Towards identifying nurse educator competencies required for simulation-based learning: A systemised rapid review and synthesis.

OBJECTIVES: This paper presents the results of a systemised rapid review and synthesis of the literature undertaken to identify competencies required by nurse educators to facilitate simulation-based learning (SBL). DESIGN: An international collaboration undertook a protocol-based search, retrieval and critical review. DATA SOURCES: Web of Science, PubMed, CINAHL Plus, PsycInfo, ERIC, the Cochrane Library and Science Direct. The search was limited to articles published in English, 2002-2012. REVIEW METHODS: The search terms used: nurse*, learn*, facilitator, simula*, lecturer, competence, skill*, qualificat*, educator, health care, "patient simulation", "nursing education" and "faculty". The search yielded 2156 "hits", following a review of the abstracts, 72 full-text articles were extracted. These were screened against predetermined inclusion/exclusion criteria and nine articles were retained. Following critical appraisal, the articles were analyzed using an inductive approach to extract statements for categorization and synthesis as competency statements. RESULTS: This review confirmed that there was a modest amount of empirical evidence on which to base a competency framework. Those papers that provided descriptions of educator preparation identified simulation-based workshops, or experiential training, as the most common approaches for enhancing skills. SBL was not associated with any one theoretical perspective. Delivery of SBL appeared to demand competencies associated with planning and designing simulations, facilitating learning in "safe" environments, expert nursing knowledge based on credible clinical realism, reference to evidence-based knowledge and demonstration of professional values and identity. CONCLUSIONS: This review derived a preliminary competency framework. This needs further development as a model for educators delivering SBL as part of nursing curricula.

Christian worship leaders' attitudes and observations of people with dementia.

BACKGROUND: The cognitive, emotional, and psychological consequences of dementia are profound and can include memory loss, processing and, communication difficulties, social isolation and agitation. Procedural memory remains fairly intact in people with dementia (PWD) and is readily triggered via sensory cues and prompts. As religious services are often highly structured, it is likely that PWD can participate competently, potentially enhancing their quality of life, and wellbeing. AIMS: This study aimed to investigate Christian worship leaders' attitudes and observations of PWD attending religious services, to identify recurring themes, and to generate hypotheses regarding the effects of participation in religious services on PWD. METHOD: The participants were Christian worship leaders experienced in conducting religious services for PWD. The study adopted a grounded theory approach consisting of two phases: a focus group of four worship leaders at Phase 1 and a series of one-to-one interviews with eight worship leaders at Phase 2. RESULTS: Five linked themes emerged: familiarity and structure; enhanced sensory cues; significance of worship leader's approach; social support from and for family and carers; and the personality and characteristics of the PWD. These themes were used to develop a conceptual model, sharing the moderating and mediating factors of wellbeing. CONCLUSION: Religious worship appeared to constitute a naturalistic psychosocial intervention comprised of the service itself and the social context. Further investigation and conceptualisation of the interaction between PWD and their social environment is warranted, and collaboration with those people who constitute the PWD's social support network.

Therapeutic lying in dementia care.

As part of a service evaluation, a questionnaire and a 12-item set of guidelines on the use of therapeutic lies were sent electronically to 76 psychiatrists in north east England; 38% (n = 29) of the psychiatrists responded. Approximately three quarters of the respondents (n = 21) thought the guidelines could improve communication skills, but only half (n = 15) felt the guidelines provided an ethical guide to practice. Of note is the fact that 69% (n = 20) of the respondents said they had lied to someone lacking capacity when it was deemed to be in the person's best interests and 66% (n = 19) said they had sanctioned the use of lies by carers. These results are discussed, alongside qualitative information to explore the use of therapeutic lies in dementia care.

Practice development: implementing a change of practice as a team.

Practice development (PD), as a framework for multiprofessional working, has immense potential, specifically within change management and the clinical governance agenda. It has been acknowledged as a vehicle for 'continuous improvement'. This article discusses PD through collaborative working using the example of a case study on change of practice in falls reduction within a localised community setting. The process is underpinned by a PD framework and facilitated by leaders of PD within a university setting. The article identifies that PD frameworks are conducive to developing leadership and management roles within a democratic process. The article discusses the potential for multiprofessional PD within the locality and further afield.

Developing an equipment library for clinical skills and simulation training.

This article describes the the development of a regional equipment library for clinical skills and simulation training. This was a project undertaken to address a reduction in the available funding for the purchasing of clinical skills equipment throughout the Yorkshire and Humber region. It was envisaged that utilizing regionally accessible equipment through the development of an equipment library could support clinical areas with no other means of acquiring the necessary equipment for training. A consultation exercise met with initial concerns around the cost of some of this equipment and who would be responsible for the repair, transportation costs and maintenance. A SWOT analysis identified how these concerns may be addressed and processes of developing a database, tracking usage and auditing of the service emerged.

Rethinking theory and practice: pre-registration student nurses experiences of simulation teaching and learning in the acquisition of clinical skills in preparation for practice.

In the United Kingdom (UK) simulation learning has been recognised in the form of a regulatory agreement that may replace hours from clinical practice. This integration has become an embedded feature of the pre-registration nursing programme at a University in the North of England, along with strategic investment in staff and simulation suites developed to underpin this curriculum change albeit in the absence of sparse empirical evidence, hence the rationale for the study which was designed to explore the relationship between simulation, theory and practice. The study features a thematic analysis of evaluation questionnaires from pre-registration student nurses (n=>500) collected over a 2 year period which informed subsequent focus group interviews to explore the themes in more detail. Consistent data findings were the students' positive response to simulation as a learning approach facilitating the application of theory in a safe controlled environment. Students reported that they felt prepared for practice, recognising that simulated learning improved their humanistic and problem solving abilities as well as the development of psychomotor, technical skills, and overall confidence. The theory-practice gap is a recurring narrative in the nursing literature, the findings of this study recognises that simulation offers an opportunity to enact the integration of theory and practice illuminating this relationship in a controlled environment thus, reinforcing the theory-practice relationship for nursing students.

Clinical Governance and the role of the lecturer/practitioner in education in one British National Health Service (NHS) Trust.

Meeting the Clinical Governance agenda is dependent fundamentally on staff education. When examined within and supported by the role of the Lecturer/Practitioner, a model of education for Clinical Governance begins to emerge. In order to implement this model and to simultaneously embrace the organizational change necessary to create a knowledgeable workforce, it is necessary to examine those factors that generate excellence in education on the ground. This paper will argue that the key determinant in developing excellence in the quality care is the presence of a rigorous system of staff education. It will argue through a short case study concerning one particular National Health Service (NHS) Trust that the role of the Lecturer/Practitioner can become instrumental in planning, assessing, maintaining and delivering quality education to clinical nurses for their roles in Clinical Governance. The paper will proceed to elucidate the interrelated factors underlying this assumption. The paper will conclude that Clinical Governance requires the recognition that service cultures and organization and styles are key to its growth. Yet although national action to support change and development are needed, there is no substitute for local inventiveness and backing. In this regard an exemplar of good practice is provided whereby the Lecturer/Practitioner role is being used as the vehicle to successfully address the issue of Clinical Governance by initiating the step change needed for excellence to occur.