INACSL Standards of Best Practice: SimulationSM Simulation Design

Exploring dialogue in virtual simulation in nursing education - An observational study

Objectives

Simulation is an important learning activity in nursing education. There is little knowledge about dialogue and communication between students and facilitators in a virtual simulation setting. The current study, conducted in Norway, explores the dialogic teaching approaches applied by facilitators in a virtual classroom and adapt an analytic tool from a physical classroom in lower education to a virtual classroom in higher education.

Methods

Sixteen virtual simulation sessions of groups with nursing students were video-taped. The videos were coded with a coding scheme developed for physical classrooms and adapted to the virtual setting. The dialogic approaches from the facilitator were analysed using descriptive analysis.

Results

The most frequently used approaches from the facilitator were categorised as asking ("Big questions") and listening ("Wait time after a question"). The most frequent pattern seen in the use of dialogic approaches fall under the category listening.

Conclusions

The coding scheme is suitable to analyse facilitators' dialogic approaches in a virtual setting in nursing education. Further research should examine how the facilitator can strategically deploy dialogic approaches in other types of simulations with students.

Innovation

The coding scheme was developed from lower to higher education, and from a physical to a virtual setting.

Is elderspeak communication in simulated hospital dementia care congruent to communication in actual patient care? A mixed-methods pilot study

AIMS

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed-methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care.

DESIGN

A 3-part mixed-methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within- and across-case coding.

METHODS

Three simulations using different modalities (manikin, role-play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio-recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed-rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged.

RESULTS

The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient.

CONCLUSIONS

Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient.

IMPLICATIONS FOR PATIENT CARE

Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person-centred communication training in nursing staff.

IMPACT

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia. This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person-centred communication.

REPORTING METHODS

STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Crisis Response in Nursing Education: An Integrative Review of Nursing Program Adaptation to COVID-19

PURPOSE

This integrative review sought to systematically examine and synthesize published research on crisis response to identify ways in which undergraduate nursing education programs in various countries adapted to the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

A computerized search of CINAHL, Science Direct, and Web of Science databases was performed. The literature search, review, and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format of identification, screening, eligibility, and inclusion.

RESULTS

Digital learning technology platforms were used in undergraduate nursing education in various ways to adapt to the teaching and learning challenges of the COVID-19 pandemic.

CONCLUSION

Teaching and learning methodologies identified included online lectures and webinars; interactive virtual learning experiences, such as videos, presentations, quizzes, games, and other web-based interactive forms of multimedia files and textual content; and virtual simulations for nursing skills and tele-health experience. [J Nurs Educ. 2024;63(7):445-451.].

Exploring Undergraduate Nursing Students' Preferences in Psychiatric Nursing Simulation Modalities

BACKGROUND

The use of high-fidelity simulators (manikins) and standardized patients (SPs) in simulation has been incorporated into many nursing schools throughout the nation to augment the clinical rotation experience. There is little to no data available on comparing undergraduate students' preferences between SPs and manikins in psychiatric nursing.

METHODS

A quantitative descriptive exploratory design was used to evaluate pre-licensure nursing students' preferences in both traditional 4-year Bachelor of Science in Nursing (BSN) and accelerated BSN programs (ABSN).

RESULTS

Overall, students preferred having an SP over a manikin to learn how to properly perform a nursing assessment on a psychiatric patient.

CONCLUSIONS

Standardized patients offer a more realistic experience when assessing various domains of the mental status examination and when practicing therapeutic communication techniques in psychiatric nursing. The growth of SP training programs should be fostered. Well-trained SPs are an asset to simulation, especially in psychiatric nursing.

Usability of Standards for Scaffolding in a Health Sciences Programme: A feasibility Study

BACKGROUND

Standards contribute to comprehensive and programmatic implementation of educational strategies, such as scaffolding. Although the development of educational standards follows a rigorous consensus approach, they are socially constructed and could result in varied interpretations by users. Reports of varied implementation of standards in health professions education underscore the need to test the developed standards for scaffolding in health sciences programmes. Usability entails determining whether a product like standards works as intended under the expected conditions and contexts. This study aimed to describe the usability of standards for scaffolding in a health sciences programme through a pilot study.

METHODS

A multi-method design employing user and expert-based usability evaluation techniques sought to describe the usability of the standards for scaffolding in a three-year pre-registration nursing programme. The user sample of nurse educators drawn from the programme, conducted a self-assessment on scaffolding practices in the programme using a developed standards checklist. For the expert sample, three-panel members with an understanding of the discipline and programme context were purposively sampled. These panelists studied the users' self-assessment reports before completing an author-generated heuristics checklist to support or refute any of the standards. Descriptive statistics, comparative and content analysis were applied to analyse data from users' interviews and expert's completed heuristics checklist, determining the standards' usability, and identifying the usability flaws or strengths.

RESULTS

The users had three or more years of teaching experience in the competency-based curriculum for nursing. The experts shared an average of 16 years of experience in teaching in higher education, and seven years of experience in quality assurance and programme accreditation. The four standards had a usability score of above average (68%). Seven usability strengths and four usability flaws were identified. Usability flaws related to misinterpretation of some criteria statements and terminologies, multiple meanings, and users' challenges in generating evidence for some criteria.

CONCLUSIONS

The pilot study revealed the context-based 'truth' regarding the fidelity of a health sciences programme evaluation on scaffolding, as well as identifying the ideal contextual conditions in which the standards for scaffolding health sciences programmes would work best. The identified usability flaws highlighted the need for further revisions of the standards. Future research on the feasibility of the standards in other health sciences programmes and contexts is recommended.

Reducing (Behavioral) Restraint Use Through Simulation at the Bedside

Hospitals are experiencing an influx of patients in active behavioral crises, leading to restraints as a behavior management strategy. Over 100 staff participated in simulation training designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants managing escalating patient behavior. Results suggest simulation can be an effective strategy to train medical staff to manage challenging behavior and reduce restraint use.

Developing a pediatric nursing simulation scenario template in South Korea: applying real-time Delphi methods

PURPOSE

This study aimed to describe the process of developing a validated pediatric nursing simulation scenario template using the real-time Delphi method.

METHODS

A panel of 13 pediatric nursing experts participated in a real-time Delphi survey conducted over two rounds. Initially, 83 items were included in the questionnaire focusing on the structure and content of the simulation scenario template. Data analysis involved calculating the content validity ratio (CVR) and the coefficient of variation to assess item validity and stability.

RESULTS

Through iterative rounds of the Delphi survey, a consensus was reached among the experts, resulting in the development of a pediatric nursing simulation scenario template comprising 41 items across nine parts. The CVR values ranged from 0.85 to 1.0, indicating a high consensus among experts regarding the inclusion of all items in the template.

CONCLUSION

This study presents a novel approach for developing a pediatric nursing simulation scenario template using real-time Delphi methods. The real-time Delphi method facilitated the development of a comprehensive and scientifically grounded pediatric nursing simulation scenario template. Our template aligns with the International Nursing Association for Clinical Simulation and Learning standards, and provides valuable guidance for educators in designing effective simulation scenarios, contributing to enhanced learning outcomes and better preparation for pediatric clinical practice. However, consideration of cultural and contextual adaptations is necessary, and further research should explore alternative consensus criteria.

Teaming Up for Community Health Simulation Intervention: A Quasi-Experimental Study

AIM

The aim of this study was to examine whether participating in a team-based simulation intervention would improve nursing students' empathy and commitment to addressing social determinants of health (SDOH) and interprofessional teamwork attitudes, beliefs, and behaviors. Outcomes were compared for intraprofessional versus interprofessional team participation.

BACKGROUND

Nursing students must learn strategies to address SDOH, but this content is not well integrated in curricula. Teaming Up for Community Health was created to provide SDOH experiential team learning.

METHOD

Eighty-five nursing students participated in the intraprofessional comparison group or interprofessional intervention group. Surveys were completed before and after the intervention and two months later.

RESULTS

Participants had heightened empathy and commitment to addressing SDOH at baseline. Interprofessional teamwork beliefs and behaviors improved for both groups.

CONCLUSION

Experiential learning about SDOH should focus on improving students' self-confidence and performance. Based on the study results, experiential team learning should be threaded through curricula.

Virtual Reality Simulation in a Health Assessment Laboratory Course: A Mixed-methods Explanatory Study Examining Student Satisfaction and Self-confidence

BACKGROUND

The purpose of this mixed-methods study was to examine the relationship between virtual reality simulation (VRS) and student satisfaction and self-confidence in a health assessment laboratory course.

METHODS

Second-year students (n = 37) completed a postoperative respiratory distress scenario using Elsevier's Simulation Learning System with Virtual Reality. All participants completed the Satisfaction and Self-Confidence in Learning Scale; a subset participated in 1:1 semistructured interviews.

RESULTS

Satisfaction and self-confidence scores were strongly correlated. VRS experiences of fidelity, communication confidence and competence, learning with peers, integrated learning and critical thinking, and a safe space to learn were related to students' satisfaction and self-confidence.

CONCLUSIONS

VRS experiences are correlated with high student satisfaction and self-confidence.

Teaching Empathic Communication at the End of Life: A Virtual Simulation for Nursing Students

ABSTRACT

There is a gap in the literature regarding prelicensure nursing students' knowledge/communication regarding death and dying. A virtual telecommunication pilot simulation-based experience (SBE) was designed to address the gap in learner experiences communicating with the family of a dying loved one. Learners had to provide the family member, a role portrayed by a simulated patient, an update on the patient's rapidly declining condition. The course leaders noticed the value in learners having personalized conversations and empathetic emotion with family members. This virtual SBE will replace an older face-to-face end-of-life SBE going forward.

An Innovative Academic-Practice Partnership Using Simulation to Provide End-of-Life Education for Undergraduate Nursing Students in Rural Settings

ABSTRACT

Innovations that foster academic-practice partnerships can fill direct clinical care gaps and supplement faculty expertise, particularly in rural settings. An end-of-life simulation was cocreated by nursing faculty and regional certified hospice and palliative care nurses (CHPNs) as a course improvement project for traditional baccalaureate students who lacked direct care experience. Groups of students experienced skills-based pain management and end-of-life conversation-based scenarios using CHPNs as standardized patients. The simulation conformed to current standards in health care simulation, including prebriefing and debriefing components. Feedback from students and CHPNs supports the partnership as an effective teaching/learning strategy.

Effects of simulation-based education module on delirium care in undergraduate nursing students: A quasi-experimental study

AIM

To examine the effects of a delirium education module on undergraduate nursing students' knowledge of and perceived confidence and competence in delirium care.

BACKGROUND

Delirium is common in intensive care units (ICUs) and leads to poor clinical outcomes. The under recognition of delirium is a major problem in ICU medicine. Nurses, as first-line health care providers, can address this by recognizing patients who are experiencing delirium. Since undergraduate nursing students will be the future ICU nurses, it is important to deliver the knowledge regarding delirium care. However, education about assessing delirium in ICUs among undergraduate nursing students is lacking.

DESIGN

Quasi-experimental study.

METHODS

A total of 74 undergraduate students were divided into an intervention group (n=34) and a comparison group (n=40). A 2-hour simulation-based delirium education module integrated into a critical care curriculum was delivered to the intervention group only. The classroom-based intervention was administered at a medical university in northern Taiwan. Study outcomes were measured using a structured survey including (1) a 16-item delirium care knowledge quiz, (2) confidence in delirium care scale and (3) competence in delirium care scale. The survey was distributed to students before and after the module in December 2020. The Mann-Whitney U test, chi-square test and Fisher's exact test were adopted to test the differences of all variables between groups. A generalized estimating equation model was used to investigate the adjusted treatment effects.

RESULTS

The participants had a median age of 22 years and 81% were female. The delirium education module yielded greater knowledge (B = 3.04, 95% confidence interval = 2.20-3.88), confidence (B = 4.20, 95% confidence interval = 2.67-5.73) and competence (B = 4.82, 95% confidence interval = 3.33-6.30) in delirium care when the treatment and control groups were compared.

CONCLUSIONS

For undergraduate nursing students, simulation-based education module is effective in improving the knowledge of and confidence and competence in delirium care. It is recommended that this be included in critical care nursing curricula.

Development and evaluation of a sepsis simulation with undergraduate nursing students

BACKGROUND

In 2016, the Centers for Disease Control found that more than 1.5 million people develop sepsis each year and about 250,000 Americans die from it. Early identification and treatment of sepsis can decrease mortality and morbidity, yet studies have shown student nurses are not prepared to rescue deteriorating patients.

METHOD

The purpose of this pilot study was to create and test a response to rescue simulation for use with undergraduate nursing students. The simulation depicted a patient deteriorating from sepsis. The Martinez Sepsis Competency Evaluation Tool (MSCET) developed to rate student behaviors during the simulation. Promoting Excellence and Reflective Learning in Simulation (PEARLS) debriefing model was used post simulation.

RESULTS

The overall content validity of the MSCET was 0.88. Each item that scored a I-CVI of 0.78 or less were revised. The total percentage of behaviors met was 68 %. The inter-rater reliability of the MSCET conciseness was 0.47 (X = 67.508, df = 48, p ≤ .05).

CONCLUSION

The results indicate the simulation based experience was effective in preparing students to care for patients with early signs of sepsis. Students were complimentary about the experience, and preliminary data on the MSCET psychometrics were positive. Limitations of the study and recommendations for further revision of the simulation were made.

Exploring facilitation in virtual simulation in nursing education: A scoping review

Objective

To systematically map existing research regarding the reflective feedback in virtual simulation in undergraduate nursing education.

Methods

A scoping review was conducted based on the Arksey and O'Malley framework and the PRISMA-ScR.

Results

We included 41 studies from 15 different countries. The simulation interventions allowed for interaction between the student and the virtual patient, the software, faculty, peers, or a combination of two or more of these. Students valued reflective feedback during and after the simulation.

Conclusions

Our review emphasizes the importance of a human in the loop. Feedback before, during, and after the simulation is possible in virtual simulation where the facilitator can pause the virtual scenario and stimulate reflections during the simulation to obtain deep learning. Virtual simulation provides opportunities to give feedback from the software, such as cues or direct feedback.

Innovation

There is a lack of focus on the feedback process and there is a need to revitalize the role of facilitators in a virtual simulation to determine their relative contribution in this process. Several studies reported the usefulness or the effect of virtual simulation on learning processes, but most lacked emphasis on investigating the significance of including a human in the loop.

Simulation-based training in Leprosy: development and validation of a scenario for community health workers

OBJECTIVES

To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection.

METHODS

Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed.

RESULTS

A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components.

CONCLUSIONS

The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

Breaking the Stigma in Mental Health Nursing through High-Fidelity Simulation Training

The social stigma toward individuals with mental health problems is habitual among nursing students, which can lead to poor quality of health care services for patients with mental illnesses. The purpose of the present study was to learn about nursing students' perceptions of providing care to patients with severe mental disorders before and after participating in a simulated student clinical case. A descriptive qualitative study was conducted through 39 interviews. The difficulties expected by the students and their perceptions about patients were explored before the simulation training. Their perceptions about the use of clinical simulation for learning about the adequate management of these patients were analyzed afterwards. Results: Before the simulation training, the students assessed the case as being complicated, expressed their lack of specific training, and felt fear and insecurity, thus reproducing the stigma towards mental health patients. After this training, they positively valued the usefulness of the clinical simulation for gaining confidence and overcoming the stigma. Discussion: The use of high-fidelity simulation offers nursing students the opportunity to approach patients with mental health conditions, overcoming their fears and normalizing mental disorders. Simulation training allows nursing students to analyze the reasoning of clinical judgment and to detect the influence of previous prejudices about mental illness in their clinical decision. This study was not registered.

Faculty development for translational simulation: a qualitative study of current practice

BACKGROUND

Translational simulation is focused directly on healthcare quality, safety, and systems. Effective translational simulation design and delivery may require knowledge and skills in areas like quality improvement and safety science. How translational simulation programs support their faculty to learn these skills is unknown. We aimed to explore current faculty development practices within translational simulation programs, and the rationale for the approaches taken.

METHODS

We used a qualitative approach to explore faculty development in translational simulation programs. We conducted semi-structured interviews with representatives who have leadership and/or faculty development responsibilities in these programs and performed a thematic analysis of the data.

RESULTS

Sixteen interviews were conducted with translational simulation program leaders from nine countries. We identified three themes in our exploration of translational simulation faculty development practices: (1) diverse content, (2) 'home-grown', informal processes, and (3) the influence of organisational context. Collaboration beyond the historical boundaries of the healthcare simulation community was an enabler across themes.

CONCLUSION

Leaders in translational simulation programs suggest a diverse array of knowledge and skills are important for translational simulation faculty and report a range of informal and formal approaches to the development of these skills. Many programs are early in the development of their approach to faculty development, and all are powerfully influenced by their context; the program aims, structure, and strategy.

Patient safety interprofessional education program using medical error scenarios for undergraduate nursing and medical students in Korea

Interprofessional education (IPE) for patient safety is becoming increasingly important worldwide. However, Korea lacks a systematic approach toward patient safety, despite the high demand for teamwork and patient communication education. This study aims to determine the effectiveness of a patient safety IPE program using medical error scenarios. The program was developed to enhance patient safety motivation and interprofessional learning attitudes among medical and nursing students, and evaluate the design of the program and students' satisfaction levels. The program comprises two modules, each consisting of lectures, team-based case analysis, role-play, and high-fidelity simulation activities. This study followed a quasi-experimental pre-post test design to determine program outcomes. An online survey for the Readiness for Interprofessional Learning Scale (RIPLS), patient safety motivation, program design evaluation, and program satisfaction was conducted before and after the program. Data were analyzed using descriptive statistics, paired sample t-tests, and Pearson's correlation. The pre-post RIPLS and patient safety results were significant (t = -5.21, p < .001;t = -3.20, p = .002). The results of the medical scenario examination of the patient safety IPE program showed improved motivation for patient safety among students, and contributed to the improvement of IPE learning attitudes by improving team work and collaboration.

Effectiveness of Virtual Reality Simulation Among BSN Students: A Meta-analysis of Randomized Controlled Trials

This study aimed to evaluate the effect of virtual reality simulation in nursing education in five domains: knowledge, skill performance, self-confidence, self-efficacy, and satisfaction. Randomized controlled trials were obtained from the databases SCOPUS, Web of Science, PubMed, and EBSCO from inception until September 2021. The standardized mean differences with 95% confidence intervals were determined for the main variables, and heterogeneity was analyzed using the I2 test. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used. Meta-analysis was performed using the Stata 15.0 software. Among the 2074 records identified, 18 trials were included. The meta-analysis of these trials indicated that virtual reality simulation caused a significant improvement in knowledge with a moderate effect, skill performance with a moderate effect, and satisfaction with a moderate effect compared with the control group. However, virtual reality simulation did not significantly influence self-confidence and self-efficiency. The findings of this study suggested that virtual reality simulation might significantly benefit knowledge, skill performance, and satisfaction but not self-confidence and self-efficiency. Further well-designed randomized controlled trials with a larger sample size are recommended to confirm these findings.

Association of external interruptions with increased medication administration duration and self-interruptions: A direct observational study: Empirical research quantitative

AIMS

To examine task duration and frequency of self-interruptions among study participants during externally interrupted compared with externally uninterrupted simulated medication administration.

BACKGROUND

Interruptions are prevalent during nursing medication administration and can lead to inefficient, delayed, omitted and unsafe patient care. Interrupted nursing tasks are shown to take longer to complete compared to uninterrupted tasks; however, studies seldom indicate if the time spent in the interruption was included or excluded in the reported task duration. It is unknown if the time spent in the interruption leads to longer task completion times or if other factors, such as the time needed to re-engage in the primary task and/or self-interruptions, are involved. Little is known about associations between external interruptions and self-interruptions during nursing tasks. Self-interruptions are caused by an individual's own decision to stop an activity to attend to something else.

DESIGN

Cross-sectional within-subjects design.

METHODS

This two-site study investigated task duration and frequencies of self-interruptions during externally interrupted and externally uninterrupted simulated medication administration. Data on medication administration duration, external interruption duration and self-interruptions were collected via direct observation from November 2019-February 2020. The time spent in the external interruption was deducted from the medication administration duration.

RESULTS

Thirty-five participants were included in the study. The externally interrupted task had a significantly longer duration and significantly more frequent self-interruptions within-subjects compared to the externally uninterrupted task. Self-interruptions were most often due to forgotten supplies.

CONCLUSIONS

The findings suggest that the time needed to re-engage with an externally interrupted task and/or self-interruptions may lead to longer task completion times.

IMPACT

Researchers are encouraged to investigate mediators of interruptions that lead to longer task completion times and errors. Findings can be used to develop and implement interruption management strategies that aim to improve the safety and quality of patient care.

REPORTING METHOD

Equator guidelines were followed using the STROBE reporting method.

PATIENT/PUBLIC CONTRIBUTION

No patient or public involvement in this study.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Educators and researchers can use the study findings to guide teaching methods and direct future studies. By gaining a better understanding of the mediators of interruptions that create longer task completion times and increase the risk for errors, tailored interruption management strategies that aim to improve the safety and quality of healthcare can be developed and implemented.

Pilot Testing of Evidence-Based Symptom Management Telehealth Simulation-Based Experiences in an Oncology Nursing Seminar

ABSTRACT

Telehealth simulation-based experiences (T-SBEs) offer one approach to prepare nursing students with the requisite skills to deliver oncology evidence-based symptom management (EBSM) using telecommunication technology. Fourteen baccalaureate nursing students participated in this one-group, pretest/posttest, convergent mixed-methods pilot study with questionnaire variant. Data were collected before and/or after two oncology EBSM T-SBEs using standardized participants. The T-SBEs resulted in significant increases in self-perceived competence, confidence, and self-confidence in clinical decision-making related to oncology EBSM. Qualitative themes included value, application, and preference for in-person SBEs. Future research is warranted to definitively determine the effect of oncology EBSM T-SBEs on student learning.

Enhancing Geriatric Competencies: Integrating the 4Ms Framework in a Baccalaureate Nursing Program

BACKGROUND

Today's nursing students will care for tomorrow's older adult population. Integrating the Institute for Healthcare Improvement's Age-Friendly Health Systems (AFHS) 4Ms framework can improve students' knowledge and ability to care for older adults.

METHODS

The 4Ms framework was pilot tested in a first-semester prelicensure course. Students were evaluated on knowledge and application of the framework through didactic, simulation, and clinical learning experiences; qualitative and quantitative data were obtained.

RESULTS

Students' average score on three knowledge checks was 77.2% (range, 73.4% to 81%). Students were assessed for application of the 4Ms during clinical experiences in the Fall (76%) and Spring (92%) semesters. Qualitative data demonstrated that students' ability to apply the 4Ms in patient care increased.

CONCLUSION

Integrating the 4Ms framework in the curriculum fostered nursing students' awareness of the essential components of AFHS. Learning experiences provided students the opportunity to care for older adults and gain competence in age-friendly care. [J Nurs Educ. 2023;62(10):589-592.].

The Development and Feasibility of an Empathy Virtual Reality Scenario in Healthcare Education

Technology-enhanced simulations such as virtual reality and computer-based experiences allow students to improve their understanding of patient perspectives and increase empathy for patients. These technologies can be daunting to nursing faculty without robust technology and video development resources. The purpose of this project was to share a guide for creating and implementing a patient-centered immersive virtual reality scenario within a nursing program. The research team developed, filmed, and produced a cost-effective virtual reality simulation scenario for use with smartphones and inexpensive virtual reality headsets, which could be widely disseminated for students to watch in class or online. The virtual reality simulation allowed an immersive first-person view and was well received by both faculty and students. The virtual reality scenario was implemented with ease in classroom, virtual, and laboratory settings. These virtual reality simulations work in the live setting or remotely, and synchronously or asynchronously with minimal equipment, which reduces barriers to access.

Web-based standardized patient simulation for taking anamnesis: an approach in nursing education during the pandemic

BACKGROUND

To address the challenges in nursing education brought about by the pandemic, this study aimed to evaluate the use of a web-based standardized patient practice in the development of nursing students' anamnesis taking skills and their views about its application.

METHOD

We conducted a descriptive intervention study with 39 s-year nursing students. The students completed anamnesis using the standardized patient practice in line with a scenario with real standardized patients in a web-based environment with audio and video.

RESULTS

The total scores of students' anamnesis skills were low. The agreement between the total scores, scores obtained from the health patterns, and each item in the control list was statistically significant (p < 0.05).

CONCLUSION

Web-based standardized patient practice is an alternative for clinical practice facilitating the gaining of competencies in making holistic nursing diagnoses under conditions that limit face-to-face interactions, such as pandemics.

A survey of knowledge and practice of simulation among health tutors in selected health training institutions

AIM

The aim of the study was to describe the knowledge and practice of simulation among health tutors with a view to promoting the use of simulation in health training institutions in the Northern and Upper East Regions of Ghana.

DESIGN

The study was quantitative research that utilized a descriptive cross-sectional survey to describe the knowledge and practice of simulation in teaching.

METHODS

A structured questionnaire was used to collect data from 138 health tutors who were enumerated through the census for the study. The return rate was 87%, representing 120 health tutors who finally completed the study. The data were presented by means of descriptive statistics.

RESULTS

The findings of the study revealed that few participants had adequate knowledge of simulation. The study also found that a slight majority of the participants practiced simulation in teaching. The study further found that there was a positive correlation between health tutors' knowledge and the practice of simulation. Indicating that an increase in the health tutors' knowledge of simulation is associated with an increase in their practice of simulation.

Effect of Simulation-Based Training on the Self-Confidence of New Nurses in the Care of Patients With Acute Deterioration and Activation of the Rapid Response Team

BACKGROUND

New nurses report feeling unprepared and having low levels of self-confidence. High-fidelity simulation (HFS) is frequently used to increase confidence and improve patient safety. This study assessed whether HFS training increased new nurses' self-confidence and activation of the rapid response team (RRT) when caring for patients with clinical deterioration.

METHOD

A quality improvement design was used. New nurses on two units at a Level I trauma center completed a 70-minute HFS. The change in self-confidence was measured by Grundy's C-Scale, and the change in percentage of staff-initiated RRT calls versus auto-triggered calls was calculated 3 months after HFS.

RESULTS

All 12 nurses who participated in the HFS showed improved self-confidence immediately after simulation. A Wilcox-on signed-rank paired data test showed statistically significantly improved confidence scores for all five items of the C-Scale from preintervention to immediately postintervention as well as 5 months later. One unit showed an increase in percentage of staff-initiated RRT calls 3 months postsimulation, and the other unit showed a decline in staff-initiated versus auto-triggered RRT calls.

DISCUSSION

The HFS increased self-confidence scores from preintervention to immediately postintervention, with the increase sustained 5 months later. However, how this increase translated into practice when activating RRT calls cannot be determined because many factors can influence RRT call patterns.

CONCLUSION

The literature review and study results suggest that HFS training embedded into an existing nurse residency program can build self-confidence in caring for patients with clinical deterioration. [J Contin Educ Nurs. 2023;54(8):367-376.].

Effectiveness of a virtual program for OSCE preparation during COVID-19: a descriptive and repeated cross-sectional study among nursing students

BACKGROUND

Despite the prevalence of distance learning during COVID-19, conducting clinical training for nursing students remains challenging. In compliance with social-distancing restrictions, a Zoom-based virtual OSCE preparation program for nursing students was designed, and it included clinical skills. The aims of this study were to assess nursing students' satisfaction with a virtual program for Objective Structured Clinical Examination (OSCE) preparation, and to evaluate its learning outcomes measured by OSCE scores as compared to those of in-person preparation programs.

METHODS

A descriptive and repeated cross-sectional study was designed. Students' satisfaction with the virtual program was based on a post-course survey and personal reflections. OSCE scores of graduates of the virtual program (n = 82) tested in 2021 were compared to those of 337 graduates of in-person programs tested in 2017-2020.

RESULTS

A post-program survey revealed that 88% of the students in 2021 were satisfied with the virtual program and felt it prepared them properly for the OSCE (26% agree and 62% strongly agree). No significant differences were found between OSCE scores following the virtual program conducted in 2021 and scores following in-person programs conducted in 2017-2020.

CONCLUSIONS

This study suggests that nursing education can benefit from integrating virtual programs which incorporate clinical practices into the curricula, without harming student competency. The study results may address the problem of maintaining clinical practices in a time of limited accessibility, and in settings of low resources. It is important to expand the investigation to long-term impact of virtual training programs on nursing students' competencies.

Can Simulation Scenarios Be Designed to Assess Ongoing Nursing Competence?

Learner-centered verification methods are at the core of Donna Wright's model for competency assessment. Using Wright's framework, an academic medical center studied the use of simulation as a verification method for their annual ongoing nursing competency assessment. Of the 10 pilot participants, 60% used simulation as a verification method to successfully show competence. Assuming adequate professional development practitioner and facility resources, simulation can be used as an option for ongoing competency assessment.

Nursing Students' Medication Administration: A Focus on Hand Hygiene and Patient Identification

BACKGROUND

Procedural failures during medication administration include a lack of appropriate hand hygiene and failure to verify patient identification prior to administration of medication. Procedural failures are common among nurses and nursing students and can lead to serious patient harm.

METHOD

A descriptive cross-sectional research design was used to collect observational data from a simulation-based experience of a medication administration scenario.

RESULTS

Thirty-five senior baccalaureate nursing students from two geographically distant universities in the United States participated in the study. All of the participants made at least one procedural failure during the simulated experience. Hand hygiene compliance was 40.3%, and patient identification compliance was 43.8%.

CONCLUSION

Students often failed to comply with medication administration safety guidelines. Nursing programs must make changes to the methods used to teach safe medication administration to prepare students for this critical skill. [J Nurs Educ. 2023;62(7):403-407.].

Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss

INTRODUCTION

Caring for families experiencing perinatal loss is a fundamental component of midwifery practice, but little attention is paid to perinatal palliative care in midwifery curricula. Lack of educational preparation and self-care resources negatively impacts midwifery students and health care teams caring for families experiencing stillbirth.

PROCESS

A private, urban university conducted a curricular quality improvement project to integrate perinatal palliative care into the midwifery curriculum using a high-fidelity, branching simulation pedagogy. Simulation objectives were developed from curricular gap analyses and the Core Competencies for Basic Midwifery Practice. Development of the Unexpected Perinatal Loss Simulation was guided by the International Nursing Association for Clinical Simulation and Learning Outcomes and Objectives and Design Standards. The Unexpected Perinatal Loss Simulation was revised based on qualitative data from student focus groups and expert content validation.

OUTCOMES

Qualitative data yielded 4 key domains: presimulation, simulation skills, prior experience/personal reflections, and recommendations. Simulation procedures and scenario content were revised, after which 8 expert clinicians in the fields of midwifery, palliative care, and psychiatry validated the scenario content using the Lynn method. Two items did not meet the content validity index (CVI) threshold of 0.78, necessitating review by stakeholders; however, the overall scenario CVI threshold was met (0.82).

DISCUSSION

Through this project, faculty integrated perinatal palliative care into the midwifery program using a novel approach of high-fidelity, branching simulation, structured debriefing, and an introductory self-care skills workshop. Potential clinical impact includes skillful perinatal palliative care with effective communication skills to mitigate how families experience and remember a traumatic loss and facilitate the grieving process. Students voiced insights into how they would process loss and seek support to mitigate their own grief as future midwives.

My hands are running away - learning a complex nursing skill via virtual reality simulation: a randomised mixed methods study

BACKGROUND

Clinical skills training is an essential component of nursing education. However, sometimes education does not sufficiently prepare nurses for the real world. Virtual reality (VR) is an innovative method to complement existing learning strategies, yet few studies investigate its effectiveness. This study compared educational outcomes achieved by three groups learning with either of two different VR simulation variants, with varying technological features, or a video training on the endotracheal suctioning skill.

METHODS

The investigated outcomes were knowledge and skill acquisition, learner satisfaction, and technology acceptance. 131 undergraduate nursing students were randomised into three groups, based on the interventions they received. Knowledge was assessed through a pre-post-test design, skill through a post-intervention objective structured clinical examination on a manikin, learning satisfaction and technology acceptance through standardised questionnaires, and qualitative feedback through focus groups.

RESULTS

All interventions led to a significant knowledge acquisition, with no significant difference between the groups. The video intervention group performed significantly better than the VR groups in skill demonstration. One of the two VR intervention groups had a significantly higher learner satisfaction than the video group. Technology acceptance was high for both VR groups, with the simpler VR simulation resulting in higher technology acceptance than the one with more experimental features. Students described the VR experience as realistic, interactive, and immersive, and saw the opportunity to practise skills in a safe environment, learn from mistakes, and increase knowledge and confidence.

CONCLUSIONS

For the development of VR trainings, we recommend keeping them simple and targeting a specific educational outcome since trying to optimise for multiple outcomes is resource intensive and hard to achieve. Psychomotor skills were easier for participants to learn by watching a video on the procedure rather than practically learning it with the VR hardware, which is a more abstract representation of reality. We therefore recommend using VR as a complementing resource to skills labs, rather than replacing existing learning strategies. Perhaps VR is not ideal for practising practical psychomotor skills at the moment, but it can increase knowledge, satisfaction, motivation, confidence and prepare for further practical training.

TRIAL REGISTRATION

Not applicable.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

The impact of an educational program based on the reproductive health of LGBT individuals developed for nursing students to improve the knowledge, skills and attitudes of students: A quasi-experimental study

AIM

This study aimed to investigate the impact of an educational program developed for nursing students to evaluate their knowledge of the lesbian, gay, bisexual and transgender (LGBT) community, their reproductive health and recording their reproductive history. The program aimed to assess the effective communication skills and attitudes of nursing students toward LGBT individuals after completion of the program.

BACKGROUND

Issues related to the reproductive health of LGBT individuals are not adequately addressed in the nursing curriculum. Innovative approaches using active learning methods will increase the knowledge and skills of the students regarding LGBT reproductive health and help them gain positive attitudes toward LGBT individuals.

DESIGN

A quasi-experimental (single group pretest-posttest) design.

METHODS

This study was conducted with 48 students in the 4th year in the Spring semester of the Academic year 2020-2021 at the Faculty of Nursing in a university. The eight-week education program included a discussion of modules developed for the reproductive health of LGBT individuals, film display and analysis, sample video display and analysis, role-play activities and standardized patient interviews. The research data were collected using a semi-structured questionnaire, Information Evaluation Test for LGBT Individuals, Attitude Scale Toward LGBTI Individuals, Reproductive Health History Taking Skills Checklist, Effective Communication Skills Evaluation Form and Student Satisfaction Evaluation Form. The data were analyzed using the mean, standard deviation, frequency, percentage distributions and Wilcoxon signed-rank test.

RESULTS

The study identified a significant increase in the median students' knowledge about LGBT individuals (p < 0.001), a substantial positive development in their attitudes toward LGBT individuals (p < 0.001) and a significant increase in the median scores of effective communication with LGBT individuals and recording the reproductive health history (p < 0.001) at the end of the education program.

CONCLUSION

The education program resulted in positive knowledge, attitude and skill changes in the nursing students supporting the reproductive health of LGBT individuals. Education programs based on LGBT reproductive health using active learning methods should be integrated into undergraduate nursing curricula to combat disparities toward LGBT individuals.

Effects of a virtual simulation-based interprofessional education activity for rehabilitation nursing using shared resources: A quasi-experimental study

BACKGROUND

Interprofessional education (IPE) is crucial for effective clinical practice but remains challenging to be implemented. The IPE activity using virtual simulation (VS) may potentially solve the time and space challenges of in-person interprofessional simulations. Using shared VS resources may increase the popularity of virtual teaching in conditions of limited resources.

OBJECTIVES

Using shared resources, this study aimed to design and implement a VS-based IPE activity for undergraduate healthcare students, exploring the effects.

DESIGN

A quasi-experimental design was used, with assessments conducted before and after the activity.

SETTINGS

One university and its affiliated hospitals in south China.

PARTICIPANTS

Forty-two undergraduate students majoring in nursing, clinical medicine, and rehabilitation therapy participated in this study.

METHODS

A test composed of ten questions was used to evaluate knowledge of rehabilitation. The Chinese version of Critical Thinking Disposition Inventory (CTDI-CV) and the Chinese version of Assessment of Interprofessional Team Collaboration in Student Learning Scale (AITCS-II (Student)-CV) were used to evaluate critical thinking and interprofessional collaboration. Participants' opinions about the activity were assessed, considering satisfaction, perceived effectiveness, the ease of shared VS platform use, and suggestions about the activity.

RESULTS

Significant improvements were shown in pre- and post-test total scores on knowledge of rehabilitation, mean scores for overall critical thinking disposition, and mean item scores on overall interprofessional team collaboration.

CONCLUSIONS

The study provides a reference for designing and implementing VS-based IPE but the effects of this innovative pedagogy on students' rehabilitation knowledge, critical thinking, and interprofessional collaboration ability still need to be further confirmed. Most of the students gave positive feedback on the activity. Technical issues should be addressed to decrease their impacts on the VS practice experience.

Experiences of Advanced Health Assessment Simulation Based on the Education Needs of Gerontological Nurse Practitioner Students

There is an insufficient exploration of how simulation educational approaches improve the job performance of students in gerontological nurse practitioner (GNP) courses. To increase the effectiveness of simulation education in GNP courses, it is necessary to explore the advanced health assessment simulation curriculum. This study aimed to investigate GNP students' educational experiences with the advanced health assessment simulation program by reflecting the needs of GNPs. A qualitative study design was employed for this study; focus group interviews were conducted among eight GNP students who participated in this simulation program. The focus group interview identified three theme clusters: 'a high-fidelity simulator that reproduces a real-life setting', 'experience with standardized patients as a reference for normal older people', and 'application in the clinical field'. Through simulation education, GNP students were able to safely demonstrate knowledge and use what they learned for clinical practice. The development and utilization of simulation education for the GNP program would help to enhance the clinical competency of students.

The effect of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy: A randomised controlled trial

BACKGROUND

Although improvements in burn care have increased the probability of survival in recent years, major complications are still common in burn patients. Nursing students should be competent to evaluate and intervene in the burn.

OBJECTIVE

To examine the effects of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy.

DESIGN

In this study, a randomised experimental design was used.

PARTICIPANTS

This study was conducted on third-year undergraduate nursing students.

METHODS

Students in this study were randomly assigned to one of two groups: the Hybrid Simulated Group (N = 26) and the Control Group (N = 30). Standard Education training was completed by all participants. Only the hybrid simulation group students received training on the standardised patient with wearable burn plasters. Students' knowledge of burn care was assessed using an information questionnaire immediately following the theoretical training and after training for three weeks. An Objective Structured Clinical Exam was used to assess students' abilities. The Objective Structured Clinical Exam was convened three weeks after the theoretical training. The Multidimensional Emotional Empathy Scale was used to assess the students' empathy ability level immediately following the theoretical training and three weeks later.

RESULTS

After the intervention, nursing students in the Hybrid Simulated group had improved empathy, knowledge, skills of physical assessment, and implementation of interventions and referral criteria on burn care (p < 0.05).

CONCLUSION

Simulated burn training could be utilised to improve nursing students' empathy, knowledge, and skills of physical assessment evaluation of interventions and referral criteria on burn care.

Low Volume, High Risk: Increasing Staff Knowledge and Teamwork During Safe Haven Events

BACKGROUND

Neonaticide is the leading cause of death for infants younger than 24 hours. Since Safe Haven laws have been in place, a large reduction in infant deaths has occurred. A literature review concluded that many healthcare staff members are unknowledgeable regarding Safe Haven infants, laws, and surrendering events. This lack of knowledge could lead to delayed care and poor patient outcomes.

METHODS

The researcher used Lewin's change theory to conduct a quasi-experimental study using a pre/posttest design.

RESULTS

Data revealed a statistically significant increase in staff knowledge of Safe Haven events, roles and teamwork after a new policy, an educational intervention, and a simulation intervention occurred.

CONCLUSION

Safe Haven laws have assisted in saving thousands of infants' lives since 1999 by allowing mothers to legally surrender their infant to any place deemed safe by the state's law. Because of this, healthcare staff should be knowledgeable of their roles and responsibilities during a relinquishment. Safe Haven policies, annual education, and annual simulations can assist healthcare staff in their preparedness and confidence of such events and increase patient outcomes.

Barriers and Facilitators to Implementing Simulation-Based Translational Research: A Qualitative Study

INTRODUCTION

Translational research has been identified as a research priority for the National Institutes of Health (NIH) and the Society for Simulation in Healthcare (SSH). Despite a larger focus on translational research in recent years, the overall amount of simulation-based translational research remains low. Greater understanding of how to approach translational simulation is required to inform novice simulation and translational researchers. This study sought to answer the following research questions: How do simulation experts describe the barriers and facilitators to implementing translational simulation programs? How do simulation experts describe their various approaches to implementing translational simulation programs? What recommendations do simulation experts describe for overcoming barriers to implementing translational simulation programs?

METHODS

A qualitative instrumental case study was used to elicit multiple instances of translational simulation research to gather an in-depth description from study participants. Three data sources were used: documents, semistructured interviews, and a focus group.

RESULTS

Data analyses revealed 5 major themes: clarifying goals and definitions, special considerations, social networking, research, and factors external to the simulation program.

CONCLUSIONS

Key findings include a lack of a standardized definitions for translational simulation and simulation-based translational research, the challenge of demonstrating the value of translational simulation, and the need for translational simulation programs to be integrated into departmental quality, patient safety, and risk management work. The findings and advice from the experts in this research can assist new researchers or those encountering challenges in implementing translational simulations.

The influence of the simulation environment on teamwork and cognitive load in novice trauma professionals at the emergency department: Piloting a randomized controlled trial

INTRODUCTION

This pilot study aimed to test the feasibility of conducting a randomized controlled trial to examine how simulation environments (in situ versus laboratory) influence teamwork skills development and cognitive load among novice healthcare trauma professionals in the emergency department.

METHOD

Twenty-four novice trauma professionals (nurses, medical residents, respiratory therapists) were assigned to in situ or laboratory simulations. They participated in two 15-minute simulations separated by a 45-minute debriefing on teamwork. After each simulation, they completed validated teamwork and cognitive load questionnaires. All simulations were video recorded to assess teamwork performance by trained external observers. Feasibility measures (e.g., recruitment rate, randomization procedure and intervention implementation) were recorded. Mixed ANOVAs were used to calculate effect sizes.

RESULTS

Regarding feasibility, several difficulties were encountered, such as a low recruitment rate and the inability to perform randomization. Outcome results suggest that the simulation environment does not affect novice trauma professionals' teamwork performance and cognitive load (small effect sizes), but a large effect size was observed for perceived learning.

CONCLUSION

This study highlights several barriers to conducting a randomized study in the context of interprofessional simulation-based education in the emergency department. Suggestions are made to guide future research in the field.

Exploring Health Care Disparities in Maternal-Child Simulation-Based Education

AIM

The purpose of this study was to explore student experiences within a health care disparity simulation, embedded in maternal-child content.

BACKGROUND

Health care disparities related to race and ethnicity in the maternal-child population are daunting among African American and Hispanic women.

METHOD

Participants completed the Simulation Effectiveness Tool-Modified, a rapid-fire huddle questionnaire, and a demographic instrument. All students participated in structured debriefing.

RESULTS

Student responses ( n = 69) demonstrated effectiveness in learning via this scenario.

CONCLUSION

The rapid-fire huddle and debriefing are important elements when health care disparities are introduced into nursing curricula.

The value of simulation-based education in developing preparedness for acute care situations: An interview study of new graduate nurses' perspectives

AIM

This study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion.

BACKGROUND

Simulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses' ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice.

DESIGN/METHOD

During the winter of 2021-2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis.

RESULTS

The results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding.

CONCLUSION

Simulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.

Evaluating an intervention of telehealth education and simulation for advanced practice registered nurse students: A single group comparison study

As healthcare delivery continues to evolve and expand, nurse educators must prepare advanced practice registered nursing (APRN) students to use telehealth technology safely, effectively, and confidently. The aims of this study were to describe APRN students' beliefs and confidence regarding the delivery of care via telehealth in their future practice. To evaluate these aims, a single group comparison study was conducted. APRN students received an intervention comprised of multimodal telehealth instruction, which involved the simulated application of telehealth with standardized patients. Students' beliefs regarding telehealth did not significantly change between the pre- and post-intervention, in which all areas were rated high pre-intervention. Students reported an increase in their perception and confidence post-intervention. Integration of telehealth into the APRN curriculum is essential to instil knowledge and confidence as healthcare technology advances.

In Situ Simulation: A Strategy to Restore Patient Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review

BACKGROUND

Patient safety is a public health problem worldwide. In situ simulation (ISS) arises as a learning strategy that allows health professionals to immerse themselves in a real environment without endangering the patients until they have learned the skills needed, thus increasing the quality of care. This systematic review aimed to verify the efficacy of the use of "in situ simulation" as a method that will allow health professionals to increase patient safety in Intensive Care Units after the situation experienced during the pandemic caused by the COVID-19 virus.

METHODS

Seven studies were reviewed using the PRISMA methodology for systematic reviews. The CASPe guide was used to assess the quality of the manuscripts.

RESULTS

The main topics that emerged from this review in relation to in situ simulation were as follows: looking at aspects such as patient self-perception of safety, adverse events, interprofessional communication and health system organization in relation to in situ simulation.

CONCLUSIONS

The adequate implementation of in situ simulation after the COVID-19 pandemic in ICU services is shown to be an efficient and effective strategy to promote improvement in the attitudes on a culture of safety and teamwork of professionals.

Development of Trigger Films to Explore Nursing Students' Attitudes Toward Patients with Obesity

Introduction

Given the increased prevalence of obesity and the existence of negative attitudes among health care providers toward patients with obesity (PWO), strategies are needed to assist nursing students in identifying and examining attitudes and beliefs related to the provision of care for individuals with obesity. Nursing school curricula should incorporate effective interventions for students in order to reduce stigmas and to modify negative attitudes and behaviors that interfere with quality nursing care for PWO. This article describes the process of developing and implementing an innovative bariatric sensitivity intervention (BSI) for prelicensure nursing students.

Methods

The BSI includes six trigger films that address the multi-faceted aspects of caring for PWO and provoke reflection on obesity-related attitudes and beliefs, as well as a facilitated debrief.

Conclusion

We discuss the practical aspects of video production and the successful use of multimedia instruction to affect prelicensure nursing students' behaviors.

Understanding the student's experience of community health nursing simulations

OBJECTIVES

The purpose of this study was to explore nursing students' experiences after completing community health nursing simulation encounters.

METHODS

The study used a descriptive qualitative design. Through conventional content analysis, the research team analyzed the experiences of 73 nursing students after participating in community health nursing simulation encounters. The data come from nursing students' responses to three post-simulation qualitative questions.

RESULTS

Nursing students identified both positive aspects (simulation as a great learning method, useful in understanding community health nurses' roles, faculty's role in facilitating an effective learning environment) and opportunities for improvement (needing for clear objectives, expectations, and roles).

CONCLUSIONS

Community health nursing simulation encounters can be a powerful educational method to help students experience and understand the roles of community health nurses.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Augmentation of the pre-brief component will further improve students' simulation experiences.

Development of a Standardized Simulation: Advance Care Planning Conversations for Nurses

BACKGROUND

Advance care planning conversations focus on articulating and documenting patients' healthcare goals. These conversations should occur early and iteratively but are often not completed. Clinicians, specifically registered nurses, lack the needed training in advance care planning to have effective conversations; hands-on teaching modalities are necessary to enhance these communication skills.

OBJECTIVES

The aim of this study was to increase knowledge and comfort in communication about advance care planning; therefore, a validated and standardized simulation was developed and tested among registered nurses. We examined the feasibility of an advance care planning simulation called Conversations Had at Trying Times to explore changes in knowledge, attitudes, and self-efficacy among registered nurses.

METHODS

The National League of Nursing Jeffries simulation theory and Bandura's self-efficacy theory framed the study, which consisted of two stages: (a) simulation development and (b) simulation testing. Construct and content validity guided simulation development; standardization was achieved through International Nursing Association for Clinical Simulation and Learning standards. Testing consisted of a pilot one-group pretest/posttest.

RESULTS

Conversations Had at Trying Times, a researcher-designed high-fidelity validated simulation, enhanced nurses' communication skills. Thirty-six registered nurses completed the simulation; knowledge, attitudes, and self-efficacy increased pre- to posttest. Postsimulation evaluations confirmed the feasibility of the simulation. The greatest variation in results was among registered nurses with less than a year of experience.

DISCUSSION

The study findings support the feasibility and effectiveness of the Conversations Had at Trying Times simulation in its development and outcome measurements of knowledge, attitudes, and self-efficacy in advance care planning. Simulation is an educational modality underutilized, and Conversations Had at Trying Times is one of the few validated simulations for nurses. Further analysis showed that years of experience was a significant factor. Younger, inexperienced nurses had positive outcomes, but not to the extent of other practicing nurses, which suggests that simulation tailoring is necessary for newer nurses or alternative education modalities need to be explored. In addition, more training in advance care planning communication is needed for newer nurses through nurse residency programs, staff development, and mentorship. Finally, advance care planning communication needs to be addressed in undergraduate education to better prepare new graduate nurses.

Self-confidence and knowledge in leadership in critical care: simulation with the "blindfolded" technique

OBJECTIVE

To verify the contributions of using the "blindfolded" technique on nursing students' self-confidence and knowledge in critical patient care in simulated clinical scenarios.

METHOD

A quasi-experimental study conducted with 25 nursing students from a Federal University in the inland of São Paulo between November and December 2021. The participants answered the "Self-confidence Scale" and the Checklist of CPR Knowledge, Skills and Attitudes, before and after the intervention. A descriptive analysis of the checklist was performed and the Wilcoxon test was used to evaluate the checklist and the "Self-confidence Scale".

RESULTS

There was a mean of 4.04 additional correct answers in the sample analyzed, based on the difference in the number of correct answers between both moments. A total of 80% of the sample showed an increase in knowledge.

CONCLUSION

After the clinical simulation with the "blindfolded" technique, the students in leadership roles presented an increase in knowledge and self-confidence during the assistance provided in critical scenarios.

Comorbid HIV Infection and Opioid Use Disorder Simulation for Nurse Practitioner Students

BACKGROUND

Human immunodeficiency virus (HIV) infection and opioid use disorder (OUD) often occur as comorbid conditions. Many nurse practitioners are treating these conditions in their practice.

PROBLEM

Most advanced practice registered nursing (APRN) students do not encounter a medically complex patient with both HIV infection and OUD during their clinical experiences.

APPROACH

We present an unfolding simulated standardized patient scenario involving both HIV infection and OUD for APRN students. During each of 3 semesters, the students encounter the patient as he presents for a sexually transmitted infection, an OUD relapse, and, finally, new-onset HIV infection. The scenarios become increasingly complex as the students progress in their clinical experiences.

CONCLUSION

This innovative series of scenarios introduces APRN students to complex comorbid patient situations, with many issues to consider.

Mindfulness for stress and anxiety management in nursing students in a clinical simulation: A quasi-experimental study

AIM

To determine the efficacy of an online mindfulness intervention in reducing anxiety and stress levels in nursing students during clinical simulations.

BACKGROUND

Clinical simulation as a learning strategy has many benefits but the high levels of stress and anxiety it produces in participants can compromise learning, motivation or performance.

DESIGN

A quasi-experimental study with a non-equivalent control group design is presented. Forty-two undergraduate nursing students from a natural group were divided into: an experimental group (n = 21) and a control group (n = 21).

METHODS

Before conducting a clinical simulation, the experimental group followed a 10-day intensive online mindfulness intervention. All students received the same information and training. Instruments used were: Self-administered Analogue Stress Scale, State-Trait Anxiety Inventory and Five Facet Mindfulness Questionnaire. In addition, physiological data (blood pressure and heart rate) were collected at baseline, pre-briefing and debriefing.

RESULTS

Physiological variables increased in the prebriefing phase but remained statistically significantly lower in the experimental group (diastolic blood pressure p = .032 and heart rate p = .048). Levels of stress (p = .029) and anxiety (p = .016) were also managed better. Both groups in the debriefing session showed a statistically significant decrease in the different physiological variables, stress and anxiety. No changes in mindfulness were observed.

CONCLUSIONS

The clinical simulation is indicated to generate stress and anxiety in nursing students. Therefore, measures must be adopted to control it. The intensive online mindfulness intervention proposed in this study reduced physiological parameters, stress and anxiety in the clinical simulation.

Introducing Nursing Students to Pastoral Care Providers Via Simulation

ABSTRACT

During a mock code simulation scenario in a medical-surgical undergraduate nursing course, two priests as pastoral care providers were included as interprofessional team members. Perceptions of the inclusion of pastoral care in an end-of-life simulation were assessed as part of a mixed-method study that included a qualitative analysis of debriefing sessions. Students reported an increase in awareness of the role of pastoral care in healthcare and learned to consider the spiritual aspects of end-of-life care. Participation of priests in an end-of-life simulation enhanced students' learning of spirituality as an aspect of nursing care.