Tag: Nursing

“Humane Touch is the most Important aspect of nursing”- Beautifully expressed view by Prof. Dr. A. T. Kora

“I attribute my success to this – I never gave or took any excuse.” Prof. Dr. A. T. Kora

These lines by Florence Nightingale has been fully lived up to by Prof. Dr. A.T. Kora as she says “ No work or excuse is more important than the life and care of a patient”.

Dr. Kora is the Nursing Superintendent at  St. Stephen’s Hospital, Delhi. She received the prestigious Florence Nightingale award from the President this year (2017).

As they say ‘You do not always have to look at famous personalities for inspiration’, Dr. Kora got her inspiration from her aunt who was the then Nursing superintendent for Delhi state. Her aunt became her role-model and motivator.

Dr. Kora joined B.Sc. Nursing at CMC College, Ludhiana in the year 1973.

For Dr. Kora at that time language was the biggest problem. She completed her intermediate in Kerala then directly went to Ludhiana and then got a Punjabi roommate  and to top it all both of us didn’t know english.

For the first year of her nursing studies she was not so sure about her choice, she wanted to leave nursing and join microbiology. “Somehow I always had that feeling, but I didn’t have the courage to quit nursing, so I continued with the studies”, she said timidly.

Dr. Kora joined St. Stephen’s in 1977 as a staff nurse and has been a part of the growth of Stephens for last 40 years. She tells us, “When I joined here it was predominantly a maternity based hospital. The old hospital which is nursing college now, was the maternity wing of St. Stephen’s. We had the pre-natal, post-natal, nursery, labour room etc. in that one building  and used to have 40-50 deliveries every day. I have seen all veteran doctors running in sarees to attend their patients.”

Dr. Kora recalls two events of all that innervated her to continue nursing and work for such a long period. On the second day of her joining, she had a fight with a doctor who was also the Director of the hospital. The doctor got a complaint that she is not caring properly for a patient but the story was something else. As she tells, “What happened was that while I was resuscitating a patient, some other patient started vomiting and the attendants of that patient started shouting at me to leave what I was doing and clear that mess up. I said I won’t come because resuscitating a patient is more important than cleaning mess at any point of time. The family of that patient complained to doctor and then I went on to say the same thing to the doctor as well, which turned into an argument and I didn’t know that she was the Director of the hospital at that time.” After this argument the director was amazed that a staff nurse was answering back to her and was quite impressed. She called Dr. Kora and gave her the keys to ICU section and asked her to set the unit.

Another incident she quotes as the turning point of her life was when she was posted in CCU in night duty and a patient got serious. Dr. Kora and her colleague Celine defibrillated a patient. When they saw the heart rate coming back on the monitor they started clapping hands and jumping out of joy. As she reminisces, “The treating doctor was Dr. Chabra, he saw us clapping and jumping. He continued to observe us without us knowing. At the end he came and said “well done children, well done”. “That was the turning point where I realised that by doing nursing we can save a lot of lives and then I decided to continue in nursing”. During the later years she went on to like teaching and was transferred to school of nursing just after two years of her joining.

As is said by someone, ‘Motivation is what gets you started, Commitment is what keeps you going’.Dr. A.T. Kora has committed 40 years of her life so far to nursing and teaching. What kept her going these many years?

“It started since I was in college of nursing, somehow I always had that feeling that I am not suitable for this profession. Mrs. Kanwaljeet Gill of Ludhiana was my mentor and was trying to convince me to stay back. When I joined St. Stephen’s Sister Mariamma Rajan came into the scenario. She was a very tough person but if she wanted something from you she would make sure that she is getting that out. In my starting year she would hide herself in curtains of ICU and watch me. She taught me the A B Cs of managing the school. When I would take theory classes, sister Rajan would come and stand outside the class against the wall and listen to what I was teaching, and when I went back to the staff room I’d have a lot of criticism waiting. It was as a scrubber is used to wash the vessel and shine it, the same way she brushed me up”

By 1982, Dr. Kora started officiating as principal in school of nursing. In 1989 she went back to CMC for her Masters in Psychiatric Nursing. She completed her MPhil in guidance and counselling in 2006 and Ph.D. in 2014.

Getting lost in the memories of past she tells us how different things were back then. She and her colleagues were not at all time oriented people. She would enter the ward in the morning and work until the task is complete.  At times in the middle of night she would get a call and rush back to hospital (with half saree fixed and half in hand) for one or the other emergency. Gallantly she speaks, “I remember, nobody would say that it is my time to leave, so I cannot do this work. Never ever anybody had any complaints and everybody enjoyed working. Those days you are not looking at the watch, instead you are looking at the patient and you are talking and listening to what he/she has to tell you”.

She feels that nursing is a noble profession and outlook of general public towards nurses has not changed much. They still look at nurses with a lot of hope, but nurse’s outlook towards nursing has changed. Those days nurses were more concerned for scientific principles, but now, that terminology has gone off and the word rationale has come in, but nobody asks why we are doing it. Without knowing the actual purpose as to why a procedure is done, nobody can practice successfully, she says. The patients whom we took care of 15 years back when they revisited the hospital after some years they would come and touch your feet and tell you how good they felt because of your care, but now these things are seldom seen. The humane connect is also going away, she added.

Patient’s response gives Dr. Kora a lot of satisfaction in her profession but she also loves teaching and never misses a chance of teaching anywhere. She has written a book  Essentials of health economics for nurses and was a part of nurse’s dictionary. She is also the content editor for revising ‘Fundamentals of Nursing’ by TNAI (Trained Nurses Association of India) and is planning to write another book on nursing administration.  People consider her a strict teacher and administrator but there is another side of her where she also cares for her students and colleagues when they are sick and even prepares food for them.

She also likes visiting old age homes since her starting years. She narrated one particular incident that pulled her even more close to old aged people, “I used to visit sister Dayal regularly in St. Mary’s home. One day she introduced me to one lady who was also a nurse and lived in the room next to sister Dayal. I tried talking to her but she would not respond. When I was leaving that day I hugged her and said that I’ll meet her soon and to my surprise she smiled at me. After that I would meet her regularly and talk to her and take her to church. We celebrated her birthday and that day she was really happy. I saw remarkable change in her. That was the time I realised that every human being has the need of somebody to talk to and if you try you can bring these people to mainstream social life again. It may seem a very small thing to you to spend 10-15 minutes with them but for them it is very important”.

How does she manage to do so many things at a time? She replies firmly, “I don’t waste time and I also don’t waste any opportunity”.

Dr. Kora has received many awards and recognitions in her efficacious career of 40 years. Dr. Prof. A.T. Kora has been awarded Nursing Excellence award from TNAI in 2012, award for excellence in healthcare by RKP foundation and India’s Highest recognition in nursing ‘National Florence Nightingale Award’ in 2017. Other prestigious awards include university gold medals by Punjab University in 1991, Jawaharlal Nehru Memorial award for outstanding work in M.Sc., and award with three ties for maximum membership enrollment in TNAI. Dr. Kora has also been conferred with the award for maximum contribution to humanity by Kerala Christian Association in 2017. Very modestly she gives all the credits of these awards to her seniors and mentors.

At the end of the discussion Dr. Kora gives a message for the young nurses joining nursing. Humane touch and connect is the most important aspect of nursing. Learn to practice communicating with people and use touch and listening as the basic techniques. Giving proper care to patients and listening to them is important for both the patient and your job satisfaction. Don’t waste your time and never miss an opportunity if you want to grow in your profession.

Augmented and Virtual Reality in the field of Nursing Education

Introduction

One of the most exciting developments in virtual reality has been its rapid entry into medical education and healthcare. Researchers, doctors, and nurse educators are discovering innovative ways to leverage immersive technologies and transform both healthcare teaching and practice.

Financial as well as regulatory restrictions has burdened the nursing education, as a result of which, providing adequate training has become a challenging task for the nursing educators. Not only the patients, but the practitioners and the devices used are at a risk of harm and malfunction if the quality of training is not up to the mark.

Simulation-based training has been used and shown to be an effective tool in the fields other than medicine as the virtual reality provides a range of learning and training enhancing aspects.

The Problem

Various problems challenge the expected level of skill proficiency of nursing students who practice clinical skills with patient manikin simulators, and inside simulated learning environments labs. These challenges include, but are not limited to,

  • limited availability of nurse faculty to provide instruction and repetitive practice needed for nursing student’s opportunities to practice outside nursing laboratories regular hours of operations.
  • The capability of nurse faculty to address individual learning needs of nursing students during each practice session
  • Instructional and evaluation variability among nurse faculty.

VR Technology can address all the above mentioned challenges and enhance the ability of faculty to sometimes quantifiably evaluate, student-learning performance. Augmented Reality (AR) and simulation are technology interventions modalities that can be integrated into nursing curriculum to help nursing student achieve and improve clinical skill proficiency.

Advantages of AR /VR application for Nursing Education

There are many advantages to using virtual reality in nurse training. Nurses can build familiarity with technology in a controlled environment, and learn by “doing,” rather than “seeing.”

  • Simulation helps develop competences for professional practice. Students who have the opportunity to develop clinical practices in a simulated environment report an increase in confidence, as they were able to transfer significantly the knowledge learned in the classroom to the simulated environment. Studies have reported improvements in the areas of critical thinking, confidence and/or knowledge/skills after participating in the simulation.
  • Simulation provides a rich learning opportunity for students to integrate theory with practice while making real-time clinical decisions in an environment that poses no risk to patients. HFS is one such example that provides students with a safe environment to learn and make mistakes without compromising patient safety.
  • Simulation can standardize clinical experiences in an environment with often unequal clinical learning opportunities. The use of High-Fidelity Simulation (HFS) in health care education has emerged as a possible solution to address limited clinical experiences.. Research studies have shown HFS to be beneficial in acquiring new knowledge in many clinical areas, including Medical-surgical, advanced cardiac life support, and acute myocardial infarction treatment.
  • Human patient simulation-based clinical nursing education has the potential to promote transformative learning and lead to a metamorphosis of students’ preconceived meaning schemes. It allows students to engage in social interactions and enhance their psychomotor skills in a patient safe environment, which helps most students relax and increases their confidence in performing clinical skills during a simulated clinical experience.

Current Implementation of AR/VR in nursing and medical education

1. The 2019 International Nursing Association for Clinical Simulation and Learning (INACSL) Conference was held in Phoenix Arizona with the Hayden Vanguard Lectureship by Bradley Chesham.

The INACSL meeting is a leading forum for nursing simulation aficionados, researchers, and vendors providing the ideal environment to gain and disseminate current, state-of-the-art knowledge in the areas of skills/simulation operations and applications in an evidenced-based venue.

The Hayden Vanguard Lectureship recognizes innovation in Nursing Simulation. Bundle of Rays focuses on “clinical skills and health-based training” utilizing virtual reality to teach anatomy and physiology, combined with simulation technology to link imaging to patient assessment. Designed by nurses, these training programs focus on patient safety, quality assessment skills and escalation of clinical deterioration. All of this is done in small class sizes at dynamic venues, conceptualizing the future of healthcare education.

Showcasing Augmented Reality (AR) in real-time, Brad shared how he could pick up a digital beating heart on his desk, bringing digital animation into a real background. Combining these technologies allows educators to have multi-user sessions across mediums to teach countless learners at the same time, even if they are located at different locations around the world. Brad shared that through his startup Bundle of Rays, to provide education for multiple learners at the same time even though they are spread across a wide geographic region.

2. Another excellent example of implementation of VR in Nursing education is A VR game that allows nursing students to practice urinary catheter insertion — what Kardong-Edgren (Suzan Kardong-Edgren, a professor at the School of Nursing and Health Science at Robert Morris University in Pennsylvania) called “a perfect marriage of nursing skills and software development”. Nursing students wearing Oculus Rift headgear and interactive gloves, called haptics, practice cleaning their hands and inserting a catheter into a patient’s bladder. In a study published in the March 2018 issue of Clinical Simulation in Nursing, Ellertson, Kardong-Edgren and Ann Butt of College of Nursing at University of Utah, report that the VR-trained students had the same pass rate as students who practiced the traditional way, on manikins, and that the VR students said they enjoyed the learning experience more.

virtual reality game

        A nursing student practicing catheterization procedures with a VR game developed by Boise State University and Robert Morris University. (Photo: Boise State University)

Catheterization was a good candidate for VR training, because it is a procedure that is difficult to learn and dangerous to patients if done incorrectly

Normally, nursing students have to practice urinary catheterization 30 to 50 times before they can do it on human beings. Many universities, however, don’t have enough medical simulation facilities and students are often not interested in repeating the same procedure over and over, Ellertson said.

“The underlying goal of the training is going to remain the same, but the shift is that we want students to practice more,” said Ellertson, who led a team of eight software developers to design, test, and then improve the VR game.

Kardong-Edgren and her team of researchers tested 20 nursing school students, who had practiced urinary catheterization on manikins. Lab assistants taught the students how to synchronize and calibrate the VR gear to their own movements, and then asked the students to perform the procedure. After an initial 15-minute orientation, students were instructed to use as little or as much of the remaining hour allotted to practice catheter insertion.

In the virtual world, the student goes from one corner of the room to another to find a tray where the sterile package lies. Then they need to wash their hands, don clean gloves, pick up the catheter package, and bring it to the patient. After cleaning the patient’s bottom, they need to correctly open the package, and insert the sterile catheter. To emphasize the importance of proper sterile technique, a green cloud of small falling particles appears on the screen if students did not wear their gloves properly.

The possibilities for using virtual reality in nursing are endless.

virtual reality result

Medical professionals will be monitoring the student’s practice on computers, where they can see the student’s vision on the left and real-time video of them on the right. (Photo: Boise State University)

Two weeks later, the students who underwent VR training for that hour did the same procedure on manikins. Professors compared their performance with that of nursing students who had only worked with manikins. Results showed that the VR-trained students not only had the same pass rate as the manikin-only group, but they also rated the VR training experience as “fun, engaging,” and they noted that it made them “lose track of time.”

A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage.

Introduction:

Postpartum hemorrhage affects approximately thirteen million women every year and remains a leading cause of maternal mortality in Asia and Africa. Mannequin-based simulation is the most common way for practicing care of critical patients but has its challenges when it comes to global health in developing countries.
A novel multiplayer screen-based simulation is developed in virtual world to practice team coordination with PPH cases. It was hypothesized that such a screen-based simulation may enhance the learner’s confidence and ability to manage critical PPH cases. The same was implemented in Mulago, Uganda.

3D virtual reality game

Screen-shot of 3DiTeams—postpartum hemorrhage—multiplayer screen-based simulation. Each character is controlled by a unique individual using a computer, mouse, and voice-over-IP headset.

Methods:

  • Study Design : pre- and a post-intervention survey.
  • Sample size : 48 interprofessional subjects
  • One of 9, 1 Hour simulation sessions in PPH software
  • The subjects were tested on 15 self-assessment question, before and after the intervention. And was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor.

Results:

The confidence scores in each category of Bloom’s Taxonomy : affective, cognitive and psychomotor as well as combined score of all three increased significantly following the simulation experience.

Conclusion:

The study provides a preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning. The same can be used effectively in global health education and training.

Award Winning AR Training and Simulation

Virtual Reality Airway Learning Lab, a program that uses cutting edge virtual reality technology in clinical education.

It was honored to win the Best in Show award at the annual International Meeting for Simulation in Healthcare in 2018 in partnership with Adtalem Global Education (NYSE: ATGE), a leading global education provider. (Dr Eric B Bauman and Dr Nick Slamon)

Acadicus simplifies and democratizes the educational learning curve associated with VR training, allowing for cost effective scenario creation by faculty and instructional staff. Stakeholders are able to create authentic environments that may not otherwise be available to students… this helps solve the bricks-and-mortar, time-and-place challenges associated with traditional simulation laboratories.

The 3D recording feature within the Acadicus environment is a powerful way for faculty and staff to create and capture their own instructional content. The multi-user feature allows for remote learners to collaborate in real-time in authentic spaces that promote environmental fidelity in ways that encourage the suspension of disbelief and promote psychological fidelity.

Applied as part of a layered learning approach, Acadicus promotes learner engagement and creates sticky learning experiences that often rival or exceed real-life learning experiences, effectively driving learners toward curriculum objectives and outcomes.”

Introduction to various airway instruments and how they’re used. Overview of steps and technique in airway management

References:

1. Shinnick MA, Woo M, Horwich TB, Steadman R. Debriefing: The most important component in simulation? Clinical Simulation in Nursing. 2011;7(3):105-11.

2. Jeffries PR. Getting in S.T.E.P. with simulations: Simulations take educator preparation. Nurs Educ Perspect. 2008;29(2):70-3.

3. Alinier G, Hunt B, Gordon R, Harwood C. Effectiveness of intermediatefidelity simulation training technology in undergraduate nursing education. J Adv Nurs. 2006;54(3):359-69.

4. Birch L, Jones N, Doyle PM, Green P, McLaughlin A, Champney C, et al. Obstetric skills drills: evaluation of teaching methods. Nurse Educ Today. 2007;27(8), 915-22.

5. Elfrink VL, Kirkpatrick B, Nininger J, Schubert C. Using learning outcomes to inform teaching practices in human patient simulation. Nurs Educ Perspect. 2010;31(2):97-100.

6. Hoadley TA. Learning advanced cardiac life support: a comparison study of the effects of low- and high-fidelity simulation. Nurs Educ Perspect. 2009;30(2):91-5.

7. National league for nursing. Society for Simulation in Healthcare 2014. A Vision for Teaching with Simulation A Living Document from the National League for Nursing NLN Board of Governors. 2015.

8. Birkhoff SD, Donner C. Enhancing pediatric clinical competency with high- fidelity simulation. J Contin Educ Nurs. 2010;41(9):418-23.

9. National League for Nursing. Main obstacle to expanding capacity by program type. 2014.

10. Brannan JD, White A, Bezanson JL. Simulator effects on cognitive skills and confidence levels. J Nurs Educ. 2008;47(11):495-500.

11. Parker B, Myrick F. Transformative learning as a context for human patient simulation. J Nurs Educ. 2010;49(6):326-32.

12. https://arvrjourney.com/nursing-students-are-learning-medical-techniques-with-vr-fd4c5a8d642d

13. https://www.healthysimulation.com/inacsl/

14. https://acadicus.com/

Top