Qualitative evaluation of a standardized patient clinical simulation for nurse practitioner and pharmacy students

Interprofessional education for healthcare professionals. A BEME realist review of what works, why, for whom and in what circumstances in undergraduate health sciences education: BEME Guide No. 83

AIM

To provide an evidence-informed program theory (PT) for Interprofessional Education (IPE) that adds to the knowledge base of how IPE in undergraduate health sciences education works.

METHODS

We undertook a realist review of the literature and synthesis of the evidence combined with stakeholder experience. Our initial program theory (IPT), built around development, delivery and evaluation of IPE interventions, was tested and refined following an in-depth search of the literature and consultation with stakeholders. The literature (2010-2022) was selected based on the realist criteria of relevance and rigor, as well as on conceptual richness of the studies.

RESULTS

Our PT is built upon 124 CMOs (Context of IPE interventions, Mechanisms that fired within that context, and IPE Outcomes), from 58 studies. Our PT comprises an array of elements found in the Context, including traits and behavioral displays of students and facilitators, and discusses four Mechanisms (feeling responsible, feeling enthusiastic/excited, feeling safe to take risks, and feeling ready), which are likely to lead to outcomes related to the Interprofessional Education Collaborative (sub)competencies.

DISCUSSION

Results were linked to learning theories to further build our understanding. The PT can serve as a guide for the development, delivery, and evaluation of IPE interventions.

The effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students psychomotor skills learning

BACKGROUND

The aim of this study was to determine the effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students' psychomotor skills.

METHODS

This semi-experimental study was carried out in the one-group pretest-posttest design. Students performed the psychomotor skills in the Non-Simulated Clinical Skill Laboratory and Simulated Hospital Environment. The skill performances of the students were evaluated with the Objective Structured Clinical Assessment form. At the same time, students' views on both environments were received.

RESULTS

Students' mean Objective Structured Clinical Assessment score in the Simulated Hospital Environment (69.42 ± 10.94) was significantly higher than their mean score in the Non-Simulated Clinical Skill Laboratory (57.07 ± 10.05) (p < 0.05). The differences in scores were particularly significant in the stages of meeting the patient, performing the procedure in accordance with the steps and ending the procedure. The majority of the students stated that they could not do some applications in the Non-Simulated Clinical Skill Laboratory in a similar way to the hospital clinic (85.9%), and they felt like they were in a real hospital clinic in the Simulated Hospital Environment (100%).

CONCLUSIONS

The results showed that students developed psychomotor skills more fully in a learning environment designed in a similar way to a real hospital clinic setting.

The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach

BACKGROUND

The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement.

METHODS

An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases.

RESULTS

The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria.

CONCLUSION

This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.

Effects of Standardized Patient-Based Training on Surgical Nurses' Competencies for Managing Hand Injuries

BACKGROUND

The competence of nurses who care for patients with finger replantation is critical for positive patient outcomes. This study sought to identify the effects of standardized patient (SP)-based training on surgical ward nurses' knowledge, clinical performance, and self-efficacy regarding finger replantation.

METHOD

A wait-list control group with a crossover design was used for this study. Nurses were randomly assigned to group A (n = 10) or to the wait-list control group B (n = 10). Training consisted of a lecture, task training, and SP-based training. Knowledge, clinical performance, and self-efficacy data were collected at baseline, after the first intervention, and after 1 month at group crossover and second intervention. Data were analyzed using repeated measures ANOVA.

RESULTS

Nurses demonstrated greater knowledge, better clinical performance, and higher self-efficacy scores after the SP-based training. Following crossover, knowledge, clinical performance, and self-efficacy scores were retained 1 month after the training in group A.

CONCLUSION

SP-based training produced improvement and retention in knowledge, clinical performance, and self-efficacy. [J Contin Educ Nurs. 2020;51(4):189-196.].

A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation

Interprofessional simulation has been linked to improved self-efficacy, communication, knowledge and teamwork skills in healthcare teams. However, there are few studies that synthesize learners' perceptions of interprofessional simulation-based approaches and barriers or facilitators they encounter in such learning approaches. The aim of this review was to explore these issues through synthesis of the published literature on healthcare staff engaging in interprofessional simulation to inform enhancement of instructional design processes. Searches of four major databases resulted in the retrieval of 2,727 studies. Following screening and full-text review, a total of 13 studies were included in the final review and deductive content analysis was used to collate the findings, which were then synthesized using a narrative approach. Three categories of barriers and facilitators were identified: characteristics of the simulation learning process, outcomes of interprofessional simulation, and interprofessional dynamics. Related to the latter, the findings indicate the instructional design of interprofessional simulation-based approaches may benefit from a greater focus on the context of healthcare teams that prioritizes teamwork. Furthermore, greater emphasis on designing realistic clinical situations promotes effectiveness of simulation. It is important to recognize the perspectives of healthcare team members engaging in these learning approaches and how they may affect clinical performance and influence patient outcomes.

Nursing and medical students' perceptions of an interprofessional simulation-based education: a qualitative descriptive study

PURPOSE

The purposes of this study were to describe the development and implementation of an interprofessional simulation-based education (IPSE) for undergraduate nursing and medical students, their perceptions of the impact of IPSE, and identify their changes in attitudes toward each other's health professions after participating in IPSE in South Korea.

METHODS

This study used a qualitative descriptive design. A purposive sample of 43 third-year medical students and a convenient sample of 44 fourth-year nursing students participated in a 2-day IPSE program that consisted of ice-breaking and patient safety activities, and 4-hour three interprofessional team-based high-fidelity simulation education sessions. Data were collected through reflective journal after the IPSE program and keywords before and after the IPSE program, and were analyzed using the content analysis and word cloud analysis.

RESULTS

Three themes emerged: "positive experience" with understanding roles and responsibilities and learning by doing in simulation environments being reported. In the second theme, "positive learning outcomes" participants reported enhancing collaboration and confidence in communication skills. The final theme "benefits to patients of interprofessional collaborative practice" included high quality of care and patient safety. Before the IPSE experience, most medical students perceived the nurse as nightingale and syringe, and nursing students perceived the doctor as order, expert, and knowledge. After their IPSE experience, both nursing and medical students viewed each other as colleagues.

CONCLUSION

These results suggest that the use of high-fidelity team-based simulation in IPE is effective in practicing and developing undergraduate nursing and medical students' interprofessional collaboration through hands-on experience.

Human Simulation in Nursing Education

Although, human simulation methodology has its origins in medical education, nursing education has increased its use of simulated patient (SP) methodology to improve the education of nursing students across the curricula. This chapter will review the history of human simulation, introduce the human simulation continuum, and review different applications of SP methodology in undergraduate and graduate nursing education.

Health care students' perceptions about learning of affective interpersonal communication competence in interprofessional simulations

BACKGROUND

Health professionals need interpersonal communication competence (ICC) in their work with patients and other professionals. Interprofessional simulation provides health care students with an opportunity to practice communication skills in a safe and authentic environment.

OBJECTIVE

The purpose of this study was to describe the perceptions of health care students of interprofessional simulations in acquiring affective interpersonal communication competence (AICC).

DESIGN

This study was conducted using the quantitative descriptive research method.

SETTINGS

The data were collected from health care students participating in interprofessional simulations at a university of applied sciences in Finland using a questionnaire titled Student questionnaire on a multiprofessional simulation exercise. The health care students included nursing, physical therapy and practical nursing students.

PARTICIPANTS

This study was participated by 149 health care students with a response rate of 41.2%.

METHODS

The quantitative data were analysed using the SPSS 24.0 for Windows statistical software. Frequencies, percentages, averages, and standard deviation were used to describe the data. Two mean sum variables were formed using factor analysis from the variables describing AICC.

RESULTS

The students' perceptions of learning AICC (attitude, motivation, emotions) in interprofessional simulations were largely positive; for example, the simulations reduced prejudice against, and increased appreciation of, other occupational groups. Even though the interprofessional simulations were sometimes perceived as stressful, stress could also be a positive source of learning and effectively fostered personal understanding of others in a team.

CONCLUSION

Interprofessional simulations increased knowledge of the activities of other professional groups for students in different fields of education. This encourages them to work together after completing their education and entering the workforce. Knowledge of the simulation process and the creating a safe learning environment also promoted students' AICC.

Adding telehealth simulation into NP programs

NP educators are challenged to ensure their students have opportunities to learn how to apply skills within a telehealth context. This article presents an integration of telehealth into clinical learning, depicting the connectedness possible when a healthcare professional and patient are challenged by geographic distance.

A Systematic Review of the Use of Standardized Patients as a Simulation Modality in Nursing Education

AIM

The objective of the study was to search, extract, appraise, and synthesize studies using standardized patients (SPs) in nursing academia to determine how this modality of simulation is being used.

BACKGROUND

SPs are a common simulation modality used in nursing education.

METHOD

This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Five databases were searched as well as keywords to retrieve nonindexed citations for the period January 2011 to September 2016. The inclusion criteria included nurses, a simulated experience with SPs, and original research published in English.

RESULTS

Sixty-five studies were identified and analyzed.

CONCLUSION

More randomized controlled trials and studies with power analyses and validated measurement instruments are needed. Studies that compare SPs to high-fidelity simulators are also desired to determine optimal student learning outcomes and standardize best practices in simulation.

Evaluation of a sepsis teaching rounds simulation for pharmacy students

BACKGROUND AND PURPOSE

The goal of this prospective, observational cohort study was to determine if simulated interdisciplinary teaching rounds improved student perceptions of confidence and attitudes towards working as part of a team. The secondary objective of this study was to investigate changes in student knowledge of the management of sepsis.

EDUCATIONAL ACTIVITY AND SETTING

Students participated in a traditional sepsis lecture followed by a simulated interdisciplinary rounding experience. Confidence and collaborative attitudes were assessed using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). Changes in knowledge were measured using multiple choice questions. Students completed these tools at three points in time: pre-lecture, post-lecture, and post-simulation.

FINDINGS

Student confidence and attitudes related to interdisciplinary rounds improved following the simulation (2 of 4 items, p=0.003; 2 of 5 items, p<0.05). Also, most students agreed or strongly-agreed that the simulation reinforced knowledge gained from lecture (94.7%), that lecture followed by a simulation was the most effective way to learn about sepsis (94.7%), and that the simulation helped reinforce critical-thinking skills (94.7%). Knowledge improved between the didactic lecture and the simulation, but these differences were not found to be statistically significant.

SUMMARY

A simulated interdisciplinary rounding experience may increase student confidence during teaching rounds and improve attitudes towards working alongside other healthcare professionals. Incorporating rounding simulations into pharmacy curricula may be beneficial towards student success on rounds.

Audiology and Speech-Language Pathology Simulation Training on the 1-3-6 Early Hearing Detection and Intervention Timeline

Purpose This study aimed to find out more about the effect of the use of the 1-3-6 early hearing detection and intervention (EHDI) timeline and interprofessional simulation training on audiology and speech-language pathology graduate students' confidence level of knowledge and skills. Method A 1-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills. The mean age for 50 graduate students participating in this study was 25.32 years ( SD = ±3.77, range: 22-37 years). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Three case scenarios represented by standardized parents were developed, and 8 students volunteered to participate in implementing the 1-3-6 EHDI timeline, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each scenario. Participants were asked to rate their readiness for interprofessional education/practice and their satisfaction of the educational experience after the last case scenario. Results Overall, the pre- and postsimulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels in knowledge and skills. The mean difference between pre- and postevent scores was 0.78 ( p < .01). The mean interprofessional learning was 2.13 (range: 1.16-2.57, SD = ±0.24) based on a Likert scale, where 1 = strongly agree and 5 = strongly disagree. The mean satisfaction level was 4.37 (range: 3.94-4.72, SD = ±0.24) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied. Conclusions The results demonstrated the value of using interprofessional simulation training among audiology and speech-language pathology students to improve their confidence in knowledge and skills. The curriculum developed in this study for the 1-3-6 EHDI timeline provides resources for educators in both professions and other related professions.

Interprofessional Perceptions and Attitudes Among Pharmacy and Family Nurse Practitioner Students

INTRODUCTION

Interprofessional education (IPE) activities involving pharmacy (PharmD) and family nurse practitioner (FNP) students is understudied. Interactions between PharmD and FNP students have become important since most recent Accreditation Council for Pharmacy Education standards included a requirement for schools of pharmacy to have IPE. The primary objective of this study is to evaluate the perceptions and attitudes among PharmD and FNP students towards an IPE activity.

METHODS

Atleast 1 student from each discipline was assigned to one team and participated in simulated ambulatory care scenarios. A survey was completed by students after the activity, which mapped each survey statement to an Interprofessional Education Collaborative (IPEC) core competency.

RESULTS

Perceptions and attitudes between PharmD and FNP students were similar, with no significant differences except with 2 statements, one survey statement in the Teams and Teamwork core competency and another in the Roles/Responsibilities core competency. A less favorable response with more than half of FNP students reporting "strongly agree" (18%) and "agree" (35%) resulted for the statement regarding their professional roles in the IPE activity.

CONCLUSION

PharmD and FNP students reported favorable perceptions and attitudes in each IPEC core competency after participation in the IPE activity. There may be a need to review the discipline's professional role before participating in the activity.

Breastfeeding Simulation With the Standardized Patient

Despite an emphasis on lactation and the availability of resources to support and sustain lactation, our community hospital's rates of exclusive breastfeeding remained less than the 50% to 70% benchmark recommended by The Joint Commission and the World Health Organization. Concluding that we had exhausted the majority of evidence-based best practices described in the literature, we sought to find a new way to provide an engaging, useful medium for nursing education and improvement of clinical nurses' skills related to breastfeeding. Here, we describe the simulation program we developed using the standardized patient model. Although our rates of exclusive breastfeeding remained unchanged after introducing the simulation program, the experience enabled us to identify inconsistent practices and knowledge gaps.

Experience of nursing students with standardized patients in simulation-based learning: Q-methodology study

BACKGROUND

Standardized patients (SPs) boost self-confidence, improve problem solving, enhance critical thinking, and advance clinical judgment of nursing students.

OBJECTIVE

The aim of this study was to examine nursing students' experience with SPs in simulation-based learning.

DESIGN

Q-methodology was used.

SETTING

Department of nursing in Seoul, South Korea.

PARTICIPANTS

Fourth-year undergraduate nursing students (n = 47).

METHODS

A total of 47 fourth-year undergraduate nursing students ranked 42 Q statements about experiences with SPs into a normal distribution grid.

RESULTS

The following three viewpoints were obtained: 1) SPs are helpful for patient care (patient-centered view), 2) SPs roles are important for nursing student learning (SPs roles-centered view), and 3) SPs can promote competency of nursing students (student-centered view).

CONCLUSION

These results indicate that SPs may improve nursing students' confidence and nursing competency. Professors should reflect these three viewpoints in simulation-based learning to effectively engage SPs.

Quality assurance processes for standardized patient programs

OUR PROBLEM

As the pharmacy profession evolves to include non-dispensing services and collaborative care, greater emphasis is placed on communication skills building through standardized patient programs. Best practices for assuring the quality of standardized patient (SP) programs, however, remains unclear. The objective of this manuscript is to summarize quality assurance processes for standardized patient programs from health professions education literature.

METHODOLOGICAL LITERATURE REVIEW

A search of PubMed and Scopus between 2011 and 2016 was conducted and 22 articles were retained for thematic analysis. Articles were screened for relevance to quality assurance.

OUR RECOMMENDATIONS AND THEIR APPLICATIONS

The thematic analysis revealed four themes: (1) enhanced SP training programs, (2) structured feedback to students, (3) statistical measurements to ensure inter-rater reliability, and (4) observation and evaluation of the SP to improve SP performance. Specific methods to assure the quality of an SP program were identified, including training program content and feedback techniques.

POTENTIAL IMPACT

Although SP programs varied widely in their implementation, there were several common strategies used to evaluate the consistency of performance, effectiveness of feedback to students, and reliability of grading. Additional research is necessary to establish standards for SP programs across professional healthcare disciplines.

The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice

Background

Novice students may have limited learning opportunities during their early exposure to complex clinical environments, due to the priorities of patient care. Immersive, high-fidelity simulation provides an opportunity for physiotherapy students to be exposed to relatively complex scenarios in a safe learning environment before transitioning to the clinical setting. The present study evaluated the influence of immersive simulation on student confidence and competence.

Methods

Sixty penultimate year physiotherapy students completed an 18-day full-time immersive simulation placement. The placement involved students spending 6 days working in each of three core practice areas (cardiopulmonary, musculoskeletal, neurological) in which they interacted with simulated patients portrayed by professional role-play actors. The patient scenarios were developed by groups of expert practitioners and incorporated full documentary and imaging information. Students completed a questionnaire to evaluate their confidence in the clinical environment at the start and completion of each 6-day rotation. Their clinical competence was evaluated at the end of each 6-day rotation using the Assessment of Physiotherapy Practice (APP) tool. In a secondary analysis, the clinical competence of this cohort was evaluated in comparison to a matched cohort of students from the same year group that had not completed an immersive simulation placement.

Results

Student confidence improved significantly in each 6-day rotation (p < 0.001); however, it reduced again at the commencement of the next rotation, and there was no cumulative improvement in confidence over the 18-day placement (p = 0.22). Students who had completed the immersive simulation placement achieved higher APP (p < 0.001) scores in an evaluation of their competence to practice during their subsequent clinical placement.

Conclusion

Immersive simulation provides a beneficial learning environment to enable physiotherapy students to transition from university-based education to working in the clinical environment.

Electronic supplementary material

The online version of this article (10.1186/s41077-018-0062-9) contains supplementary material, which is available to authorized users.

Clinical simulation with dramatization: gains perceived by students and health professionals

Objective:

to identify in the literature the gains health students and professionals perceive when using clinical simulation with dramatization resources.

Method:

integrative literature review, using the method proposed by the Joanna Briggs Institute (JBI). A search was undertaken in the following databases: Latin American and Caribbean Health Sciences Literature, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, Scientific Electronic Library Online.

Results:

53 studies were analyzed, which complied with the established inclusion criteria. Among the different gains obtained, satisfaction, self-confidence, knowledge, empathy, realism, reduced level of anxiety, comfort, communication, motivation, capacity for reflection and critical thinking and teamwork stand out.

Conclusion:

the evidence demonstrates the great possibilities to use dramatization in the context of clinical simulation, with gains in the different health areas, as well as interprofessional gains.

Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education

PURPOSE

The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills.

METHOD

A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents.

RESULTS

Overall, the pre- and post-simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p < .01). The mean satisfaction level was 4.71 (range = 3.91-5.00; SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied.

CONCLUSIONS

The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

Integrating the 2013 Psychiatric Mental Health NP Competencies Into Educational Programs: Where Are We Now?

Since the introduction of the revised National Organization of Nurse Practitioner Faculties (NONPF) Nurse Practitioner Core Competencies and Population Focused Psychiatric Mental Health Nurse Practitioner (PMHNP) Competencies, a national forum took place to hear from many PMHNP program directors in the field comparing how they have integrated the lifespan competencies and the master's (MS)/or doctor of nurse practice (DNP) essentials into their curriculum. In this paper, we will report first on the major areas of change in the structure and content of the PMHNP-lifespan curriculum as well as the comments made by many faculty from across the country as to challenges and innovative strategies used to meet these challenges. We will review some of the major issues in content, pedagogy, and evaluation methods as well as examples of how these curricular elements have been infused into select programs across the country. We conclude highlighting several key areas, suggested foci for change, and how the specialty might focus attention and accelerate the significant growth we are seeing in PMHNP programs.

Using Simulation for Clinical Practice Hours in Nurse Practitioner Education in The United States: A Systematic Review

OBJECTIVES

The National Organization for Nurse Practitioner Faculty (NONPF) does not allow simulation to be used in lieu of traditional clinical hours. The NONPF cites a lack of empirical evidence related to learning outcomes with simulation as rationale for its stance. The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of simulation in Nurse Practitioner (NP) education in order to answer the two following questions: 1) What research related to simulation in NP education has emerged in the literature between 2010 and April 2015?, and 2) Of the research studies that have emerged, what level of Kirkpatrick's Training Evaluation Model (1994) is evaluated?

DESIGN

This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

DATA SOURCES

A literature search was completed in PubMed and CINAHL using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve non-indexed citations.

REVIEW METHODS

The inclusion criteria for this review were broad in order to disseminate information on future research needed. The review considered studies related to NP education that included any form of simulation intervention, e.g. role-playing and standardized patients. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language.

RESULTS

The database search strategy yielded 198 citations. These results were narrowed down to 15 studies based on identified inclusion criteria.

CONCLUSIONS

There is a lack of empirical evidence in the literature to support using simulation in lieu of direct patient care clinical hours in NP education. The evidence in this systematic review affirms NONPF's statement. Five years after the inception of NONPF's position statement, research to support learning outcomes with simulation in nurse practitioner education remains lacking. There is a need to produce rigorous scientific studies in the future in order to provide quantitative support to allow simulation to be counted as clinical hours in NP programs.

Aligning care initiatives to reduce medication adverse effects in nursing homes

Medication adverse effects in nursing homes continue to be an ongoing issue in long-term care, resulting in adverse events and temporary harm that lead to increased hospitalizations. In 2014, the Office of the Inspector General report noted that among Medicare beneficiaries in Part A stays less than 35 days, 22% experienced an adverse event and 11% experienced temporary harm. Ongoing initiatives and clinical services that can be aligned to address medication adverse events are discussed within the current article.