PATIENTS Day 2019: Towards a Learning Healthcare System v2.0 a.k.a. Learning Health Care Community
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Other TitlesTowards a Learning Healthcare System v2.0 a.k.a. Learning Health Care Commuity
DescriptionPoster presented at the 3rd PATIENTS Day held on May 31, 2019 Baltimore, MD.
Rights/TermsAttribution-NonCommercial-NoDerivs 3.0 United States
Keywordlearning health care community
learning health system
Patient-centered health care
University of Maryland, Baltimore. School of Pharmacy
Delivery of Health Care
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/10112
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Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivs 3.0 United States
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Clinical Simulation in Pre-Licensure Nursing Students: Improving Learning Outcomes in Psychologically Safe Learning EnvironmentsDaniels, Amy Louise; Johantgen, Mary E. (2018)Background: Simulation-based education in pre-licensure nursing programs is increasing exponentially as alternative clinical teaching experiences. Implementing quality simulation experiences is resource intensive, cost limiting, with limited evidence of the impact on learning outcomes. Standards of Best Practice: SimulationSM identify formal training is essential for quality debriefing, including providing a psychologically safe learning environment. However, a recent nationwide survey of 150 nursing schools identified only 40% of programs formally train simulation facilitators. In addition, there are limited valid and reliable instruments measuring reflective thinking as a learning outcome and debriefing competence. Purpose: The first paper reviewed literature on psychological safety in nursing pre-licensure simulation and assessed alignment with Edmondson's work-team learning model. A second paper described reflective thinking measured by the Reflective Thinking Questionnaire (RTQ), and explored RTQ scores in relation to facilitator training length and Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV)© scores. A third paper explored the psychometric qualities of the RTQ. Methods: Using a quasi-experimental, cross-sectional, nonequivalent, two-group design, pre-licensure nursing students were surveyed using the RTQ and the DASH-SV (N=99). The six facilitators had varied experience and training. Descriptive and bivariate analyses examined RTQ subscales in relation to student characteristics and DASH-SV© scores in relation to student and facilitator characteristics. MPLUS was used for CFA of the RTQ to explore how well a hypothesized model based on pre-licensure nursing students fit sample data. Results: Simulation-based nursing education literature demonstrates alignment with Edmondson's work-team learning model, although only 10 articles met inclusion criteria. RTQ subscale scores did not differ across differing facilitator characteristics. Students rated 1-day trained facilitators higher in establishing psychological safety and provoking in-depth discussions compared to 5-day trained facilitators. Confirmatory factor analysis of the RTQ supported the hypothesized model from the literature, although model fit remains inadequate. Conclusions: No associations were found between 1-day and 5-day facilitator training and student reflective thinking. Although a small single-site study with limited measures, nursing schools should require 1-day training at a minimum. It is imperative to conduct more rigorous simulation studies to establish efficacy of simulation as a training methodology, development conceptual frameworks, and improve measures.
Transitioning from learning healthcare systems to learning health care communitiesMullins, C.D.; Wingate, L.T.; Edwards, H.A. (Future Medicine Ltd., 2018)The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype. Copyright 2018 Hillary A Edwards.