Canadian Journal of Respiratory Therapy最新文献

Despite the apparent centrality of fidelity to clinical simulation instructional design and practice in respiratory therapy education, it remains one of most contested constructs in the simulation literature. Fidelity has been described as educationally under-theorized resulting in an emphasis often being placed on technological sophistication rather than theory-informed design, particularly in respiratory therapy. This article critically examines various conceptualizations of fidelity in the field of clinical simulation in an effort to inform its instructional design practices. We adopt the perspective that a shift in the theoretic lens from individualistic to a more socio-cultural orientation may better support our understanding of learning in simulation environments. The instructional design framework (IDF) developed by the Canadian Network for Simulation in Healthcare provides a solid pedagogical foundation on which to base clinical simulations design. The IDF has also been a platform upon which designers can frame the characteristics of simulation environments. We propose an enhanced IDF informed by contemporary education theory describing the joint learning relationship that exists between learners and technology-enhanced learning environments. The enhanced IDF includes each of the interdependent design elements in the original model and incorporates a socio-culturally informed conceptualization of fidelity. The framework will be useful in fostering the relationships that support an effective clinical simulation learning environment. This will be of particular value to practitioners, researchers, and theorists in the clinical simulation-based respiratory therapy education field.

Clinical simulation has gained prominence as an educational approach in many Canadian respiratory therapy programs and is strongly associated with improved learning, clinical and nonclinical skill, future performance, and patient outcomes. Traditionally, the primary assessment approach employed in clinical simulation has been formative debriefing for learning. Contextual factors, such as limited opportunities for learning in clinical practice and technologically oriented perspectives on learning in clinical simulation, are converging to prompt a move from using formative debriefing sessions that support learning in simulation to employing high-stakes testing intended to measure entry-to-practice competencies. We adopt the perspective that these factors are intricately linked to the profession's regulatory environment, which may strongly influence how simulation practices become embedded with respiratory therapy educational programs. Through this discussion we challenge the profession to consider how environmental factors, including externally derived requirements, may ultimately impact the effectiveness of simulation-based learning environments.

Background: Simulation-enhanced interprofessional education (sim-IPE) is a growing component of undergraduate health curricula, preparing learners for the practice environment and, in doing so, redefining practice culture. The Canadian Interprofessional Health Collaborative (CIHC) has established a national competency framework of integrative competency domains focused on fostering core skills, attitudes, and values in an effort to evolve interprofessional collaboration (IPC). This framework serves as the foundational underpinning for IPE within all health professions. Partnering for Patti is a sim-IPE experience collaboratively developed by faculty from Bachelor of Nursing and Respiratory Therapy programs within two Atlantic institutions leveled for third-year nursing and respiratory therapy students. This event provides an opportunity for participants to enhance their knowledge of the six CIHC IPE domains, and improve their understanding of and appreciation for IPC. Within this context learners must work together, and rely on the expertise of both professional groups to critically think through and improve a declining client scenario. Once complete, debriefing and reflective journaling help participants solidify learning and deduce new frames of understanding. It has been hypothesized that this event enhances student knowledge of CIHC IPE domains, and creates a deeper appreciation for, and understanding of IPC. The primary objective of this research was to determine if participants' understanding of CIHC IPE domains improved, and if perceptions of their own and the other profession were reframed as a result of this innovation.

Methods: This article describes the educators' approach in setting up and delivering this learning experience and the results of this event through students' perceptions. This cross-sectional study used a descriptive mixed-methods design. Two data collection tools were used to explore changes in participants' perceptions and event feedback.

Results: Data analysis found that the majority of participants identified value in this IPE learning experience. Qualitative and quantitative findings suggest participants developed a deepened appreciation for IPC and an improved understanding of the CIHC IPE competency domains.

Discussion: The evaluative findings of this study support the value of Partnering for Patti as a novel IPE learning experience. Although it is unclear to what degree objectives were met, findings strongly support continued integration of this learning experience.

Background: There is a paucity of patient safety information from the community sector related to the medically fragile population requiring home mechanical ventilation (HMV). To improve safety, the risks HMV patients encounter must first be understood.

Objectives: To describe patient safety incidents within the HMV population and discuss opportunities for preventing harm.

Methods: A retrospective observational review of on-call logs from the Ontario Ventilator Equipment Pool (VEP) was conducted. Classification of 248 on-call logs from April 1, 2011 to March 21, 2012 was completed using the standardized tool of the World Health Organization's (WHO) Patient Safety Taxonomy - International Classification System to quantitatively describe the types of incidents arising. Analysis of data classification was completed using descriptive and nonparametric statistics.

Results: Patient incidents were positive in 188 on-call logs; emerging from these were 227 incident types. Patient incident types included medical device issues (99 device failures, 41 user errors, 12 equipment availability), documentation (20 unavailable labels/prescriptions, four unclear information), clinical processes (16 inadequate treatment or general care) and clinical administration (10 inadequate handover or transfer of care). Patient incidents were associated with mild harm in 87 cases.

Conclusions: The on-call logs were a good source of quality improvement data to understand harm and patient safety issues emerging in the HMV population. However, establishing a formal incident review and reporting system is required to provide a more comprehensive understanding.