How Do Simulated Error Experiences Impact Attitudes Related to Error Prevention?

Scenario-Based e-Simulation Design for Global Health Education: Theoretical Foundation and Practical Recommendations

Electronic simulation (e-simulation)-particularly scenario-based e-simulation (SBES)-is an increasingly used, promising educational strategy for global health education that can address gaps in training access, effectiveness, and cost. However, there is little guidance for educators on how to develop an SBES, and guidance is lacking outside the clinical context. Moreover, literature on medical education rarely uses the theoretical basis for e-simulation design and development, including for SBES. Hence, we aim to differentiate and describe the concept, design elements, and theoretical basis of SBES with examples from different topics in global health. In addition to enhancing the understanding of the potential of SBES for global health education, this manuscript also provides practical recommendations for global health educators in designing and developing SBESs based on the existing literature and authors' experiences. Overall, this manuscript will be useful for global health educators as well as other medical educators seeking to develop an SBES for similar skill sets.

A National Survey of Medication Dosage Calculation Teaching Methods and Competency Criteria on Nursing Student Success: Recommendations for Nurse Educators

AIM

The purpose of this study was to synthesize the current landscape of medication dosage calculation (MDC) education for prelicensure nursing students in the United States.

BACKGROUND

There is little consistency in the format of MDC education and evaluation in prelicensure nursing education, yet consequences of not passing MDC exams can affect the number of graduating nurses. Consequences can include withdrawal from the course, delayed progression of a semester or more, or dismissal from the nursing program.

METHOD

An electronic survey was emailed to prelicensure administrators of 1,620 associate, bachelor's, and master's entry programs in the United States.

RESULTS

Surveys were received from 210 programs. Results confirmed inconsistent methods used to teach and evaluate MDC competency.

CONCLUSION

Inconsistent teaching methods and competency criteria can affect retention and subsequent growth of the nursing workforce. Based on the characteristics associated with MDC success, recommendations are made for nurse educators.

Nursing students' risk perceptions related to medication administration error: A qualitative study

AIM

The purpose of this study was to explore and describe pre-licensure nursing students' perceptions of risk for medication administration errors in fourth-year baccalaureate student nurses from three campuses at a large central Pennsylvania university.

BACKGROUND

Medication administration errors continue to be a significant safety concern in healthcare settings. Pre-licensure nursing education is a critical time period during which to have an impact on future medication administration practices. Perception of risk influences decision making and behavior, including nursing clinical decision making.

DESIGN

This descriptive, exploratory study involved a qualitative design.

METHODS

A thematic analysis of the qualitative data resulting from 60 individual, in-depth semi-structured interviews was conducted.

RESULTS

The participants offered rich, detailed narratives which revealed the following themes: (1) the nature of risk perceptions, (2) more opportunities to learn, (3) experiences with medication administration error, and (4) intrinsic characteristics influence errors.

CONCLUSIONS

The findings provide a broad description of the nature of student nurse risk perceptions for future medication administration errors. Recommendations for nursing education practice and pedagogy include additional clinical experiences, modified pharmacology curricula and instruction, and expanded simulations involving medication administration error.

Parkinson's Disease Medication Administration During a Care Transition: The Impact of Interprofessional Team Simulation on Student Competency, Comfort, and Knowledge

AIM

This study investigated the impact of an interprofessional mock code on students' comfort and competency related to Parkinson's disease (PD) medication administration during care transitions.

BACKGROUD

Patients with PD are at increased risk for medication errors during hospitalization. Individualization of PD medication creates vulnerability during care transitions.

METHOD

Four interprofessional groups took part in this study: baccalaureate degree senior nursing students (n = 113), master's level nurse anesthesia students (n = 35), doctor of osteopathic medicine fourth-year students (n = 32), and doctor of clinical psychology fourth-year students (n = 22). Groups participated in an unfolding case study simulation involving a mock code with a focus on the omission of time-sensitive PD medication. Pre- and postsimulation test results were compared.

RESULTS

Findings indicated an increased understanding among three of the four groups relating to medication timing during care transitions.

CONCLUSION

All groups improved with respect to perceived comfort and competency.

Does participation in extended immersive ward-based simulation improve the preparedness of undergraduate bachelor's degree nursing students to be ready for clinical practice as a registered nurse? An integrative literature review

AIMS AND OBJECTIVES

To determine if extended immersive ward-based simulation programmes improve the preparedness of undergraduate bachelor's degree nursing students to be ward ready for professional practice as a registered nurse.

BACKGROUND

The practice readiness of new graduate nurses to enter the workforce continues to raise concern among educators and industry. Often the transition period is a vulnerable time when the reality of clinical practice bears little resemblance of their experiences as a student. Simulation of a busy ward offers the opportunity for pre-registered nurses to practise a variety of situations they are likely to encounter once qualified in a safe and supportive learning environment.

METHODS

The review considered studies that investigated the experiences and learning outcomes of nursing students following participation in extended immersive ward-based simulation. Databases searched included CINAHL, EMBASE, Medline and Scopus. Two reviewers independently assessed retrieved studies that matched inclusion criteria using standardised critical appraisal instruments. Reporting of review followed PRISMA checklist.

RESULTS

Fourteen studies met the inclusion criteria. The majority of studies used a quasi-experimental mixed methods approach (10). Programme evaluations focused on self-reporting in learning satisfaction and student perceptions of performance. Six studies used a pre- and post-test design to compare the after effect on preparedness for professional practice. Two studies investigated student learning between simulated experiences and experiences gained during clinical placements.

CONCLUSION

Learning satisfaction was high among students who participated in programmes that incorporated extended immersive ward-based simulation experiences. Students are able to practise what they need to know and on what will be expected of them in professional practice. Evidence on whether these programmes make a difference in workplace performance, and retention of graduate nurses is yet to be established.

RELEVANCE TO CLINICAL PRACTICE

Extended immersive ward-based simulation allows educators the opportunity to meet the perceived needs of students in preparation for professional practice.

Attitudes of Undergraduate Nursing Students towards Patient Safety: A Quasi-Experimental Study

Improving nursing students' attitudes towards patient safety is a current and relevant topic. This study aims to evaluate the effectiveness of an educational intervention based on critical incident and root cause analysis (RCA) techniques regarding attitudes towards patient safety in nursing students. A quasi-experimental before and after study was developed between January 2018 and December 2019 in a sample of 100 nursing students at Universitat Jaume I (Spain). The intervention was developed in two phases. Phase I was at university, where students applied the RCA technique in a real case. Phase II took place during clinical practice. Students used critical incidents to identify a risk situation for the patients and applied RCA to detect its root causes. The measurement of attitudes was performed with the Attitudes to Patient Safety Questionnaire (APSQ-III). The global score of the questionnaire in the baseline measurement was 3.911 (±0.335), in the intermediate measurement it was 4.031 (±0.337) and in the final measurement it was 4.052 (±0.335), with significant differences (p = 0.03). However, intra-group differences were observed in the final measurement (p = 0.021). The teamwork dimension had the highest mean score on all three measures and the notification dimension had the lowest mean scores. An educational intervention combining critical incident and RCA techniques can improves nursing students' attitudes toward patient safety.

Development of a Medication Safety Science Curriculum for Nursing Students

BACKGROUND

Medication errors, now thought to be 4 times greater than previous estimates, harm patients, families, health care institutions, and nurses themselves, who are second victims of their mistakes.

PROBLEM

Current nursing education may lack coherent medication safety frameworks other than the classic Five Rights construct.

APPROACH

This project piloted an educational intervention with senior associate degree nursing students based on high-reliability organization (HRO) safety principles.

OUTCOMES

Subjects evaluated the HRO safety concepts learning experience positively and improved pretest to posttest scores by 74%.

CONCLUSIONS

This study demonstrates subjects' ready acceptance and comprehension of HRO safety theory as applied to medication safety, an alternative to the Five Rights construct.

Innovative Methodologies to Teach Patient Safety in Undergraduate Nursing: Scoping Review

Objective: This work sought to identify the innovative methodologies used to teach patient safety in undergraduate Nursing. Materials and method: this is a scoping review conducted according to the recommendations by the Joanna Briggs Institute Reviewers’ Manual, through the databases: Medline/PubMed, Cumulative Index of Nursing and Allied Health, Scopus, Web of Science, Education Resources Information Center, Latin American and Caribbean Literature on Health Sciences, Catálogo de Tesis de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, The National Library of Australia’s Academic Archive Online, Digital Access to Research Theses Europe E-Theses Portal, Electronic Theses Online Service, Repositório Científico de Acesso Aberto de Portugal, National ETD Portal, and Theses Canada. Results: the study included 19 studies, most of descriptive type (n = 8; 42.1 %) and quasi-experimental (n = 7; 36.8 %) with quantative approach (n = 11; 57.9 %), conducted in the United States (n = 4; 21.1 %), in 2013 (n = 4; 21.1 %) and 2017 (n = 4; 21.1 %). The innovative methodologies used to teach patient safety in undergraduate Nursing that were highlighted included the scenario of the care practice simulated in the laboratory (n = 14; 73.7 %) and educational videos (n = 7; 36.8 %). Conclusions: it was identified that innovative methodologies used to teach patient safety in undergraduate Nursing were simulation, videos, staging/role playing, and films, all applied in the classroom teaching modality.

Development of a safe drug administration assessment instrument for nursing students

OBJECTIVE

to determine the content and face validity of a safe drug administration assessment instrument for nursing students.

METHOD

quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice.

RESULTS

nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice.

CONCLUSION

the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

"To Err Is Human" but Disclosure Must be Taught: A Simulation-Based Assessment Study

INTRODUCTION

Although error disclosure is critical in promoting safety and patient-centered care, physicians are inconsistently trained in its practice, and few objective methods to assess competence exist. We used an immersive simulation scenario to determine whether providers with varying levels of clinical experience adhere to the disclosure safe practice guidelines when exposed to a serious adverse event simulation scenario.

METHODS

This was a prospective cohort study with medical students, junior emergency medicine (EM) residents (PGY 1-2), senior EM residents (PGY 3-4), and attending EM physicians participating in a simulated case in which a scripted medication overdose resulted in an adverse event. Each scenario was videotaped and scored by two expert raters based on a 6-component, 21-point disclosure assessment instrument.

RESULTS

There were 12 participants in each study group (N = 48). There was good interrater reliability (κ = 0.70). Total scores improved significantly as the level of training increased: medical student = 10.3 (2.7), PGY 1-2 = 12.3 (6.2), PGY 3-4 = 13.7 (3.2), and attending physicians = 12.8 (3.7) (P = 0.03). Seventy-five percent of participants did not address preventing recurrence of the error. Fifty-six percent offered no apology or only offered it with prompting from the patient; only 23% offered an apology with the initial disclosure.

CONCLUSIONS

We demonstrated suboptimal adherence to best practices guidelines for error disclosure when providers are assessed in an immersive simulation setting. Despite a correlation in performance of medical error disclosure with increased physician experience, this study suggests that healthcare providers may need additional training to comply with safe practice guidelines for disclosure of unanticipated adverse events.