Does Simulation Training for Acute Care Nurses Improve Patient Safety Outcomes: A Systematic Review to Inform Evidence‐Based Practice

Developing Clinical Judgment During Transition to Practice With Rapid-Cycle Deliberate Practice Simulation

BACKGROUND

New-to-practice nurses (NPNs) make more errors than their experienced peers, affecting patient safety and contributing to sentinel events. Additionally, new nurses have a high attrition rate in their first year of practice. Simulation-based education may bridge the gap between education and practice by supporting the development of clinical judgment of NPNs.

METHOD

With quality improvement methods, an intradisciplinary team implemented a quality improvement project to improve NPNs' clinical judgment skills. A multipatient simulation that used rapid-cycle deliberate practice gave NPNs an opportunity to refine clinical decision-making and communication skills.

RESULTS

In total, 24 NPNs participated in the pilot simulation. Pre- and postsurvey scores using the simulation effectiveness tool-modified showed self-reported improvement in clinical judgment and communication skills, among other competencies.

CONCLUSION

Rapid-cycle deliberate practice simulation may support the development of essential nursing competencies, along with increased confidence and enhanced psychological safety among NPNs. [J Contin Educ Nurs. 2024;55(11):549-555.].

Nursing students' perceptions and satisfaction with a self-learning methodology in simulated environments: A mixed-methods study

AIM

The aim of this study was to explore the perceptions and satisfaction of last-year nursing students with the Self-Learning Methodology in Simulated Environments (MAES©).

BACKGROUND

As a learning method, clinical simulation uses elements that replicate real clinical practice scenarios and facilitates the acquisition of competencies and learning objectives. Simulations promote critical thinking, knowledge, techniques and teamwork in nursing students. The Self-Learning Methodology in Simulated Environments (MAES©) is a method that integrates problem-based learning with realistic clinical simulation.

DESIGN

A cross-sectional mixed-method study implemented a simulation learning method as part of the mandatory nursing training practice; that was registered in Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/R89PZ).

METHODS

Students were invited to complete a cross-sectional questionnaire about satisfaction with the simulation and were asked to participate in an interview about their perceptions on the simulation. All data were collected in December 2023 in a mid-sized southern Spanish university. A total of 69 last-year nursing students were enrolled in the simulation course and were selected using eligibility criteria.

RESULTS

Satisfaction measures showed no significant differences across gender, university access, or age (p>0.05 each). However, strong correlations were found between students' preference for the simulation method and perceived effort value (p<0.001 each). Qualitative analysis identified key themes in different stages of simulation (prebriefing, scenario, briefing, debriefing), simulation benefits (learning, usefulness, positive emotions) and challenges (difficulty, realism, time constraints). Despite some realism concerns, overall, students viewed the methodology positively.

CONCLUSIONS

The findings of this study underscore the vital role of simulation-based learning in nursing education. As the field of nursing continues to evolve, so too must the educational methods we employ, with simulation-based learning standing at the forefront of this transformative journey.

Using In Situ Simulation to Identify Latent Safety Threats in Emergency Medicine: A Systematic Review

SUMMARY STATEMENT

This review aimed to explore existing literature on the use of in situ simulation to identify latent safety threats in emergency medicine. Studies were required to take place in a clinically active emergency department and have either a primary or secondary aim of identifying latent safety threats. A total of 2921 articles were retrieved through database searches and a total of 15 were deemed to meet the inclusion criteria.Latent safety threats were detected by a variety of methods including documentation during debrief/discussion (66%), during the simulation itself (33%), participant surveys (20%), and video analysis (20%). Using a multimodality approach with input from observers and participants from different professional backgrounds yielded the highest number of threats per simulation case (43 per case). Equipment was the most commonly reported threat (83%), followed by teamwork/communication (67%). Some studies did not report on mitigation of identified risks; formal processes should be implemented for the management of latent safety threats identified by in situ simulation. Future research should focus on translational outcomes to further strengthen the position of in situ simulation in emergency medicine.

Simulation-based caregiving skills training for family members of high-grade glioma patients

Background

Because family caregivers of patients with a high-grade glioma experience high levels of distress and feel unprepared to perform the complex caregiving tasks associated with the disease and its treatment, we pilot-tested a caregiving skills intervention that integrates hands-on caregiving with coping skill training.

Methods

In this single-arm trial, caregivers participated in a 4-session research nurse-led intervention involving simulation-based caregiving skills training at the hospital and psychoeducation delivered via videoconference. We collected measures of patients' and caregivers' psychological symptoms; caregivers' caregiving self-efficacy and role adjustment; and patients' cancer-related symptoms (MDASI) at baseline and again postintervention. We tracked feasibility data.

Results

We approached 29 dyads of which 10 dyads (34%) consented. All patients (mean age: 60 years, 89% male) and caregivers (mean age: 58 years, 80% female, 80% spouses) completed the baseline and 7 dyads completed the follow-up assessments (attrition was related to patient's hospice transfer). Seven caregivers completed all 4 sessions and rated the program as beneficial. Paired t-tests revealed a significant improvement in caregiving self-efficacy at 6 weeks postintervention (t = -3.06, P = .02). Although improvements in caregiver role adjustment and patient and caregiver symptoms were not observed, no decreases in symptom burden or role adjustment were found during the follow-up period.

Conclusions

This novel supportive care program appears to be safe, feasible, acceptable, and perceived as useful for caregivers of patients with high-grade glioma. Based on feasibility indicators and a signal of intervention efficacy, a randomized controlled trial is warranted.

Gaining experience in the provider role: Exploration of a novel simulation intervention to prepare nurse practitioner students to detect and manage skin cancer

BACKGROUND

The high prevalence and negative outcomes associated with skin cancer demand effective strategies to prepare nurse practitioner students to detect cancerous lesions and manage patient care. However, few studies have examined dermatologic simulations to prepare nurse practitioner students to detect and manage skin cancer.

PURPOSE

An exploratory-descriptive qualitative approach was used to examine nurse practitioner students' experiences with simulations involving standardized patients wearing three-dimensional (3-D) prosthetic skin lesions, perceptions of ability to apply the simulations to clinical practice, and preferences for learning dermatologic care.

METHODOLOGY

A convenience sample of 39 nurse practitioner students participated in simulations with standardized patients wearing 3-D skin lesions. Focus groups were conducted following simulation participation, and thematic analysis was performed by two researchers.

RESULTS

Four themes emerged: Simulation provides a safe place to practice , Dermatology should be an integral part of education , Realism makes a difference , and Improved confidence and preparation for practice .

CONCLUSIONS

Simulations with standardized patients wearing 3-D skin lesion prosthetics provided students the opportunity to assess, diagnose, and manage the care of patients with cancerous skin lesions. Participants valued the realistic practice with dermatologic care and reported improved confidence and preparation for practice.

IMPLICATIONS

Faculty can use simulations to provide experiential learning about the provider role in general and as it pertains to skin cancer care. Attention to realism is important to aid in building students' confidence and preparation for practice.

Implementing a Standardized Phase-of-Care Craniotomy Education Program

Leaders at a community hospital in the southeastern United States sought to add a craniotomy program to meet the needs of the local patient population. Perioperative and critical-care nurses required specific knowledge and skills to care for patients undergoing craniotomy procedures. The facility's education team applied adult learning theories and an innovation diffusion framework when developing an evidence-based craniotomy education program. A clinical nurse specialist conducted a gap analysis and readiness assessment to determine the nurses' knowledge, skills, and competence to care for patients; attitudes and behaviors toward implementation of the new program; and preferred learning methods. The three-tiered phase-of-care education program included didactic learning sessions, shadowing experiences, hands-on experience with equipment, and simulation sessions. The program focused on effective collaboration and care transitions. Nurses were satisfied with the program, and they continue to participate in ongoing quarterly simulation sessions with case study scenarios to enhance their skills.

Using Video to Describe the Patient-Controlled Analgesia Pump Programming Process: A Qualitative Study

BACKGROUND

Patient-controlled analgesia (PCA) pumps are complex medical devices frequently used for postoperative pain control. Differences in how nurses program PCA pumps can lead to preventable medication errors.

PURPOSE

To describe similarities and differences in how surgical nurses program PCA pumps.

METHODS

We conducted a qualitative study using video reflexive ethnography (VRE) to film nurses as they programmed a PCA pump. We spliced and collated videos into separate clips and showed to nursing leaders for their deliberation and action.

RESULTS

We found nurses ignored or immediately silenced alarms, were uncertain about the correct programming sequence, and interpreted how to load a syringe in the pump in multiple ways; in addition, the PCA pump design did not align with nurses' workflow.

CONCLUSIONS

VRE was effective in visualizing common challenges nurses experienced during PCA pump programming. Nursing leaders are planning several nursing process changes due to these findings.

Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

BACKGROUND

Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature.

METHODS

This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar.

RESULTS

A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs.

CONCLUSIONS

Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.

Room of horrors simulation in healthcare education: A systematic review

OBJECTIVES

A room of horrors simulation is one tool that healthcare educators use to improve learners' awareness of patient safety hazards and other critical matters in a safe and controlled environment. This review aimed to summarize research on use of room of horrors simulation in healthcare education, examine its effectiveness, and recommend directions for future education and research.

DESIGN

A systematic review of the literature.

DATA SOURCES

Relevant publications in English were identified in PubMed, Embase, CINAHL, Scopus, and dissertation databases, and through a manual search of the reference lists of included articles.

REVIEW METHODS

The systematic review and its reporting process conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Included articles were evaluated for quality using the Mixed Methods Appraisal Tool. Two authors independently extracted data from each article, and two additional authors confirmed the accuracy of the extracted data. The "horrors" used in the studies' simulations were mapped into 13 different incident types.

RESULTS

Sixteen studies were included in the final review. All of them were conducted in Western countries. Simulation scenarios were developed based on existing resources, expert guidance, or patient safety concerns frequently reported at a particular institution. The number of horrors per scenario ranged from nine to 68, with the most common being medication-related and clinical procedure-related incidents. Participants completed a room of horrors simulation as individuals, a team, or both. When competing as a team, the team sizes ranged from two to 11. Studies reported high participant satisfaction.

CONCLUSIONS

Room of horrors simulation is a useful teaching tool for healthcare students and professionals. However, there is little conclusive evidence about the ideal composition and size of teams, and therefore this merits more research attention, as does attention to the longer term impacts on learners.

Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation

INTRODUCTION

Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training.

METHODS

We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test.

RESULTS

A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers.

DISCUSSION

Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.

The Effect of Simulation on Newly Licensed Nurses' Confidence in Initiating Cardiopulmonary Resuscitation: A Narrative Review

Hospitalized patients experiencing cardiac arrest are more likely to receive resuscitative interventions such as cardiopulmonary resuscitation (CPR), advanced cardiac life support, and defibrillation, than patients who experience a cardiac arrest outside the hospital setting. Annually, there are nearly 290,000 inpatient cardiac arrests each year in the United States. These cardiac arrests are associated with a mean survival rate of only 25%. Increasing nurses' feelings of confidence in initiating CPR may lead to faster reaction times, shorter hospital stays, and improved patient outcomes. A narrative review of literature about the effectiveness of simulations on newly licensed nurses' perceived confidence in initiating CPR confidence levels yielded 16 articles.

Validating a Simulated Emergency Course for Nurses Working in ENT

OBJECTIVES

Nurses are increasingly providing routine and emergency ENT care; yet there are often limited training opportunities. The aim of this study was to validate an intensive 1-day ENT emergency simulation course for nurses.

METHODS

The course included short lectures, practical skills stations and mannequin simulation scenarios. Sixteen nurse participants were video-recorded managing simulated scenarios before and after the course. Two assessors scored individual participant performance on a 15-point competency grid (maximum score 30), blinded to the timing of the recording. Participants also rated their confidence and skill before and immediately following the course across 11 items using a 5-point Likert score (maximum score 55).

RESULTS

Blinded assessor ratings for performance were significantly improved after the course compared to baseline (overall score 12 vs 7, respectively; P = .015). There was strong assessor inter-rater reliability (R = 0.965). Self-rated skills and confidence also increased following the course (46.7 vs 24.4 at baseline; P < .01).

CONCLUSION

Simulation-based training is an effective and desirable method of teaching ENT emergency management to nurses, with greatest impact on participant confidence. Future courses need to refine the content and increase the validation sample size using a nurse-specific scoring system.

Scaffolding safety in nursing simulation: A grounded theory

BACKGROUND

Simulation-based learning is a teaching technique that allows learners to apply theoretical knowledge to enhance patient safety. Despite limited evidence about the relationship between simulation and patient safety outcomes, nursing programs continue using simulation to improve student competencies.

PURPOSE

To explore the processes driving the actions of nursing students while providing care for a rapidly deteriorating patient during a simulation-based experience.

METHOD

Following the constructivist grounded theory method, the study recruited 32 undergraduate nursing students to explore their experiences during simulation-based experiences. Data were collected using semi-structured interviews over 12 months. Interviews were recorded, transcribed and analyzed using constant comparison and simultaneous data collection, coding, and analysis.

RESULTS

Two theoretical categories emerged from the data to explain the processes driving the students' actions during simulation-based experiences: Nurturing and contextualizing safety. The themes revolved around a core category of "Scaffolding Safety" in simulation.

CONCLUSION

Simulation facilitators can use the findings to build effective and targeted simulation scenarios. Scaffolding safety steers students' thinking and contextualizes patients' safety. It can be utilized as a lens to guide students and assist them with transferring skills from simulation to the clinical practice setting. Nurse educators should consider deliberately integrating the concepts of scaffolding safety into simulation-based experiences to connect theory and practice.

The Outcomes of an Interprofessional Simulation Program for New Graduate Nurses

This study explored the learning outcomes of an interprofessional simulation program for new graduate nurses during their training program. It was a single-group, pre-test and post-test research design. Ninety-three new graduate nurses participated in the study. The Nursing Competence Instrument and program satisfaction survey questionnaires were used to evaluate the learning outcomes of the program. Data were collected between 1 July 2019 and 30 June 2020 in a medical center in Taiwan. It was found that four nursing core competencies were significantly higher after the simulation, including advancing career talents (t = 10.12, p < 0.0001), integrating care abilities (t = 10.19, p < 0.001), dealing with tension (t = 6.87, p < 0.0001), and leading humanity concerns (t = 6.86, p < 0.001). The average satisfaction score for the interprofessional simulation training among nurses was 4.42 out of 5. In conclusion, interprofessional simulation education can help novice nurses improve their nursing core competencies. The results of this study provide an important indicator for hospitals and governments when making policy and training programs for new graduate nurses.

The Use of Patient Simulations to Teach and Assess Clinical Competencies in Colleges of Podiatric Medicine: A Survey of US Podiatric Medical Schools

Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric Medical Examiners implemented the Clinical Skills Patient Encounter, an examination using standardized patients. Similar clinical skills examinations already existed as part of medical and osteopathic licensure examinations. The purpose of this study was to assess the use of simulation-based education in the nine colleges of podiatric medicine in the United States to inform podiatric clinical faculty and other stakeholders about current trends within the podiatric education system. In 2019, the Clinical Skills Patient Encounter committee of the National Board of Podiatric Medical Examiners developed a survey and contacted each podiatric school to voluntarily participate. The mailed survey instrument gathered information on patient simulation modalities, years used, clinical content application, simulation program administration, facilities and equipment available, and the role of simulation educators. All nine schools participated anonymously. The survey showed that simulation modalities were used in all of the schools during the first 3 years, although there was considerable variance in their use.

High-fidelity simulation in undergraduate nursing education: A meta-analysis

OBJECTIVES

To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021.

REVIEW METHODS

The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I².

RESULTS

Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown.

CONCLUSIONS

High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

Critical Care Resource Nurse Team: A Patient Safety and Quality Outcomes Model

The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study

BACKGROUND

Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops.

OBJECTIVE

The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images.

METHODS

Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator's exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted.

RESULTS

A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course's objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students.

CONCLUSIONS

The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills.

What Should Be Considered in the Evidence-Based Practice Competency-Based Curriculum for Undergraduate Nursing Students? From the Student's Point of View

Background: The nursing curriculum should be systematically developed to improve the evidence-based practice (EBP) competencies of undergraduate nursing students. We attempted to identify the factors important for developing or improving the EBP-integrated nursing curriculum. Methods: This study adopted the qualitative research design using qualitative content analysis. A total of 168 study participants were included in the study. The participants were third-year nursing students at a private university located in southeastern South Korea. An open-ended question was asked: “To improve students’ EBP competencies during theory classes, on-campus practicums, or clinical practicums, what do you think is necessary?” Result(s): The analysis presented thirty themes, which were grouped into 10 sub-categories and further into four categories, and finally into three main categories. The students responded that they needed to form their own attitudes toward EBP. Regarding educator-related needs, students responded that effective teaching and learning methods should be used in classes. The students also suggested that the EBP process should be applied during clinical practicum. Regarding school-related needs, students suggested that EBP education should be applied at the beginning of the curriculum. Furthermore, the students recommended that repeated teaching should be used for EBP, and that EBP education should be connected to the major courses. Conclusions: The development of EBP competencies among undergraduate students is an important factor that can impact the nursing quality and patient safety. Based on the findings of this study, multidimensional efforts are needed to improve the liberal arts education of students and strengthen the educators’ competencies of EBNP and EBTP. Furthermore, schools should strive to assess students’ educational needs regularly and integrate the subsequent EBP-integrated nursing curricula consistent with these needs.

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.

Innovative Approach to Procedure Skills: A Nurse Practitioner Educator's Response to COVID-19

BACKGROUND

The The Neonatal Nurse Practitioner program at The Ohio State University transitioned from a traditional face-to-face program to a distance-enhanced hybrid model providing course content online with campus visits for procedural skills and simulation in 2017. Although the 2020 COVID-19 pandemic necessitated cancellation of all in-person events across the university, the neonatal nurse practitioner students' learning needs remained the same.

METHOD

The onsite experience was redesigned for virtual delivery. Procedural content was accomplished through student-led small-group collaborative critical thinking activities surrounding procedural complications, and other faculty-led scenario discussions.

RESULTS

Students collaborated for a Complications Rounds activity (1-day) that promoted learning about procedural skills from a global perspective including safe techniques, monitoring, risks, and troubleshooting complications.

CONCLUSION

Procedural content can be achieved when in-person learning is not possible. The Complications Rounds approach can mitigate delays or gaps in practical experiences. Examining complications in-depth increases preparedness, promoting greater awareness of harm prevention when these present in future practice. [J Nurs Educ. 2020;59(12):692-696.].

Evaluation of Simulation Outcomes

Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.

Simulations using telehealth to collaborate with other health-care professionals: effect on pre-licensure nursing students' competencies and amount of collaboration in the clinical setting

Nursing students must gain experience collaborating with other members of the health-care team. Simulation can provide intra- and interprofessional collaboration experience; however, there can be barriers such as scheduling difficulties. We evaluated multi-patient, standardized patient simulations using telehealth as a strategy to provide baccalaureate nursing students with opportunities to learn and practice intra- and interprofessional collaboration. Forty-four final-semester nursing students participated. Student groups rotated to the simulation laboratory over 12 weeks to participate in two simulations that used telehealth to enable them to communicate patient concerns to other clinicians: a nurse practitioner, respiratory therapists, and social workers. Self-reported collaborative competencies and amount of collaboration in the clinical setting were measured at the start and end of the semester. Satisfaction and self-confidence were measured immediately after each simulation. For collaborative competencies, there was a statistically significant improvement in all item, subscale, and overall scale mean scores. Amount of clinical collaboration significantly improved, with the amount who indicated they never reported a patient concern to another professional decreasing from 39.5% to 6.8%. Findings also revealed a high level of student satisfaction and self-confidence following the simulations. Using telehealth to collaborate during simulations is a promising strategy to prepare nursing students for practice by improving collaborative competencies and encouraging more collaboration in the clinical setting.

Toward an Integrative Nursing Curriculum: Combining Team-Based and Problem-Based Learning with Emergency-Care Scenario Simulation

Objective: The study intended to combine team-oriented, problem-based learning (PBL) with emergency-care simulation to investigate whether an integrative intervention could positively impact the core nursing competencies and teacher performance of nursing students. Methods: The study belonged to the domain of action research, which aimed to address the weaknesses of traditional teacher-led, lecture-based learning. An 18-week, single-case experimental design, in which 58 senior nursing students at a medical university in central Taiwan participated, was conducted to test the possible benefits of the intervention. The measures included the Scale of Core Nursing Competencies and the Teacher Performance Evaluation Scale. Results: The research results showed that nursing students who received integrative training that combined team-based PBL with emergency-care scenario simulation had stronger mastery over core nursing competencies. At the same time, they also evaluated both the “Emergency Care” course for which the curriculum was used and the teachers’ performance in that course more highly. Conclusions: The findings suggest that an integrative curriculum combining team-based PBL with scenario simulation is worth pursuing. Compared with traditional teacher-led, lecture-based teaching, this curriculum may be more effective in helping nursing students develop core competencies in their field.