The efficacy of simulation-based and peer-learning handover training for new graduate nurses

Comparing the impact of PASS-BAR handoff education for new nurses between simulation-based and case-based approaches: A quasi-experimental design

AIM

To develop a patient, assessment, situation, safety concerns, background, action, recommendation (PASS-BAR) handoff training program and compare the educational effects of the program between simulation-based (experimental group) and case-based (control group) groups using repeated measures among new nurses.

BACKGROUND

New nurses are not well prepared to provide clear handoff reports because nursing schools and healthcare institutions rarely offer structured programs or training for handoff communication practices.

DESIGN

This study used a pretest-posttest quasi-experimental design with repeated measures with two non-randomized groups.

METHODS

This study targeted new nurses with less than 12 months of experience and was conducted at a university hospital's clinical nursing education center in Seoul, South Korea, between September 2022 and April 2023. Seventeen participants were allocated to the experimental group and 17 participants to the control group. Both groups were given lectures and exercises for both scenarios. Participants were asked to complete a questionnaire on nursing handoff competency, handover performance competency and perceived self-efficacy of handoff at pre- and posttest and two weeks after training. Satisfaction with learning was measured after the intervention.

RESULTS

We developed a simulation-based learning handoff program that includes a simulated handoff performance and debriefing and a case-based learning handoff program that includes discussion, handoff performance and feedback. This study found no immediate difference in the educational effect of PASS-BAR handoff training between simulation-based learning and case-based learning; however, over time, simulation-based learning was more effective than case-based learning in improving nursing handoff competency and handover performance competency.

CONCLUSIONS

Based on the results of this study, a simulation-based handoff training program using PASS-BAR can enhance handoff competencies and help new nurses strengthen their communication skills to understand patients and convey important information.

TWEETABLE ABSTRACT

Developing a simulation-based handoff training program using PASS-BAR helps nurses strengthen their communication skills with colleagues.

Effectiveness of a Simulation-Based Education Program to Improve Novice Nurses' Clinical Judgment Skills

INTRODUCTION

We assessed the effectiveness of a simulation-based education program to improve novice nurses' clinical judgment skills.

METHODS

A simulation education program was implemented for 21 novice nurses. Surveys were conducted on program satisfaction, learning, and clinical judgment skills before, immediately after, and two months after the program.

RESULTS

Novice nurses were highly satisfied with the simulation education program. The following nine categories were identified as learnings: provide psychological care for patients, conduct sufficient observation, conduct assessment and make judgment based on observational findings, consult and report appropriately to senior nurses, take response action calmly, collect necessary information, acquire knowledge, predict patients' conditions, and make environmental arrangements. The subscale score for theoretical and practical reasoning was significantly higher immediately after and two months after the program than before it. In addition, the subscale for grasping the condition by observation was significantly higher two months after the program than before and immediately after it.

CONCLUSION

The novice nurses learned to sufficiently observe, obtain necessary information, and prospectively assess patients' conditions by taking part in the simulation education program. The subscale score for grasping the condition by observation was significantly higher two months after the program than before and immediately after it. After the simulation program, novice nurses were likely actively practicing nursing; therefore, this program may not be directly responsible for the improvement of these new nurses' clinical judgment. Nevertheless, we found that the completion of the simulation program was correlated with enhanced clinical judgment.

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review

OBJECTIVE

To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice.

DESIGN

Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment.

METHODS

Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics.

RESULTS

Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study.

CONCLUSION

In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Educational interventions for improving nursing shift handovers: A systematic review

AIM

This study analyzed the components of educational interventions for handovers among nursing students and nurses.

BACKGROUND

A handover is a communication process that occurs when patient care responsibilities and rights are transferred from one nurse to another. This process is important in nursing to ensure the continuity of nursing care and patient safety.

DESIGN

A systematic literature review of Korean and international studies was conducted to identify the components of handover educational programs for nursing students and nurses and analyze their effects, thereby providing a basis for the further development of these programs.

METHODS

Studies published in English or Korean no later than June 30, 2022, were found via an electronic database search using the MEDLINE, Embase, and CINAHL databases. Three reviewers independently evaluated all the studies. These studies focused on educational interventions for nursing students and nurses regarding covering shift-to-shift nursing handovers. After reviewing 1971 extracted articles, 18 satisfied the inclusion criteria.

RESULTS

Nine articles involved nursing students and nine involved nurses. Four articles covered bedside handovers as educational topics. Educational methods included lectures and active practice. Active practice comprised demonstrations, role-play, and feedback. The main content areas of the educational programs were an introduction to handovers; training regarding how to extract important information for handovers; and strategies using informatic and thematic structures, such as mnemonics, and concept mapping. The patient cases for role-play were provided in forms of written scenarios, virtual electronic charts, videos, scenario-based simulated situations, and actual patient cases assigned in clinical practice. The effects of the educational interventions were evaluated regarding knowledge, performance, and self-efficacy. Performance and self-efficacy were significantly higher in a study in which the intervention group was provided additional individual feedback compared to the control group and in a study in which the intervention group received multiple additional practice opportunities.

CONCLUSIONS

Handover education for nursing students and nurses should include individual feedback, demonstrations, and opportunities to practice to improve their performance and self-efficacy. Feedback methods should be further developed to increase the effectiveness of educational programs. Sample cases involving patients should be devised to increase these opportunities, and methods for improving educator efficiency should be identified.

Using a simulation-based approach to promote structured and interactive nursing clinical handover: a pre- and post-evaluation pilot study in bilingual Hong Kong

Effective clinical nursing handover involves the transfer of responsibility and accountability for patient care between nurses, leading to better patient safety and continuity of care. Nurses in bilingual contexts, such as Hong Kong - where nurses are trained in English but communicate in Cantonese - may find it challenging to deliver a safe clinical handover. This article reports a pilot study in which a simulation-based approach is being developed to enhance nursing handover with structured and interactive interactions, using handover protocols such as ISBAR (introduction, situation, background, assessment, recommendation and readback) and CARE-team (connect, ask, respond, empathise) protocols in a bilingual context. The study has a pre- and post-evaluation design involving a questionnaire survey before and after a 4-hour workshop. Fourteen selected bilingual nurses in Hong Kong were trained according to the ISBAR and CARE-team protocols, and their perceptions of complete and structured handovers were evaluated before and after training using the questionnaire. The nurses reported that they were more self-confident in their handover experiences, with a deeper understanding of ISBAR and CARE-team protocols after the simulation-based training intervention, leading to better (i.e., more structured and interactive) clinical handover between nurses. Overall, the staff perceived their handover communication to have improved using simulation-based training.

Construction of learning objectives and content for newly graduated nurses in tertiary teaching hospitals: A Delphi study

BACKGROUND

Transition education is a robust strategy to improve the core competency of newly graduated nurses and the quality of clinical nursing and ensure people's safety. Limited information about the learning objectives and educational content for newly graduated nurses in China was available.

OBJECTIVE

Construct the learning objectives and educational content for newly graduated nurses based on defined core competencies.

DESIGN

We used a literature review and the e-Delphi method to conduct this study.

SETTINGS

Ten tertiary teaching hospitals and six nursing schools in Zhejiang Province, China, were selected.

PARTICIPANTS

Experts (n = 21) were invited to the e-Delphi study.

METHODS

Based on seven competencies from the literature review and the research group discussions, we formed an initial set of objectives and specific educational content for newly graduated nurses. Subsequently, experts provided supportive and modification advice on the competencies, objectives, and specific content in the two Delphi rounds. The consensus percentage and the weight of each first-level, second-level, and third-level item were calculated.

RESULTS

Consensus was achieved on seven core competencies, 44 learning objectives, and 60 components of educational content. The positive coefficient of the two Delphi rounds was 100 %, the authority coefficient was 0.83 and 0.87, the proportion of experts who made suggestions was 71.40 %, the coefficient of variation (CV) was <0.25 (P < 0.05) except for two items and the Kendall coefficient (W) was 0.15-0.48 (P < 0.01).

CONCLUSION

The developed objectives and content framework provide a reference for implementing systematic and standardized education for newly graduated nurses.

Clinical judgment in new nurse graduates: identifying the gaps

OBJECTIVES

Clinical judgment has been identified as a key component of clinical practice. We sought to measure the elements of clinical judgment in new nurse graduates to identify future educational interventions.

METHODS

Lasater's clinical judgment rubric was adapted and distributed to nurse preceptors at two significant health care systems in central Illinois.

RESULTS

One hundred and six surveys were returned and one hundred and five of those were included in the study. New nurse graduates were found to be the lowest ranking in ability to identify significant data and calm, confident responses.

CONCLUSIONS

The findings can guide nurse educators to create innovative, targeted educational interventions to improve students' ability to identify important pieces of data and respond to challenging situations in a self-assured manner.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

Identifying and addressing the gaps to improve students' clinical judgment may facilitate NCLEX success and entry to practice.

Experiences of handovers between shifts among nurses in small and medium-sized hospitals: a focus-group study

Nursing handovers represent an important and complex form of communication in healthcare organizations that involve the exchange of patient-related information between nurses. This qualitative descriptive study aimed to identify the intershift handover experiences among nurses working in small and medium-sized hospitals. Focus-group interviews were conducted with 30 nurses who directly participated in patient care in such hospitals in South Korea. The reporting of the study findings adhered to the Consolidated Criteria for Reporting Qualitative Research checklist. The data were analysed using content analysis. Under the main theme of "baton touch in a relay", 6 categories, 17 subcategories and 45 codes (concepts) were derived. The six categories were "procedural rituals for shifts", "non-standardized handover training", "inconsistent handover style", "stress due to handovers", "coping strategies for handovers" and "interruptions of handovers". Nurses in small and medium-sized hospitals strive to improve the quality of handovers by preparing individual-level coping strategies under difficult conditions. This indicates that standardized handover education strategies need to be developed for nurses that are suitable for the personnel systems of small and medium-sized hospitals.

Five ways for facilitators to get a grip on small group learning

Successful groups do not happen by chance, and they do not depend solely or even mainly on the interpersonal skills of the group members. Cooperative learning (CL) theory tells us that small groups are successful when facilitators structure and organize the small group to include each one of the five elements of cooperative learning. In this article, we have described each of these five elements as a way to get a grip on small group learning: positive interdependence, promotive interaction, group and individual accountability, interpersonal and small group skills, and group processing. To help our readers remember the five key elements of CL, the five ways to get a grip on small group facilitation, we have created an infographic.

Development and implementation of a standardized training program for newly graduated mental health nurses: Process and preliminary outcomes

BACKGROUND

Training programs are crucial for newly graduated nurses transitioning from nursing school to independent clinical nursing careers. However, few studies have focused on the training of newly graduated mental health nurses.

OBJECTIVES

The aim of this study was to develop, implement, and preliminarily evaluate a standardized training program for newly graduated nurses entering psychiatric nursing.

DESIGN

The Delphi technique was adopted for program development, and a quasi-experimental design was employed for program implementation.

SETTINGS

Six mental health institutions were involved in the practice training, and among these, three university-affiliated psychiatric hospitals were the study sites for theoretical training.

PARTICIPANTS

A total of 180 newly graduated nurses hired by the six hospitals were involved and 154 finished the training program.

METHODS

The program was developed using the Delphi method based on the results of a literature review and semi-structured interview with clinical practitioners. Change in mental health nurses' core competencies before and after the program was compared during program implementation. Focus group interviews were employed to collect the opinions and influence of the standardized training program after the intervention, and content analysis was used to analyze it.

RESULTS

A two-round Delphi expert consultation was done, and 7 core competency elements and 37 training topics were designed for the standardized training program. The six-month training program consisted of two months for course training and four months of practical training, which were guided by a manual. Total CIRN scale score improved (142.29 ± 34.87 vs. 160.35 ± 32.46, P < 0.01) after receiving the program as did the scores for each dimension (P < 0.01). Participants gave positive feedback and suggested optimal training length and certification for the program.

CONCLUSIONS

The standardized training program focused on mental health nursing proved to be a viable method of novice nurse training and resulted in positive outcomes. The program length and its long-term effects deserve further exploration to determine the best practical training program for sustaining optimal development of mental health nursing.

Patient handover education programme based on situated learning theory for nursing students in clinical practice

AIM

If not conducted correctly, nursing handover can threaten patient safety, and so nursing students require good handover education. This study evaluated a handover education programme based on situated learning theory in a clinical practicum.

METHODS

A quasi-experimental design and convenience sampling technique were used. The participants (fourth-grade nursing students recruited from a college in the C province of South Korea) were assigned to an intervention group (n = 38) or a control group (n = 39). A handover education programme that included lectures, expert observations, role playing, peer learning and reflection was received by the intervention group. The control group attended lectures and observed handovers. The handover skills of all participants were tested 2 weeks before and on the last day of the clinical practicum. Handover performance ability, handover clinical judgement ability and handover self-efficacy were outcome variables.

RESULTS

Significant improvements in handover performance ability, handover clinical judgement ability and handover self-efficacy were observed in the intervention group compared with the control group.

CONCLUSION

The significance of this study lies in the development and application of a programme based on situated learning theory for handover education. Application of theory-based handover education in clinical practicums is recommended to improve the handover capabilities of nursing students.

The Effectiveness of Simulation Use in Transition to Practice Nurse Residency Programs: A Review of Literature From 2009 to 2018

Representatives of three international associations reviewed literature published from 2009 to 2018 to ascertain the effectiveness of simulation use in transition to practice programs for newly licensed registered nurses (NLRNs). A review of nine quantitative studies demonstrated that simulation positively influences NLRN self-perception of skills, competence, readiness for practice, and confidence. However, evidence of objective measures of NLRN competence and the impact of simulation on patient and organizational outcomes was lacking.

Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses

AIM

This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses.

BACKGROUND

Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses.

METHOD

Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points.

RESULTS

The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time.

CONCLUSION

Replication of the study with a randomized controlled trial and large sample size is warranted.

Newly graduate nurse perception and experience of clinical handover

BACKGROUND

Clinical handover is challenging for newly graduated nurses. Previous studies have showed that many new graduates perform handover ineffectively and unsystematically; however, our knowledge of newly graduated nurse perceptions of handover, including barriers and challenges to handover, is incomplete.

OBJECTIVES

The study aimed to explore newly graduated nurse experience of clinical handover in Hong Kong public hospitals.

DESIGN

This was a descriptive phenomenological study.

SETTING

Participants were recruited from 11 public acute care hospitals in Hong Kong.

PARTICIPANTS

The participants were a convenience sample of 20 nurses who had graduated within the previous 12 months.

METHODS

Individual semi-structured interviews were conducted, and the data were analysed using content analysis.

RESULTS

Three themes emerged from the data: 'significance of clinical handovers,' 'feelings of frustration about clinical handover,' and 'perceived barriers to handover.' Participants perceived clinical handover as an essential nursing practice in the provision of continuous patient care. Further, some new graduates experienced stress and anxiety in clinical handover, which severely affected their quality of life. Perceived barriers to handover included inadequate professional judgement, poor ability to synthesize the important information, and unsystematic reporting.

CONCLUSIONS

Newly graduated nurses face challenges and encounter difficulties in performing clinical handover. Handover theory and, in particular, skills training should be introduced into the undergraduate nursing curriculum, to arm students with the confidence and competence to perform appropriate clinical handover.

Training in communication and interaction during shift-to-shift nursing handovers in a bilingual hospital: A case study

AIM

To explore the perceptions and practices of nurses on handovers.

BACKGROUND

At handover, accountability must be transferred to ensure a consistent quality of patient care. Studies highlighted unstructured handovers as a major factor contributing to critical incidents. The design of handover training requires a systematic method for evaluating nurses' practices.

DESIGN

An explorative case study, qualitative design that combined ethnography with discourse analysis.

METHODS

A training programme based on these practices was administered to 50 nurses, and a protocol focused on CARE was implemented. The nurses' perceptions and practices were evaluated, and 80 handovers were recorded.

RESULTS

Three areas likely to enhance the continuity of care emerged: 1) explicit transfer of responsibility by outgoing nurses; 2) responsible engagement of incoming nurses in the handover and 3) adherence to a systematic handover structure.

CONCLUSION

The change in practice from monologic handovers with passive incoming nurses before training to interactive and collaborative handovers, where all nurses appeared to take an active role in clarifying patients' cases, after training was significant.

Evaluation of an unfolding obstetric experience simulation in an undergraduate nursing program

BACKGROUND

Clinical practice for pre-licensure nurses in obstetrics widely varies and many sites do not consistently present opportunities to meet course objectives or manage complex obstetric nursing care. To address this problem at our institution, we designed a large-scale obstetric simulation using recommendations for best practice in simulation design criteria. We designed an unfolding, obstetric simulation that allowed students repeated opportunities for deliberate practice after micro-debriefing.

METHOD

A convenience sample of junior level nursing students (n = 53) participated in a pre/post design evaluation to measure achievement of communication skills based on student perception of obstetric nursing self-efficacy and their ability to transfer those skills to a similar scenario.

RESULTS

Scores for obstetric self-efficacy were significantly improved. Pre-simulation (M = 40.78), Time 1 (M = 61.0) and Time 2 (M = 69.27), F (2, 159), =112.12, p = .00. A significant difference was found (t (52) = -7.839, p = .000) when comparing the mean pre and posttest clinical accuracy and completion scores for SBAR forms (n = 53).

CONCLUSION

Our unfolding, obstetric simulation was effective in helping our students demonstrate the achievement of course objectives through improved obstetric self-efficacy scores and scores for shift to shift communication.

Optimizing Registered Nurse Bedside Shift Report: Innovative Application of Simulation Methods

Compliance with evidence-based shift report practices varies, and handoff processes are often inconsistent, increasing the risk for compromised patient safety. This pilot study evaluated registered nurse adherence to and self-efficacy with evidence-based shift report practices presimulation and postsimulation. Statistically significant increases in adherence to and self-efficacy with shift report practices after simulation were noted. Simulation offers nursing professional development practitioners a feasible method to enhance practice competency and standardization of care during registered nurse shift report.