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Study Methods

Discuss About The Quality Of Reporting Randomized Controlled.

The study population entailed all Monash University, undertaking nursing, medicine, physiotherapy, occupational therapy, dietetics and social work, who have been placed on intervention or control wards at Peninsula Health.
Study Methods

This study employed a cross over randomized controlled trial having concurrent economic evaluations. Further random allocation of eight health services in Peninsula health Victoria Australia was used.

Data was analyzed using stata, statistical soft ware. Quantitative information on student knowledge, skills and attitudes outcomes were made comparable between groups and within intervention group.

Qualitative data was analyzed thematically establishing the relationship between interviewer and interviewee.
Evaluation tools/methods

  • rate of falls per 1000 occupied bed days
  • proportion of patients who experiences more falls
  • rate of falls resulting in serious injury or linked to death occurring per 1000 occupied days

this data will be collected from the hospital by RA using a computerized hospital incident reporting tool, manual searching of the medical records and interviews. This reporting tool is based on studies indicating that falls can be under reported while using hospital incidence reporting tool.

After the intervention, practice change was assessed using end of placement survey tool where by students were asked to make reports on the occasions they provided three categories of safe Recovery Program, the following questions were raised;

  1. Explaining to the patient on the nature of fall in hospital through, where, when and why criteria.
  2. Assessment of patient self perceived risks status of falling in hospital
  • Instances of offering the patient to set their own goals aimed at reducing the risk of fall while at the hospital.

Assessment of data on enablers and barriers related to students providing safe care recovery program on clinical placement were collected using end of placement and end of study interview.

Interview among key informant interview were assessed also. Change in knowledge process was measured using self report surveys, among the study participants on knowledge on when the falls occur and common employed strategies.

The results of this study showed that simulation based nursing techniques are effective in assessing learning domains, having pooled random effects and standardized mean difference of 0.70, sub group analysis showed that effect sizes were higher for fidelity simulations at 0.86. In cognitive outcomes, the effect size as indicated for high fidelity simulation was indicated as 0.80 and standardized patients was 0.73 having largest effect sizes on affective outcomes high fidelity. the intervention on students improved the domains of health care assessment on falls among patients.
Conclusions:

The results shows that simulation nursing education is effective as a educational intervention and have strong education effects on learners so as to reduce falls among hospitals patients. The education based simulation is effective in improving nursing care approach towards reducing the number of falls among the patients who are hospitalized.

Clinical education approaches are aimed at integrating nursing theoretical knowledge into practice towards improving health status. Simulation based module is aimed at ensuring that there is utilization of pedagogical approach to health care practice, by providing appropriate techniques to provide opportunities for effective clinical skills through real life experience experiences.

Evaluation tools/methods

Simulation based approaches are geared towards using the patients as simulators. This article has utilized patients as simulators, aimed at improving the practices of nurses and helping them in enabling adoption of effective skills, (Cook, 2014).

This study has brought about is providing immediate feedback to the patients, providing feedback , repetitive practice and integrating simulation process into the learning process of learners thus offering an opportunity of individualizing learning process.

Description of simulation process entails those ranging from low to high fidelity simulations. Many simulation methods and various educational levels can be adapted to suit the environment. The study has constructed a simulation technique for prevention of falls in the hospital. The effect size for this simulation process is essential in improving clinical outcomes of the patients towards reduction of the fall, through nursing education, (McGaghie et al, 2010).

The study has used cross over study design which is a longitudinal in nature as a subjects receive various treatments. Many crossover treatments are observation however few are controlled experiments. This study has utilized randomized controlled cross over designs. This kind of design is essential in health care practice in that subjects are randomly assigned to different forms of treatment of study. When the clinical trial is repeated, it calls for collection of same measurements over multiple times for each subject case, (Issenberg et al, 2005).

In this treatment all the subjects have received the same treatment, thus creating balance effect; with all the subjects receive same treatment with same equal number participation. Further the subjects used in this study are serving as their controls thus limiting the number of covariates. Cross over trials are often associated to study duration, as the risks need to persist for long for subject exposure status. However a drawback which was not highlighted in the study is the effect of crossover effects which may alter the response other treatment offered by the medical students offering the care. With critical analysis of the study, effect of the carry effects could not be observed as the risks for patients could  not have any significant impact on the overall study design. The study utilized wash out effect to mitigate on the cross over effect during the consecutive application of simulation application which is usually long enough to offer wearing of treatment effects, thus duration of stay played central  role in assigning the wash out effect on the study participants, (Waxman, 2010).

Outcome measures

Thus research design allowed for answering of the research question on assessing the simulation education strategies on medical health care staff and further usage of medical students on placements serves an appropriate and ideal opportunity for assessment of the education based simulation strategy.

Educational strategy of offering medical skills has been increasingly been utilized to teach various skills to health and clinical professionals and students alike. The various modalities employed in facilitated this kind of study is key in ensuring that education effect is utilized in nursing health care. Various avenues of simulation based techniques have been employed, (Cheng et al, 2014). These include those pertaining to procedural training models and manikin simulated patients. Studies have shown that simulation based education techniques have an impact in improving patient outcomes, procedure based tasks like catheter and air way management. On the other end simulated patients have the ability to be given an opportunity to given feedback to health professionals or even students. Simulated subjects are crucial for raising the patient profiling and have characteristics of demonstrating wide range of emotional and mental state thus improving patient engagement, (Lorello et al, 2014).

The study has used ill patients who are at risk of fall in hospitals as stimulants, while the medical students on placement have been offered an opportunity in assessing and improving the education strategies so as to prevent falls and improve patient risks assessment. With the current changes in placement of students, safety of the patients, the experience of the students play critical role in ensuring that problems such as falls in hospitalized patients are handled effectively and patients are thought on self management aspects. Thus this clinical simulation based approach is geared towards ensuring effective practice of students on clinical process and improving response in real life situations post placement.

Clinical based simulations are key in ensuring that application of teaching methodologies which mimic real life is put to be learnt. Simulation of learning aspects is linked to philosophical contemporary theories of constructivism. The medical students who are the learners in the study are able to learn and understand how to manage and tackle falls among hospitals patients. Simulation  based using education model approaches are essential in ensuring that health education  and mental state of the participants is improved, they enhance the memory status and improve the overall efficacy of health education, thus the conversion of this factors are key in effective cognitive process, (Juni et al, 2001).

Change outcomes measures

This study for the purposes of effectiveness has utilized patients as subjects while the medical team students as simulators. This gives an opportunity for exposure to patients, for acquisition of necessary skills and reduction of falls in hospitals. Further it incorporates provision and acquisition of necessary skills which develop health professionals and improves their skills, knowledge and attitude while offering protection to the patient. Nursing education though simulated process, it allows exposure of the students in order for feting necessary practical skills, this further is geared towards providing the patient with the necessary safety and well being during the illness process. Simulation progresses are crucial in that they provide the relevant skills. In the study this was evident in the manner that there the simulation process was aimed at reducing hospitals fall thus improving overall care process to the patient. This gives room for other health care staff to have opportunity for the development of refining skills using simulation technology process.

Thus simulation based intervention in this study is crucial in providing key and relevant nursing concepts and patient care process. Thus equipping the participants or the users with key tools and resources is paramount t in ensuring effective simulation process. This study showed improved status of patient’s occurrence with falls, thus signaling the effectiveness of the intervention.

Improvement of simulation process entails the use of other skills which play key role in ensuring effective simulation process. There is need to include technical and functional expertise in the simulation based education in the study, improving problem solving skills and improving interpersonal and communication skills. These improvement aspects portray a common share of the thread in that they posses active listening and possession of skills and knowledge, (Begg et al, 1996).

Common mishaps that occur in simulation process include lack of focused understanding on roles and responsibilities, absence of clear and defined roles, process that incorporate back up plans and efficient of duties to be done. In the simulation based education intervention in the study, improvements can be made on linking roles and sharing responsibilities with team members and motivating members for 100% efficiency on tasks given and assigned in the care process.

The use of simulation techniques and approaches are rapidly and progressively expanding the scope of knowledge. This has prompted the use of CONSORT, referring to consolidated standards of reporting trials framework and STROBE, referring strengthening the reporting of observational studies in epidemiology. Adopting CONSORT framework is key so to improve the reporting processes. The CONSORT checklist contains checklist elements which entrench quality aspects, (Plint et al, 2006). This SBE thus need to be modified so as to sit changing trends of care process. The use of STROBE process on the care process is key towards ensuring inclusion of both clinical and educational approaches, (Cheng et al 2006). Thus adoption of SBE which suits the intervention is key so as to maximize effect of intervention. Thus SBR has to align itself though incorporating of clear and concise interventions which produce the expected effect.

References

Barry Issenberg, S., McGAGHIE, W. C., Petrusa, E. R., Lee Gordon, D., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical teacher, 27(1), 10-28.

Begg, C., Cho, M., Eastwood, S., Horton, R., Moher, D., Olkin, I., ... & Stroup, D. F. (1996). Improving the quality of reporting of randomized controlled trials: the CONSORT statement. Jama, 276(8), 637-639.

Cheng, A., Eppich, W., Grant, V., Sherbino, J., Zendejas, B., & Cook, D. A. (2014). Debriefing for technology?enhanced simulation: A systematic review and meta?analysis. Medical Education, 48(7), 657-666.

Cheng, A., Kessler, D., Mackinnon, R., Chang, T. P., Nadkarni, V. M., Hunt, E. A., ... & Hui, J. (2016). Reporting guidelines for health care simulation research: extensions to the CONSORT and STROBE statements. Advances in Simulation, 1(1), 25

Cook, D. A. (2014). How much evidence does it take? A cumulative meta?analysis of outcomes of simulation?based education. Medical education, 48(8), 750-760.

Jüni, P., Altman, D. G., & Egger, M. (2001). Assessing the quality of controlled clinical trials. Bmj, 323(7303), 42-46.

Lorello, G. R., Cook, D. A., Johnson, R. L., & Brydges, R. (2014). Simulation-based training in anaesthesiology: a systematic review and meta-analysis. British journal of anaesthesia, 112(2), 231-245

McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010). A critical review of simulation?based medical education research: 2003–2009. Medical education, 44(1), 50-63.

Plint, A. C., Moher, D., Morrison, A., Schulz, K., Altman, D. G., Hill, C., & Gaboury, I. (2006). Does the CONSORT checklist improve the quality of reports of randomised controlled trials? A systematic review. Medical journal of Australia, 185(5), 263.

Waxman, K. T. (2010). The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35.

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