Exploring Faculty Perceptions about Simulation Training: Influence on Career, Confidence, Knowledge and Skill Acquisition and Competence

Abstract Even with insufficient evidence in the literature regarding the impact of faculty development with simulation education, faculty development is critical to building a successful simulation program. Despite simulation being ubiquitous in nursing education across the United States (US), there is little investigation of the impact of the education and training on job satisfaction, skill development and overall confidence when using simulation to teach nursing students. The purpose of this qualitative study was to investigate how has simulation education and training has influenced faculty career fulfillment, acquisition of knowledge, overall self-confidence and competence? Themes that emerged included the following: competency, professional role change, role acquisition, course learner needs, course impact, skill development, and overall ability and confidence. The study results confirmed that a gap exists where faculty without formal education may not be aware of their lack of competence and what training they need to be effective in facilitating clinical simulation.</jats:p

The TRANSFORM Patient Safety Project: a microsystem approach to improving outcomes on inpatient units.

BackgroundImprovements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective.ObjectiveWe aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units.DesignA 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase.Setting and participantsFour medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants.InterventionsIn situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork.OutcomesHospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey.ResultsRates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p &lt; 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p &lt; 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents.ConclusionA multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses' perceptions of safety culture on inpatient study units

The TRANSFORM Patient Safety Project: A Microsystem Approach to Improving Outcomes on Inpatient Units

BACKGROUND: Improvements in hospital patient safety have been made, but innovative approaches are needed to accelerate progress. Evidence is emerging that microsystem approaches to quality and safety improvement in hospital care are effective. OBJECTIVE: We aimed to evaluate the effects of a multifaceted, microsystem-level patient safety program on clinical outcomes and safety culture on inpatient units. DESIGN: A 1-year prospective interventional study was conducted, followed by a 6-month sustainability phase. SETTING AND PARTICIPANTS: Four medical and surgical inpatient units within an academic university medical center were included, with registered nurses and residents representing study participants. INTERVENTIONS: In situ simulation training; debriefing of medical emergencies; monthly patient safety team meetings; patient safety champion role; interdisciplinary patient safety conferences; recognition program for exemplary teamwork. OUTCOMES: Hospital-acquired severe sepsis/septic shock and acute respiratory failure; unplanned transfers to higher level of care (HLOC); weighted risk-adjusted mortality. Safety culture was measured using a widely accepted, validated survey. RESULTS: Rates of hospital-acquired severe sepsis/septic shock and acute respiratory failure decreased on study units, from 1.78 to 0.64 (p = 0.04) and 2.44 to 0.43 per 1,000 unit discharges (p = 0.03), respectively. The mean number of days between cases of severe sepsis/septic shock increased from baseline to the intervention period (p = 0.03). Unplanned transfers to HLOC increased from 715 to 764 per 1,000 unit transfers (p = 0.08). The weighted risk-adjusted observed-to-expected mortality ratio on all study units decreased from 0.50 to 0.40 (p < 0.001). Overall scores of safety culture on study units improved after the 1-year intervention, significantly for nurses (p < 0.001), but not for residents (p = 0.06). Scores significantly improved in nine of twelve survey dimensions for nurses, compared to in four dimensions for residents. CONCLUSION: A multifaceted patient safety program suggested an association with improved hospital-acquired complications and weighted, risk-adjusted mortality, and improved nurses’ perceptions of safety culture on inpatient study units

Stratified analyses refine association between TLR7 rare variants and severe COVID-19

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (<60 years) cases with no reported clinical risk factors (n = 378), compared to 0.24% of controls (odds ratio [OR] = 12.3, p = 1.27 × 10−10). Incorporation of the results of either functional assays or protein modeling led to a pronounced increase in effect size (ORmax = 46.5, p = 1.74 × 10−15). Association signals for the X-chromosomal gene TLR7 were also detected in the female-only subgroup, suggesting the existence of additional mechanisms beyond X-linked recessive inheritance in males. Additionally, supporting evidence was generated for a contribution to severe COVID-19 of the previously implicated genes IFNAR2, IFIH1, and TBK1. Our results refine the genetic contribution of rare TLR7 variants to severe COVID-19 and strengthen evidence for the etiological relevance of genes in the interferon signaling pathway