A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education: A Systematic Review.

ABSTRACT: With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: ( a ) research study (of any design), ( b ) focused on learners in health professions, and ( c ) compared VR with traditional simulation. Studies were excluded for the following reasons: ( a ) not a research study, ( b ) focused on learners outside health professions, ( c ) used screen-based or computer-based simulation, ( d ) used a task trainer, and ( e ) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review.

AIM: The purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BACKGROUND: Hypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DESIGN: A discursive review. RESULTS: Several issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DISCUSSION: The review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. IMPACT TO NURSING PRACTICE: Nurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

AIM AND OBJECTIVE: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND: With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION: Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Healthcare needs and experiences of foreign residents in Japan by language fluency.

OBJECTIVE: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. DESIGN: A quantitative, descriptive design was used. SAMPLE: We surveyed foreign residents in the greater Tokyo area (N = 209). MEASUREMENTS: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. RESULTS: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p = .000). CONCLUSIONS: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them.

Use of simulation for global health pre-departure training.

BACKGROUND: Opportunities for students to participate in global health mission trips have expanded. However, lack of pre-departure training is often reported and has been associated with negative outcomes for participants. Simulation is an effective method for providing customized situational learning. OBJECTIVE: To evaluate the effectiveness of a Pre-Departure Training program incorporating simulation for advanced practice registered nursing (APRN) students prior to a global health mission trip. DESIGN: This program employed a pre-posttest design with surveys administered at baseline, after a computer-based learning module, and after a simulation-based learning experience. SETTING: A university in the Southeastern United States. PARTICIPANTS: Twenty-two APRN students in their first clinical rotation of the program. METHODS: APRN students with interest in global health missions partake in a pre-departure training program. Pre-departure training includes a computer-based learning module followed by an outdoor simulation replicating a low-income setting. Pre-posttest surveys assessed students' perceptions of confidence, skill, knowledge and comfort regarding global health. A skills checklist was used to evaluate student clinical patient presentation during the simulation. RESULTS: Students' preparedness scores increased after the computer-based learning and significantly increased after the simulation. In the simulation, 42% of students successfully completed their patient presentation during their first attempt while 58% required remediation. CONCLUSION: After the pre-departure program, students felt more confident in their global health knowledge, and felt significantly more prepared to provide health care in a low-income country. Schools of nursing offering global health mission trips or study abroad programs should consider implementing pre-departure programs using simulation as a teaching method.

Barriers and Facilitators of Asthma Management as Experienced by African American Caregivers of Children with Asthma: An Integrative Review.

INTRODUCTION: African American children with asthma demonstrate significant health disparities and poor health outcomes. Understanding the burdens faced by parents and caregivers of children with asthma may be helpful to develop future interventions to address this disparity. PURPOSE: The purpose of this integrative review was to reveal the barriers and facilitators of child asthma management experienced by African American caregivers. METHOD: Whittemore and Knafl's (2005) method of integrative review was used to review 40 articles. The integrative review involved appraising the quality of the literature, conducting a thematic analysis, and evaluating the barriers and facilitators of pediatric asthma management experienced by African American caregivers. RESULTS: Barriers and facilitators were identified as themes. Barriers included caregiver burdens, and lack of home and neighborhood safety. Facilitators were family and community support, education and empowerment, and culturally competent healthcare providers. DISCUSSION: To improve the care of African American children with asthma, nurses should work to engage, communicate, and foster trust with families. Nurses should assess and address the family caregivers' burdens while emphasizing support systems.

Psychological and Socioeconomic Burdens Faced by Family Caregivers of Children With Asthma: An Integrative Review.

INTRODUCTION: Asthma affects nearly 1 in every 12 children in the United States. Caring for a child with asthma poses significant challenges for the parent or caregiver. The purpose of this integrative review was to identify the psychological and socioeconomic burdens faced by family caregivers of children with asthma. METHOD: An integrative review was conducted to review and appraise 80 studies. RESULTS: Psychosocial burdens included decreased mental health, quality of life, sleep, family stress, educational deficits, cultural and health disparities, and health care communication challenges. Socioeconomic burdens included poor access to care, as well as work and financial challenges. Studies demonstrated a link between family caregiver health and child health outcomes. Facilitators included education and empowerment, social support, and use of technology. DISCUSSION: As the family caregiver's health directly affects the asthmatic child's health, addressing the burdens of family caregivers should be a key consideration in pediatric asthma care.

Healthcare Providers' Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases.

PURPOSE: The purpose of this study was to identify healthcare providers' experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. DESIGN AND METHODS: A qualitative, descriptive design was used with 13 pediatric healthcare providers. FINDINGS: Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. CONCLUSIONS: Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. PRACTICE IMPLICATIONS: The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.

Virtual Simulation in Nursing Education: A Systematic Review Spanning 1996 to 2018.

STATEMENT: As virtual simulation is burgeoning, faculty and administrators are asking for evidence of its effectiveness. The objective of this systematic review was to identify how virtual simulation impacts nursing student learning outcomes. Applying the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, 80 studies were reviewed. Results indicate that most research (n = 69, 86%) supported virtual simulation as an effective pedagogy to support learning outcomes while highlighting gaps and areas of bias. Adding search terms could have expanded the findings. The body of evidence supports virtual simulation as an effective pedagogy. Future studies should use more robust research designs, prioritize curricular integration of virtual simulation, and determine best practices in virtual simulation methodology.

Medication Adherence of Latino Children and Caregivers: An Integrative Review.

INTRODUCTION: There are significant disparities in medication adherence among underserved minority groups such as Latinos. Adherence to medication is a primary determinant of treatment success. Little is known about medication adherence among Latino children. This integrated review aims to describe what is known about medication adherence among Latino children and explore barriers and facilitators to medication adherence. METHOD: This review was guided by Whittemore and Knafl's method of integrative review and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RESULTS: Of the 20 articles reviewed about medication adherence among Latino children, the analysis of these articles revealed four major themes: (1) low adherence, (2) low adherence associations, (3) child outcomes, and (4) effective interventions. CONCLUSION: Health practitioners should consider medication adherence associations and interventions when collaborating with the family caregiver to improve child outcomes.

Evaluating Nurse-Physician Communication With a Rubric: A Pilot Study.

Poor communication is a leading cause of sentinel events. The aims of this pilot study were to determine whether the ISBAR (Identification, Situation, Background, Assessment, and Recommendation) Interprofessional Communication Rubric (IICR) was a reliable tool among nurses and to examine the communication performance of new graduate nurses in a hospital-based simulation center. The IICR demonstrated reliability among raters in this setting (rs = .91). The new graduate RNs' communication performance scores were low, warranting continued professional development. The IICR may be used to guide continued education and development for nurse-physician communication. [J Contin Educ Nurs. 2019;50(4):163-169.].

Student preferences and perceptions of learning from vSIM for Nursing™.

This study explored BSN students' perceptions of learning with vSim for Nursing™. Using a mixed methods design with 99 students, key points of learning were medication administration and respiratory interventions. Qualitative data demonstrated learning of assessment, prioritization, and emergency management. The top student preferences of how to use virtual simulation were as a clinical makeup or to enhance lecture. The findings support the use of virtual simulation and provide data to guide nurse educators to more strategically integrate virtual simulation exercises.

Virtually Nursing: Emerging Technologies in Nursing Education.

Augmented reality and virtual simulation technologies in nursing education are burgeoning. Preliminary evidence suggests that these innovative pedagogical approaches are effective. The aim of this article is to present 6 newly emerged products and systems that may improve nursing education. Technologies may present opportunities to improve teaching efforts, better engage students, and transform nursing education.

A Mixed-Methods, International, Multisite Study to Develop and Validate a Measure of Nurse-to-Physician Communication in Simulation.

AIM: This study examined the reliability and validity of the ISBAR Interprofessional Communication Rubric (IICR). BACKGROUND: Improving education regarding communication in health care is a global priority. Communication is difficult to measure and no evaluation rubrics were located that uniquely focused on nurse-to-physician communication in simulation. METHOD: This study used a mixed-methods design and included five sites. RESULTS: The IICR was determined reliable among nurse educator raters (r = 0.79). The scale was found valid as assessed by nurse and physician experts (content validity index = 0.92). When describing their experience of using the tool, nurse educator raters described three categories: overall acceptability of the tool, ease of use, and perceptions of the importance of communication skills for patient safety. CONCLUSION: Teaching and evaluating communication in simulation with a standardized rubric is a research area in need of further exploration and refinement.

Short of transformation: American ADN students' thoughts, feelings, and experiences of studying abroad in a low-income country.

ADN students are a large yet distinct subgroup of nursing students who require research and understanding. The purpose of this study was to describe the thoughts, feelings, and experiences of American associate degree nursing (ADN) students who participated in a short study abroad course in a low-income country. A qualitative, narrative method was used. Three categories emerged from the analysis. Participants revealed thoughts of "constant comparisons", feelings of an "emotional journey", and they experienced "learning". Participants did not demonstrate perspective transformation as defined by Mezirow as participants signified no intent for social action. Several potential blocks to perspective transformation were identified: egocentrism/emotional disconnect, perceived powerlessness/being overwhelmed, and a vacation mindset. The findings provide insight into the student experience of studying abroad. Transformative learning is not a guaranteed result. Nurse educators must consider strategies to foster transformation including discussing global systemic oppressors, international relations, coping, connecting, and social action.

A concept analysis of cultural sensitivity.

Cultural sensitivity is used ubiquitously, yet different meanings are constructed. An improved understanding of the term as described within health care and in general would enhance nurses' understanding and communication with professionals and clients. To uncover the current meaning of cultural sensitivity, a concept analysis was performed. Findings included the attributes of knowledge, consideration, understanding, respect, and tailoring. Necessary antecedents were diversity, awareness, and an encounter. The consequences were effective communication, effective intervention, and satisfaction. A definition of cultural sensitivity was proposed. Providers may benefit from recognizing and addressing the identified antecedents and attributes to obtain the positive consequences of employing cultural sensitivity.