International journal of evidence-based healthcare
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Int J Evid Based Healthc · Sep 2008
Effectiveness of simulation on health profession students' knowledge, skills, confidence and satisfaction.
Background Despite the recent wave of interest being shown in high-fidelity simulators, they do not represent a new concept in healthcare education. Simulators have been a part of clinical education since the 1950s. The growth of patient simulation as a core educational tool has been driven by a number of factors. Declining inpatient populations, concerns for patient safety and advances in learning theory are forcing healthcare educators to look for alternatives to the traditional clinical encounter for skill acquisition for students. Objective The aim of this review was to identify the best available evidence on the effectiveness of using simulated learning experiences in pre-licensure health profession education. Inclusion criteria Types of studies: This review considered any experimental or quasi-experimental studies that addressed the effectiveness of using simulated learning experiences in pre-licensure health profession practice. In the absence of randomised controlled trials, other research designs were considered for inclusion, such as, but not limited to: non-randomised controlled trials and before-and-after studies. ⋯ This review included participants who were pre-licensure practitioners in nursing, medicine, and rehabilitation therapy. Types of intervention(s)/phenomena of interest: Studies that evaluated the use of human physical anatomical models with or without computer support, including whole-body or part-body simulators were included. Types of outcome measures Student outcomes included knowledge acquisition, skill performance, learner satisfaction, critical thinking, self-confidence and role identity. Search strategy Using a defined search and retrieval method, the following databases were accessed for the period 1995-2006: Medline, CINAHL, Embase, PsycINFO, HealthSTAR, Cochrane Database of Systematic Reviews and ERIC. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for evidence of effectiveness, developed by the Joanna Briggs Institute. Disagreements were dealt with by consultations with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the standardised data extraction tool from the Joanna Briggs Institute. Disagreements were dealt with by consultation with a third reviewer. Data synthesis Due to the type of designs and quality of available studies, it was not possible to pool quantitative research study results in statistical meta-analysis. As statistical pooling was not possible, the findings are presented in descriptive narrative form. Results Twenty-three studies were selected for inclusion in this review including partial task trainers and high-fidelity human patient simulators. The results indicate that there is high learner satisfaction with using simulators to learn clinical skills. The studies demonstrated that human patient simulators which are used for teaching higher level skills, such as airway management, and physiological concepts are useful. While there are short-term gains in knowledge and skill performance, it is evident that performance of skills over time after initial training decline. Conclusion At best, simulation can be used as an adjunct for clinical practice, not a replacement for everyday practice. Students enjoyed the sessions and using the models purportedly makes learning easier. However, it remains unclear whether the skills learned through a simulation experience transfer into real-world settings. More research is needed to evaluate whether the skills acquired with this teaching methodology transfer to the practice setting such as the impact of simulation training on team function.
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Int J Evid Based Healthc · Sep 2008
The clinical effectiveness of Ginger (Zingiber officinale) in adults with osteoarthritis.
Background Osteoarthritis (OA) is a degenerative joint disease, which is associated with increased pain and disability, and a simultaneous decline in the quality of life of sufferers. While there is no cure for OA, there are numerous treatments that aim to reduce sufferers' symptoms and disability, and improve their quality of life. Medications, which have long been integral interventions for the management of OA, have recently been found to cause harm in some patients. ⋯ Conclusion Current evidence is weak for the use of Ginger in adults with OA of the knee and/or hip. Much of this can be attributed to significant heterogeneity between studies. Improvements in research design, instrumentation and ginger dosage, which more closely reflect current clinical practice, may help to demonstrate the safe and effective use of Ginger in OA sufferers.
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Int J Evid Based Healthc · Sep 2008
Compliance with best practice: implementing the best available evidence in the use of physical restraint in residential aged care.
The Aged Care Clinical Fellowship, funded by the Commonwealth Department of Health and Ageing and conducted through the Joanna Briggs Institute is an initiative designed to improve the care of older Australians through clinical leadership and promotion of best practice. This paper outlines one of the projects undertaken at Carinya of Bicton, a residential aged high care facility, using an audit and feedback process to implement best practice standards in the use of physical restraint. Aims Between 12% and 47% of residents in residential care facilities are restrained; however, initial observation of residents restrained in the project facility showed that restraint devices were utilised in up to 40% of residents. ⋯ This support will need to continue because while practice has improved in the short term, there are still barriers to change in this area. Also of benefit has been a shift in emphasis of the continuous quality improvement program at the facility to a more clinical focus. Management and staff, especially members of the project team have agreed that this process be utilised to improve practice in a number of other areas such as falls, constipation and behaviour management.
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Int J Evid Based Healthc · Jun 2008
A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults.
Objectives This review had two objectives: (i) to determine what is required in an assessment of faecal incontinence issues for older community-dwelling adults; and (ii) to determine the psychometric tools most effective for assessment of faecal incontinence in older community-dwelling adults. Inclusion criteria For the review of psychometric tools, studies were included if they were concerned with people living in the community, included a significant proportion of the sample aged 65 years or over, and either examined psychometric properties of assessment tools or assessed sensitivity of assessment tools to non-surgical interventions available in the community setting. For the review of expert opinion, the search was limited to expert opinion provided by an expert in faecal incontinence that related to community-based assessment. ⋯ Although studies in the review of psychometric properties suffer from limitations such as inadequate sample sizes, the Vaizey and Wexner scales would appear to be the tools of choice. The FIQLS is clearly the tool of choice at this stage for measuring faecal incontinence quality of life. Further validation of tests used in faecal incontinence assessments is required.
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Int J Evid Based Healthc · Jun 2008
Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review.
Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. ⋯ No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: • Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved • Encourage active participation in educational interventions for caregivers • Offer individualised programs rather than group sessions • Provide information on an ongoing basis, with specific information about services and coaching regarding their new role • Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: • Simply refer caregivers to support groups • Only provide self help materials • Only offer peer support.