Gerontological Simulation Lab: Process Mapping a New Virtual Ward for the Nursing Home Liaison Service

<h3>Background</h3> The safe use of syringe pumps for palliative medication administration is essential in end-of-life care. However, many nursing homes in the UK face significant challenges in ensuring staff are adequately trained and competent in managing these devices (Anstey, Powell, Coles, et al. BMJ Support Palliat Care. 2016;6(3):353-61). A significant barrier is the infrequency with which syringe pumps are used in nursing homes, leading to a lack of hands-on experience among staff. Nursing homes may have limited number of residents who require syringe pumps at any given time, which makes it difficult to maintain practical proficiency in their use (Seymour, Kumar, Froggatt. Palliat Med. 2011;25(2):125-38). Additionally, there is often a high turnover rate of staff in nursing homes, meaning that new staff members may not receive adequate or ongoing training, or they may not stay long enough to develop and retain competency with this critical skill. Training tends to be theoretical with limited practical assessment or opportunities for skill refreshment. Without structured assessments, staff may lose confidence or competence over time. This skill gap poses risks to patient safety and the quality of care. <h3>Aims</h3> This project aims to address the shortage of staff competent in syringe pump management within local nursing homes. The initiative provides both initial training and practical competency assessments to improve the quality of palliative care delivered to residents (Seymour, Kumar, Froggatt. Palliat Med. 2011;25(2):125-38). <h3>Methods</h3> We deliver initial training on syringe pump theory to nursing home staff, or confirm completion of similar training within the past three months. After signing a Memorandum of Understanding, nursing homes send staff to the hospice to complete a practical competency assessment under supervision. <h3>Results</h3> Despite being in the early stages, we have had excellent engagement from nursing homes locally. We aim to collect both qualitative and quantitative data demonstrating how this project bridges the skill gap, strengthens collaboration between hospices and nursing homes, and enhances patient care and symptom management.

DESPITE THE GROWING NEED FOR NURSES TO WORK WITH THE OLDER ADULT POPULATION, THE TEACHING OF GERONTOLOGICAL NURSING PRESENTS MANY CHALLENGES TO NURSING EDUCATION, Multiple factors, including the faculty shortage, a lack of faculty expertise, and the need to develop sites for clinical placements (Ironside, Tagliareni, McLaughlin, King, & Mengel, 2010; Mueller, Goering, Talley, & Zaccagnini, 2011; Thornlow, Latimer, Kingsborough, & Arietti, 2006), affect the ability of schools of nursing to educate the nurses needed to ensure that older adults maintain functional ability to age well in the community and manage the care needs for older adults in acute care and rehabilitation settings. With the population of people over the age of 60 expected to double worldwide between 2000 and 2050, from 600 million to 2 billion (World Health Organization, 2012), the need for nurses trained in gerontology is greater now than ever before. Gerontology content varies in schools of nursing, with some programs having a single gerontology course and others integrating content across the curriculum. Either way, schools must prepare graduates with the competencies required to manage care for older adults across a diversity of health care settings. This article describes how the creation of a geriatric nurse instructor position maximized educational benefits and enhanced the academic-practice partnership between a community college in Maine and local nursing homes. Implications for those interested in designing, funding, or implementing such a position are presented. Background First-level nursing students in the associate degree nursing program traditionally received initial clinical experiences at local nursing homes (Ironside et al., 2010). A faculty shortage, combined with lack of expertise in gerontological nursing, led to an inefficient learning experience for students, one that did not meet the program's expected learning outcomes. With nursing homes in the area struggling to recruit and retain new graduate nurses, the nursing leadership of a rural geriatric health agency, which partnered with five nursing homes, met with the chair of the nursing department at the community college, to explore barriers to the use of nursing homes as clinical sites and as potential employers for new graduate nurses. These discussions led to a proposal to create a geriatric nurse service instructor position with a threefold purpose: a) to address gaps in gerontology nursing in the curriculum and help with the nursing faculty shortage, b) to increase the effectiveness of clinical experiences for students at two of the nursing homes, and c) to provide mentorship opportunities for students and new graduate nurses. A grant proposal was submitted to a foundation to help with initial funding for the position's salary. The community college also supports the position with funding, and the agency contributes administrative, human resources, and technology support for the position. The instructor maintains an office at the geriatric health agency and divides her time equally between the community college and the agency, with flexibility to offer additional time at either site as needed. (In the fall, the ratio is 60/40, with more time spent at the community college.) With four organizations helping to fund the position, financial sustainability is supported. As envisioned, the position called for, at a minimum, a master's prepared, certified gerontology nurse with academic experience at the undergraduate level. Additional skills in interdisciplinary communication, leadership and management concepts, and collaboration were identified as essential requirements for success in the position, and the ability to use technology to deliver educational programs such as web-based, online training program modules was preferred. Support of Nursing Students A first step for the geriatric nurse service instructor was the completion of a curriculum review of the associate degree program to identify gaps in gerontological nursing education. …

Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference.

Generative pretrained transformer-4 (GPT-4) has gained widespread attention from society, and its potential has been extensively evaluated in many areas. However, investigation of GPT-4's use in medicine, especially in the ophthalmology field, is still limited. This study aims to evaluate GPT-4's capability to identify rare ophthalmic diseases in three simulated scenarios for different end-users, including patients, family physicians, and junior ophthalmologists. We selected ten treatable rare ophthalmic disease cases from the publicly available EyeRounds service. We gradually increased the amount of information fed into GPT-4 to simulate the scenarios of patient, family physician, and junior ophthalmologist using GPT-4. GPT-4's responses were evaluated from two aspects: suitability (appropriate or inappropriate) and accuracy (right or wrong) by senior ophthalmologists (> 10years' experiences). Among the 30 responses, 83.3% were considered "appropriate" by senior ophthalmologists. In the scenarios of simulated patient, family physician, and junior ophthalmologist, seven (70%), ten (100%), and eight (80%) responses were graded as "appropriate" by senior ophthalmologists. However, compared to the ground truth, GPT-4 could only output several possible diseases generally without "right" responses in the simulated patient scenarios. In contrast, in the simulated family physician scenario, 50% of GPT-4's responses were "right," and in the simulated junior ophthalmologist scenario, the model achieved a higher "right" rate of 90%. To our knowledge, this is the first proof-of-concept study that evaluates GPT-4's capacity to identify rare eye diseases in simulated scenarios involving patients, family physicians, and junior ophthalmologists. The results indicate that GPT-4 has the potential to serve as a consultation assisting tool for patients and family physicians to receive referral suggestions and an assisting tool for junior ophthalmologists to diagnose rare eye diseases. However, it is important to approach GPT-4 with caution and acknowledge the need for verification and careful referrals in clinical settings.

Therapeutic reasoning focuses on the decisions related to patient disposition and management. This is in contrast to diagnostic reasoning, which is the focus of much of the current discourse in the medical literature. Few studies relate to therapeutic reasoning, and even fewer relate to the rural and remote context. This project sought to explore the therapeutic reasoning used by rural generalists working in a small rural hospital setting in Australia, caring for patients for whom it was unclear if escalation of care, including admission or interhospital transfer, was needed. This study was conducted using an interpretivist approach. A simulation scenario was developed with rural generalists and experts in medical simulation to use as a test bed to explore the reasoning of the rural generalist participants. The simulation context was a small rural Australian hospital with resources and treatment options typical of those found in a similar real-life setting. A simulated patient and a registered nurse were embedded in the scenario. Participants needed to make decisions throughout the scenario regarding the simulated patient and two anticipated patients who were said to be coming to the department. The scenario was immediately followed by a semi-structured interview exploring participants' therapeutic reasoning when planning care for these three patients. An inductive content analysis approach was used to analyse the data, and a mental model was developed. The researchers then tested this mental model against the recordings of the participants' simulation scenarios. Eight rural generalists, with varying levels of experience, participated in this study. Through the semi-structured interviews, participants described five themes: assessing clinician capacity to manage patient needs; availability of local physical resources and team members; considering options for help when local management was not enough; patients' wishes and shared decision making; and anticipating future requirements. The mental model developed from these themes consisted of seven questions: 'What can I do for this patient locally and what are my limits?'; 'Who is in my team and who can I rely on?'; 'What are the advantages and disadvantages of local management vs transfer?'; 'Who else needs to be involved and what are their limits?;' 'How can we align the patient's wants with their needs?'; 'How do we adapt to the current and future situation?'; and 'How do I preserve the capacity of the health service to provide care?' This study explored the therapeutic reasoning of rural generalists using a simulated multi-patient emergency scenario. The mental model developed serves as a starting point when discussing therapeutic reasoning and is likely to be useful when providing education to medical students and junior doctors who are working in rural and remote contexts where resources and personnel may be limited.

This article was migrated. The article was not marked as recommended. IntroductionThe recognition and initial response of clinical teams to patients who suffer a deterioration in their condition is an essential capability of healthcare institutions. Simulation can provide some of this training, but creating appropriate 'cues' for recognising unwell patients can be challenging. We aimed to investigate how medical students recognise whether a patient is 'sick', and what they do in response to that recognition, using scenarios of clinically deteriorating simulated patients.MethodsSenior medical students at Bond University participating in simulation scenarios were invited to participate in this study. Scenarios were delivered with simulated patients (SPs). During the post simulation debrief and in subsequent interviews, students were asked questions related to their recognition of, and response to, sick 'patients' in their scenarios. Debriefing sessions involving the students were audio recorded and transcribed. Thematic analysis of responses was conducted.ResultsResults suggest that verbal and non-verbal cues from SPs were the most significant influence on student's recognition of clinical deterioration. Responses to that recognition were varied, but calling for help was perceived by the students to be an effective response.ConclusionEffective simulation training for medical students to recognise and respond to clinical deterioration requires scenarios that offer strong cues in patient appearance, speech and behaviour, and suggests that human simulated patients are effective educators for this purpose.

Patient Simulator Competency Testing

Service-learning is an ideal teaching approach to use in courses on the psychology of aging because it allows experiential education to be actively integrated with classroom instruction. This article describes the results of adding a service-learning option to a lecture course on the psychology of aging. For this course, service-learning took place at local nursing homes, area retirement communities, and the local community center, which houses an activity program for older adults. Each student was required to complete 30 hr community service-learning during the semester, maintain a journal, write a summary paper, join a reflection group, and participate in a group presentation. Students were involved in a wide range of activities, from assisting with a hot lunch program to spending time talking with nursing home residents. Evaluation of the effectiveness of this approach was established by using open-ended student evaluations that were completed at the end of the semester. Data were gathered over 2 years from the portion of the class (approximately one third) each semester) who chose to complete a one-credit service-learning experience. The service-learning component significantly enhanced the course experience for the students, instructor, graduate and undergraduate teaching assistants, and facilities involved. Overall, the majority of students affirmed that their participation in the service-learning project related well to the course, and facility responses to student service-learning participants were overwhelmingly positive.

The Promise of Nursing Home Medical Direction: A Work in Progress

Introduction NHS England is committed to the expansion of virtual wards, necessitating patient engagement with home care technology. Literature suggests there is a technology adoption lag among older populations. We investigated if this lag was evident in geriatric virtual ward patients. Methods Data from three NHS trusts using a virtual care platform (March 2021–August 2023) were aggregated to assess differences in perceived ease of use, technology adoption style, and measures of adherence. All patients received the Telehealth Usability Questionnaire Ease of Use (EOU) subsection (higher scores indicate higher EOU). Patients completed surveys via tablet, wore monitoring devices, and took blood pressure readings. We dichotomised age (&amp;lt;75 vs. 75+) and used Fisher’s exact and Wilcoxon-Mann–Whitney tests. Results Of 857 patients, 36.9% were geriatric (mean age 81.5 years). The younger group (mean age 59.1 years) had 541 patients. Gender was evenly split between age groups (p = 0.62). Median EOU scores were 5.5 (geriatric) and 6.2 (younger) (p &amp;lt; 0.001). Geriatric patients were more likely to avoid or delay technology adoption (82% vs. 56% in younger patients, p &amp;lt; 0.001). Geriatric patients had higher adherence to the wearable device (median 95.3%) compared to younger patients (93.3%, p &amp;lt; 0.001). Blood pressure (median 81.6%) and survey adherence (median 83.3%) did not significantly differ between groups (p = 0.076, p = 0.0501). Conclusions Despite perceptions and literature suggesting older patients are less comfortable with technology, our findings demonstrate high engagement in virtual ward technology. While differences exist in technology adoption and EOU scores, geriatric patients exhibit equal or higher adherence to remote monitoring tasks. These results challenge stereotypes and underscore the importance of incorporating technology in geriatric care.

Expanded Access to Rehabilitation Services for Older People

Optimal care in nursing home (NH) settings requires effective team communication. Certified nursing assistants (CNAs) interact with nursing home residents frequently, but the extent to which CNAs feel their input is valued by other team members is not known. We conducted a cross-sectional study in which we administered a communication survey within 20 Utah nursing home facilities to 650 team members, including 124 nurses and 264 CNAs. Respondents used a 4-point scale to indicate the extent to which their input is valued by other team members when reporting their concerns about nursing home residents. We used a one-way ANOVA with a Bonferroni correction. When compared to nurses, CNAs felt less valued (CNA mean = 2.14, nurse mean = 3.24; p < 0.001) when reporting to physicians, and less valued (CNA mean = 1.66, nurse mean = 2.71; p < 0.001) when reporting to pharmacists. CNAs did not feel less valued than nurses (CNA mean = 3.43, nurse mean = 3.37; p = 0.25) when reporting to other nurses. Our findings demonstrate that CNAs feel their input is not valued outside of nursing, which could impact resident care. Additional research is needed to understand the reasons for this perception and to design educational interventions to improve the culture of communication in nursing home settings.

Management of COVID-19 in a French Nursing Home: Experiences from a Multidisciplinary Mobile Team.

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Nurse Notes Inspiration of Her 40-Year Career