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Mujlli G, Al-Ghosen A, Alrabah R, Munshi F, Ozdemir B. Development and validation of Simulation Scenario Quality Instrument (SSQI). BMC MEDICAL EDUCATION 2023; 23:972. [PMID: 38115012 PMCID: PMC10731859 DOI: 10.1186/s12909-023-04935-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Due to the unmet need for valid instruments that evaluate critical components of simulation scenarios, this research aimed to develop and validate an instrument that measures the quality of healthcare simulation scenarios. METHODS A sequential transformative mixed-method research design was used to conduct the study. The development and validation of the instrument involved two phases: the qualitative phase, which included defining the instrument's theoretical background and instrument construction, followed by the quantitative phase, where the instrument was piloted and validated. The qualitative study included 17 healthcare simulation experts, where three focus group was conducted, and the first version of the instrument was constructed based on the focus group analysis and the theoretical framework constructed using the literature review. During the quantitative phase, the instrument's quantitative piloting included 125 healthcare simulation scenarios; then, the instrument went through construct validity and reliability testing. RESULTS Content experts confirmed the theoretical model and instrument framework. The average item content validity index (I-CVI) scores and the average of the I-CVI scores (S-CVI/Ave) for all items on the scale or the average proportion relevance judged by all experts was 0.87. The conformity factor analysis results showed a good fit for the proposed 10-factor model (CFI (the comparative fit index) = 0.998, Tucker-Lewis index = 0.998, Root mean square error of approximation (RMSEA) = 0.061. The final instrument included ten domains: 1. Learning objectives, 2. Target group, 3. Culture, 4. Scenario case, 5. Scenario narrative briefing, 6. Scenario complexity, 7. Scenario flow, 8. Fidelity, 9. Debriefing, and 10. ASSESSMENT The SSQI included 44 items that are rated on a 3-point scale (Meets Expectations = (2), Needs Improvement, (1), Inadequate (0)). CONCLUSION This validated and reliable instrument will be helpful to healthcare educators and simulation experts who want to develop simulation-based training scenarios and ensure the quality of written scenarios.
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Grants
- 44- PRFA-P- 134 Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding
- 44- PRFA-P- 134 Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding
- 44- PRFA-P- 134 Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding
- 44- PRFA-P- 134 Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding
- 44- PRFA-P- 134 Deanship of Scientific Research, Princess Nourah bint Abdulrahman University, through the Program of Research Project Funding
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Affiliation(s)
- Gadah Mujlli
- Simulation and Skills Development Center, Health Affairs, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Abdulmajeed Al-Ghosen
- Simulation and Skills Development Center, Health Affairs, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rola Alrabah
- King Abdullah bin Abdulaziz University Hospital, Health Affairs, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Fadi Munshi
- King Salman Global Academy for Arabic Language, Riyadh, Saudi Arabia
- Abdulrahmans's Oasis, The Child Life Foundation, Riyadh, Saudi Arabia
| | - Burhanettin Ozdemir
- Department of Mathematics and Sciences, Prince Sultan University, Riyadh, Saudi Arabia
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Curtis K, Fry M, Shaban RZ, Wolf L, Delao A, Kolbuk ME, Kennedy B, Considine J. Emergency nurses' perceptions of the utility, adaptability and feasibility of the emergency nursing framework HIRAID TM for practice change in US: An exploratory study. Int Emerg Nurs 2023; 71:101377. [PMID: 37972519 DOI: 10.1016/j.ienj.2023.101377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patient assessment is a core component of nursing practice and underpins safe, high-quality patient care. HIRAIDTM, an evidence-informed emergency nursing framework, provides nurses with a structured approach to patient assessment and management post triage. In Australia, HIRAIDTM resulted in significant improvements to nurse-led communication and reduced adverse patient events. OBJECTIVES First, to explore United States (US) emergency nurses' perceptions of the evidence-informed emergency nursing framework, HIRAIDTM; second, to determine factors that would influence the feasibility and adaptability of HIRAIDTM into nursing clinical practice in EDs within the US. METHODS A cross-sectional cohort study using a survey method with a convenience sample was conducted. A 4-hour workshop introduced the HIRAIDTM framework and supporting evidence at the Emergency Nurses Association's (ENA) conference, Emergency Nursing 2022. Surveys were tested for face validity and collected information on nurse-nurse communication, self-efficacy, the practice environment and feedback on the HIRAIDTM framework. RESULTS The workshop was attended by 48 emergency nurses from 17 US States and four countries. Most respondents reported that all emergency nurses should use the same standardised approach in the assessment of patients. However, the greatest barriers to change were a lack of staff and support from management. The most likely interventions reported to enable change were face-to-face education, the opportunity to ask questions and support in the clinical environment. CONCLUSION HIRAIDTM is an acceptable and suitable emergency nursing framework for consideration in the US. Successful uptake will depend on training methods and organizational support. HIRAIDTM training should incorporate face-to-face interactive workshops.
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Affiliation(s)
- Kate Curtis
- Emergency and Trauma Nursing RC Mills Building, Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia.
| | - Margaret Fry
- Emergency and Critical Care, Conjoint Clinical Chair, Northern Sydney Local Health District, Australia; University of Technology Sydney Faculty of Health School of Nursing and Midwifery, PO Box 123 Broadway, NSW 2007, Australia.
| | - Ramon Z Shaban
- Communicable Diseases Control and Infection Prevention, Sydney Institute for Infectious Diseases and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; Communicable Diseases Control, Public Health Unit, Centre for Population Health. Director and Chief Infection Control Practitioner Western Sydney LHD, Building 68, 5 Fleet Street, North Parramatta, NSW 2151, Australia; New South Wales Biocontainment Centre, Australia.
| | - Lisa Wolf
- Emergency Nursing Research, Emergency Nurses Association, Schaumburg, IL, USA; Elaine Marieb College of Nursing, University of Massachusetts, Amherst, MA, USA.
| | - Altair Delao
- Research, Emergency Nurses Association, 930 Woodfield Rd., Schaumburg, IL 60173, USA.
| | - Monica Escalante Kolbuk
- Novice Nurse Education Programs, Emergency Nurses Association, 930 E. Woodfield Road, Schaumburg, IL 60173, USA.
| | - Belinda Kennedy
- The University of Sydney, Rm 169, RC Mills, Camperdown, NSW 2006, Australia.
| | - Julie Considine
- Chair in Nursing (Eastern Health), Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
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Vemuri S, O'Neill J, Hynson J, Gillam L. Informing Simulation Design: A Qualitative Phenomenological Study of the Experiences of Bereaved Parents and Actors. Simul Healthc 2023; 18:75-81. [PMID: 35081089 DOI: 10.1097/sih.0000000000000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Simulations, which represent reality, are effective in pediatric healthcare communication skills education and training. Parents are increasingly engaged in simulation development, particularly for authentic character development, to help achieve greater psychological fidelity. For simulated encounters related to a child's end-of-life, involvement of bereaved parents would make sense. However, this is challenging because there is limited research to guide their inclusion and significant responsibility for any approach to be thoughtful and psychologically safe for participating parents. This study explores the impact and experiences of bereaved parents and actors who participated in simulation design. METHODS This qualitative phenomenological study involved five bereaved parents and two actors who participated in a full-day workshop to design and develop characters for use in a simulation. Individual semistructured interviews were conducted up to four weeks after the workshop. Data collected from these telephone interviews were analyzed using inductive content analysis. RESULTS Bereaved parents found the workshop emotionally challenging but positive, worthwhile, and beneficial. Similarly, actors found the workshop helpful in character development and, although it was an intense experience for them, it validated the importance of their work. Key elements of our research findings could inform future such activities. CONCLUSIONS Involving bereaved parents in simulation design can be psychologically safe and beneficial for both parents and actors. Ongoing involvement of bereaved parents may lead to higher-quality simulated experiences, allowing clinicians to practice skills to enhance care provided at a child's end-of-life.
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Affiliation(s)
- Sidharth Vemuri
- From the Department of Paediatrics (S.V.), The University of Melbourne, Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Murdoch Children's Research Institute; Department of Nursing Research (J.O.), The Royal Children's Hospital Melbourne; Victorian Paediatric Palliative Care Program (J.H.), The Royal Children's Hospital Melbourne; Department of Paediatrics The University of Melbourne; and Department of Paediatrics (L.G.), The University of Melbourne, Children's Bioethics Centre, The Royal Children's Hospital Melbourne, Parkville, Australia
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Promoting critical thinking through simulation-based healthcare training (SBHT): A scoping review. AFRICAN JOURNAL OF HEALTH PROFESSIONS EDUCATION 2022. [DOI: 10.7196/ajhpe.2022.v14i1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Critical thinking (CT) is an essential graduate attribute for health professions (HP) students. Yet, achieving a higher level of CT in HP students through education is often difficult for educators. SBHT has proven to be an effective strategy to promote CT, but it is not clear how this educational pedagogy should be implemented to achieve higher levels of CT.Objective. To identify and describe the use of simulation-based healthcare training (SBHT) strategies to promote CT in HP students.
Methods. Based on the revised methodology of Levac et al., a scoping review was conducted on studies reporting an improvement in CT through simulation-based healthcare education published between January 2010 and August 2021.Results. Twenty articles were included. Through thematic analysis, three main themes were identified: contact simulations, computer-based simulations, and debriefing. The focus was on how these approaches were used to promote CT. Various subthemes were also identified.
Conclusion. Correctly planning and implementing a simulation-based experience that relates to the relevant learning activities, combined with repeat practice and guided reflection during the debriefing stage, improves the CT skills of HP students.
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Espejo-Antúnez L, Fernández-Morales C, Hernández-Sánchez S, Cardero-Durán MDLÁ, Toledo-Marhuenda JV, Albornoz-Cabello M. The Impact on the Stress-Associated Autonomic Response of Physiotherapy Students Receiving Interferential Current in an Electrotherapy Training Session. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13348. [PMID: 36293928 PMCID: PMC9603673 DOI: 10.3390/ijerph192013348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Electrical currents are didactic contents widely applied in the training of physiotherapy students, but the treatment is considered a stressful situation for both the patient who receives it and the student who applies it. The aim of this study was to evaluate the stress-associated autonomic response of physiotherapy students receiving interferential current by measuring and analysing heart rate variability. An observational case-control study was conducted. Ninety healthy male volunteers, all physiotherapy degree students, were enrolled while attending laboratory practice during the 2020-2021 academic year. Participants were randomly allocated to a sham electrotherapy group (44 subjects), in which heart rate variability was recorded for 10 min, both at rest and during the application of sham technique on the lower back (10 min), and an electrotherapy group (46 subjects), applying the same procedure with the electrical current flowing. Outcome measures included baseline (seated position) and postintervention (prone position) time domain parameter, diameters of the Poincaré plot 1 and 2, stress score, and sympathetic/parasympathetic ratio. The sham electrotherapy group exhibited significant increases in time domain parameter (p = 0.027) and diameters of the Poincaré plot 1 (p = 0.032), with a small effect size (d ≤ 0.5). The electrotherapy group exhibited significant increases in time domain parameter and diameters of the Poincaré plot 1 and 2 (p < 0.001) and decreases in the stress score and sympathetic/parasympathetic ratio (p < 0.001), with a large effect size (d > 0.8) other than for the time domain parameter (d = 0.42), indicating increased parasympathetic and decreased sympathetic activity. After interventions, there were significant differences between groups in diameters of the Poincaré plot 2 (p < 0.001), stress score (p = 0.01) and sympathetic/parasympathetic ratio (p = 0.003), with moderate effect size (d > 0.5). The application of the interferential current technique produces stress-associated autonomic response characterized by greater parasympathetic activity and decreased sympathetic activity. Further studies are needed to determine possible adverse effects.
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Affiliation(s)
- Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Carlos Fernández-Morales
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery (Area of Physiotherapy), Faculty of Medicine, Miguel Hernández University, 03550 Alicante, Spain
| | | | - José Vicente Toledo-Marhuenda
- Department of Pathology and Surgery (Area of Physiotherapy), Faculty of Medicine, Miguel Hernández University, 03550 Alicante, Spain
| | - Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, 41009 Seville, Spain
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Undergraduate Health Professional Students’ Team Communication in Simulated Emergency Settings: A Scoping Review. Clin Simul Nurs 2021. [DOI: 10.1016/j.ecns.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Almeida AOD, Dantas SRPE, Paula MABD, Silva JLG, Franck EM, Oliveira-Kumakura ARDS. Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists. Rev Bras Enferm 2021; 74:e20200360. [PMID: 33787798 DOI: 10.1590/0034-7167-2020-0360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to build and validate three clinical simulation scenarios and report the application with candidates for the specialist's degree in stomatherapy. METHODS methodological study, building three scenarios and evaluation checklists; content validation with judges, using content validity index and Modified Kappa Coefficient; pre-test and application. RESULTS scenarios built based on nursing care for: 1. insufficiency and venous ulcer; 2. demarcation of intestinal stomia; and 3. Clean intermittent catheterization. In the content validation of the 24 items appreciated, 83%, 80%, and 92% were validated without change. In the pre-test, the objectives and checklists were adjusted. In the application, to standardize the evaluation, actors and evaluators were trained previously, and each candidate passed the three stations. CONCLUSIONS scenarios built and with validated content, based on evidence and covering the three areas of stomatherapy. The pre-test allowed for adjustments in the scenarios, and the candidates achieved the expected objectives.
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Bellido-Esteban A, Beltrán-Velasco AI, Ruisoto-Palomera P, Nikolaidis PT, Knechtle B, Clemente-Suárez VJ. The Effect of Psychology Objective Structured Clinical Examination Scenarios Presentation Order on Students Autonomic Stress Response. Front Psychol 2021; 12:622102. [PMID: 33841253 PMCID: PMC8024632 DOI: 10.3389/fpsyg.2021.622102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/02/2021] [Indexed: 01/14/2023] Open
Abstract
The objective structured clinical examination (OSCE) is a method for assessment clinical competencies and skills. However, there is a need to improve its design in psychology programs. The aim of this study was to analyze the effect of the different scenario's presentation order with different complexity/difficulty on the autonomic stress response of undergraduate students undergoing a Psychology OSCE. A total of 32 students of Psychology Bachelor's Degree (23.4 ± 2.5 years) were randomly selected and assigned to two OSCE scenarios of different complexity. While undergoing the scenarios, participants heart rate variability was analyzed as an indicator of participant's stress autonomic response. Results indicate that the order of presentation of different complexity/difficulty scenarios affects the autonomic stress response of undergraduate Psychology students undergoing an OSCE. Students who underwent the high-complexity scenario (difficult) first, reported significantly higher autonomic stress response than students who began the OSCE with the low-complexity scenario (easy). Highly complex or difficult scenarios require good executive functions or cognitive control, very sensitive to autonomic stress responses. Therefore, OSCE design will benefit from placing easy scenarios first.
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Affiliation(s)
| | | | | | - Pantelis T Nikolaidis
- Department of Physical and Cultural Education, Hellenic Army Academy, Athens, Greece.,Exercise Physiology Laboratory, Nikaia, Greece
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Vicente Javier Clemente-Suárez
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla, Colombia
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Rim D, Shin H. Effective instructional design template for virtual simulations in nursing education. NURSE EDUCATION TODAY 2021; 96:104624. [PMID: 33099091 DOI: 10.1016/j.nedt.2020.104624] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Virtual-reality simulation (VRS) is an innovative teaching method in nursing education. However, information regarding the educational elements that should be included in the associated instructional design, and the technology necessary for its optimal implementation, is limited. OBJECTIVES To develop an effective template for VRS-based nursing education, and to evaluate its usability. DESIGN A methodological study. SETTING Multimedia room in university. PARTICIPANTS Sixteen undergraduate nursing students. METHODS First, we developed a template, which was validated by content experts. The template was then modified based on the experts' feedback, and was then applied in three VRS scenarios. RESULTS The developed template consisted of educational elements, virtual elements, and scenario outlines. The educational elements were learning target, learning objectives, instructional design, course flow, feedback strategies, follow-up and evaluation, debriefing structures, and human resources. The virtual elements were virtual framework, degree of virtuality, and virtual resources. The scenario outline included scenario target, learning objectives, evaluation, course flow, associated knowledge and skill, setting, scenario background, protocols, nursing intervention, algorithm and storyboard, documentation forms, mechanical supports, scenario characters, accessory items, and debriefing components. Three VRS scenarios were developed using this template. Students in focus group interviews described their learning experience. CONCLUSIONS The template can help educators administer effective VRS-based nursing education; however, the technical level of the platform used should be considered.
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Affiliation(s)
- Dahae Rim
- Kyung Hee University, College of Nursing Science, 26 Kyungheedaero, Dongdaemungu, Seoul, Republic of Korea.
| | - Hyunsook Shin
- Kyung Hee University, College of Nursing Science, 26 Kyungheedaero, Dongdaemungu, Seoul, Republic of Korea.
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Beltrán-Velasco AI, Bellido-Esteban A, Ruisoto-Palomera P, Mendoza KH, Clemente-Suárez VJ. The Effect of Cultural Differences in Psychophysiological Stress Response in High Education Context: A Pilot Study. Appl Psychophysiol Biofeedback 2020; 45:23-29. [PMID: 31612295 DOI: 10.1007/s10484-019-09452-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The simulation scenarios are increasingly being used to assess professional competences in health sciences at university level. The objective of this study was to explore the effect of differences in the stress psychophysiological response of Psychology degree students from Spain and Colombia undergoing to clinical practice. Multiple psychophysiological measures were obtained in a sample of 25 Colombian and Spanish Psychology students undergoing to simulation scenario. Differences in the initial level of stress and habituation process as reported by self-reported and psychophysiological measurements as discussed. Differences in stress-related psychological traits are also analyzed and further discussed.
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Affiliation(s)
| | | | - Pablo Ruisoto-Palomera
- Department of Basic Psychology, Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Ketty Herrera Mendoza
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla, Colombia
| | - Vicente Javier Clemente-Suárez
- Applied Psychophysiological Research Group, European University of Madrid, Madrid, Spain.
- Faculty of Sports Science, Universidad Europea de Madrid, Madrid, Spain.
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla, Colombia.
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Aufegger L, Soane E, Darzi A, Bicknell C. Shared leadership in tertiary care: design of a simulation for patient safety decision-making in healthcare management teams. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:216-222. [PMID: 35516831 PMCID: PMC8936880 DOI: 10.1136/bmjstel-2020-000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 11/04/2022]
Abstract
Introduction Simulation-based training (SBT) on shared leadership (SL) and group decision-making (GDM) can contribute to the safe and efficient functioning of a healthcare system, yet it is rarely incorporated into healthcare management training. The aim of this study was design, develop and validate a robust and evidence-based SBT to explore and train SL and GDM. Method Using a two-stage iterative simulation design approach, 103 clinical and non-clinical managerial students and healthcare professionals took part in an SBT that contained real-world problems and opportunities to improve patient safety set within a fictional context. Self-report data were gathered, and a focus group was conducted to address the simulation's degree of realism, content, relevance, as well as areas for improvement. Results Participants experienced the simulation scenario, the material and the role assignment as realistic and representative of real-world tasks and decision contexts, and as a good opportunity to identify and enact relevant tasks, behaviours and knowledge related to SL and GDM. Areas for improvement were highlighted with regard to involving an actor who challenges SL and GDM; more preparatory time to allow for an enhanced familiarisation of the content; and, video debriefs to reflect on relevant behaviours and team processes. Conclusions Our simulation was perceived as an effective method to develop SL and GDM within the context of patient safety and healthcare management. Future studies could extend this scenario method to other areas of healthcare service and delivery, and to different sectors that require diverse groups to make complex decisions.
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Affiliation(s)
- Lisa Aufegger
- (NIHR) Imperial Patient Safety Translation Research Centre, Imperial College London, London, UK
| | - Emma Soane
- Department of Management, London School of Economics and Political Science, London, UK
| | - Ara Darzi
- (NIHR) Imperial Patient Safety Translation Research Centre, Imperial College London, London, UK
| | - Colin Bicknell
- (NIHR) Imperial Patient Safety Translation Research Centre, Imperial College London, London, UK
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Lamé G, Dixon-Woods M. Using clinical simulation to study how to improve quality and safety in healthcare. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:87-94. [PMID: 32133154 PMCID: PMC7056349 DOI: 10.1136/bmjstel-2018-000370] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023]
Abstract
Simulation can offer researchers access to events that can otherwise not be directly observed, and in a safe and controlled environment. How to use simulation for the study of how to improve the quality and safety of healthcare remains underexplored, however. We offer an overview of simulation-based research (SBR) in this context. Building on theory and examples, we show how SBR can be deployed and which study designs it may support. We discuss the challenges of simulation for healthcare improvement research and how they can be tackled. We conclude that using simulation in the study of healthcare improvement is a promising approach that could usefully complement established research methods.
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Affiliation(s)
- Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Lateef F, Yin S, Suppiah M. The 2019 WACEM Expert Document on the Framework for Setting up a Simulation Centre. J Emerg Trauma Shock 2019; 12:232-242. [PMID: 31798235 PMCID: PMC6883496 DOI: 10.4103/jets.jets_102_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/28/2019] [Indexed: 11/04/2022] Open
Abstract
Almost every institution and academic medical center has its own simulation center today. It seems to have become a prerequisite and is incorporated into the guidelines of setting up new centers as well as in the upgrading and enhancement plans of existing institutions. In considering this, it is critical to consider the needs and demands of the healthcare population and staff the center will be serving. Setting up a simulation center is not an endeavor to be undertaken lightly. It entails a sustainable commitment in terms of political will, professional, educational and financial commitments. On the other hand, setting up a simulation center can be the most worthwhile and rewarding experience if the objectives and goals are met and effective learning occurs. The latter is an important element to be considered in the step toward nurturing an effective healthcare practitioner. In this paper, the principle author, who is the Director of the SingHealth Duke NUS Institute of Medical Simulation (SIMS) in Singapore, shares her views and experience of leading a world-class simulation facility. She has been involved in SIMS from its conception and is a strong advocate of medical education and lifelong learning. At the end of this paper, she shares a Checklist which puts together all the important considerations for anyone or any institution what is looking at setting up a simulation facility, a simulation-based training program, or even upgrading and upscaling their current simulation centre.
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Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Founder Member, World Academic Council of Emergency Medicine
| | - Shanqing Yin
- Division of Cell and Molecular Biology, KK Women's and Children's Hospital, Singapore
| | - Madhavi Suppiah
- SingHealth Duke-NUS Institute of Medical Simulation, Singapore
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Analysis of Psychophysiological Stress Response in Higher Education Students Undergoing Clinical Practice Evaluation. J Med Syst 2019; 43:68. [PMID: 30734084 DOI: 10.1007/s10916-019-1187-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
The aim of this study was to analyze the psychophysiological response of Physiotherapy degree students during a complete clinical practice as well as their psychological profile in relation to coping style in stressful situations, and its impact on academic performance. We analysed in 15 students heart rate variability (HRV) to analyse autonomic modulation in three moments during the entire clinical practices of 3 months (4 h per day, 3 days per week), first session, middle session and last session; perceived stress, personality, life engagement, cognitive flexibility before starting the clinical practice the academic performance after the clinical practice. Results based on HRV and related indexes parameters fail to indicate the expected autonomic adaptation during the practice. A complete clinical practice of Physiotherapy degree students did not produce an habituation process since a high sympathetic autonomic nervous system modulation was measured in the beginning, at the middle and at the final of the clinical practice. Below-average scores are presented in a personality factor associated with traditional and non-adaptive coping styles that could explain the non-habituation of the students. Finally, none of the analyzed indexes has been able to relate to academic performance.
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Scheunemann LP, Khalil R, Rajagopal PS, Arnold RM. Development and Pilot Testing of a Simulation to Study How Physicians Facilitate Surrogate Decision Making Based on Critically Ill Patients' Values and Preferences. J Pain Symptom Manage 2019; 57:216-223.e8. [PMID: 30408496 PMCID: PMC6348012 DOI: 10.1016/j.jpainsymman.2018.10.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT There are no evidence-based programs to train physicians to facilitate shared decision making based on incapacitated intensive care unit patients' values and preferences. OBJECTIVES The objective of this study was to develop a high-fidelity simulation to fill this gap. METHODS Case development involved six steps: 1) drafting a case about an elderly patient receiving prolonged mechanical ventilation; 2) engaging an expert advisory board to optimize case content; 3) revising the case based on advisory board input; 4) training actors to portray the case patient's daughter; 5) obtaining physician feedback on the simulation; and 6) revising the case based on their feedback. We conducted a cross-sectional pilot study with 50 physicians to assess feasibility and acceptability, defined a priori as an enrollment rate >40 physicians/year, study procedures <75 minutes/participant, >95% actor adherence to standardization rules, and high physician ratings of realism and acceptability. RESULTS Advisory panel feedback yielded two modifications: 1) refocusing the case on decision making about tracheostomy and percutaneous gastrostomy and 2) making the patient's values more authentic. Physician feedback yielded two additional modifications: 1) reducing how readily the actor divulged the patient's values and 2) making her more emotional. All 50 physicians enrolled in the pilot study over 11 months completed study procedures in <75 minutes. Actor adherence to standardization rules was 95.8%. Physicians' mean ratings of realism and acceptability were 8.4 and 9.1, respectively, on a 10-point scale. CONCLUSION Simulation is feasible, is acceptable, and can be adequately standardized to study physicians' skills for facilitating surrogate decision making based on an incapacitated intensive care unit patient's values and preferences.
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Affiliation(s)
- Leslie P Scheunemann
- Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Ramy Khalil
- St. Clair Hospital, Pittsburgh, Pennsylvania, USA
| | - Padma S Rajagopal
- Division of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative and Supportive Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Negri EC, Pereira Júnior GA, Cotta Filho CK, Franzon JC, Mazzo A. CONSTRUCTION AND VALIDATION OF SIMULATED SCENARIO FOR NURSING CARE TO COLOSTOMY PATIENTS. ACTA ACUST UNITED AC 2019. [DOI: 10.1590/1980-265x-tce-2018-0199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: to construct and validate a high fidelity clinical simulation scenario on nursing care to colostomy patients. Method: descriptive study of construction and validation of the appearance and content of a high fidelity clinical simulation scenario referring to nursing care for colostomy patients. To guide the elaboration of the scenario, a study was carried out in the literature on nursing care for the colostomy patient in the hospital environment. The scenario was constructed according to the items proposed by Fabri, based on the Bloom’s Taxonomy. For the selection of the nine experts, the criteria proposed by Fehring were used. The scenario, after being structured, was tested by a group of students from the 3rd and 4th years of graduation in nursing in a clinical simulation laboratory of a public university. It was considered 80% level of agreement. Results: in the validation of the scenario, all the experts agreed with the proposed items, suggesting the inclusion of some references, book chapters, skills training, preparation of reading material and checklist follow-up of participants. This scenario test allowed the identification of relevant contributions for adjustments of the simulated activity and allowed to test the debriefing with the support of the checklist. It was also evidenced the need to include information in the patient medical record and to increase the time of development of the scenario to solve the proposed objectives. Conclusion: the results show that for practical simulated well defined and successful are required to careful preparation, validation and prior testing of the planned activities.
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Lamé G, Simmons RK. From behavioural simulation to computer models: how simulation can be used to improve healthcare management and policy. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 6:95-102. [PMID: 35516085 PMCID: PMC8936879 DOI: 10.1136/bmjstel-2018-000377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/04/2022]
Abstract
Simulation is a technique that evokes or replicates substantial aspects of the real world, in order to experiment with a simplified imitation of an operations system, for the purpose of better understanding and/or improving that system. Simulation provides a safe environment for investigating individual and organisational behaviour and a risk-free testbed for new policies and procedures. Therefore, it can complement or replace direct field observations and trial-and-error approaches, which can be time consuming, costly and difficult to carry out. However, simulation has low adoption as a research and improvement tool in healthcare management and policy-making. The literature on simulation in these fields is dispersed across different disciplinary traditions and typically focuses on a single simulation method. In this article, we examine how simulation can be used to investigate, understand and improve management and policy-making in healthcare organisations. We develop the rationale for using simulation and provide an integrative overview of existing approaches, using examples of in vivo behavioural simulations involving live participants, pure in silico computer simulations and intermediate approaches (virtual simulation) where human participants interact with computer simulations of health organisations. We also discuss the combination of these approaches to organisational simulation and the evaluation of simulation-based interventions.
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Affiliation(s)
- Guillaume Lamé
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Rebecca K Simmons
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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18
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Abstract
PURPOSE/AIMS Many critically ill patients undergo a tracheostomy. Tracheostomy care is performed to maintain the airway and promote stoma skin integrity. Variation in practices may affect outcomes. The study purpose was to describe tracheostomy care practices of caregivers who perform tracheostomy care in critical care settings and compare practices with published recommendations. DESIGN This is a descriptive, exploratory study of tracheostomy care practices of nurses and respiratory therapists using a simulated setting. METHODS Staff working in critical care and step-down units were approached to participate in the study. Equipment used for tracheostomy care and the steps performed were observed and video recorded. Observations were compared with recommended practices. Data were analyzed with descriptive statistics. RESULTS Fifteen registered nurses (75%) and 5 respiratory therapists (25%) participated. Most participants (80%) were female and held a baccalaureate degree; median experience was 5 years. Equipment used and order of steps varied widely. Only 1 individual performed in the order recommended in a commonly used procedure manual. The most common sequence performed was hand hygiene, clean flange, clean stoma, change inner cannula, change ties, and apply dressing. CONCLUSION Wide variability in equipment and practices emphasizes the need for establishing an evidence-based approach for performing tracheostomy care to prevent complications.
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Beltrán-Velasco AI, Bellido-Esteban A, Ruisoto-Palomera P, Clemente-Suárez VJ. Use of Portable Digital Devices to Analyze Autonomic Stress Response in Psychology Objective Structured Clinical Examination. J Med Syst 2018; 42:35. [PMID: 29327087 DOI: 10.1007/s10916-018-0893-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/05/2018] [Indexed: 01/16/2023]
Abstract
The aim of the present study was to explore changes in the autonomic stress response of Psychology students in a Psychology Objective Structured Clinical Examination (OSCE) and their relationship with OSCE performance. Variables of autonomic modulation by the analysis of heart rate variability in temporal, frequency and non-linear domains, subjective perception of distress strait and academic performance were measured before and after the two different evaluations that composed the OSCE. A psychology objective structured clinical examination composed by two different evaluation scenarios produced a large anxiety anticipatory response, a habituation response in the first of the evaluation scenarios and a in the entire evaluation, and a no habituation response in the second evaluation scenario. Autonomic modulation parameters do not correlate with academic performance of students.
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Affiliation(s)
| | | | - Pablo Ruisoto-Palomera
- Department of Psychology, European University of Madrid, Madrid, Spain.,Department of Basic Psychology, Psychobiology and Methodology of Behavioural Sciences, University of Salamanca, Salamanca, Spain
| | - Vicente Javier Clemente-Suárez
- Applied Psychophysiological Research Group, European University of Madrid, Madrid, Spain. .,Center of Excellence in Sports and Life Sciences, European University of Madrid, Madrid, Spain. .,Facultad de Ciencias de la actividad física y el deporte, Universidad Europea, Calle Tajo s/n, Madrid, Spain.
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20
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Munroe B, Curtis K, Buckley T, Lewis M, Atkins L. Optimising implementation of a patient-assessment framework for emergency nurses: A mixed-method study. J Clin Nurs 2017; 27:e269-e286. [DOI: 10.1111/jocn.13932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Belinda Munroe
- Sydney Nursing School; University of Sydney; Camperdown NSW Australia
- Emergency Services; Illawarra Shoalhaven Local Health District; NSW Australia
| | - Kate Curtis
- Sydney Nursing School; University of Sydney; Camperdown NSW Australia
- Emergency Services; Illawarra Shoalhaven Local Health District; NSW Australia
| | - Thomas Buckley
- Sydney Nursing School; University of Sydney; Camperdown NSW Australia
| | - Melinda Lewis
- Educational Innovation; University of Sydney; Camperdown NSW Australia
| | - Lou Atkins
- Centre for Behaviour Change; University College London; London UK
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Munroe B, Curtis K, Murphy M, Strachan L, Considine J, Hardy J, Wilson M, Ruperto K, Fethney J, Buckley T. A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation. J Clin Nurs 2016; 25:2262-74. [PMID: 27135203 DOI: 10.1111/jocn.13284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. BACKGROUND Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. DESIGN A pre-post design was used. METHODS The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. RESULTS From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. CONCLUSION The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. RELEVANCE TO CLINICAL PRACTICE HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.
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Affiliation(s)
- Belinda Munroe
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, The Wollongong Hospital, Wollongong, NSW, Australia.,Trauma Service, St George Hospital, Sydney, NSW, Australia
| | - Margaret Murphy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia.,Emergency Department, Westmead Hospital, Westmead, NSW, Australia
| | - Luke Strachan
- Emergency Department, Blacktown Hospital, Blacktown, NSW, Australia
| | - Julie Considine
- School of Nursing and Midwifery/Eastern Health, Deakin University, Geelong, Vic., Australia
| | - Jennifer Hardy
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Mark Wilson
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Kate Ruperto
- Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Judith Fethney
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
| | - Thomas Buckley
- Sydney Nursing School, University of Sydney, Sydney, NSW, Australia
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