‘Failure to fail’ is the allocation of pass grades to nursing students who do not display satisfactory clinical performance. This issue can have significant implications for individual students and ...assessors involved, as well as for nursing professionalism and patient safety. The aim of this systematic integrative literature review was to determine what is currently known about the issue of ’failure to fail’ within undergraduate nursing programs. A literature search of five databases up to May 2015 was conducted to identify primary research papers. The search yielded 169 papers of which 24 met the inclusion criteria. The majority of papers had moderate or good methodological rigour, with most of the literature originating from the Northern Hemisphere. Five main themes emerged: failing a student is difficult; an emotional experience; confidence is required; unsafe student characteristics; and university support is required to fail students. The results suggest that ’failure to fail’ is a real issue in tertiary facilities, with many complex facets. Given the costs of nurse education and the potential social and professional costs of poor quality nursing graduates, further rigorous research is required in this area.
•The quality of research on failure to fail is moderate to good quality.•Failing a student is a difficult, emotional process for assessors and students.•There are significant implications of failure to fail for nurses, organisations, and potentially for patient safety.•More research needs to be conducted to examine if failure to fail impacts on patient safety.
Emerging contaminants (ECs) are a group of anthropogenic organic pollutants known to have a host of adverse environmental and health implications. The removal of such pollutants from aqueous ...environments to ensure water is of a quality fit for reuse is therefore highly important and gaining considerable interest. Whilst there are multiple approaches used for EC remediation from water matrices, sorption using layered double hydroxides (LDHs) has been reported as a suitable technique. LDHs are interesting clay-like materials with numerous properties which lend LDHs to being suitable sorbent materials. Such properties include low toxicity, anion exchange capacity and tuneable structures through possible variations in metals, anions and preparation techniques. To design a successful sorbent material, it is important to fully understand the materials structure-property-function relationship. However, in the application of LDHs as sorbent materials for the removal of organic pollutants, this relationship is not well understood. Hence the ability to design bespoke high-performing LDH sorbent material is currently limited.
This review considers the impact of structure and related physiochemical properties of LDHs on their sorption capacity for the removal of organic pollutants from water matrices. Methyl Orange (MO) is first considered as a model pollutant, with the importance of the characteristics of the metal layers, interlayer anions and resulting textual properties of LDHs on reported sorption capacity observed. A comparison is then made between the findings from the MO case study and for the sorption of other organic pollutants using LDHs, with a particular focus on pharmaceuticals. Finally, the role of environmental conditions and considerations linked to possible commercial applications are discussed, with recommendations made for future work.
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•LDH properties impacting sorption capacity broadly similar for organic pollutants.•Sorption is described by the Langmuir isotherm and pseudo-second order kinetics.•Anion exchange is a key mechanism for high sorption capacity of LDHs.•Synergistic sorption mechanisms result in complex ideal LDH properties.•Environmental conditions play a significant role in sorption processes using LDHs.
Aim
To develop and psychometrically test an occupational violence (OV) risk assessment tool in the emergency department (ED).
Design
Three studies were conducted in phases: content validity, ...predictive validity and inter‐rater reliability from June 2019 to March 2021.
Methods
For content validity, ED end users (mainly nurses) were recruited to rate items that would appropriately assess for OV risk. Subsequently, a risk assessment tool was developed and tested for its predictive validity and inter‐rater reliability. For predictive validity, triage notes of ED presentations in a month with the highest OV were assessed for presence of OV risk. Each presentation was then matched with events recorded in the OV incident register. Sensitivity and specificity values were calculated. For inter‐rater reliability, two assessors—trained and untrained—independently assessed the triage notes for presence of OV risk. Cohen's kappa was calculated.
Results
Two rounds of content validity with a total of N = 81 end users led to the development of a three‐domain tool that assesses for OV risk using aggression history, behavioural concerns (i.e., angry, clenched fist, demanding, threatening language or resisting care) and clinical presentation concerns (i.e., alcohol/drug intoxication and erratic cognition). Recommended risk ratings are low (score = 0 risk domain present), moderate (score = 1 risk domain present) and high (score = 2–3 risk domains present), with an area under the curve of 0.77 (95% confidence interval 0.7–0.81, p < .01). Moderate risk rating had a 61% sensitivity and 91% specificity, whereas high risk rating had 37% sensitivity and 97% specificity. Inter‐rater reliability ranged from 0.67 to 0.75 (p < .01), suggesting moderate agreement.
Conclusions
The novel three‐domain OV risk assessment tool was shown to be appropriate and relevant for application in EDs. The tool, developed through a rigorous content validity process, demonstrates acceptable predictive validity and inter‐rater reliability.
Impact
The developed tool is currently piloted in a single hospital ED, with a view to extend to inpatient settings and other hospitals.
Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if ...simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment.
Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges.
Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting.
Students who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting.
This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.
•Simulation improves students' knowledge, skill and confidence in mental health care.•Realistic scenarios encourage nursing students to engage in mental health care.•Opportunity to practice mental health care delivery enhances learners' self-efficacy.
Aims
Identify and synthesize evidence of nurses’ competency in electrocardiogram interpretation in acute care settings.
Design
Systematic mixed studies review.
Data sources
Cumulative Index to ...Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021.
Review methods
Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta‑Analysis framework. A data‐based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers.
Results
Forty‐three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to ‘competency’ in the context of nurses’ knowledge in electrocardiogram interpretation. Nurses’ knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses’ competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives.
Conclusion
The definition of ‘competency’ was inconsistent, and nurses’ competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses’ competency.
Impact
This review addressed questions related to nurses’ competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses’ competency in electrocardiogram interpretation.
Abstract Purpose The goal of this review was to synthesize existing evidence regarding outcomes (mortality) for patients who present to the emergency department, are administered antibiotics ...immediately (within 1 hour) or later (>1 hour), and are diagnosed with sepsis. Methods A search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL, using the MeSH descriptors “sepsis,” “systemic inflammatory response syndrome,” “mortality,” “emergency,” and “antibiotics,” was performed to identify studies reporting time to antibiotic administration and mortality outcome in patients with sepsis. The included studies (published in English between 1990 and 2016) listed patient mortality based on time to antibiotic administration. Studies were evaluated for methodologic quality, and data were extracted by using a data extraction form tailored to this study. From an initial pool of 582 potentially relevant studies, 11 studies met our inclusion criteria, 10 of which had quantitative data for meta-analysis. Three different models (a random effects model, a bias-adjusted quality-effects synthetic bias model, and an inverse variance heterogeneity model) were used to perform the meta-analysis. Findings The pooled results suggest a significant 33% reduction in mortality odds for immediate (within 1 hour) compared with later (>1 hour) antibiotic administration (OR, 0.67 95% CI, 0.59–0.75) in patients with sepsis. Implications Immediate antibiotic administration (<1 hour) seemed to reduce patient mortality. There was some minor negative asymmetry suggesting that the evidence may be biased toward the direction of effect. Nevertheless, this study provides strong evidence for early, comprehensive, sepsis management in the emergency department.
•Emergency department clinicians are exposed to a myriad of occupational stressors.•Exposure to occupational stressors can lead to demoralisation.•Factors contributing to demoralisation are unlikely ...to occur in isolation.•Clinicians can inform solutions designed to minimise the risk of demoralization.
To explore emergency department clinicians (nurses and medical doctors) perceptions of stressors and coping strategies in their work environment.
A descriptive qualitative design was adopted. Twelve semi-structured interviews were conducted with medical and nursing personnel working in one Australian emergency department. A thematic inductive approach was used for analysis.
Four key themes emerged regarding perceptions of and factors that influenced stressors around the emergency department working environment: i) workload and departmental activity, ii) lack of support; iii) inadequate resourcing; and iv) a mis-match between societal, organisational and staff expectations. The overlap between these themes is such that an overarching theme of ‘demoralisation in the workforce’ can be described. Staff reported both problem- and emotion-focussed coping strategies with varying levels of self-perceived effectiveness. The foci of solutions proposed by participants typically addressed the source of the stressors.
Exposure to occupational stressors remains problematic for emergency department clinicians. Continued exposure can, in some instances, result in demoralisation of the workforce. Immediate attention to causes and effects of occupational stress and demoralisation is warranted. Implementing tailored strategies has the potential to ameliorate effects of occupational stressors.
Correlations between personality traits and a wide range of sensory thresholds were examined. Participants (N = 124) completed a personality inventory (NEO-FFI) and underwent assessment of olfactory, ...trigeminal, tactile and gustatory detection thresholds, as well as examination of trigeminal and tactile pain thresholds. Significantly enhanced odor sensitivity in socially agreeable people, significantly enhanced trigeminal sensitivity in neurotic subjects, and a tendency for enhanced pain tolerance in highly conscientious participants was revealed. It is postulated that varied sensory processing may influence an individual's perception of the environment; particularly their perception of socially relevant or potentially dangerous stimuli and thus, varied with personality.
•Clinicians frequently understood that adverse childhood experiences are common among adult frequent ED attenders.•Clinicians were more aware of the adult psychosocial impacts of childhood adversity ...than the risks to physical health.•Clinicians believed it was important to ask about childhood adversity, but most never asked, citing a variety of barriers.•The healthcare needs of frequent attenders with a childhood adversity history were often seen to be ineffectively met.•Gaps in clinicians’ knowledge regarding trauma-informed care were common and a desire for education was identified.
Adults who frequently present (FPAs) to emergency departments (EDs) often have a history of adverse childhood experiences (ACEs) and related adult health sequelae. Implications for ED care of this group remains poorly understood. This study explored clinicians’ knowledge and attitudes toward the care needs of FPAs who have an ACEs history, providing preliminary evidence to inform further research and interventions.
A purposive sample of ED clinicians completed an investigator developed mixed-methods survey. Descriptive statistics and content analysis were applied.
Forty-three ED clinicians completed the survey. Most perceived that ACEs were common among FPAs and influenced their ED presentations. Clinicians were more aware of the psychosocial impacts of ACEs than the risks to physical health. While most clinicians agreed that FPAs should be asked about ACEs for management planning, most never asked, describing multiple barriers to doing so. Consumer’s healthcare needs were often described as unmet by clinicians who desired additional support to provide care for this group.
This study highlights clinicians’ perceptions of gaps in healthcare for this patient group and introduces requirements for appropriate knowledge and resources to partner with consumers to provide patient-centred and trauma-informed health care responses.
Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) ...is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula.
The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education.
This study used a qualitative approach that included thematic analysis of the transcribed interviews.
Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran.
Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE.
A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified.
Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature.
The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.
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