BACKGROUND: Despite efforts to improve undergraduate clinical pharmacology & therapeutics (CPT) education, prescribing errors are still made regularly. To improve CPT education and daily prescribing, it is crucial to understand how therapeutic reasoning works. Therefore, the aim of this study was to gain insight into the therapeutic reasoning process. METHODS: A narrative literature review has been performed for literature on cognitive psychology and diagnostic and therapeutic reasoning. RESULTS: Based on these insights, The European Model of Therapeutic Reasoning has been developed, building upon earlier models and insights from cognitive psychology. In this model, it can be assumed that when a diagnosis is made, a primary, automatic response as to what to prescribe arises based on pattern recognition via therapy scripts (type 1 thinking). At some point, this response may be evaluated by the reflective mind (using metacognition). If it is found to be incorrect or incomplete, an alternative response must be formulated through a slower, more analytical and deliberative process, known as type 2 thinking. Metacognition monitors the reasoning process and helps a person to form new therapy scripts after they have chosen an effective therapy. Experienced physicians have more and richer therapy scripts, mostly based on experience and enabling conditions, instead of textbook knowledge, and therefore their type 1 response is more often correct. CONCLUSION: Because of the important role of metacognition in therapeutic reasoning, more attention should be paid to metacognition in CPT education. Both trainees and teachers should be aware of the possibility to monitor and influence these cognitive processes. Further research is required to investigate the applicability of these insights and the adaptability of educational approaches to therapeutic reasoning.
BACKGROUND AND PURPOSE: Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants. METHODS: A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders. RESULTS: In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum. CONCLUSIONS: Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula.
- MeSH
- autonomní nervový systém patofyziologie fyziologie MeSH
- dospělí MeSH
- klinické kompetence * MeSH
- konzultanti MeSH
- kurikulum * MeSH
- kurzy a stáže v nemocnici * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci autonomního nervového systému terapie MeSH
- neurologie * výchova MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
PURPOSE: During the initial phase of the pandemic, healthcare professionals faced difficulties due to the limited availability of comprehensive learning resources on managing patients affected with coronavirus disease 2019 (COVID-19). The COVID-19 Skills Preparation Course (C19_SPACE) was tailored to meet the overwhelming demand for specialized training. The primary objective of this study was to assess the efficacy and impact of this program on enhancing clinical knowledge and to identify factors affecting this improvement. METHODS: As part of the project, data were collected prospectively to measure the baseline knowledge. After the descriptive statistics, multiple and multivariate logistic regression models were executed to identify the factors associated with knowledge increase. RESULTS: The final sample included 3140 medical doctors (MDs) and 3090 nurses (RNs). For the primary analysis, the mean value of the baseline knowledge test score of MDs was 62.41 (standard deviation, SD = 13.48), and it significantly (p < 0.001) increased to 84.65 (SD = 11.95). Factors influencing overall knowledge scores were female sex (AOR = 1.34 [1.04-1.73]), being a specialist qualified for intensive care medicine (adjusted odds ratio, AOR = 0.56, [0.33-0.96]), and performance on the pre-test (AOR = 0.91, [0.90-0.92]). As for the RNs, the mean value of the total knowledge score was 63.25 (SD = 13.53), which significantly (p < 0.001) increased to 81.51 (SD = 14.21). Factor associated with knowledge was performance on the pre-test (AOR = 0.92 [0.92-0.93]). CONCLUSIONS: C19_SPACE effectively increased the clinical knowledge of doctors and nurses. The effect was more pronounced in the program's target group of healthcare workers with less experience in the intensive care unit (ICU). Other factors associated with knowledge enhancement were sex and being a specialist in intensive care.
- MeSH
- COVID-19 * epidemiologie MeSH
- distanční studium metody MeSH
- dospělí MeSH
- klinické kompetence * normy statistika a číselné údaje MeSH
- lékaři MeSH
- lidé středního věku MeSH
- lidé MeSH
- pandemie MeSH
- prospektivní studie MeSH
- SARS-CoV-2 MeSH
- zdravotní sestry statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Evidence-based nursing practice (EBNP) has been regarded core competencies in nursing practice and education. Defining evidence-based nursing practice and translating evidence into nursing practice by nursing students who are green to clinical practice in their education journey remain unclear. AIM: To explore how pre-registered nursing students define and characterize evidence-based nursing practice as they participate in their clinical practicum. DESIGN: This study used an interpretive phenomenological qualitative study design. SETTINGS AND PARTICIPANTS: Twenty nursing students were interviewed for their clinical practicum experience from four universities, one nursing college and one hospital-based nursing school in Hong Kong. METHODS: Data was generated through semi-structured in-depth interview and analyzed following interpretative phenomenological analysis guidelines, using a cyclical coding process. RESULTS: Four themes emerged regarding nursing students' definition of EBNP, highlighting that EBNP is 'identifying a reliable learning source', by which they can 'rationalize their nursing practice', and enabling them to 'establish care standard through critical thinking', and eventual 'fostering their professionalism' to improve health outcomes and reduce potential harms. CONCLUSION: Nursing students defined and characterized evidence-based nursing practice as core competencies in accompany their practicum that enables them to learn and grow professionally with a universal desire to be qualified, cope with doubt, and improve patient outcome. They recognized the challenges in identifying evidence and emphasized conservative approach to validate the evidence to avoid patient harm. Students expressed doubt towards their instructors EBNP when observing procedures untaught at school, which requires the curriculum model to foster students' skills in applying and appraising evidence and instructors' capacity to rationalize and role model EBNP.
- MeSH
- dospělí MeSH
- klinické kompetence * normy MeSH
- kvalitativní výzkum * MeSH
- lidé MeSH
- ošetřovatelství založené na důkazech * MeSH
- rozhovory jako téma metody MeSH
- studenti ošetřovatelství * psychologie MeSH
- studium ošetřovatelství bakalářské * normy metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Hongkong MeSH
Pokročilá prax v ošetrovateľstve je pomerne mladou rolou. Kreovala sa v dôsledku potrieb a požiadaviek doby. V súčasnosti národné politiky deklarujú, že situácia vďaka stúpajúcej krivke výskytu neinfekčných a chronických ochorení je s momentálnym systémovým nastavením dlhodobo neudržateľná. Je potrebné posilniť ľudské zdroje obzvlášť v oblasti ošetrovateľstva v primárnej starostlivosti. Slovenské zdravotníctvo vníma sestru s pokročilou praxou od roku 2018. Hlavným cieľom príspevku odborného charakteru je priblížiť sestru - praktika v primárnej starostlivosti ako jednu z kategórií pokročilej praxe v ošetrovateľstve, ktorej prioritným odborným zameraním je komplexný manažment ošetrovateľskej starostlivosti a poskytovaných služieb. Príspevok vysvetľuje nomenklatúru a koncepciu pokročilej praxe v ošetrovateľstve, jej zaradenie v kontexte vzdelávania na základe európskeho a národného kvalifikačného rámca, stručne popisuje históriu a vývoj z dôvodu pochopenia opodstatnenosti jej potreby v súčasnej náročnej dobe, a predkladá podmienky pre jej integráciu prostredníctvom odporúčaného vzdelania a praktickej prípravy. Uplatnenie pokročilej praxe v ošetrovateľstve so zdôvodnením podporujú mnohé medzinárodné a európske organizácie, vrátane ICN a EFN. Potreba vnímania ošetrovateľstva ako odboru na pokročilej úrovni, a pochopenia roly ako takej, sú predpokladom zefektívnenia ošetrovateľskej a zdravotnej starostlivosti s významne pozitívnymi výsledkami pre pacientov/ klientov, ale aj pre samotné sestry a ich pracovnú spokojnosť.
Advanced practice nursing is a relatively modern topic. It has been shaped by the needs and demands of the times. At present, national policies declare that the situation due to the rising curve of non-communicable and chronic diseases is unsustainable in the long term with the current system set-up. There is a need to strengthen human resources, particularly in the field of nursing (specifically advanced practice nursing, according to the ICN), in order to be able to cope effectively with health promotion, prevention and disease management. The Slovak health sector has seen the advanced practice nurse since 2018. The main aim of this paper of a professional nature is to present the nurse practitioner as one of the categories of advanced practice in nursing, whose priority professional focus is the management of nursing care and services provided to patients/clients in primary health care. The paper explains the nomenclature and concept of advanced practice in nursing, its inclusion in the context of education based on the European and National Qualifications Framework, briefly describes its history and development in order to understand the rationale for its need in the current challenging times, and presents the conditions for its integration through recommended education and practical training according to the model of other countries where the role is established. A summary of the positive benefits of establishing advanced practice nursing in primary health care is the conclusion of this paper.
Aim: The present research aimed to provide a systematic analysis of the work ability (WA) of nurses assessed through the Work Ability Index (WAI) with a focus on factors influencing WA in the studied population. Design: A systematic literature review. Methods: In January 2024, a literature search was performed using Medline / PubMed and ScienceDirect databases, in order to identify studies focused on assessment of WA with the WAI among nurses. Databases were searched using 'work ability index' and 'nurse' as key terms. Articles were selected according to PRISMA guidelines. Results: Three hundred twenty-two studies were identified in the initial search (230 studies indexed by Medline / PubMed and 92 by ScienceDirect). After applying inclusion and exclusion criteria, a total of 16 studies were included in the systematic review. The results revealed common factors that affect WA among nurses. These factors are grouped as follows: age, gender, marital status, education, years of work, shift work, and diagnosed diseases. Conclusion: Assessing the WA of nurses with the WAI provides a comprehensive and structured approach to understanding their capacity to meet the demands of their profession while considering various dimensions of health and work-related factors.
- Klíčová slova
- Work Ability Index, WAI,
- MeSH
- klinické kompetence * statistika a číselné údaje MeSH
- průzkumy a dotazníky statistika a číselné údaje MeSH
- sběr dat MeSH
- zdravotní sestry * MeSH
- Publikační typ
- systematický přehled MeSH
The purpose of supervision is to ensure that clients' needs are met and to monitor the effectiveness of therapeutic interventions and the therapeutic relationship. Cognitive behavioural therapy (CBT) supervision is the systematic cooperation of the supervisee with the supervisor, which aims at increasing the therapists' competencies when working with specific clients. The advantage of supervision is the possibility to shape and develop the therapist's practical skills through specific techniques. This paper aims to review currently available CBT supervision strategies that boost the development of therapists' skills and provide possible examples. Various techniques are discussed, including behavioural, cognitive, imagery and psychodrama methods that facilitate supervisors in enhancing therapists' skills. In addition, complementary approaches are discussed, such as role-playing, modelling, chaining, or imitation to present at a particular moment of the therapy, increase the insight into the client's perspective or the treatment itself, and search for an alternative approach to improve the therapeutic outcomes for the client. Overall, the article describes the supervisor's need to have a flexible variety of skills and know which learning methods might be most effective for boosting the supervisee's skill level and needs with a particular client.
- MeSH
- behaviorální terapie * výchova MeSH
- klinické kompetence * MeSH
- kognitivně behaviorální terapie * metody MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
PURPOSE: With the global epidemic of obesity, the importance of metabolic and bariatric surgery (MBS) is greater than ever before. Performing these surgeries requires academic training and the completion of a dedicated fellowship training program. This study aimed to develop guidelines based on expert consensus using a modified Delphi method to create the criteria for metabolic and bariatric surgeons that must be mastered before obtaining privileges to perform MBS. METHODS: Eighty-nine recognized MBS surgeons from 42 countries participated in the Modified Delphi consensus to vote on 30 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus. RESULTS: Consensus was reached on 29 out of 30 statements. Most experts agreed that before getting privileges to perform MBS, surgeons must hold a general surgery degree and complete or have completed a dedicated fellowship training program. The experts agreed that the learning curves for the various operative procedures are approximately 25-50 operations for the LSG, 50-75 for the OAGB, and 75-100 for the RYGB. 93.1% of experts agreed that MBS surgeons should diligently record patients' data in their National or Global database. CONCLUSION: MBS surgeons should have a degree in general surgery and have been enrolled in a dedicated fellowship training program with a structured curriculum. The learning curve of MBS procedures is procedure dependent. MBS surgeons must demonstrate proficiency in managing postoperative complications, collaborate within a multidisciplinary team, commit to a minimum 2-year patient follow-up, and actively engage in national and international MBS societies.
- MeSH
- bariatrická chirurgie * normy výchova MeSH
- chirurgové normy výchova MeSH
- delfská metoda * MeSH
- klinické kompetence normy MeSH
- konsensus * MeSH
- křivka učení MeSH
- lidé MeSH
- morbidní obezita chirurgie MeSH
- stipendia normy MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: To explore the influence of supervisory and mentoring relationships on the clinical learning experiences of Czech Nursing and health professional students in the context of patient safety events BACKGROUND: Clinical experience is integral to healthcare education, shaping skills, behaviours, values and professional identity. During clinical placements, students may encounter memorable patient safety events and experience varied reactions from mentors/supervisors/others. Some research has highlighted challenges faced by students on clinical placement. Few studies involve multiple professions, most emanating from Western Europe, the UK, the USA and Australia with little relating to central European countries such as the Czech Republic. DESIGN: Two stage interpretivist qualitative study based in social constructionism METHODS: Convenience sample across 13 undergraduate and 18 postgraduate health professions courses. Stage 1 (2022): using SLIPPS Learning Event Recording Tool translated into Czech. 20 students' (Midwifery=11, Nursing=1, Paramedic=1, Occupational therapy =7) submitted 21 patient safety learning event narratives. Stage 2 (2022): Focus group with 2 nursing and nine midwifery students. Phased thematic analysis involving multiple researchers. RESULTS: Three themes illustrate the circumstances and impact of placement mentoring/supervision experiences, conceptualised as: 'Clinical and Emotional Companionship', 'Clinical and Emotional Abandonment' and 'Sense of agency - Professional and personal growth'. 'Companionship' reflected the students' feelings of being welcomed, respected, heard, trusted and supported. Conversely 'abandonment' emerged from feelings of being unheard, vulnerable, humiliated, afraid, leaving students feeling abandoned, lonely and 'useless'. Notwithstanding these conditions, students showed the ability to identify patient safety issues with agency evident in reactions such as stepping-in to try to ameliorate a situation, rather than speaking-up. Professional and personal growth was also apparent in their narratives and a conceptual diagram illustrates the students' learning journeys in a patient safety context. CONCLUSION: The findings and new conceptualisations around abandonment and companionship emerging from this study expand the evidence base regarding the profound impact of clinical experience and mentorship/supervision on learning and students' emotional wellbeing. A sense of companionship appears to play a buffering role even in challenging circumstances of involvement in or witnessing compromised patients' safety. Allowing students a sense of belonging, to vent, grow, feel supported and safe to ask/learn - contributing to 'emotional safety for learning', promotes students' behaviour that may prevent/minimize hazards or ameliorate the aftermath. However, we must not simply blame mentors/supervisors, staff, or the students themselves- they are simply part of a much larger complex environment of professional education encompassing hidden curriculums, power dynamics and professional socialisation.
- MeSH
- bezpečnost pacientů * MeSH
- dospělí MeSH
- klinické kompetence MeSH
- kvalitativní výzkum * MeSH
- lidé MeSH
- mentoring MeSH
- školitelé psychologie MeSH
- studenti ošetřovatelství * psychologie MeSH
- studenti zdravotnických povolání psychologie MeSH
- studium ošetřovatelství bakalářské MeSH
- učení MeSH
- zjišťování skupinových postojů * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
