Effectiveness of a Web-Based Simulation in Improving Nurses' Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study

Determining the effectiveness of a virtual service /patient-based education program on patient care and clinical decision-making in nursing: A quasi-experimental study

OBJECTIVE

The aim of this study was to determine the effectiveness of a virtual service/patient-based program (vSPBP) developed for nursing education and its effect on the development of care plan preparation and clinical decision-making skills.

METHODS

The study was conducted in a quasi-experimental design with a sample of fourth-year nursing students. Participants were assigned to the intervention group (n=44) and control group (n=51). The intervention group participated in a full-day vSPBP in addition to clinical training, whereas the control group received only the clinical training. Both groups were evaluated at the end of the intervention for care planning skills and at the beginning, middle, and end of the academic year for clinical decision-making skills. The Modified Simulation Effectiveness Tool (mSET) and focused group interview were used to evaluate the effectiveness of the vSPBP; nursing students' Clinical Decision-Making in Nursing Scale (CDM-NS) and Care Plan Evaluation Form were used to evaluate learning outcomes. Quantitative data were analyzed using the t-test and ANOVA. Qualitative data were analyzed by three researchers, and themes were identified. Ethical permissions were obtained from the relevant units.

RESULTS

The total score of the Turkish Version of the mSET was 84.39±12.08 (51-95) and the education program was found to be highly effective. The mean care plan preparation skills scores of the intervention and control groups were 44.84±2.77 and 27.75±4.28 (0-50), respectively, and the total scores of the CDM-NS (at the last measurement) were 147.90±11.28 and 146.42±12.21. While there was a significant difference between the intervention and control groups in the ability to prepare a care plan (p=0.001), there was no difference between the groups in clinical decision-making skills over time (p=0.433), between the second and third measurements over time (p>0.05), but both measurements increased significantly compared with the first measurement (p=0.000).

CONCLUSION

The vSPBP was determined to be an effective learning activity for the development of care plan preparation and clinical reasoning skills, as well as effective in closing the gap between theoretical and clinical knowledge and adaptation to the nursing process when applied in an integrated manner with the existing nursing program.

Student nurses' views on an E-Learning module on comfort, safety, and mobility with older adults: a cross-sectional study

BACKGROUND

Nursing students often receive insufficient training in older adults' care.

PURPOSE

Examine nursing students' perceptions of an e-learning module developed to enhance their knowledge about the comfort, safety, and mobility of older adults.

METHODS

A cross-sectional survey was administered to third-year baccalaureate nursing students at a Canadian university after they had completed the comfort, safety, and mobility module. The survey assessed students' perceptions of the e-learning module using four 5-pointLikert-type items. The survey also contained demographic questions and one open-ended question that invited participants to make any comments they wished. Descriptive statistics were used to summarize participants'demographic characteristics. Responses to the open-ended quesiton were summative content analyzed.

RESULTS

The survey was completed by 119 participants, who reported that the module increased their confidence, perceptions and knowledge in working with older adults. Participants also found the method of instruction to be convenient, interactive, and enjoyable.

CONCLUSIONS

Results suggest that the learning module has the potential to facilitate student nurses' learning about comfort, safety, and mobility.

Evaluating Clinical Skill Competence and Professional Behaviors in Nursing Students Following Simulation Training at the University of Tabuk

Introduction

Simulation training has become an integral component of nursing education, offering students opportunities to develop and refine their clinical skills in a controlled and safe environment.

Objective

This study aimed to evaluate the clinical skill competence and professional behaviors of undergraduate nursing students following simulation training.

Design

A descriptive cross-sectional design was employed for this study.

Setting

The study was conducted in the simulation center at the University of Tabuk using the Clinical Competency Questionnaire (CCQ), with data collected between January 1, 2023 and February 28, 2023. Participants were enrolled using a convenience sampling method, including nursing students in the 3rd and 4th years who trained in the simulation center and agreed to participate.

Results

The study results indicate that a majority of students demonstrated strong theoretical knowledge and practical competence in performing sterile techniques and administering oral medications with minimal or no supervision, with percentages of 74.7% and 73.3%, respectively. A significant proportion of students reported uncertainty or lack of skill in performing shift reports using SBAR (38.4%) and assessing gastrostomy tube placement (32.9%). Students exhibited satisfactory knowledge and competence in maintaining appropriate appearance, attire, and conduct (71.2%), understanding, and supporting group goals (71.2%), and comprehending patients' rights (69.9%).

Conclusion

The findings suggest that nursing students attain a relatively high level of clinical competence and self-confidence after simulation training. This study recommends incorporating simulation training in nursing education, which enhances professional behaviors like appearance, group goals, and patient rights, but requires improvement in constructive criticism, problem prevention, and cultural competence.

The effectiveness of education strategies for nurses to recognise and manage clinical deterioration: A systematic review

OBJECTIVES

To identify, critically appraise and synthesise evidence on the efficacy of education strategies for nurses to recognise and manage clinical deterioration, as well as provide recommendations for standardised educational programmes.

DESIGN

A systematic review of quantitative studies.

METHODS

Quantitative studies published in English between 1 January 2010 and 14 February 2022 were chosen from nine databases. Studies were included if they reported education strategies for nurses to recognise and manage clinical deterioration. The quality appraisal was performed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project. The data were extracted and the findings were integrated into a narrative synthesis.

RESULTS

Altogether, 37 studies published in 39 eligible papers were included in this review, encompassing 3632 nurses. Most education strategies were determined to be effective, and outcome measures can be divided into three types: nurse outcomes; system outcomes; and patient outcomes. The education strategies could be divided into simulation and non-simulation interventions, and six interventions were in-situ simulations. Retention of knowledge and skills during the follow-up after education was determined in nine studies, with the longest follow-up interval totalling 12 months.

CONCLUSIONS

Education strategies can improve nurses' ability and practice to recognise and manage clinical deterioration. Simulation combined with a structured prebrief and debrief design can be viewed as a routine simulation procedure. Regular in-situ education determined long-term efficacy in response to clinical deterioration, and future studies can use an education framework to guide regular education practice and focus more on nurses' practice and patient outcomes.

Expansion of MyDispense: A Descriptive Report of Simulation Activities and Assessment in a Certified Pharmacy Technician Training Program

BACKGROUND

Yale New Haven Health (YNHH) implemented a pharmacy technician training program in 2016. The curriculum includes 14 weeks of combined didactic and simulation hours (280 h in total), followed by 360 h of experiential learning. MyDispense, an online pharmacy simulation, allows students to develop and practice their dispensing skills in a safe environment with minimal consequences for mistakes. We describe a novel innovation, expanding the functionality of MyDispense to the training of pharmacy technicians.

METHODS

Technician training coordinator, supervisor, faculty members with experience in MyDispense, and experiential pharmacy students created cases within the MyDispense software that were targeted towards pharmacy technician activities. Activities were aligned with current American Society of Health-System Pharmacists (ASHP)-Accreditation Council for Pharmacy Education (ACPE) Accreditation Standards for pharmacy technician education and training programs.

RESULTS

A total of 14 cases were developed to be utilized in student technician training, and account for approximately 14 h of simulation.

CONCLUSIONS

MyDispense is an innovative software that could allow students to access and complete exercises, and to continue developing dispensing skills in a safe, remote environment. We identified similarities between activities performed by student pharmacists and student pharmacy technicians, expanding MyDispense to a new learner group to practice, develop and be assessed on dispensing skills within their scope, as part of a formal technician training program and in preparation for the Pharmacy Technician Certification Examination (PTCE).

Implementation of a Web-Based Educational Intervention for Promoting Flipped Classroom Pedagogy: A Mixed-Methods Study

Introduction

Flipped classroom pedagogy (FCP) is recognised as an effective and efficient teaching-learning method. However, nursing students and teachers may be hesitant to adopt FCP due to technophobia and time constraints linked to academic and clinical responsibilities. This necessitates the provision of promotional training for adopting FCP. However, there is a dearth of research regarding how the practice of FCP could be promoted and in demonstrating its efficacy in developing countries. Thus, this study aimed to examine the educational impact of a web-based education intervention, branded as the Flipped Classroom Navigator (FCN), for promoting FCP in nursing education in Sri Lanka.

Methods

This mixed-methods study employed pre- and post-training knowledge tests, the Instructional Materials Motivation Survey (IMMS), the Perceived Transfer of Learning Questionnaire survey, and collected students' and teachers' open-ended responses to evaluate the impact of the FCN. Fifty-five undergraduate nursing students and 15 university teachers participated in the study from two state universities in Sri Lanka. Repeated-measures ANOVA, t-tests, Levene's test of homogeneity, Cohen's d, and an inductive thematic approach were employed in the data analysis.

Results

Post-training knowledge test scores were significantly higher than the pre-training knowledge test scores indicating improved understanding of FCP. Participants were also highly motivated to learn in the FCN instructional materials. Participants exhibited positive attitudes towards FCN training with transfer of learning to their teaching-learning practice. The inductive thematic analysis identified the following themes: user experiences, FCN learning content, behaviour changes, and suggested improvements.

Conclusion

Overall, the FCN enhanced both students' and teachers' knowledge and understanding of FCP in undergraduate nursing education.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-022-01706-7.

E-learning modules to enhance student nurses' perceptions of older people: a single group pre-post quasi-experimental study

OBJECTIVES

To examine whether e-learning activities on cognitive impairment (CI), continence and mobility (CM) and understanding and communication (UC) improve student nurses' knowledge and attitudes in the care of older adults.

METHODS

A quasi-experimental single group pre-post-test design was used. We included 299 undergraduate nursing students for the CI module, 304 for the CM module, and 313 for the UC module. We administered knowledge quizzes, Likert scales, and a feedback survey to measure student nurses' knowledge, ageist beliefs, and feedback on the modules respectively.

RESULTS

Participants demonstrated significantly more knowledge and reduced ageist attitudes following the e-learning activities.

CONCLUSIONS

Findings suggest that e-learning activities on cognitive impairment, continence and mobility, and understanding and communication improve knowledge and reduce ageist attitudes among nursing students.

Improving practicing nurses' knowledge of the cognitive impairment, continence, and mobility needs of older people

OBJECTIVES

To test if two e-learning modules - one on cognitive impairment, and one on continence and mobility - in older people would improve the knowledge of nurse members from the Canadian Gerontological Nurses Association and College of Licensed Practical Nurses of Alberta.

METHODS

A pre-post-test design was used to test 88 nurses' knowledge of cognitive impairment and 105 nurses' knowledge of continence and mobility and their perceptions of how the modules contributed to their learning.

RESULTS

There was a statistically significant increase in practicing nurses' knowledge about cognitive impairment (0.68 increase), continence (2.30 increase), and its relationship to mobility. Nurses' self-report on the feedback survey demonstrated increases in knowledge, confidence, and perceptions about older people.

CONCLUSION

These results suggest the modules have strong potential to enhance practicing nurses' knowledge about cognitive impairment, continence, and mobility.

The transcultural adaptation and validation of the Chinese version of the Attitudes Toward Recognizing Early and Noticeable Deterioration scale

Background

In China, clinical deterioration events present a real problem for every clinical nurse. Patient deterioration is determined in part by nurses' attitudes toward early recognition of clinical deterioration. However, research on attitudes toward the early identification of clinical deterioration is still in its infancy, and even less research has been done on ward nurses' attitudes toward the early identification of clinical deterioration. To drive behavioral change and improve the care of deteriorating patients, nurses need comprehensive, valid, and reliable tools to assess their attitudes toward early identification of deterioration.

Objective

In this study, we aimed to translate the Attitudes Toward Recognizing Early and Noticeable Deterioration (ATREND) scale into Chinese and to assess its validity and reliability tests.

Methods

From March 2022 to July 2022, the ATREND scale was translated, back-translated, and cross-culturally adapted into the Chinese version using a modified Brislin translation model. Then, 460 ward nurses were recruited from tertiary Grade A general hospitals in two cities: Shenyang and Jinzhou in Liaoning Province, China. Reliability analyses were conducted using internal consistency, split-half, and test-retest reliability. We convened a committee of experts to determine the validity of the content. Tests of the structural validity of the scale were conducted using exploratory and validation factor analyses.

Results

The Cronbach's α value of the Chinese version of the ATREND scale was 0.804, and the Cronbach's α value of the dimensions ranged from 0.782 to 0.863. The split-half reliability and test-retest reliability were 0.846 and 0.711, respectively. Furthermore, the scale has an index of content validity of 0.922, indicating a high level of content validity. In exploratory factor analysis, eigenvalues, total variance explained, and scree plot supported a three-factor structure. The three-factor model supported by this study was confirmed by confirmatory factor analysis (CFA). Moreover, the model fitting indexes (e.g., χ ²/DF = 1.498, GFI = 0.954, RMSEA = 0.047) were all within acceptable limits based on the CFA.

Conclusion

The Chinese version of the scale is reliable and valid among ward nurses. Nursing educators and clinicians will be able to develop targeted educational programs to enhance the competence and behaviors of Chinese ward nurses in recognizing clinical deterioration. It will be based on the developed scale to assess Chinese nurses' attitudes and practices regarding early recognition of clinical deterioration. As a result, it is necessary to consider the Chinese scale's three-factor structure. The developed three-factor structured scale will assess Chinese ward nurses' attitudes and practices toward patient observation and vital sign-monitoring empowerment, enlightening them on the importance of patient observation, encouraging ward nurses to use a wider range of patient assessment techniques to capture early signs of clinical deterioration, and helping ward nurses to develop clinical confidence to monitor clinical deterioration.

Effectiveness of a combined web-based and simulation-based continuing education on home-care professionals' competence to evaluate older people's acute care needs in Finland

Home-care professionals need competences to ensure that they evaluate their older peoples' health conditions, especially in acute care situations. This study aims to investigate the effectiveness of combined web-based and simulation-based continuing education on home-care professionals' competence regarding evaluating older people's needs for acute care. A quasi-experimental pre-test-post-test study was conducted with home-care professionals who were working in older people's care in Finland. Home-care professionals (N = 254) had participated in combined web-based and simulation-based continuing education in 2017-2019. Data were collected using a questionnaire developed for this study before (n = 171) and after (n = 83) the education. The data were analysed statistically. The mean competence score was 3.22 ± 0.51 before the education and 3.92 ± 0.57 after the education. Improvements were detected in overall competence and in all eight subscales. Improvements were highest in health assessment and consultation and the lowest in type 2 diabetes, but this was already the highest level of self-assessed competence in the pre-test assessment. The combined web-based and simulation-based continuing education was effective in increasing the home-care professionals' competence in evaluating older people's needs for acute care. Evaluating older people's needs for acute care should be embedded in curricula and continuing education programmes.

Using an E-learning activity to enhance student nurses' understanding of cognitive impairment

BACKGROUND

Nurses often lack the knowledge and expertise to work with older people with cognitive impairment, which includes dementia, delirium and depression. This is due in part to deficits in their basic nursing education related to older people and managing the care needs of people with cognitive impairment. We developed an e-learning activity to facilitate student nurses' knowledge of cognitive impairment.

OBJECTIVES

To test if the e-learning activity could improve student nurses' knowledge of cognitive impairment and whether they would find the style of learning beneficial.

DESIGN

A quasi-experimental pre-post-test design was used to test if the cognitive impairment e-learning activity could improve student nurses' knowledge about assessing and managing the needs of older people who are experiencing cognitive impairment. A 12-item true/false quiz was completed by participants.

SETTINGS

One large Western Canadian university.

PARTICIPANTS

Second year nursing students in the four-year baccalaureate degree program, second year nursing students in the bilingual four-year baccalaureate degree program, and first year nursing students in the two-year after-degree nursing program were invited to participate. Data from 166 students were included in the analysis (n = 166).

RESULTS

Based on the results of a paired t-test (p < 0.001 and an average score increase of 1.12 out of nine), we conclude that students' knowledge about cognitive impairment in older people increased following the e-learning activity. Students also offered qualitative feedback that identified the activity as both helpful and as an enjoyable way to learn and provided suggestions for improvement.

CONCLUSIONS

This e-learning activity was effective in helping students learn about how to work with older people experiencing cognitive impairment. This mode of learning might be useful for other difficult-to-teach content areas.

Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial

BACKGROUND

Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills.

OBJECTIVE

The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills.

METHODS

This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01.

RESULTS

All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious.

CONCLUSIONS

Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.

Awakening Canadians to ageism: a study protocol

Background

Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies.

Methods

To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies.

Discussion

Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

Asynchronous group learning in learn from the learner approach: A Learning Object That Enhances and Facilitates Distance Self and Shared Learning

Learning with the learner in an asynchronous group learning approach is a promising method of education that provides a rich, interactive, and socially mediated education. As online learning became more prevalent, and more users are adopting this approach, innovative and theory-based educational activities became necessary. In this article, we introduce and describe a novel form of asynchronous, interactive, and socializing educational activity using educational technology.

The educational session is based on a small group learning activity that is made available for all learners anywhere and anytime. The approach avoids the trap of using educational technology for mere simulation of in-person learning. Based on learning theories, learning with the learner enhances interactive, self-directed, experiential, and social learning. Future development and enhancement with ongoing discussions through online chat platforms open the door for the continuous evolution of the concept.

•

Educational technology has evolved from basic use to provide self-directed learning opportunities for learners.

•

Learning from learners offers a stimulating, socially interactive, and entertaining educational alternative approach.

•

It provides a better alternative to the classical video lectures or other unidirectional delivery of information activities.

•

It is a practical, easy to structure with a low-cost approach that accommodates how students like to learn.

Testing and e-learning activity designed to enhance student nurses understanding of continence and mobility

OBJECTIVES

The aim of this study was to test if the e-learning activity that we developed could improve student nurses' knowledge of continence and mobility and whether or not students would find the style of learning beneficial.

METHODS

A quasi-experimental pre-post-test design was used to test if the continence and mobility e-learning activity could improve student nurses' knowledge about assessing and managing the needs of continence and mobility. An 18-item true/false knowledge of continence quiz was completed by 116 student nurses and a Likert style feedback learning survey was completed by 135 nursing students.

RESULTS

There was a statistically significant increase in students' knowledge about continence and its relationship to mobility following the e-learning activity. The e-learning activity also enhanced students' knowledge, confidence and perceptions about older people.

CONCLUSIONS

The e-learning activity we developed has the potential to improve nursing students' knowledge about continence and mobility in an enjoyable manner.

The impact of web-based and face-to-face simulation education programs on nurses' response to patient deterioration: A multi-site interrupted time series study

BACKGROUND

Nurses' response to patient deterioration in acute hospital wards is a priority issue. Simulation education programs improve nurses' knowledge and confidence, but the translation into better care is largely unknown for both web based (WB) and face to face (F2F) simulation programs.

AIM

To measure the impact of simulation education on nurses' response to patient deterioration in acute medical ward settings, and to compare the impact of WB and F2F versions.

DESIGN

An interrupted time series, non-randomised trial across four medical wards in Victoria, Australia. Wards were allocated to either web-based or face-to-face versions of the same simulation program, FIRST2ACT. Interrupted time series measurement for six fortnights both before and after the intervention were used to measure and compare responses to deterioration. Responses to patient deterioration were extracted from medical records and grouped into outcomes for escalation (e.g. initiation of clinical review), assessment and observation (e.g. increased recording of vital signs, conscious state and pain scores) and clinical interventions (e.g. oxygen administration).

RESULTS

126 nurses (89%) participated across the four wards. 946 patient records (506 in the F2F; 440 in the WB group) were included in analyses. There were significant and sustained improvements between pre and post samples in outcomes for escalation (13.0% to 28.8%; p = 0.000) and assessment and observation (conscious state recorded increased from 91.1% to 100%; p = 0.000, and pain score recorded increased from 97.8% to 99.8%; p = 0.000). There were no differences between the web-based and face-to-face groups except in appropriate oxygen application which increased by 7.7% in the F2F group and decreased by 11.8% in the WB group (p = 0.046).

CONCLUSIONS

There was a significant improvement in nurses' response to patient deterioration following both versions of simulation, indicating that both have a role to play in supporting nurses' response to patient deterioration.

A systematic review of rapid response applications based on early warning score for early detection of inpatient deterioration

AIM

The aim of this study was to investigate the effectiveness of current rapid response applications available in acute care settings for escalation of patient deterioration. Current challenges and barriers, as well as key recommendations, were also discussed.

METHODS

We adopted PRISMA review methodology and screened a total of 559 articles. After considering the eligibility and selection criteria, we selected 13 articles published between 2015 and 2019. The selection criteria were based on the inclusion of studies that report on the advancement made to the current practice for providing rapid response to the patient deterioration in acute care settings.

RESULTS

We found that current rapid response applications are complicated and time-consuming for detecting inpatient deterioration. Existing applications are either siloed or challenging to use, where clinicians are required to move between two or three different applications to complete an end-to-end patient escalation workflow - from vital signs collection to escalation of deteriorating patients. We found significant differences in escalation and responses when using an electronic tool compared to the manual approach. Moreover, encouraging results were reported in extensive documentation of vital signs and timely alerts for patient deterioration.

CONCLUSION

The electronic vital signs monitoring applications are proved to be efficient and clinically suitable if they are user-friendly and interoperable. As an outcome, several key recommendations and features were identified that would be crucial to the successful implementation of any rapid response system in all clinical settings.

Determining the effects of blended learning using the community of inquiry on nursing students' learning gains in sudden patient deterioration module

Aims

To determine the effectiveness of blended learning using the community of inquiry framework on nursing students' learning gains in a sudden patient deterioration module.

Design

A quasi‐experimental trial.

Methods

233 Chinese nursing students in their fourth semester of a sudden patient deterioration learning module were assigned to control (N = 113) and experimental group (N = 120). Students in experimental group engaged in community of inquiry‐based blended learning in sudden patient deterioration module, including computer‐aided self‐instruction, team‐based topic discussion and simulation training. Control group learned similar contents through face‐to‐face teaching comprising of a presentation with lecture, tutorial and simulation training. Student assessment of learning gains, knowledge and practical ability was quantified after the interventions.

Results

Compared with control group, students in experimental group had improved student assessment of learning gains (p = .001, Cohen d = 0.69) and practical ability (p < .001, Cohen d = 0.48). Although no significant difference in overall knowledge score, experimental group students did better performance in application and analysis (p = .001, Cohen d = 0.45).

Integration of a Virtual Dispensing Simulator "MyDispense" in an Experiential Education Program to Prepare Students for Community Introductory Pharmacy Practice Experience

BACKGROUND

Technology is increasingly used to enhance pharmacy education. We sought to evaluate student learning and preparedness for community introductory pharmacy practice experiences (IPPEs) after implementation of "MyDispense" into experiential education.

METHODS

Both first-year pharmacy students and assigned community IPPE preceptors were eligible. Students were stratified based on previous community pharmacy experience (< or ≥ 50 h), then randomized to complete MyDispense exercises before IPPE (group A) or after 24-32 h of IPPE (group B). We evaluated preceptors' assessment of student readiness using a 6-item Likert scale survey and students' readiness and opinion of MyDispense using an anonymous 9-item survey. Descriptive statistics were used to characterize data. The Mann-Whitney U test was used to compare groups and a p-value < 0.05 was considered statistically significant.

RESULTS

Of 177 eligible students, 155 were randomized and 56 completed study. Group A included 32 students; 56.3% had prior community practice experience. Group B included 24 students; 50% had prior community practice experience. Forty-eight preceptors were enrolled. Students who completed exercises before rotation received higher preceptor scores for patient counseling of self-care and of medications (p < 0.05 for both). Students self-assessed their counseling skills lower than all other skills; 30.4% and 42.9% of students felt mostly or always prepared to counsel for self-care and medications, respectively. Students found MyDispense straightforward, realistic, and appreciated the ability to practice in a safe, electronic, community pharmacy, patient-care environment.

CONCLUSION

Simulation-based software, such as MyDispense, can enhance learner understanding of the prescription fill and counseling process in a community pharmacy practice setting.

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.

Innovation in Education With Acute Care Nurses

As health care is continuously changing, it is important that nurses are continually learning to promote evidence-informed practice. eLearning has gained prominence to gain information and enhance learning within time and space constraints. Innovation such as gamification within and outside of eLearning has also risen in interest to increase engagement in the learning process. In this article, we discuss the usefulness of innovation such as gamification via an ePlatform for continuing education of acute care nurses. Although innovative methods using an ePlatform have the potential to meet nurses' desires for continuing education that is flexible and applicable to their work, more research is needed to understand its effectiveness among acute care nurses. [J Contin Educ Nurs. 2020;51(9):420-424.].

Assessing validity evidence for a serious game dedicated to patient clinical deterioration and communication

Background

A serious game (SG) is a useful tool for nurse training. The objectives of this study were to assess validity evidence of a new SG designed to improve nurses’ ability to detect patient clinical deterioration.

Methods

The SG (LabForGames Warning) was developed through interaction between clinical and pedagogical experts and one developer. For the game study, consenting nurses were divided into three groups: nursing students (pre-graduate) (group S), recently graduated nurses (graduated < 2 years before the study) (group R) and expert nurses (graduated > 4 years before the study and working in an ICU) (group E). Each volunteer played three cases of the game (haemorrhage, brain trauma and obstructed intestinal tract). The validity evidence was assessed following Messick’s framework: content, response process (questionnaire, observational analysis), internal structure, relations to other variables (by scoring each case and measuring playing time) and consequences (a posteriori analysis).

Results

The content validity was supported by the game design produced by clinical, pedagogical and interprofessional experts in accordance with the French nurse training curriculum, literature review and pilot testing. Seventy-one nurses participated in the study: S (n = 25), R (n = 25) and E (n = 21). The content validity in all three cases was highly valued by group E. The response process evidence was supported by good security control. There was no significant difference in the three groups’ high rating of the game’s realism, satisfaction and educational value. All participants stated that their knowledge of the different steps of the clinical reasoning process had improved. Regarding the internal structure, the factor analysis showed a common source of variance between the steps of the clinical reasoning process and communication or the situational awareness errors made predominantly by students. No statistical difference was observed between groups regarding scores and playing time. A posteriori analysis of the results of final examinations assessing study-related topics found no significant difference between group S participants and students who did not participate in the study.

Conclusion

While it appears that this SG cannot be used for summative assessment (score validity undemonstrated), it is positively valued as an educational tool.

Trial registration

ClinicalTrials.gov ID: NCT03092440

Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes

Background

Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training.

Objective

This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes.

Methods

In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions.

Results

The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points.

Conclusions

Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education.

Trial Registration

ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924

Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration: a randomized study in nursing students

BACKGROUND

Early detection and response to patient deterioration influence patient prognosis. Nursing education is therefore essential. The objective of this randomized controlled trial was to compare the respective educational value of simulation by gaming (SG) and a traditional teaching (TT) method to improve clinical reasoning (CR) skills necessary to detect patient deterioration.

METHODS

In a prospective multicenter study, and after consent, 2nd year nursing students were randomized into two groups: Simulation by gaming "SG": the student played individually with a serious game consisting of 2 cases followed by a common debriefing with an instructor;Traditional Teaching "TT": the student worked on the same cases in text paper format followed by a traditional teaching course with a PowerPoint presentation by an instructor. CR skill was measured by script concordance tests (80 SCTs, score 0-100) immediately after the session (primary outcome) and on month later. Other outcomes included students' satisfaction, motivation and professional impact.

RESULTS

One hundred forty-six students were randomized. Immediately after training, the SCTs scores were 59 ± 9 in SG group (n = 73) and 58 ± 8 in TT group (n = 73) (p = 0.43). One month later, the SCTs scores were 59 ± 10 in SG group (n = 65) and 58 ± 8 in TT group (n = 54) (p = 0.77). Global satisfaction and motivation were highly valued in both groups although significantly greater in the SG group (p < 0.05). The students declared that the training course would have a positive professional impact, with no difference between groups.

CONCLUSIONS

In this study assessing nursing student CR to detect patient deterioration, no significant educational difference (SCT), neither immediate nor 1 month later, was observed between training by SG and the TT course. However, satisfaction and motivation were found to be greater with the use of SG.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT03428269. Registered 30 january 2018.

Simulation and novice nurses: A review

OBJECTIVE

To identify the existing simulation session and the impact of simulation on novice nurse.

METHOD

The articles were searched through CINAHL, Scopus, Proquest, and OVID online database. Articles published from 2000, in English and among novice nurses were selected for review. Then, a narrative review was conducted guided by what are the existing simulation session been used and the impact on novice nurse.

RESULT

Total of 19 articles been selected for review out of 272 articles. The findings of the reviewed were divided into 3 main themes. The themes are the existing simulation session, simulation as a support tool in the transition program and the impact of simulation on novice nurses.

CONCLUSION

In summary, each simulation type has its learning domain. The effectiveness of the simulation will much depend on the appropriate simulation type selection.

Participant perceptions of virtual simulation to develop non-technical skills in health professionals

Background

Research has identified that virtual simulations may be effective in developing non-technical skills including communication, teamwork and decision making. However, little is known about how participants perceive learning non-technical skills via engagement in virtual simulation.

Aims

The aim of this research was to investigate participant perceptions and the learning experiences when engaging in virtual simulations focused on developing non-technical skills.

Method

A descriptive exploratory approach was used. An online voluntary survey collected qualitative extended responses from participants after each virtual simulation. Ethics approval was obtained for the research and guidelines adhered to throughout the study.

Results

A total of 675 responses were obtained. Participants perceive that engaging with the virtual simulation made them aware of non-technical skills including communication, teamwork, decision making, critical thinking and problem solving, and, to a lesser extent, situational awareness. Additional categories of learning, clinical practice and limitations were identified.

Conclusions

Engaging in virtual simulation can develop awareness of non-technical skills, as well as confidence and vigilance in practice and mindfulness of a person-centred approach to healthcare. Engaging in virtual simulation may support change in the professional performance of the participants through role modelling and learning through error.

Finding the Right Blend of Technologically Enhanced Learning Environments: Randomized Controlled Study of the Effect of Instructional Sequences on Interprofessional Learning

Background

With the availability and capabilities of varied technologically enhanced learning activities, the blended learning approach has become increasingly popular in interprofessional education. The combined use of different technologically enhanced learning activities has not been fully examined, particularly to determine the effects of instructional sequences for effective learning outcomes.

Objective

The objective of this study was to investigate whether the instructional sequences of a blended learning approach can improve students’ learning outcomes on interprofessional competencies.

Methods

A randomized controlled study was conducted with 40 interprofessional health care teams. These teams undertook three technologically enhanced learning activities—Web-based instruction (WI), virtual reality (VR), and simulation exercise (SE)—after random assignment to three groups based on three different instructional sequences (WI-VR-SE, WI-SE-VR, and SE-WI-VR). Pretests and posttests were conducted to evaluate the students’ learning outcomes on interprofessional competencies.

Results

A total of 198 participants from the three groups completed the questionnaires. All three groups reported significant improvement in their levels of self-efficacy (P<.05) and attitudes (P<.001) toward interprofessional team care about 1 month after the interprofessional learning activity. Although no significant difference was found (P=.06) between the WI-VR-SE and WI-SE-VR groups in the self-efficacy posttests, participants in the SE-WI-VR group reported significantly lower (P<.05) posttest scores than those in the WI-SE-VR group. The majority of the participants (137/198, 69.1%) selected the instructional sequence “WI-VR-SE” as their top preference.

Conclusions

This study shows that the instructional sequence of a blended learning approach can have a significant impact on students’ learning outcomes. The learning of concepts from WI followed by problem-solving activity in the SE was found to be a more effective learning sequence than the reverse sequence. We recommend that future studies focus on scaffolding students’ learning when planning instructional sequences for technologically enhanced learning activities within blended learning environments.

How do nurses use the early warning score in their practice? A case study from an acute medical unit

AIMS AND OBJECTIVES

This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS.

BACKGROUND

early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system.

DESIGN

A holistic single descriptive case study design was used.

METHODS

Data triangulation was used including non-participant observation, semi-structured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

RESULTS

Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes.

CONCLUSION

This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols.

RELEVANCE TO CLINICAL PRACTICE

Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored.

Effectiveness of a learning support program for respiratory physical assessment: A quasi-experimental study

BACKGROUND

Although the need for physical assessment in home nursing care has been shown, little research has examined the development of visiting nurses' physical assessment capabilities.

OBJECTIVES

This study aimed to evaluate the effectiveness of a learning support program to help working visiting nurses utilize their respiratory physical assessment skills.

DESIGN

This study used a quasi-experimental design of two groups with pre-test, post-test measurements of training and follow-up test 8 weeks practice in their work place after the training.

METHODS

57 currently working visiting nurses were assigned to 1 of 2 groups: a control group in which nurses would not receive any special support after respiratory physical assessment training, and an experimental group in which nurses would receive support to utilize the knowledge and skills they had learned during the training.

RESULTS

The average practical examination score was significantly higher after the training. In the experimental group, the average score 8 weeks after training was not significantly higher than that obtained just after training. Further, after 8 weeks, the experimental group's average score was not significantly higher than that of the control group. Practice evaluation scores obtained by an investigation of daily clinical practice were not significantly higher seventh weeks compared to third weeks after training for either the experimental or control groups. Seventh weeks after training, the average practice evaluation score of the experimental group was significantly higher than that of control groups. The mean learning support program satisfaction score was higher among the experimental group than the control group.

CONCLUSIONS

The results suggested that support from others was effective in maintaining motivation for learning and making use in the regular practice of the knowledge and skills acquired in the respiratory physical assessment training.

The educational impact of web-based and face-to-face patient deterioration simulation programs: An interventional trial

BACKGROUND

There are international concerns relating to the management of patient deterioration. The "failure to rescue" literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses' recognition and management of patient deterioration.

OBJECTIVES

To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs.

DESIGN & SETTING

A mixed methods interventional cohort trial with nursing staff from four Australian hospitals.

PARTICIPANTS

Nursing staff working in four public and private hospital medical wards in the State of Victoria.

METHODS

In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention.

RESULTS

Both WB and F2F participants' knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups' performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback.

CONCLUSION

WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education strategy is recommended to enhance competence and patient safety.

Qualitative study exploring factors influencing escalation of care of deteriorating children in a children's hospital

BACKGROUND

System-level interventions including rapid response teams and paediatric early warning scores have been designed to support escalation of care and prevent severe adverse events in hospital wards. Barriers and facilitators to escalation of care have been rarely explored in paediatric settings.

AIM

This study explores the experiences of parents and healthcare professionals of in-hospital paediatric clinical deterioration events to identify factors associated with escalation of care.

METHODS

Across 2 hospital sites, 6 focus groups with 32 participants were conducted with parents (n=9) and healthcare professionals (n=23) who had cared for or witnessed a clinical deterioration event of a child. Transcripts of audio recording were analysed for emergent themes using a constant comparative approach.

FINDINGS

Four themes and 19 subthemes were identified: (1) impact of staff competencies and skills, including personal judgement of clinical efficacy (self-efficacy), differences in staff training and their impact on perceived nursing credibility; (2) impact of relationships in care focusing on communication and teamwork; (3) processes identifying and responding to clinical deterioration, such as patient assessment practices, tools to support the identification of patients at risk and the role of the rapid response team; and (4) influences of organisational factors on escalation of care, such as staffing, patient pathways and continuity of care.

CONCLUSIONS

Findings emphasise the considerable influence of social processes such as teamwork, communication, models of staff organisation and staff education. Further studies are needed to better understand how modification of these factors can be used to improve patient safety.

Does simulation enhance nurses' ability to assess deteriorating patients?

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care.

Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

BACKGROUND

Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM) residency training. Traditionally, mannequins have been the simulation tool used in these scenarios.

OBJECTIVE

To compare IM residents' performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs) as compared to mannequin.

METHODS

Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis). Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score).

RESULTS

Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01). When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002).

CONCLUSIONS

Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents.

Implementation of a virtual dispensing simulator to support US pharmacy education

INTRODUCTION

A key element for pharmacy practice defined by the Accreditation Council for Pharmacy Education (ACPE) is medication use systems management. A web-based community pharmacy simulation originally created for Australian pharmacy students was adapted for pharmacy students in the United States (US). The objective of this study was to collaboratively adapt an existing international simulation program for utility in the US and measure student perceptions of a web-based community pharmacy simulation program in three US schools of pharmacy.

METHODS

An Australian development team in collaboration with US pharmacy school faculty modified the existing MyDispense software to create a virtual environment that accurately represented US community pharmacy practice. Students at three US schools of pharmacy used the newly adapted version of MyDispense and were surveyed on their prior experience in community pharmacy and their perceptions of MyDispense as a learning tool.

RESULTS

Overall 241 (44%) students completed the satisfaction survey. Approximately 40% of these students worked in a community pharmacy before starting pharmacy school. Most students agreed or strongly agreed that MyDispense was straightforward to learn (76%), was more realistic than addressing similar paper cases (73%), and offered a learning opportunity to safely make errors (84%). Qualitative thematic analysis revealed that MyDispense allowed students to practice how to gather patient information and ask appropriate questions, counsel patients, and practice the dispensing process.

DISCUSSION AND CONCLUSIONS

Response to the US version of My Dispense is positive and proves to be a viable option for introducing and reinforcing community pharmacy practice skills to students during in their pharmacy education.

The Effectiveness of Simulation on Recognizing and Managing Clinical Deterioration: Meta-Analyses

The purpose of these meta-analyses was to quantitatively synthesize the effectiveness of simulation on student nurses’ and registered nurses’ ability to recognize and manage clinical deterioration in the acute care setting. A search of the literature resulted in 22 reports and 19 studies meeting inclusion criteria. Four random-effects analyses were conducted to examine two-group posttest and single-group pre–posttest intervention effect sizes for knowledge and performance. A total of 41 effect sizes were calculated from the data extracted. The standardized mean difference ( d) for two-group posttest knowledge was d = 0.964 ( p = .001) and for performance was d = 1.382 ( p ≤ .001). The standardized mean difference for single-group pre–posttest knowledge was d = 1.231 ( p ≤ .001) and performance was d = 1.610 ( p ≤ .001). Findings indicate that simulation-based interventions have a positive effect on knowledge and performance. As simulation is increasingly used as a teaching modality in nursing, further research should aim to test standardized simulation-based education programs.