OBJECTIVE: The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students. DESIGN: A drill-and-practice program to control for time on task, and tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease. SETTING: Subjects were tested in 30 undergraduate dietetics programs. SUBJECTS: Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD). INTERVENTION: After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3). MAIN OUTCOME MEASURES: Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was computed. STATISTICAL ANALYSIS: One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20. RESULTS: The reliability coefficient of the stimulation test was 0.93. Group 2 higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3. APPLICATIONS/CONCLUSIONS: A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experimental learning before their clinical intern practicums.

Introduction: Early supported discharge intervention offers strokerehabilitation in the home environment. Digitalisation in society may make it demanding to perform everyday activities in traditional ways. Considering that the use of technology now is part of our daily activities, occupational therapists need to maintain a client-centred practice and make sure that their own competencies in using the technology is adequate. Aim: The aim with this study is to explore occupational therapists' perceptions and experiences of interventions involving digital technology with post-stroke patients in early supported discharge settings. Method: A qualitative study with aphenomenological approach was carried out. Four interviews of occupational therapists were conducted. A qualitative content analysis approach was done for the analysis. Findings: Two main categories emerged which were interpreted into the theme Digitalization requires clinical reasoning. Many factors that involved the digitalization of today's society affected both the patients' occupations pre- and post-stroke and therefore also affected the OTs roles and work process. Conclusions: This study highlights that more knowledge is required regarding digital technology and enhancing competence and clinical reasoning within the occupational therapy practice process. Significance: This3study may provide a better understanding for the potential effects that digitalization has within occupational therapy practise.

Submitted in fulfilment of the requirements for the Degree in Master of Technology: Nursing, Durban University of Technology, 2012. / Background : Work Integrated Learning is an educational approach that aligns academic and workplace practices for the mutual benefit of students and workplaces. Work Integrated Learning like in any other nursing course is essential in primary health care as required by the South African Nursing Council. In the clinical setting, students develop clinical and diagnostic reasoning; they also learn how to make the appropriate clinical decisions which they need as qualified primary health care practitioners. This is achieved through instruction and guidance by lecturers, mentors and clinical staff. However it has been noted that the clinical learning environment confronts students with challenges that are absent from the classroom situation. So this study seeks to explore and describe the experiences of post basic nursing students in primary health care clinics so as to address the challenges that are faced within the clinical settings. Aim of the study The aim of the study was to explore and describe primary health care post basic nursing students’ experiences during clinical placements. Methodology : A descriptive exploratory qualitative approach was used to guide the study. In-depth interviews were conducted with ten primary health care post basic nursing students who were allocated for Work Integrated Learning at the clinics in District A and District B in 2011. The main research question for this study was asked: ‘What are the experiences of primary health care post basic nursing students regarding Work Integrated Learning?’ Results : The findings of this study revealed that Work Integrated Learning is vital for the development of clinical skills amongst primary health care post basic nursing students. However, shortage of staff, inadequate material/ non-human resources, lack of supervision in the clinical facilities, distant clinical facilities and insufficient practice in the clinical skills laboratory were identified as challenges that students experience during Work Integrated Learning placement.

Thesis (MCur)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Differences were observed in clinical demonstration and assessment techniques of clinical supervisors involved with the supervision of undergraduate nursing students at an institution of higher education. These differing techniques displayed by the clinical supervisors may have implications for the standard of nursing care provided by the students and the throughput of these students. A qualitative approach with a descriptive design was applied to explore the perceptions and experiences of the undergraduate nursing students’ on clinical supervision. Nine (n=9) students were deliberately selected by means of purposive sampling from each year to participate in focus group interviews. Nine 1st year students, nine 2nd year students, nine 3rd year students and nine 4th year students respectively constituted the groups that were interviewed. Thus the total sample consisted of n=36 nursing students. Consent to conduct the study was obtained from the Health Research Ethical Committee at Stellenbosch University, as well the institution under study. Informed consent was obtained from all the participants. Data collection was completed by two trained fieldworkers who were not affiliated with the institution under study. The interviews were analysed through content analysis. Six themes emerged from the data. These included support, professionalism, realities of supervision, student preferences regarding supervisors, experiences that relate to abusive behaviour and the clinical supervision process. The findings indicated negative and positive experiences on clinical supervision. Recommendations were proposed to enhance clinical supervision and the learning experiences of student nurses. Key words: Clinical supervision, undergraduate nursing, clinical supervisor, clinical practice, differing techniques. / AFRIKAANSE OPSOMMING: Verskille was waargeneem in kliniese demonstrasie- en assesseringstegnieke van kliniese toesighouers wat betrokke is met die supervisie van voorgraadse verpleegstudente by 'n institusie van hoër onderwys. Die verskille in tegnieke gedemonstreer deur die kliniese toesighouers mag implikasies hê vir die standaard van verpleegsorg gelewer deur die studente en die slaagsyfer van hierdie studente. 'n Kwalitatiewe benadering met 'n beskrywende ontwerp was toegepas om die persepsies en ervaringe van die voorgraadse verpleegstudente oor kliniese supervisie te verken. Nege (n = 9) studente vanuit elke jaargroep was bewustelik gekies by wyse van doelgerigte steekproefneming om deel te neem in fokusgroep onderhoude. Nege 1ste jaar studente, nege 2de jaar studente, nege 3de jaar studente en nege 4de jaar studente het onderskeidelik die groepe gevorm waarmee onderhoude gevoer was. Die totale steekproef het uit n=36 verpleegstudente bestaan. Toestemming om die studie te doen was vanaf die Etiese Komitee vir Gesondheidsnavorsing by Stellenbosch Universiteit, asook die instelling ter ondersoek verkry. Ingeligte toestemming is van al die deelnemers verkry. Data insameling was deur twee opgeleide veldwerkers gedoen wat nie geaffilieer is met die instelling ter ondersoek nie. Die onderhoude was deur inhoudsontleding geanaliseer. Ses temas het uit die data ontstaan. Dit sluit in ondersteuning, professionaliteit, realiteite van supervisie, student voorkeure ten opsigte van toesighouers, ervaringe wat verband hou met mishandelende gedrag en die kliniese supervisie-proses. Die bevindinge het negatiewe en positiewe ervaringe oor kliniese supervisie getoon. Aanbevelings is voorgestel om kliniese supervisie en die leerervaring van die studentverpleegsters te verbeter. Sleutelwoorde: Kliniese supervisie, voorgraadse verpleging, kliniese toesighouer, kliniese praktyk, teenstrydige tegnieke.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Aim - The aim of this study was to explore second year medical students’ perceptions of their early clinical experiences with a view to improving curriculum development so as to enhance early clinical training programmes at Stellenbosch University (SU). Methodology - A qualitative, interpretive study, based on semi-structured focus group discussions with second year medical students was conducted in order to capture the relevant data that would provide information about their attitudes, feelings, beliefs and views on their early clinical learning experiences during their first year of studying medicine at SU. Thirty seven students participated in four focus group discussions after a process of selection of candidates using purposive sampling methods and stratification criteria to obtain the research sample. The interviews were moderated by an external facilitator, and were audiotaped and transcribed verbatim. The data transcripts were analysed and manually coded, and four broad categories with subthemes which illustrated the findings of the study, were identified and decided upon by the researcher and verified by the supervisor. Results - Early clinical exposure was generally positively perceived by students. It fostered a sense of vocation and feeling like real doctors, leaving students motivated and enhancing their learning interest. Early clinical skills training led to students’ professional development, acquiring the technical skills of a doctor, familiarisation with basic clinical terminology, and normal clinical findings which prepared them for later clinical studies. The new setting of practical learning in a simulated environment required students to adapt to small group learning and student clinical demonstrations which developed new learning styles and study skills. Some of the challenges that students encountered in the transition to clinical learning were, understanding the new subject of clinical medicine, having limited background knowledge to acquire basic clinical skills, and student clinical demonstrations. Although the strategy of peer physical examination was perceived to be effective, some ethical dilemmas emerged for students in terms of autonomy, and no opportunities available to practice on female models. Acting as a simulated patient proved to have both positive and negative outcomes on students’ skills acquisition. Factors that had a negative outcome on clinical skills learning were limited practice opportunities due to high student to teacher ratios per clinical session, and the variability of teaching content and practical techniques taught by various clinical tutors with different teaching strategies. The most stressful experience for students was the OSCE since it was a new method of assessment. Stress was attributed to uncertainty about the correct clinical content and techniques resulting from the teaching variability, while performance anxiety during the exam was related to inappropriate examiner behaviour. The OSCE was a positive learning experience because its format simulated the hospital setting which fostered students’ critical thinking abilities and time management. Conclusion - Early clinical exposure and practice have a great impact on junior medical students’ academic growth, and have positive learning outcomes. However, further development by the faculty in the areas of didactic skills, addressing the ethical issues related to student clinical demonstrations, and supporting students to enable a smooth transition to clinical learning will enhance and optimise their early clinical training.

Thesis (MPhil)--Stellenbosch University, 2014. / INTRODUCTION: For this MPhil research assignment, I have chosen to write an article based on a small scale research project conducted in the Clinical Skills Centre (CSC) at Stellenbosch University. Medical students’ perceptions were gathered in order to evaluate the usefulness and relevance of the Clinical Skills module and the different components thereof as experienced by the students themselves. This in the end led to valuable feedback that were given to the course coordinators which in turn may lead to curricula changes being made to improve the overall teaching and learning experience for future medical students rotating through the CSC.

Estudo descritivo, metodológico que teve como objetivo construir e validar os Marcos de Competências e as Entrustable Professional Activities (EPAs) para formação e avaliação de enfermeiros na assistência de pacientes adultos na abordagem das vias aéreas, ventilação e circulação, e avaliar o uso das EPAs em ambientes clínicos simulados. Após aprovação do Comitê de Ética e Pesquisa da Escola de Enfermagem de Ribeirão Preto e da Comissão Ética da Unidade de Investigação em Ciências da Saúde: Enfermagem da Escola superior de Enfermagem de Coimbra. O estudo contou com a participação de experts que atenderam os critérios adaptados de Fehring e se desenvolveu em três sub-estudos: na primeiro realizou-se uma revisão de literatura para avaliar os ganhos percebidos dos enfermeiros com o uso da simulação clínica nas atividades de urgência e emergência. No segundo realizou-se uma oficina em uma Universidade pública localizada em uma cidade no interior do estado São Paulo, composta por sete experts para a construção dos marcos de competências; na segunda fase desse sub-estudo participaram 15 experts para a validação de aparência e conteúdo por meio da Snowball Technique e a Técnica Delphi, a terceira fase ocorreu após a análise de conteúdo das considerações e sugestões realizadas pelos experts ao material a ser validado. Após a organização dos dados e análise, uma nova versão dos marcos de competências foi emitida e, posteriormente, uma segunda rodada de opiniões foi solicitada. Os 15 experts participantes receberam um novo correio eletrônico com os marcos de competências reformulados, participaram dessa fase 13 experts, caracterizando a concordância do material apresentado. Após foi realizado uma análise de conteúdo das sugestões realizadas e calculado o Índice de Validação de Conteúdo (IVC) para aferir a concordância dos juízes quanto à representatividade de cada item. Com a análise de conteúdo das sugestões recebidas dos experts, chegou-se à conclusão que houve um consenso sobre o conteúdo apresentado, resultando nos quadros dos marcos de competências. A concordância dos juízes quanto à representatividade dos itens em relação ao conteúdo dos quadros resultou na análise final em todos os itens com um IVC >= 85%. No terceiro sub-estudo, construiu-se as EPAs para desenvolver e avaliar no ambiente clínico simulado os marcos de competências construídos e validados. Assim, diante dos marcos de competências e baseados no referencial teórico os autores construíram 21 EPAs. A validação das EPAs quanto ao conteúdo, aparência e aplicabilidade em cenários clínicos simulados em situações de urgência, ocorreu através da participação de nove experts. Para validação utilizou-se quatro cenários clínicos simulados no qual cinco EPAs foram validadas. Embora o número de experts participantes em todas as fases do estudo possa ser considerado em fator limitante, acredita-se que os resultados podem contribuir de maneira efetiva, sendo fonte de estímulo para discussões e mudanças positivas no ensino, na formação e capacitação em enfermagem / This is a descriptive methodological study with the aim to construct and validate milestones of competencies and entrustable professional activities (EPAs) for the education and evaluation of nurses in the delivery of care to adult patients in the approach to their airways, ventilation, and circulation, and to assess the EPAs in simulated clinical environments. The research project was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing at the University of São Paulo and by the Ethics Committee of the Health Sciences Research Unit of the Higher School of Nursing of Coimbra. The study had the participation of experts who complied with the criteria adapted by Fehring and was developed in three sub-studies. A literature review was conducted in the first study to assess the benefits perceived by nurses with the use of clinical simulation in urgency and emergency activities. In the second study a workshop was developed in a public university located in a city in the state of São Paulo, with the participation of seven experts for the construction of milestones of competencies; in the second stage of this sub-study 15 experts participated in the face and content validation through the snowball and the Delphi techniques; and the third stage took place after analysis of content of the considerations and suggestions made by the experts to the material to be validated. After data organization and analysis, a new version of the milestones of competencies was designed and, later, a second round of reviews was requested. The 15 participating experts received a new e-mail with the reformulated milestones of competencies, and 13 of them participated in this stage, characterizing agreement with the material presented. Analysis of content of the suggestions was conducted and the content validity index (CVI) was calculated to measure the agreement of the experts as regards the representativeness of each item. This content analysis showed that there was a consensus among the experts on the content presented, resulting in charts with the milestones of competencies. Experts\' agreement as regards the items\' representativeness in relation to the content in the charts resulted in the final analysis of all items with a CVI >= 85%. In the third sub-study, the EPAs were constructed to develop and assess the validated milestones of competencies in the simulated clinical environment. Thus, the authors constructed 21 EPAs in face of the milestones of competencies and based on the theoretical framework. The validation of the EPAs regarding content, face, and applicability in simulated clinical environments in emergency situations took place with the participation of nine experts. Four simulated clinical settings were used in the validation of five EPAs.. Although the number of experts participating in each study stage may be considered a limitation, the authors believe that the results of this study can contribute effectively to encourage discussions and positive changes in nursing teaching, education, and qualification

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No. of bitstreams: 2 Dissertação - Rayana Gomes Oliveira Loreto - 2015.pdf: 1169507 bytes, checksum: 46f8b0eba8fb564884382192db0e7a7d (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-07-30 / The customer service of people with venous ulcers requires appropriately trained professionals with knowledge, skills and attitudes compatible with quality care. It is known that professionals don’t always have qualified to serve this population. For the educational activity planning and training of human resources it is necessary to have as a starting point the competencies expected of professionals. There aren’t documents in which are established competencies for nurses in the care of people with venous ulcers. The objective is to map the skills necessary to professional nursing care for people with venous ulcers. This is an integrative review that comes through the five stages second methodological framework adopted. The search was performed using the databases: Source of Nursing and Allied Health Literature (CINAHL), National Library of Medicine National Institutes of Health (PUBMED), and SciVerse Scopus, and guidelines published by organizations with internationally recognized experts in area of assessment and treatment of wounds. For definition of competence adopted the inductive and deductive method. 20 articles and 21 guidelines were included, totaling 41 references. Were identified six general competencies: assessment of people with venous ulcers, venous ulcer assessment, the individual treatment with venous ulcers, treatment of venous ulcers, the person monitoring with venous ulcers, prevention of venous ulcers. For each general competency were identified specific skills and their knowledge, skills and attitudes. CONCLUSION: The identified skills represent a boundary for the teaching of the nursing care of people with venous ulcers. Should be the subject of discussion and reflection among educators, for a decision wherein levels they’ll be addressed in the process of training of human resources. / A úlcera venosa é a mais prevalente dentro das úlceras de perna, e representa um problema de saúde pública. Para prestar assistência a essas pessoas exige profissionais qualificados. Os conhecimentos, habilidades e atitudes dos profissionais de saúde tem uma impacto significativo sobre a qualidade da assistência.Sabe-se que mais da metade dos profissionais que atende pessoas com úlceras venosas não possuem qualificação para atender essa população. Para o planejamento de ação educativa e formação de recursos humanos é preciso ter como ponto de partida as competências esperadas dos profissionais. Não há documentos que esteja estabelecido as competências para o enfermeiro no atendimento a pessoas com úlceras venosas.O objetivo deste estudo é mapear as competências necessárias ao profissional de enfermagem para atendimento a pessoas com úlceras venosas. Trata-se de um revisão integrativa que percorreu cinco etapas segundo referencial metodológico. A busca foi utitlizando as base de dados: Source of Nursing and Allied Health Literature (CINAHL), National Library of Medicine National Institutes of Health (PUBMED), e SciVerse Scopus, e guidelines publicados por organizações com reconhecimento internacional de especialistas na área de avaliação e tratamento de feridas. Para definição das competências adotou-se o método indutivo (DEMO, 2007). RESULTADOS: Mediante aos mecanismos de buscas, aplicação dos critérios de inclusão, exclusão e avaliação de qualidade foram identificados 21 artigos e 21 guidelines, totalizando 41 referências incluídas nesta pesquisa. Foram identificadas seis competências gerais: avaliação da pessoa com úlcera venosa, avaliação da úlcera venosa, tratamento da pessoa com úlcera venosa, tratamento da úlcera venosa, acompanhamento da pessoa com úlcera venosa, prevenção da úlcera venosa. Para cada competência específica foram identificadas as competências gerias, os conhecimentos, as habilidades e as atitudes. As competências que foram tratadas no presente estudo precisam ser objeto de reflexão dos educadores para que se decida em que níveis elas serão tratadas, na graduação e/ou especialização, devendo ser incorporadas ao processo de ensino, uma vez que são necessárias ao enfermeiro para o atendimento adequado a esta população.

Recente profusão de novos papéis profissionais do enfermeiro e mudanças nas práticas da enfermagem têm sido descritas mundialmente e exercem impacto no tipo de cuidado provido e nas formas de sua provisão. O interesse deste estudo é a ideia de papel clínico, que, apesar de ser uma expressão comumente usada no cotidiano, é pouco explorada em termos conceituais. Este estudo teve como objetivo desenvolver o conceito de papel clínico do enfermeiro. A Metodologia de Análise Qualitativa de Conceito foi aplicada em suas três fases: Identificação dos Atributos, Verificação dos Atributos e Identificação das Manifestações do Conceito. Na primeira fase, os atributos abstratos e universais do conceito foram identificados, utilizando-se a Análise Crítica da Literatura, que resultou no estudo de 24 publicações. Na segunda fase, aplicou-se a Teoria Fundamentada nos Dados para verificar os atributos do papel clínico na experiência do enfermeiro. Nessa fase, realizou-se estudo com sete enfermeiros assistenciais do Hospital Universitário da Universidade de São Paulo. Os dados foram coletados por entrevistas abertas, que foram analisadas e interpretadas em categorias inter-relacionadas, com a derivação de um modelo teórico da experiência do papel clínico do enfermeiro. Na terceira fase, os dados das fases anteriores foram comparados e integrados, possibilitando a proposição teórica do conceito. Os resultados da análise evidenciaram que papel clínico do enfermeiro é um processo psicossocial resultante da interação do enfermeiro com o paciente, com o contexto e consigo mesmo. Autonomia clínica configurou-se como elemento central da interação do enfermeiro com o paciente na experiência do papel clínico. O significado da experiência do papel clínico foi expresso no empoderamento do enfermeiro pelo exercício da autonomia clínica, que mostra o alcance de resultados manifestados na própria interação do enfermeiro com o paciente, consigo mesmo ou com o contexto. Os dados indicaram ter o paciente como o centro do cuidado, ter finalidades e intencionalidade como atributos principais do papel clínico. O desempenho do papel clínico requer que o enfermeiro tome posse da autonomia clínica, que a exerça nas interações e nas ações junto ao paciente e se perceba empoderado por esse exercício. Papel clínico é uma competência que se articula como uma forma de poder, mediado pela autonomia clínica. A autonomia clínica concede ao enfermeiro o poder de pensar, de imaginar, de planejar o cuidado e de influir na saúde do paciente. A análise do conceito do papel clínico contribuirá para reflexões sobre as dimensões envolvidas na prática e no ensino de enfermagem e para informar não só as políticas de ensino e de práticas profissionais, mas também as políticas de saúde. / Recent profusion of new professional roles of the nurse and changes in the practice of nursing have been worldwide described and have an impact on the type of care provided as well as on the forms of its provision. The interest of this study is the idea of the clinical role, which inspite of being a commonly used daily expression, is little explored in conceptual terms. This study has had as an objective the development of the concept of the clinical role of the nurse. The Methodology of Qualitative Analysis of Concept has been applied in its three phases: Identification of the Attributes, Verification of the Attributes and Identification of the Manifestations of the Concept. In the first phase, abstract and universal attributes of the concept have been identified using Critical Analysis of Literature, which resulted in the study of 24 publications. In the second phase, Grounded Theory has been applied to verify the attributes of the clinical role in the nurses experience. In this phase, a study has been carried out with seven assistential nurses from the São Paulo Universitys Hospital. Data has been collected by open interviews, which has been analysed and interpreted in interrelated categories, deriving to a theorical model of the nurses clinical roles experience. In the third phase, the data of the previous phases were compared and integrated, permitting the theorical proposition of the concept. The results of the analysis have proved that the nurses clinical role is a psychosocial process resulting from the interaction of the nurse with the patient, with the context and with himself. Clinical autonomy has configured as a central element in the interaction of the nurse with the patient in the clinical roles experience. The significance of the clinical roles experience has been expressed in the empowerment of the nurse through the exercise of clinical autonomy, which shows the range of achieved results shown in the nurses interaction with the patient, with himself or with the context. Data has indicated to have the patient as the center of attention, to have purposes and intentions as the main attributes of the clinical role. The performance of the clinical role requires that the nurse takes lead of the clinical autonomy, exercises it during interactions and actions with the patient and feels empowered by this exercise. The clinical role is an ability which, through clinical autonomy, is articulated as a form of power. Clinical autonomy concedes the nurse the power to think, to imagine, to make care plans and to influence the patients health. The analysis of the clinical roles concept will help to have reflections about the dimensions involved in the practice and teaching of nursing and to inform, not only the educational and professional practices politics, but health politics as well.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice