Nurturing a Nursing Workforce: Developing and Implementing Role-Play.

Nurses' demands and challenges can sometimes lead to burnout, compassion fatigue, and a lack of focus on self-care. Implementing innovative strategies, such as role-play, may be instrumental in nurturing and rejuvenating the health care workforce. Role-play simulations offer a promising method to support essential skills and practices for health care workers. Using health care simulation is a widely accepted method to enhance critical thinking and decision-making among health care professionals. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards Committee in 2021 released the Healthcare Simulation Standards of Best Practice (HSSOBP), providing a structured framework to build and implement quality simulation-based education. These standards guide simulation scenarios' development, implementation, and evaluation, ensuring they align with educational objectives and promote experiential learning. This article describes role-play and how to develop and implement role-play scenarios built upon the HSSOBP.

Remembering to Resume: A Randomized Trial Comparing Combined Interruption Management Training and Simulation-Based Education to Simulation-Based Education Alone.

AIM: This study aimed to determine if purposeful presimulation interruption management training impacts cognitive load and successful completion of simulation objectives more than the experience alone. BACKGROUND: Practicing nurses are frequently interrupted, increasing the risk for error and task time. Novices are particularly vulnerable to interruption consequences. METHOD: A between-subjects design and block randomization of prelicensure baccalaureate nursing students ( n = 146) was used to compare group differences in cognitive load, use of interruption management strategies, and completion of simulation required elements. Potential relationships between outcomes and age, mindfulness, and experience were explored. RESULTS: An analysis of covariance demonstrated significantly lower perceived mental demand for those receiving training. Older learners and those receiving training implemented more interruption management strategies. CONCLUSION: Combining simulation-based education (SBE) with purposeful training enhances interruption management more than SBE alone. Frequent interruption training and SBE are recommended to enhance risk awareness.

Mpox in the United States: Current implications for public health nursing.

In 2022, mpox, an orthopoxvirus first isolated in 1958 in cynomolgus monkeys, became a global public health threat. While the virus can be communicated through skin-to-skin contact from any infected person to non-infected person, most cases in the United States have been in gay and bisexual men. Consequently, early public health and community-based efforts concentrated on reducing infections in this population. This article explores current mpox case count epidemiologic data and trends. In addition, vaccination indications, contraindications, adverse events, and national administration data are provided along with directions for nurses and other clinicians moving forward in the outbreak.

Telehealth across nursing education: Findings from a national study.

BACKGROUND: The onset of COVID-19 perpetuated the necessity for nursing students to be telehealth savvy upon graduation. There is minimal research regarding the integration of telehealth in nursing curricula across multiple levels. PURPOSE: The purpose of this survey study was to determine the current or future use of telehealth content and experiences in prelicensure and graduate nursing program curricula. METHODS: Following vetting, an adapted survey was sent to 386 nursing program or simulation directors in June 2020. FINDINGS: The survey had a 21 % (n = 82) response rate. Fifty-five percent of prelicensure and 40 % of graduate programs had no telehealth curricular content, while 22 % and 45 %, respectively, planned to integrate. The top barrier to integration was a lack of funds. DISCUSSION: Further research is needed to evaluate telehealth in nursing curricula. Due to many factors, the addition of telehealth curricula in nursing schools is inevitable.

Nurse Practitioner Student Perceptions of a Pilot Simulated Gerontologic Telehealth Visit.

BACKGROUND: Recently published nurse practitioner (NP) education organization recommendations and telehealth equipment acquisition necessitated integration of telehealth simulation into NP curricula at a large, public university. The COVID-19 pandemic and associated rapid uptake of telehealth accelerated the need for evidence-supported research in tele-health simulation in NP education. METHOD: A formative gerontologic simulation scenario using telehealth robot technology was developed by synthesizing best practice guidelines for simulation and telehealth delivery. The simulated telehealth visit used standardized patients and embedded participants. Primary care NP students' perceptions of simulation effectiveness, situational realism, and telehealth robot usability were evaluated using three quantitative tools. RESULTS: Thirty-three primary care Doctor of Nursing Practice students participated in this gerontologic telehealth simulation. Students found the simulation to be effective and realistic, and found the telehealth robot technology to be usable. CONCLUSION: NP students positively evaluated this telehealth simulation experience. Additional research is needed on evidence-based teaching strategies to guide faculty in teaching and evaluating telehealth content. [J Nurs Educ. 2021;60(7):408-413.].

Considerations for the Effective Integration of Virtual Simulation in the Undergraduate Nursing Curriculum.

ABSTRACT: Nursing education employs a cadre of strategies to address faculty shortages, increased student admissions, and the decreased availability of clinical sites. Virtual simulation provides an innovative way to provide a robust learning experience that can be used in conjunction with or in lieu of some portion of clinical experiences. The authors highlight how virtual simulation can be used and outline considerations for educators considering virtual simulation integration.

Comparison of Clinical Options: High-Fidelity Manikin-Based and Virtual Simulation.

BACKGROUND: Minimal evidence compares nursing student outcomes when replacing clinical hours with manikin-based high-fidelity patient simulation (HFPS) or virtual simulation. PURPOSE: The study aims were to compare differences in outcomes: (1) between 2 intervention groups (HFPS or virtual simulation) when replacing 25% of pediatric/obstetrics clinical hours and (2) pass/fail for clinical practice between the intervention groups and a face-to-face clinical group (control). METHODS: A quasi-experimental study was conducted to determine differences in knowledge between intervention groups participating in 6 pediatric/obstetrics simulation scenarios. RESULTS: No differences in composite knowledge were found between simulation groups (P = .319). There also was no difference in clinical practice pass/fail among the groups. CONCLUSIONS: HFPS and virtual simulation were equally effective in achieving learning goals.

Standardizing nurse practitioner student evaluation during high-stakes clinical examinations.

ABSTRACT: Nurse practitioners (NPs) require clinical competence in advanced health assessment skills to differentiate between normal, variations of normal, and abnormal patient findings. High-stakes clinical examinations, using live hands-on simulation scenarios and standardized patients (SPs) or other human role players, are accepted teaching and evaluation tools for NP students. Providing objective, valid, and reliable feedback to students during high-stakes clinical examinations is of considerable value for ongoing skill development. The study examined opportunities to improve the quality of student evaluation in simulation testing modes. A purposive sample of 17 video recordings of health students' comprehensive examination of an SP or physical examination teaching associate (PETA) from a nursing graduate level health assessment course was evaluated. Using a standardized rubric, students were scored live and after a comprehensive examination of a SP/PETA and via a secure web-based video platform by the faculty and an independent reviewer. Evaluator group examination score comparisons revealed that distributions of examination scores within evaluator groups were not similar. Median examination scores were significantly different between groups; faculty median examination scores significantly higher than SPs/PETAs. Efficiency of student evaluation may be increased by improving reviewer training, reducing checklist length, and adopting electronic scoring. Development of an exemplary teaching video providing explanation and detail for expected student skill performance will allow reviewers to practice and improve competence in reliable scoring, reduce time and effort of scorers, and increase accuracy of scoring.

The Physical-Virtual Patient Simulator: A Physical Human Form With Virtual Appearance and Behavior.

INTRODUCTION: We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse). METHODS: We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board-approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed. RESULTS: Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories. CONCLUSIONS: We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.

Early Recognition of Pediatric Sepsis Simulation Checklist - An Exploratory Study.

PURPOSE: To report on the modification and exploration of a 21-item Early Detection of Pediatric Sepsis Assessment Checklist aimed at improving nursing students' recognition of key factors that contribute to early detection of sepsis in pediatric patients through clinical simulation. DESIGN AND METHODS: One hundred and thirty-one undergraduate, pre-licensure nursing students were evaluated using the adapted 21-item Early Detection of Pediatric Sepsis Assessment Checklist in simulation using high-fidelity manikins. Categorical Principle Component Analysis was used to evaluate for factor structure, with items accounting for <0.20 of the variance were dropped from the loadings. RESULTS: Two factors emerged from the analysis: assessment and deterioration, accounting for 68% of the variance. Factor one, assessment, contained nine items (α = 0.77; λ = 3.36). Factor two, deterioration, contained seven items (α = 0.72; λ = 2.85). Five items did not load and were dropped from the factor structure, resulting in a 16-item checklist. CONCLUSIONS: Two factors emerged from the analysis which is key to improving the early detection of pediatric sepsis. Assessment, factor one, accounted for the nursing students' central skills of recognizing baseline vital signs and timely medication administration. Deterioration, factor two, contained items reflecting the recognition of changes from baseline that require action. Conceptually, these factors reflect the most central points in the early detection of signs in pediatric patients at risk for sepsis. PRACTICE IMPLICATIONS: This checklist forms a valuable tool to assess the knowledge of pre-licensure students and may possibly be extended as a tool to assess the clinical readiness and performance of new graduates through the safety and supervision allotted by simulation.

The Impact of Critical Thinking on Clinical Judgment During Simulation With Senior Nursing Students.

AIM: The study examined the impact of critical thinking (CT) on clinical judgment (CJ) during a pediatric Objective Structured Clinical Evaluation (OSCE) with 160 pre-licensure nursing students. BACKGROUND: Educators are called to transform teaching strategies to develop CJ but confusion exists over definitions. METHOD: A descriptive correlational design was used to examine demographics and Tower of Hanoi (TOH) and Health Science Reasoning Test (HSRT) scores. CJ was measured by scores on the Lasater Clinical Judgment Rubric (LCJR) from videotaped OSCEs. RESULTS: Participants were: 86 percent female, 42 percent Caucasian, median 23 years, with 49 percent having health care experience. Students averaged seven moves over minimum on the TOH. Average scores were: HSRT 25/38 and LCJR 31/44. Statistically significant predictors of CJ were gender, ethnicity, HSRT deduction, and analysis; 11 CT variables accounted for 17 percent of LCJR scores. CONCLUSION: Educators need to utilize/develop innovative teaching strategies addressing CJ predictors.

Can a virtual patient trainer teach student nurses how to save lives--teaching nursing students about pediatric respiratory diseases.

INTRODUCTION: Virtual environments offer a variety of benefits and may be a powerful medium with which to provide nursing education. The objective of this study was to compare the achievement of learning outcomes of undergraduate nursing students when a virtual patient trainer or a traditional lecture was used to teach pediatric respiratory content. METHODS: This was a randomized, controlled, posttest design. A virtual pediatric hospital unit was populated with four virtual pediatric patients having different respiratory diseases that were designed to meet the same learning objectives as a traditional lecture. The study began in Spring 2010 with 93 Senior I, baccalaureate nursing students. Students were randomized to receive either a traditional lecture or an experience with a virtual patient trainer. Students' knowledge acquisition was evaluated using multiple-choice questions, and knowledge application was measured as timeliness of care in two simulated clinical scenarios using high-fidelity mannequins and standardized patients. RESULTS: Ninety-three students participated in the study, of which 46 were in the experimental group that received content using the virtual patient trainer. After the intervention, students in the experimental group had significantly higher knowledge acquisition (P = 0.004) and better knowledge application (P = 0.001) for each of the two scenarios than students in the control group. CONCLUSIONS: The purpose of this project was to compare a virtual patient trainer to a traditional lecture for the achievement of learning outcomes for pediatric respiratory content. Although the virtual patient trainer experience produced statistically better outcomes, the differences may not be clinically significant. The results suggest that a virtual patient trainer may be an effective substitute for the achievement of learning outcomes that are typically met using a traditional lecture format. Further research is needed to understand how best to integrate a virtual patient trainer into undergraduate nursing education.

Research regarding debriefing as part of the learning process.

INTRODUCTION: Debriefing is a process involving the active participation of learners, guided by a facilitator or instructor whose primary goal is to identify and close gaps in knowledge and skills. A review of existing research and a process for identifying future opportunities was undertaken. METHODS: A selective critical review of the literature on debriefing in simulation-based education was done. An iterative process of analysis, gathering input from audience participants, and consensus-based synthesis was conducted. RESULTS: Research is sparse and limited in presentation for all important topic areas where debriefing is a primary variable. The importance of a format for reporting data on debriefing in a research context was realized and a "who, when, where, what, why" approach was proposed. Also, a graphical representation of the characteristics of debriefing studies was developed (Sim-PICO) to help guide simulation researchers in appropriate experimental design and reporting. CONCLUSION: A few areas of debriefing practice where obvious gaps that deserve study were identified, such as comparing debriefing techniques, comparing trained versus untrained debriefers, and comparing the effect of different debriefing venues and times. A model for publication of research data was developed and presented which should help researchers clarify methodology in future work.

Alternative educational models for interdisciplinary student teams.

BACKGROUND: Few studies compare instructor-modeled learning with modified debriefing to self-directed learning with facilitated debriefing during team-simulated clinical scenarios. OBJECTIVE: : To determine whether self-directed learning with facilitated debriefing during team-simulated clinical scenarios (group A) has better outcomes compared with instructor-modeled learning with modified debriefing (group B). METHODS: This study used a convenience sample of students. The four tools used assessed pre/post knowledge, satisfaction, technical, and team behaviors. Thirteen interdisciplinary student teams participated: seven in group A and six in group B. Student teams consisted of one nurse practitioner student, one registered nurse student, one social work student, and one respiratory therapy student. The Knowledge Assessment Tool was analyzed by student profession. RESULTS: There were no statistically significant differences within each student profession group on the Knowledge Assessment Tool. Group B was significantly more satisfied than group A (P = 0.01). Group B registered nurses and social worker students were significantly more satisfied than group A (30.0 +/- 0.50 vs. 26.2 +/- 3.0, P = 0.03 and 28.0 +/- 2.0 vs. 24.0 +/- 3.3, P = 0.04, respectively). Group B had significantly better scores than group A on 8 of the 11 components of the Technical Evaluation Tool; group B intervened more quickly. Group B had significantly higher scores on 8 of 10 components of the Behavioral Assessment Tool and overall team scores. CONCLUSION: The data suggest that instructor-modeling learning with modified debriefing is more effective than self-directed learning with facilitated debriefing during team-simulated clinical scenarios.

Application of the Health Belief Model to bariatric surgery.

This article discusses the challenging issues faced by women who are diagnosed as being medically obese (i.e., body mass index > or = 30 kg/m). Recently cited as the new national epidemic by some healthcare professionals, obesity can lead to other medical comorbidities, including chronic heart problems, joint deterioration, sleep apnea, depression, and lower self-esteem. On the basis of medical records released by Methodist Hospital in Houston, TX, most patients who seek medical or surgical health options to control obesity are women between 25 and 40 years of age. This article discusses bariatric surgery as a weight loss option and applies the Health Belief Model to explain why patients are choosing this option to help them change eating behaviors. Interventions for nurses and other healthcare professionals are addressed.

Effectiveness of 2 methods to teach and evaluate new content to neonatal transport personnel using high-fidelity simulation.

Neonatal transport team members undergo initial and periodic training to ensure knowledge and performance competencies. Given that various methods can be employed in this effort, it is important to evaluate how well new knowledge is learned and applied by transport team members and assess learner satisfaction. Self-paced modular learning and expert-modeled learning using high-fidelity simulations (HFSs) are 2 teaching/learning/evaluation tools for content application for team members. This article describes 2 educational approaches using simulated scenarios and evaluations. These experiences occurred in 2006, summer I (self-paced modular learning) and in 2007 for the same participants, summer II (expert-modeled learning). A group of experienced nurses, respiratory therapists, emergency medical technicians, and paramedics participated. Satisfaction was measured using a 5-point Likert scale. Effectiveness of HFS was evaluated using the Technical Evaluation Tool. Behavioral performance was assessed using the Behavioral Assessment Tool. The Technical Evaluation Tool showed that expert-modeled learning using HFS as a teaching/ learning/evaluation tool for application of content was effective as self-paced modular learning. Experienced participants appear to be satisfied with the use of HFS scenarios.

Playing it safe: simulated team training in the OR.

Health care professionals are expected to make prompt, accurate decisions in life-threatening emergency situations in the OR. Perioperative leaders are faced with the challenge of ensuring that OR team members are prepared to respond to potentially lethal emergencies, including rare and infrequent events. This article describes the importance of team training for all members of the OR team. The use of simulation is discussed as a tool to accomplish this goal. Steps for developing a simulation scenario are presented.

Comparison of self-directed learning versus instructor-modeled learning during a simulated clinical experience.

BACKGROUND: There are no reports in the literature that compare instructor-modeled learning to self-directed learning when simulation is used. Therefore, no evidence exists to know which approach is superior. This study aims to test the hypothesis that instructor-modeled learning is more effective compared with self-directed learning during a simulated clinical experience. METHODS: This is a descriptive pilot study to compare instructor-modeled learning with self-directed learning during a clinical simulated experience. Four evaluation tools were used at three time points to evaluate knowledge, self-efficacy (self confidence), and behaviors. RESULTS: Sixteen students participated. There were no statistically significant differences between the groups on the Knowledge Assessment Test. There were significant differences between the groups in the Self-Efficacy Tool (SET) at three times (time 1: P = 0.006, time 2: P = 0.008, time 3: P = 0.012). The only significance between the groups on the Technical Evaluation Tool was time to start Albuterol. The Behavioral Assessment Tool (BAT) showed significant differences between the groups in 8 out of 10 components of the tool. A strong correlation was observed between the overall score of the BAT and the SET Score. CONCLUSION: Although the small sample size prohibits definitive conclusions, the data suggest that instructor-modeled learning may be more effective than self-directed learning for some aspects of learning during a clinical simulated experience.