Weekly Review #18

Matthew Limb discusses an Israeli study that examined the impact of rudeness on medical team performance. The research led by Arieh Riskin determined that incivility amongst healthcare professionals negatively impacts team performance, and could result in iatrogenesis. In this study physician/nurse teams were exposed to an introductory message, than assessed as they performed simulated care on an ill preterm infant. The teams exposed to incivility as part of the introductory message made 12% more errors in both procedural and diagnostic domains than those exposed to a neutral introductory message. The experimental arm had worse information sharing, reduced helpfulness, worse cognitive function, and decreased performance of collaborative processes. The unmeasured consequences of decreased performance due to incivility could potentially be huge. From a nursing perspective the message here is clear: if civility for the sake of it isn't enough reason to keep negative commentary to yourself perhaps the increased risk to patients and liscensure is.

http://careers.bmj.com/careers/advice/Rudeness_in_medical_teams_harms_clinical_performance,_study_finds




Jesse Spurr hosted a discussion this week on Injectable Orange with Damian Roland and Victoria Brazil on their recently published article "Top 10 ways to reconcile social media and 'traditional' education in emergency care". There is a 30 minute podcast with accompanying slides, in which the authors discuss each of the 10 points covered in the paper. Roland and Black argue that using social media is no different from using "traditional" approaches to education; and that the discussion about social media in medical education ought to be one that discusses FOAMed as a how (a means) rather than a what (a curriculum) of medical education. They suggest that education has always faced the challenges that are now present with learning using social media, and offer specific commentary on the critical appraisal skills and scrutiny that are required with FOAMed as well as traditional forms of literature. They highlight the particular effectiveness of social media at contextualizing research, of translating and distilling information into something that is easy for clinicians to connect with. There is additional commentary on the effectiveness of social media on reflective practice and faculty development. I would suggest that this discussion summarizes quiet nicely the similarities of FOAMed to traditional education, both in the sense of formal learning academic articles, and informal education (peer based learning): an excellent resource for nurses wanting to increase their understanding of the role of social media in clinical education.

http://injectableorange.com/2015/09/podcast-ep-6-reconciling-social-media-with-traditional-education/




The Annals of Internal Medicine published a systematic review of the science of cleaning hospital surfaces. It turns out we don't actually know a great deal about what we're doing. 80 studies were identified, 49 examined cleaning processes, 14 monitoring, and 17 implementation of strategies; of these only 5 were randomized controlled trials. Most of the studies on cleaning processes examined the effects of different cleaning agents on surface bacterial/spore levels: either as a preventive measure or in relation to infection incidence rates. Strategies for monitoring cleanliness assessed the percentage and frequency of targeted areas cleaned, and surface microbial burden. The studies examining implementation mostly used before/after designs and assessed surface contamination rates. Unfortunately the lack of studies directly comparing cleaning agents, the poorly articulated standard for defining "clean", the poorly standardized process for using cleaning agents, and our inability to isolate surface cleaning effects from hand hygiene effects prevent the authors from being able to synthesize the information, and from making specific recommendations about cleaning strategies. This review does highlights how little we actually know about cleaning; disappointing given the amount of time, labor, money, and administrative effort we put toward cleaning. Hopefully this review can identify some avenues for directly comparing agents, for standardizing processes, and may offer some suggestions on linking cleaning with meaningful clinical metrics.

http://annals.org/article.aspx?articleid=2424875

An article published in Nursing reviewed the effects of a mentorship program on student success and retention in a college practical nursing program. The mentorship model used third or fourth semester nursing students to provide peer support to first semester students. Mentors received 3 hours of training, mentored 2 "mentees", and were in turn supported by two faculty staff members. The mentor began by discussing the mentorship program, outlining expectations, and by helping to set goals for the mentee, they would than reach out to the mentee at times of peak stress, and at an as needed basis (an average of 6 times/semester). There was a significant impact on success rates with those who were mentored, with 76% completing the semester, and 83% the term. Those not mentored averaged only a 36% success rate for the semester, and a 56% rate for the term. Menteees also reported higher grades, more confidence, and less stress. The results of this study, as well as anecdotal experience would suggest that mentorship programs, in general, are beneficial; however I would be hesitant to say that this research contributes meaningfully to our net understanding of these programs in any way. The students in the intervention arm self selected to join the program, as a result the intervention arm may likely be more motivated individuals, which will confound the results. We know that there were 23 students in the intervention arm, we don't know how large the total population of students is, so assessing a population impact is impossible. In addition to the confounding variables, and the poorly articulated population, the extremely high fail rate (44-64%) of this private college likely outstrips the average of publicly funded institutions, and limits the generalizability of the findings. This study set out to show the benefit of a peer mentorship program, which they did, although the findings are much too weak to generaelize. What they also did however was show an extremely high fail rate at their nursing school. I think this study raises some questions about not only their quality of nursing education, their student recruiting practices, and the ethics of what would appear to a predatory process of recruiting and accepting tuition from students that are unlikely to succeed.

http://journals.lww.com/nursing/Citation/2015/09000/A_peer_mentorship_program_boosts_student_retention.6.aspx

In keeping with the spirit of civility Rob Bryant contributed to the EM mindset series on emDocs. His post: "seven rules to make me nicer" offers, unsurprisingly, 7 tips that will not only make you nicer to work with; but also perhaps a better clinician. This post is approachable and is general enough for all healthcare professions to have something to take home.

Anna Pickens discussed cardiogenic shock in a video posted on EMin5. The video begins by describing the physiology of cardiogenic shock, how to determine the cause, and suggestions for maintaining blood pressure. She offers some specific recommendations about NIPPV, fluid therapy and balancing pressors and ionotropes to correct hypotension. A very approachable 4 minute video.

Ian Miller linked to a TedTalk on palliative care by a HPC physician BJ Miller, who discusses the difference between pathology vs patient centered care, the difference between loss and regret, and the power of changing our perspective on death: from one of repugnance; to one where we accept that dying is an integral part of living. A great talk on medicine not as simply removing suffering,  but as tending to human dignity.

Ian Bodford posted a great review on emDocs this week that reviews toxic alcohol poisoning. Toxic alcohols are non-ethanol bases alcohols and include methanol (windshield washer fluid), isopropyl (rubbing alcohol), and ethylene glycol (antifreeze). Bodford offers some suggestions on maintaining a degree of suspicion with all inebriated patients, suggests some lab studies, and highlights treatment options for patients with toxic alcohol poisoning. A good review for ED nurses, and a good reminder to avoid assumptions when dealing with inebriated patients.

Laurie Bickhoff's post "Sending Nursing Education Viral" on Defining Nursing serves as a nice adjunct to Jesse Spurr's video on social media in education. This post offers some nursing applications for social media and highlights it's usefulness as a tool for: continuing education, engaging and networking with peers, conducting research, and curating clinical resources.