Browsing by Author "Mannion, Cynthia A."
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Item Open Access Improving Triage to ECG Time in the Emergency Department(2018-03-15) Nosworthy, Sara Eileen; Hirst, Sandra P.; Reay, Gudrun; Mannion, Cynthia A.Background: The ST-segment elevation myocardial infarction (STEMI) team of a large Canadian urban tertiary care hospital identified that best practice recommendations were not being met for walk-in patients diagnosed with STEMI to the Emergency Department (ED). The American Heart Association (AHA) (2013) recommends triage to first-device time should be 90-minutes. However, this target was only achieved 6% of the time for walk-in patients diagnosed with STEMI. It is recommended that the initial electrocardiogram (ECG) be completed within 10-minutes for patients presenting with suspected ischemic chest pain (SICP) to the ED (AHA, 2013). Data analysis, performed by the STEMI quality improvement team, identified a significant delay with the initial ECG, for walk-in patients diagnosed with STEMI. This delay places patients at risk for serious adverse outcomes, such as cardiac arrest. Therefore, it was essential to implement a streamlined process to improve triage to ECG times. Objective: The objectives of this study were to investigate if the implementation of a streamlined process at triage for walk-in patients with SICP decreased triage to ECG times, and secondarily if triage to first-device time for walk-in patients diagnosed with STEMI was decreased. Methods: A retrospective study was conducted at a large Canadian urban tertiary care hospital. A new streamlined process at triage for walk-in patients presenting with SICP was evaluated by comparing daily data from May 2016 to May 2017. The primary outcome measured was triage to ECG time for walk-in patients presenting with SICP, and secondarily triage to first-device time for walk-in patients diagnosed with STEMI. Results: There was a statistically significant difference between May 2016 and May 2017 (U = 28425, Z=-5.01, p <.001). Following the streamlined process there was a significant decrease of 16-minutes in the median triage to ECG time for walk-in patients presenting with SICP compared to those prior to the streamlined process. None of the 288 patients evaluated in May 2016 were diagnosed with STEMI. Four of the 265 patients evaluated in May 2017 were diagnosed with STEMIs. Two of the four patients met the recommended target time of triage to first-device time within 90-minutes (AHA, 2013: Heart and Stroke, 2015). Discussion: The best practice recommendation of triage to ECG time within 10-minutes was not achieved for all walk-in patients presenting with SICP. However, the streamlined process has significantly decreased time in triage to ECG for this patient population. Future interventions directed at decreasing triage to ECG time should focus on early identification of patients with chest pain, examining the streamlined process for further improvements, and ongoing evaluation of triage to ECG data. There was limited data for triage to first-device time as there were no walk-in patients diagnosed with STEMI in May 2016. Therefore, it was not possible to evaluate if the streamlined process improved triage to first-device time. Continual evaluation of the triage to first-device times is needed to see if the streamlined process is making a difference.Item Open Access Let Us Greet our Young, Not Eat our Young: Nursing Preceptors(2018-08-02) Carrington, Kendra Adele Smith; Mannion, Cynthia A.; Hirst, Sandra P.; Seneviratne, Cydnee C.Background: During the final term of nursing education programs, students are placed in clinical learning environments (CLE) with assigned registered nurses (RN) commonly known as preceptors. The experiences within a preceptorship are related to students’ satisfaction, job recruitment and, in the long term, retention in the profession. Despite having participated in preceptorships as students, new nursing graduates often report feeling unprepared to enter the profession. In 2010, Willemsen-McBride estimated 35-65% of new Canadian graduates leave their place of employment within their first year. Students who experience unsatisfactory preceptorships are thought likely to leave the profession altogether. Attributes of preceptors which foster positive CLEs contribute to students’ satisfaction and success in preceptorship experiences. Such attributes include: kindness, patience, commitment, support, effective communication skills, clinical competence, providing clinical exposure, role modeling, and positive coaching. Objective: To investigate nursing students’ perceptions of preceptor attributes as these attributes relate to their satisfaction in the CLE, expectations from before and after their preceptorship, and their perceived preparedness for licensure and nursing practice. Method: A pretest-posttest study was conducted during the 2017 fall term of the Faculty of Nursing at the University of Calgary in Calgary, Alberta. Students were recruited from the final term course (NURS 599). Participants (n=74) were tested prior to commencing their preceptorship experience and 55 participants were tested at the end of their preceptorship. Demographic data were gathered and participants were asked to complete the Preceptor Attributes survey, the Clinical Learning Environment Inventory (CLEI), and the My Preceptorship tool. Results: Two attributes of preceptors were identified as contributing to students’ satisfaction with their preceptor and with the CLE. The attribute of providing exposure significantly affected students’ satisfaction when compared to the influence of the preceptor in the CLE (t = 3.77, p = .000, [CI 95%: 4.57, 14.91]). Providing exposure also significantly affected students’ satisfaction when compared to the influence of the CLE (t = 3.59, p = .001, [CI 95%: 3.86, 13.64]). The attribute of clear communicator significantly affected students’ satisfaction when compared to the influence of the preceptor in the CLE (t = 3.56, p = .001, [CI 95%: 3.21, 11.47]). Clear communicator also significantly affected students’ satisfaction when compared to the influence of the CLE (t = 3.04, p = .004, [CI 95%: 2.05, 9.99]). Students’ expectations pretest to posttest were not met for CLE aspects of innovation (t = 3.36, p = .002, [CI 95%: 0.85, 3.38]), student involvement (t = 2.96, p = .010, [CI 95%: 0.43, 2.98]), task orientation (t = 2.82, p = .007, [CI 95%: 0.56, 3.33]), or satisfaction (t = 2.64, p = .011, [CI 95%: 0.42, 3.07]) as measured by the CLEI. Approximately half of the students (41%, n=25) reported they did not feel prepared for their licensing exam. Many students reported feeling prepared to practice (92%, n=56) because of their preceptor. Most students were satisfied with their preceptor (95%, n=58) and 53 (87%) wanted to return to the CLE to work post-graduation. No significant difference was reported in students’ perception of preceptor attributes (t = -0.06, p = .956, [CI 95%: -4.59, 4.53]) or of the six CLE aspects (p>.05) for students having two preceptors as opposed to those having only one. Discussion: Students’ satisfaction with their preceptorship in the CLE is highly dependent upon specific attributes of preceptors. Preceptors with effective communication skills who provide exposure to learning opportunities in the CLE are highly prized by students and contribute to their satisfaction throughout preceptorships.Item Open Access Nurse Educators and Multiple Choice Examination Practices(2018-09-12) Mannion, Cynthia A.; Hnatyshyn, Tammy; O'Rae, Amanda; Beck, Amy J.; Patel, ShrutiItem Open Access Nurse educators' reflections on their current multiple choice exam practices and their vision for the future(2017-03-24) O'Rae, Amanda; Mannion, Cynthia A.; Hnatyshyn, Tammy; Beck, Amy J.; Patel, Shruti