Basics of qualitative research: Grounded theory procedures and techniques

Traditional engineering instruction is deductive, beginning with theories and progressing to the applications of those theories Alternative teaching approaches are more inductive Topics are introduced by presenting specific observations, case studies or problems, and theories are taught or the students are helped to discover them only after the need to know them has been established This study reviews several of the most commonly used inductive teaching methods, including inquiry learning, problem-based learning, project-based learning, case-based teaching, discovery learning, and just-in-time teaching The paper defines each method, highlights commonalities and specific differences, and reviews research on the effectiveness of the methods While the strength of the evidence varies from one method to another, inductive methods are consistently found to be at least equal to, and in general more effective than, traditional deductive methods for achieving a broad range of learning outcomes

Inductive Teaching and Learning Methods: Definitions, Comparisons, and Research Bases

Interpreting qualitative data

BACKGROUND In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3‐hour bundle of care for patients with sepsis (i.e., blood cultures, broad‐spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3‐hour bundle and risk‐adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3‐hour bundle completed within 3 hours. The median time to completion of the 3‐hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3‐hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk‐adjusted in‐hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS More rapid completion of a 3‐hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk‐adjusted in‐hospital mortality. (Funded by the National Institutes of Health and others.)

Supplement to: Time to treatment and mortality during mandated emergency care for sepsis.

Background. Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. Method. Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. Results. Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1·90 [95% confidence interval (CI) 1·22-2·98] in women, and 2·00 (95 % CI 1·13-3·56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. Conclusions. Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.

Work stress precipitates depression and anxiety in young, working women and men. Commentary

First year registered nurses and delegation of duties

A nursing innovation to promote healthy bowel functioning in children

An assessment process with a difference : an avenue for nurses to regain their registration

BACKGROUND
Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context.


METHODS
Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding.


RESULTS
Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily.


CONCLUSIONS
Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/birt.12665

Midwives' recognition and response to maternal deterioration: A national cross-sectional study.

This chapter presents an overview of simulation, including fidelity, modalities, standards, guidelines and frameworks for simulation, phases of simulation, challenges and general tips. Simulation is an educational strategy where elements of the real world are integrated to achieve specific goals relating to learning or evaluation. Fidelity simply means how authentic or life-like the manikin and/or the simulation is and how accurately the modality reflects a real-life situation or scenario. Low-fidelity simulation experiences include those that are often static and lack realism and/or situational context. Medium-fidelity simulation experiences are considered to be more dynamic and realistic than low-fidelity ones. High-fidelity simulations reflect the conditions and circumstances of real life as accurately as possible. Simulated patients, sometimes called standardised patients, are usually volunteer members of the community or paid actors who support the education of healthcare professionals. Part task trainers are replications of body parts that provide key elements relative to performing a procedure or learning a task.

Kerry Reid-Searl

Papers

First year registered nurses and delegation of duties

A nursing innovation to promote healthy bowel functioning in children

An assessment process with a difference : an avenue for nurses to regain their registration

Midwives' recognition and response to maternal deterioration: A national cross-sectional study.

Simulation in nursing education