This paper presents concepts and strategies for using standardized patients (SP) in teaching and evaluation of nursing students. SP encounters are an alternative to clinical experiences and a standardized criterion for student performance evaluation. Careful development of encounters, selection and training of SPs, support and debriefing of all participants are essential to a positive SP encounter. SP encounters should be developed based on objectives and competency criteria and relate to actual events. Encounter scripts incorporating any "traditional" language often associated with a specific medical condition are beneficial to standardizing the process. SP preparation involves providing background on medical conditions, feedback when practicing the role-play, and validation of performance consistency. Orientation of students and faculty to the SP experience ensures that participants stay in role. SPs can also be utilized to complete written evaluation tools and provide verbal feedback to students. All participants should evaluate the encounter process for future improvement.
A review of the formal ethics consultations performed at a rural academic medical center during 2006 revealed that only 5 of 72 consultations were initiated by nurses. A descriptive exploratory convenience study used a 3-item survey to collect information from registered nurses who provide direct patient care at the rural academic medical center. The purpose of this study was to (1) identify and describe the ethical issues perceived by registered nurses employed at a rural academic medical center and (2) analyze the variables influencing the registered nurses' ethical decision making and the process used by these registered nurses when resolving ethical issues.The 17 registered nurses who completed the survey identified a total of 21 ethical issues that they had experienced during the last year. The ethical issues that nurses recalled were significantly more likely to be relationship issues, whereas issues documented within the ethics consultation service were significantly more likely to involve limiting treatment. Communication was a major variable influencing nurse's ethical decision making. Nurses felt the ethical issue resolved satisfactorily when the patient's needs were met, communication occurred with the patient and/or family, the entire healthcare team was involved and in agreement, and there was sufficient time available to make a decision. The nurses did not feel that the ethical situation was resolved satisfactorily when not handled from the patient's perspective; the patient suffered; there was a lack of teamwork, agreement, and/or support; and the process took too long. The nurses' recommendations for resources needed to assist with the resolution of ethical issues included accessible ethics mechanisms, education, improved interprofessional relationships and collaboration, and unbiased support for patient and family decision making. Implications for nurse managers are discussed and future research questions are identified.
The implementation of an electronic health record is a dramatic change in a healthcare organization; however, little is known about how nurse attitudes toward the electronic health record change over time. The purpose of this research project was to compare nurses' attitudes before and at 6 and 18 months after implementation of a comprehensive electronic health record. A presurvey-postsurvey design using a modified Nurses' Attitudes Toward Computerization Questionnaire was implemented with a population of nurses employed at an academic medical center. On average, the nurses' attitude about the electronic health record became less positive between preimplementation (n = 312) and 6 months after implementation (n = 410) (74.2 vs 65.9, P < .0001) and preimplementation and 18 months after implementation (n = 262) groups (74.2 vs 67.7, P < .0001). No significant improvement between 6 and 18 months after implementation groups (P = .16) was noted. Prior to electronic health record implementation, the nurses were uncertain yet hopeful about the benefits. However, 18 months after implementing a comprehensive electronic health record, challenges remain regarding cumbersome documentation processes and promoting interdisciplinary communication. Thus, the results demonstrate a gap between preimplementation expectations and the postimplementation reality of the actual experience. Nonetheless, some subjects have experienced positive benefits after implementation of the comprehensive electronic health record and remain hopeful for the future.
Implementation of an electronic health record has multiple facility-wide challenges affecting all direct care providers. Because the dialysis unit and emergency department had already undergone transition with differing electronic systems several years before, could anything be learned from these past experiences to inform the future institution-wide implementation? Utilizing focus groups and surveys, recurring themes emerged: "It will take one hundred charts"; allowing for "self-discovery" of individual learning progression; establishing and communicating "clear processes" for use of the electronic record; and ensuring adequate support to facilitate a "customer-focused" approach in learning how to utilize electronic documentation. Although training related to the electronic health record was discussed in all focus groups, training was not described as a main concern, which challenged our initial presumptions that education was the key resource for a successful change. Three of the four themes uncovered in this study are not unique and corroborate the findings in other studies. "Clear processes" is a new theme not previously identified. These themes with recommendations were presented to the electronic health record design team to assist with the hospital-wide implementation.
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