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Debra Nestel

Publications and source records attributed to Debra Nestel.

At least 19 recordsLinked to original sources
PubMed2006

Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview.

UNLABELLED: Nurses' perceptions and experiences of communication in the operating theatre: a focus group interview BACKGROUND: Communication programmes are well established in nurse education. The focus of programmes is most often on communicating with patients with less attention paid to inter-professional communication or skills essential for working in specialised settings. Although there are many anecdotal reports of communication within the operating theatre, there are few empirical studies. This paper explores communication behaviours for effective practice in the operating theatre as perceived by nurses and serves as a basis for developing training. METHODS: A focus group interview was conducted with seven experienced theatre nurses from a large London teaching hospital. The interview explored their perceptions of the key as well as unique features of effective communication skills in the operating theatre. Data was transcribed and thematically analysed until agreement was achieved by the two authors. RESULTS: There was largely consensus on the skills deemed necessary for effective practice including listening, clarity of speech and being polite. Significant influences on the nature of communication included conflict in role perception and organisational issues. Nurses were often expected to work outside of their role which either directly or indirectly created barriers for effective communication. Perceptions of a lack of collaborative team effort also influenced communication. CONCLUSION: Although fundamental communication skills were identified for effective practice in the operating theatre, there were significant barriers to their use because of confusion over clarity of roles (especially nurses' roles) and the implications for teamwork. Nurses were dissatisfied with several aspects of communication. Future studies should explore the breadth and depth of this dissatisfaction in other operating theatres, its impact on morale and importantly on patient safety. Interprofessional communication training for operating theatre staff based in part on the key issues identified in this study may help to create clarity in roles and focus attention on effective teamwork and promote clinical safety.

Journal Article↗
PubMed2006

The effects of stress on surgical performance.

BACKGROUND: Although the general literature on stress and performance is extensive, little is known about specific effects of stress in surgical practice. This qualitative study explored key surgical stressors, their impact on performance, and coping strategies used by surgeons. METHODS: Individual in-depth semistructured interviews with surgeons were analyzed by 2 researchers independently. Key themes were discussed within the research team. RESULTS: Sixteen interviews were performed, including interviews with consultants (n = 9) and surgeons in training (n = 7). A wide range of intraoperative stressors was identified. Although stress had both positive and negative effects, undue levels of stress impaired judgment, decision making, and communication. Although junior surgeons showed uncertainty about their ability to cope, senior surgeons had developed sophisticated strategies for controlling each situation. CONCLUSIONS: Although stress poses significant risks, coping strategies are not taught explicitly during surgical training. This article presents a framework for categorizing surgical stress and suggests key elements for effective coping strategies.

Adaptation, Psychological↗
PubMed2006

The human face of simulation: patient-focused simulation training.

Simulation is firmly established within health care training but often focuses on training for technical tasks and can overlook crucial skills such as professionalism and physician-patient communication. The authors locate this paper within current developments in health care and relate it to the literature on simulation. They make the case for placing real human "patients" (played by actors) within simulation environments, thereby ensuring that the training experience remains rooted in actual practice. By practicing repeatedly within a safe environment, technical skills, communication with patients and team members, decision making, and clinical judgment may all be practiced and mastered while preserving patient safety. In elaborating this concept of patient-focused simulation (PFS), the authors draw on work already published by their group and several recent studies that are in review. These explore PFS in low, medium, and high complexity settings. Important or rare situations can be recreated and practiced, as well as key procedures required across a range of experience levels and clinical specialties. Finally, the case is made for curriculum redesign to ensure that simulator-based technical skills training and assessment take place within an authentic context that reflects the wider elements of clinical practice.

Computer Simulation↗
PubMed2006

Reflection: a critical proficiency essential to the effective development of a high competence in communication.

Reflection, or the ability to step back from an experience and consider it critically, in an analytical, non-subjective manner, is an essential aspect of problem solving and decision making, and also of effective communication with clients and colleagues. Reflective practice has been described as the essence of professionalism and is therefore a core professional skill; rarely, however, has it been explicitly taught in veterinary curricula, and it has only a recent history in undergraduate human medical curricula. We describe here two preliminary case studies, one in a veterinary medical education context and the other within a human medical education framework, as examples of approaches to assessing a student's ability for ''reflection.'' The case studies also illustrate some of the key principles. Both of the case studies described had as their end goal the enhancement of communication skills through critical reflection. At Monash University, Australia, the majority of students were assessed as being at a level of ''reflection in development.'' The students in the Ontario Veterinary College case study showed moderately good use of self-awareness and critical reflection as a basis for modifying and integrating communication skills into practice. While both preliminary case studies point to the fact that students recognize the importance of communication and value the opportunity to practice it, few students in either case study identified the importance of reflection for lifelong learning and professional competence. Opportunities to complete critical reflection exercises in other parts of curricula and outside of communication would likely reinforce its importance as a generic skill. Ongoing scholarly approaches to teaching, learning, and evaluating reflection and self-awareness are needed.

Cognition↗
PubMed2005

Peer assisted learning in patient-centred interviewing: the impact on student tutors.

Effective methods for teaching patient-centred interviewing skills are resource intensive. Providing students the opportunity to work in small groups with simulated patients is highly valued and has demonstrable long-term benefits. Expanding cohorts of medical students and diminishing faculty resources led to the implementation of a peer assisted learning (PAL) project in patient-centred interviewing skills. The paper reports the evaluation of a PAL project on student tutors. The methodology included direct and indirect measures of student tutors' skills in facilitation and patient-centred interviewing. The self-report evaluations strongly suggest that participating in a PAL project has substantial benefits for student tutors that included both interviewing and facilitation skills. Objective measures revealed no change in patient-centred interviewing skills after participating in the project. The study concludes that formalizing PAL may tap a valuable resource within the medical school and provide benefits for student tutors. Careful consideration needs to be given to ways in which student tutors are supported before, during and after the project.

Communication↗
PubMed2005

Handheld computers in veterinary medical education: a view from human medical education.

Handheld computers are widely used in clinical practice, and their use in both human medical education and veterinary medical education is increasing, especially, for the former, in activities involving point-of-care access. This article references the insights that can be obtained from the usage and activities that are gaining a strong foothold in human medical education. Handheld computer technology gives students access to a large and changing knowledge base for clinical practice, especially when they are geographically dispersed. Differences in use between education and practice largely relate to the importance clinicians place on patient information. Student use focuses on progress mapping and ready access to clinical reference material. Suggestions are made for future use in medical education.

Computer-Assisted Instruction↗
PubMed2005

Personal and professional development in undergraduate health sciences education.

During the last decade, ''medical professionalism'' has been scrutinized as a consequence of pressures from within and outside the health sciences professions. In response, professional organizations have reviewed ethical principles and developed explicit guidelines for the behavior of their members. Medical educators have revised undergraduate curricula with a view to supporting the development and maintenance of these essential professional behaviors. This article outlines perspectives on professionalism before describing the evolution of personal and professional development curricula in undergraduate health science education. While the bulk of data on personal and professional development in the health sciences has come from human medicine, the principles are being recognized as applying to the breadth of the health professions. In the veterinary profession, the dyad of the physician-patient relationship of human medicine is expanded to the triad of the veterinarian-patient-client relationship, and this brings with it an added set of professional relationships and responsibilities. In order to be faithful to the primary literature and not expand beyond the various authors' data and conclusions, this article is presented principally in the terms of human medical education. For those in veterinary education, it is hoped that the inferences and applications will be readily apparent. In this article, challenges associated with defining content and educational methods are outlined, as well as selection criteria for medical school and promoting the value of PPD to students. Approaches to assessment, implementation, and evaluation of PPD curricula are also discussed. Two case studies are presented. The article concludes with suggestions for curriculum development.

Animals↗
PubMed2004

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training.

BACKGROUND: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. METHODS: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. RESULTS: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. CONCLUSIONS: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme - both trainers and trainees will be essential.

Adolescent↗
PubMed2004

Facilitating reflection in an undergraduate medical curriculum.

A reflective practitioner is one of the desired outcomes of medical education. This paper describes the introduction of a reflective assignment in the first year of a medical curriculum. Students completed written reflective assignments for which individual and group feedback was provided. Tutors reflected on their roles throughout the development and implementation of this new assignment. The majority of students completed the assignments and while some students became highly involved in the task others worked at a surface level. Tutors found the process time consuming and less enjoyable than working directly with students who need to be supported in the development of skills necessary for reflective practice.

Australia↗
PubMed2004

Teaching and learning about written communications in a United Kingdom medical school.

CONTEXT: Written communications have a long history in medicine. Today, doctors spend a significant part of their work time completing paper work. Although the importance of accurate written communications is acknowledged, medical curricula rarely include focused teaching on this topic. OBJECTIVES: The aim of this paper is to assess the feasibility of a teaching session for second-year medical students aimed at raising their awareness of written communications in the context of health care. METHODS: Immediately after the session, students and tutors completed written evaluations of their experiences. Four months after the session the entire cohort completed a knowledge test, and scores of attendees and non-attendees were compared. FINDINGS: Three of four learning objectives were completely met by at least half of the students and the exercises were rated as helpful. Students' and tutors' comments identified specific aspects of the session that require improvement, in particular, developing the exercise on patient-centred written communications. Students who attended the session scored significantly higher in a relevant knowledge test than non-attendees. DISCUSSION: The session provided students with the knowledge to identify patient-centred written communications and other features of effective writing in the context of medical care. CONCLUSIONS: Introducing the topic early in the medical curriculum may prove valuable in establishing effective practice. Providing students with opportunities to revisit this important topic throughout their medical education may also be beneficial. The long-term impact of the session needs to be evaluated.

Curriculum↗
PubMed2004

Making patient safety the focus: crisis resource management in the undergraduate curriculum.

BACKGROUND: This paper examines the role of high fidelity simulation and crisis resource management in bridging the gap between theory and practice. Patient safety is fundamental to healthcare professional practice and is a common goal for healthcare providers. It provides a focus to motivate practitioners. Patient safety issues are not a priority in undergraduate curricula. Raising the profile at this level is crucial to improving the safety and quality of healthcare delivery. This paper explores the role of simulation in providing a realistic, safe environment for participants with different levels of experience to manage evolving crises in the context of their work environment. METHODS: The Southern Health Simulation and Skills Centre uses a patient safety focus in delivering a specialised educational programme adapted from aviation to healthcare. The programme, crisis resource management, enables participants to consolidate knowledge, attitudes and skills to achieve a deeper understanding of how their performance impacts on patient safety and the quality of healthcare provided. Self-reported written evaluation data was collected from participants of three different courses at Southern Health. RESULTS: Participants consistently report that these courses offer unique learning experiences that address aspects of workplace learning in ways that have not previously been possible. A video-assisted reflective process powerfully reinforces learning. CONCLUSION: Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

Clinical Competence↗
PubMed2003

Teaching and learning about skills in minor surgery.

The aim of this study was to assess the feasibility of a scenario-based approach to learning minor surgery skills. After learning component technical skills for ellipse excision and wound closure, nurses were provided with an opportunity to integrate these skills with communication skills and contextual factors in a quasi-clinical environment. Feasibility was assessed using observation of procedures and a group interview with participants, simulated patients and tutors. The scenario-based approach to teaching and learning about technical and communication skills proved feasible and was valued by participants in this course on minor surgery. Although all participants expressed anxiety about integrating skills in the quasi-clinical setting, they valued the opportunity to undergo a formative assessment prior to working in supervised settings with real patients. Learners valued highly the opportunity to reflect on their performance and to receive feedback on technical and communication skills. Future courses should include focused teaching on communication skills prior to the scenario-based exercise. Limitations of the study centre on the small numbers of participants and the novelty of the course. Repeating the evaluations on a subsequent course will provide insight into the ways in which nurses acquire and integrate new skills.

Clinical Competence↗