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      Evaluation of simulation skills of healthcare workers at a tertiary care center: A perspective towards coronavirus disease 2019 (COVID-19) third wave preparation

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          Abstract

          BACKGROUND:

          Simulation-based training for healthcare providers was established as an efficacious training tool to sharpen the performance skills of nontechnical team as necessary for the prevention of errors and adverse events in the pandemic. To tackle this third wave, our institute started preparations with a faculty development course of simulation-based learning to evaluate participants' knowledge and skills and their attitudes and feedback.

          MATERIALS AND METHODS:

          As part of the simulation workshop, a module was developed to train the staff on recognizing and responding to acute coronavirus disease 2019 affecting adults and children. Case-based scenarios were provided in the application. Pretest and posttest questionnaires were administered to all trainees. The questionnaires included questions on knowledge, skills confidence and attitude marked on a 5-point Likert scale. Data were entered and analyzed using the Microsoft Excel 2018. Qualitative variables were expressed as percentages, whereas mean and standard deviations were computed for quantitative variables. Paired t-test was used to test the difference between pre and post test scores; P < 0.05 was taken as significant value.

          RESULTS:

          A total of 296 participants were included in the study. A statistically significant increase in knowledge and skills confidence scores was found from pre-test to post-test. The most significant improvement was found in the assessment of pediatric hemodynamic status and the management of fluid and electrolytes. The most interesting benefit to the participants was the acquisition of knowledge about the proper use of technology after the faculty development course.

          CONCLUSIONS:

          Such workshops play a crucial role in training healthcare workers, especially as preparation for the pandemic. Most participants suggested that there should be such workshops at regular intervals to enhance their skills confidence in handling emergency situations in the clinical settings.

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          Most cited references27

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          In situ simulation: detection of safety threats and teamwork training in a high risk emergency department.

          Implement and demonstrate feasibility of in situ simulations to identify latent safety threats (LSTs) at a higher rate than lab-based training, and reinforce teamwork training in a paediatric emergency department (ED). Multidisciplinary healthcare providers responded to critical simulated patients in an urban ED during all shifts. Unannounced in situ simulations were limited to 10 min of simulation and 10 min of debriefing, and were video recorded. A standardised debriefing template was used to assess LSTs. The primary outcome measure was the number and type of LSTs identified during the simulations. Secondary measures included: participants' assessment of impact on patient care and value to participants. Blinded video review using a modified Anaesthetists Non-Technical Skills scale was used to assess team behaviours. 218 healthcare providers responded to 90 in situ simulations conducted over 1 year. A total of 73 LSTs were identified; a rate of one every 1.2 simulations performed. In situ simulations were cancelled at a rate of 28% initially, but the cancellation rate decreased as training matured. Examples of threats identified include malfunctioning equipment and knowledge gaps concerning role responsibilities. 78% of participants rated the simulations as extremely valuable or valuable, while only 5% rated the simulation as having little or no value. Of those responding to a postsimulation survey, 77% reported little or no clinical impact. Video recordings did not indicate changes in non-technical skills during this time. In situ simulation is a practical method for the detection of LSTs and to reinforce team training behaviours. Embedding in situ simulation as a routine expectation positively affected operations and the safety climate in a high risk clinical setting.
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            Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses.

            In 2006, the National League for Nursing published three measures related to novice nurses' beliefs about self-confidence, scenario design, and educational practices associated with simulation. Despite the extensive use of these measures, little is known about their reliability and validity.
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              Plausibility of a third wave of COVID-19 in India: A mathematical modelling based analysis

              Background & objectives: In the context of India's ongoing resurgence of COVID-19 (second wave since mid-February 2021, following the subsiding of the first wave in September 2020), there has been increasing speculation on the possibility of a future third wave of infection, posing a burden on the healthcare system. Using simple mathematical models of the transmission dynamics of SARS-CoV-2, this study examined the conditions under which a serious third wave could occur. Methods: Using a deterministic, compartmental model of SARS-CoV-2 transmission, four potential mechanisms for a third wave were examined: ( i ) waning immunity restores previously exposed individuals to a susceptible state, ( ii ) emergence of a new viral variant that is capable of escaping immunity to previously circulating strains, ( iii ) emergence of a new viral variant that is more transmissible than the previously circulating strains, and ( iv ) release of current lockdowns affording fresh opportunities for transmission. Results: Immune-mediated mechanisms (waning immunity, or viral evolution for immune escape) are unlikely to drive a severe third wave if acting on their own, unless such mechanisms lead to a complete loss of protection among those previously exposed. Likewise, a new, more transmissible variant would have to exceed a high threshold ( R 0 >4.5) to cause a third wave on its own. However, plausible mechanisms for a third wave include: ( i ) a new variant that is more transmissible and at the same time capable of escaping prior immunity, and ( ii ) lockdowns that are highly effective in limiting transmission and subsequently released. In both cases, any third wave seems unlikely to be as severe as the second wave. Rapid scale-up of vaccination efforts could play an important role in mitigating these and future waves of the disease. Interpretation & conclusions: This study demonstrates plausible mechanisms by which a substantial third wave could occur, while also illustrating that it is unlikely for any such resurgence to be as large as the second wave. Model projections are, however, subject to several uncertainties, and it remains important to scale up vaccination coverage to mitigate against any eventuality. Preparedness planning for any potential future wave will benefit by drawing upon the projected numbers based on the present modelling exercise.
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                Author and article information

                Journal
                J Family Community Med
                J Family Community Med
                JFCM
                Journal of Family & Community Medicine
                Wolters Kluwer - Medknow (India )
                1319-1683
                2229-340X
                May-Aug 2022
                13 May 2022
                : 29
                : 2
                : 102-107
                Affiliations
                [1] Department of Community Medicine, ESIC Medical College, Hyderabad, Telangana, India
                [1 ] Department of Obstetrics and Gynaecology, ESIC Medical College and Hospital, Hyderabad, Telangana, India
                [2 ] Department of Pharmacology, ESIC Medical College,, Hyderabad, Telangana, India
                Author notes
                Address for correspondence: Dr. Sudha Bala, Flat No-301, Shubodaya Enclave, Bagh Amberpet, Hyderabad - 500 013, Telangana, India. E-mail: dr.sudhabala78@ 123456gmail.com
                Article
                JFCM-29-102
                10.4103/jfcm.jfcm_23_22
                9221233
                4b33d717-4f04-4873-b036-72c62fcfce1e
                Copyright: © 2022 Journal of Family and Community Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 18 January 2022
                : 02 April 2022
                : 13 April 2022
                Categories
                Original Article

                Health & Social care
                coronavirus disease 2019,health personnel,simulation training
                Health & Social care
                coronavirus disease 2019, health personnel, simulation training

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