Implementing a surgical first assistant role into that of a clinical nurse specialist at an orthopaedic specialist hospital

Background: Clinical nurse specialists (CNSs) are experienced senior nurses with advanced clinical knowledge, communication and leadership skills and commonly take on extended roles to optimise care delivery within health and social care. Aim: To critically explore the experience of one clinical nurse specialist who undertook an enhanced qualification to become a surgical first assistant. Methods: A case-study approach based on Gibbs' reflective model is used to reflect on the experience, its benefits to patient care and the challenges and facilitators related to taking on advanced surgical roles. Findings: Long-term benefits can be achieved by investing in CNSs educated to hold the enhanced surgical first assistant qualification. Advanced roles enhance evidence-based service delivery, while also benefitting the clinical nurse specialist, the patient and the trust.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study

Background The Western Pacific region constitutes one-quarter of the world’s population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses’ professional development within the Western Pacific region. Methods This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 – December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. Results Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. Conclusions Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Exploring User Needs in the Development of a Virtual Reality–Based Advanced Life Support Training Platform: Exploratory Usability Study

Background Traditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool. Objective This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms. Methods Semistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence. Results The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles. Conclusions This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.

Exploring User Needs in the Development of a Virtual Reality–Based Advanced Life Support Training Platform: Exploratory Usability Study (Preprint)

BACKGROUND Traditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool. OBJECTIVE This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms. METHODS Semistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence. RESULTS The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles. CONCLUSIONS This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.

Nurses in Advanced Roles as a strategy for equitable access to health care in the WHO Western Pacific Region: A mixed methods study

Purpose: This study investigated the current responsibilities of nurses in advanced roles (NARs), future healthcare needs, and the implications of these components for professional development of nurses. Design: This study employed a descriptive survey on the current status of NARs in the Western Pacific region (WPR), followed by a Delphi survey and exploratory interviews. Experts from WPR countries who were individuals with recognized national expertise on NARs from clinical, academic, and/or government-related backgrounds were invited to participate in this study from December 2017 to December 2018. Methods: Fifteen experts from ten countries provided descriptive data on the current status of NARs in the WPR via email. The data were used to grasp the spectrum of NAR and construct a working definition of NARs. This formed the basis for the Delphi survey, in which 27 experts from 14 countries completed the following three sections via email: Areas in need of NARs; Strengths, Weakness, Opportunities, and Threats analysis; and the role of NARs in promoting universal health coverage. Descriptive statistics were used for the survey and Delphi survey. For the exploratory interviews, semi-structured individual interviews were conducted with 19 key informants from 12 countries. Content analysis was performed for interview data. Delphi and interview findings were integrated in the final stage. Findings: Thirty-seven roles were identified and categorized according to the regulations for the specific roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for NARs. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary for NAR to improve equitable healthcare access. Conclusions: Demand for NARs is high in the WPR and we presented 15 items across five core strategic areas within the nursing community to enhance NAR development. Governmental-level recommendations include establishing legislative protection, remuneration, supportive channels, and conducting national needs assessments.