpasangan dan uji Wilcoxon. Ada perbedaan yang bermakna rerata pengetahuan sebelum dan sesudah pelatihan (p value < 0,001), ada perbedaan yang bermakna rerata kemampuan perawat sebelum dan sesudah pelatihan komunikasi SBAR dalam timbang terima pasien antar shift (p value < 0,001). Efektifitas pelaksanaan komunikasi SBAR perlu menjadi sebuah budaya, dan pelaksanaannya perlu ada dukungan dari pihak manajerial dan komitment perawat, dengan adanya pedoman komunikasi efektif dengan metode SBAR, motivasi, mentoring, dan supervisi, serta pengembangan pendidikan yang berkelanjutan.Kata kunci: Kemampuan, komunikasi, pengetahuan, SBAR, timbang terima ABSTRACTIneffective communication in hand over patients can increase the incidence of medication errors, endanger patients, extend the treatment process, reduce patient satisfaction, extend patient care days, which will have an impact of the lack on quality nursing care given to patients. Communication with the groove Situation, Background, Assessment, Recommendation (SBAR) is one of the effective clear, focused and structured communication method. The objective of this research is to identify differences in the knowledge and ability of nurses after training, research design with pre-experiment with pre-post without a control group, the study sample whole Nurses Primary and responsible shift (n = 17), data analysis with paired t test and Wilcoxon test. There is a significant difference in the average nurse's knowledge before and after training (p value <0.001), and there is a significant difference means the ability of nurses before and after training SBAR communication in shifts handover (p value <0.001). Effective implementation of the SBAR communication needs of the managerial support and commitment of nurses, with the guidance effective methods SBAR communication, motivation, mentoring, and supervision, as well as the development of continuing education.Keywords: Abilities, Communication, handover, knowledge, SBAR

Using Simulated Handover to Assess Team-Based Competencies in a Virtual Environment

We utilized simulated patient scenarios in a virtual environment to improve students’ communication skills during handovers. To determine how students performed during the scenarios, we assessed several behaviors: structured communication, closed-loop communication, and asking clarification questions. Results revealed that the students’ performance was stronger in the first area (structure communication) and weaker in the second (closed-loop communication) and third (asking clarifying questions) areas.

Creative Communication Tools in Vilnius Architectural Heritage Communication

Research purpose. The purpose of this study is to single out the tools of creative communication and to identify which of them are most used in the communication of architectural heritage in Vilnius. Design / Methodology / Approach. Comparative analysis of scientific literature, qualitative expert interviews. Findings. The communication of the architectural heritage is multifaceted because the heritage is multifunctional. Heritage communication operates through various channels and is focused on different target groups; however, in order for the communication to be effective, as expected, the coherence of communication is required, as well as a comprehensive approach to all aspects of communication. Structured communication is essential for the best communication impact. Originality / Value / Practical implications. Heritage communication is an actively developing field that is receiving increasing attention from scientists and the public. Much attention is paid to heritage during various cultural events, during which the public has the opportunity to get acquainted with the usually inaccessible heritage or its premises. In this way, the revitalisation of heritage involves urban residents, communities, interested groups who, for cultural, religious or other reasons, are concerned with heritage preservation. Although much attention is paid to heritage communication and sponsors are being attracted, there are fears that the communication of architectural heritage is not sufficient due to the lack of funding for architectural heritage. The consequence of the lack of funding is the disappearance of architectural objects. Thus, the analysis of architectural heritage communication is a relevant and researched topic.

Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager (Preprint)

BACKGROUND Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. OBJECTIVE We seek to identify whether the structure of the collected communication data provides insights into hospitals’ workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. METHODS We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. RESULTS We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (<i>P</i>&lt;.001) and sent-to-completed (<i>P</i>&lt;.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (<i>P</i>&lt;.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). CONCLUSIONS Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff.

Search for persuasive strategies in tourism advertising discourse

Tourism as a social phenomenon has attracted the attention of marketers throughout all stages of its development. Successful cooperation between tourism entities and customers is based on communication. The persuasive power of advertising language is very much experienced today. The same happens in relation to tourism marketing materials. In fact, in order to attract the attention of the viewers, the travel companies choose various signs to express their notion of the brand. Hence, there exist different approaches in tourism marketing to attract and convince potential tourists to book a tourism product. The present article elucidates and discusses important aspects in relation to the language of tourism and the ways of its analysis for detecting persuasive techniques that are used to allure potential tourists. In this regard, the speech impact on travel advertising is realized by convincing a potential customer of the need for service / product. When advertising a travel product, the advertiser influences the consumer, attracting various effective means to intensify his desire to purchase travel services (travel product). The paper reviews the elements of persuasive tourism marketing such as structured communication, storytelling, copywriting, neuromarketing; Cialdini’ (2001) persuasion techniques to influence people, namely, reciprocation, commitment and consistency, social proof, liking, authority, and scarcity. The article also highlights gender-targeting factors as important components in selecting an appropriate persuasive strategy when designing tourism promotional materials. The result section provides the real examples of deployment of the mentioned strategies in influencing the audience by the websites of “Karpaty” and “Solva” resorts. All these techniques form a theoretical framework for researches on persuasiveness and are worth attention as they play a main role in promotion of any kind. The data collection of this study will provide updated information in relation to rhetoric of tourism.