Quality and impact of pharmacology digital simulation education on pre-registration healthcare students: A systematic literature review.

OBJECTIVE: This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand the influence of simulations on the knowledge, satisfaction, and confidence of pre-registration nurses and other healthcare students participating in such educational programs. DESIGN: Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This study was registered in the Prospective Register of Systematic Reviews (PROSPERO, reg no: CRD42023437570). DATA SOURCES: PubMed, MEDLINE, APA PsycInfo, ProQuest, Web of Science, ScienceDirect, and CINHAL databases were searched. REVIEW METHODS: The review focused on the quantitative findings from the studies published from 2016 to 2023. Only the studies that assessed the impact of digital simulation-based pharmacology education on pre-registration healthcare students' knowledge, satisfaction, and confidence were selected for review. Data were synthesized using a narrative approach. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. This was followed by a narrative synthesis to consolidate the themes. RESULT: Out of 1587 articles,16 met the inclusion criteria. A wide variety of digital technologies have been utilised, such as virtual simulation, computer simulation (2D/3D), mixed reality, and augmented reality, with the majority using virtual simulation. All studies implemented single-user simulations. The themes emerging from the narrative synthesis suggest that a digital simulation-based pharmacology course is an effective tool for enhancing students' knowledge, confidence, and satisfaction in learning pharmacological concepts. Furthermore, simulation-based teaching with a blended approach was found to be beneficial. However, the integration of the polypharmacy concept and the intra and interprofessional approach to teaching and learning was not evident in these studies. CONCLUSION: This systematic literature review provides evidence of the potential of digital simulation-based education in pharmacology teaching among healthcare pre-registration students. In future studies, the integration of polypharmacy content with an intra and interprofessional teaching-learning approach is recommended.

The influence of practice experiences on feelings of role proficiency in emergency nurse practitioners: A phenomenological study.

INTRODUCTION: This research explores how emergency nurse practitioners (ENPs) become role proficient given experience variation and lack of role standardisation. AIM: To understand how ENPs experiences in practice influence their feelings of role proficiency. METHODS: A hermeneutic phenomenological study was undertaken utilizing an interpretive standpoint. A two-phase approach was adopted with ten participants using a digital diary informing a semi-structured interview. A three-stage data analysis approach was applied. FINDINGS: Six themes emerged: the meaning of role proficiency, relationships, confidence, learning and knowledge, exposure and experience, and care. Models of proficiency and its development are presented. DISCUSSION: Proficiency is defined where confidence in the components that proficiency consists of and their application to each clinical presentation is required. Proficiency is a continuum supported by regulatory mode theory. Inconsistency of role understanding gives rise to three ENP groups, resistors, maintainers, and innovators. CONCLUSION: Role clarity is required to establish a consistent culture within organisations founded on the voice of the ENP as captured in this research. This model of proficiency be incorporated in ENP role development for current and future ENPs.

Educators' perceptions of their experiences of transnational education in nursing: A grounded theory study.

AIM: The study aim was to explore educators' perceptions of their experiences of participating in transnational education in nursing. BACKGROUND: In an increasingly globalised world, involvement with the delivery of transnational education has become commonplace across the international higher education sector. In recent years, transnational education within the academic discipline of nursing has developed at pace, evolving in response to a global need to invest in nurse education, address nursing shortages and strengthen nursing leadership. However, despite acknowledgement that transnational education is a complex activity that needs to be more fully understood, research specifically exploring transnational education in nursing is scarce, as previous studies predominantly focus on other academic disciplines. The study addresses this knowledge gap, advancing understanding of transnational education in the context of nursing. DESIGN: The study was positioned within the interpretivist paradigm and underpinned by a constructivist grounded theory methodological design, acknowledging the prior knowledge and experience of the research team in relation to phenomenon under investigation. METHODS: Ethical approval was obtained before the study commenced, ensuring adherence to key ethical principles. The study was conducted during May to August 2020, in a university in the North of England that provides undergraduate and postgraduate nurse education in the United Kingdom and transnational context. Participants were recruited via e mail and invited to complete a brief questionnaire, informing a preliminary theoretical sampling strategy. Ten educators with experience of transnational education across a diverse range of international locations participated in individual, semi-structured, online interviews that were recorded and transcribed verbatim. Data were analysed using initial and focused coding, constant comparison, theoretical memos and diagrams. FINDINGS: The findings uncovered three overarching data categories, each of which were crucial to supporting effective transnational education in nursing. Prepare- involved developing an understanding of the context of healthcare and education, being supported and collaborating with transnational partners. Perform- involved recognising language and cultural influences, adapting to the environment and implementing responsive educational pedagogies. Progress- involved recognition of personal development at individual level and valuing the benefits at organisational level. CONCLUSIONS: Although transnational education in nursing can be challenging and complex, it can offer worthwhile advantages for all stakeholders. However, effective transnational education in nursing is dependent on strategies which prepare educators appropriately and enable them to perform effectively, thereby promoting successful outcomes at individual, organisational and transnational partner level and facilitating advancement in future potential collaborative activity.

Compassion in nursing: exploring the perceptions of students and academics.

BACKGROUND: Compassion is integral to effective nursing practice, yet there is limited empirical research exploring this concept, particularly from a professional perspective. Aim To advance understanding of compassion from a professional perspective, specifically through the perceptions of students and academics from the fields of adult, child, learning disability and mental health nursing. METHOD: A constructivist grounded theory study was undertaken, and a theoretical sampling strategy was used to guide the selection of appropriate participants. A total of 12 nursing students and eight nurse academics were interviewed to explore their perceptions of compassion in nursing between January and August 2018. The interview transcripts were analysed using grounded theory techniques. FINDINGS: Four categories were identified from the interview data: character for compassion, competence for compassion, culture for compassion, and connections for compassion. These categories were interlinked, with each having the potential to influence the implementation of humanising approaches to care, which participants perceived to be fundamental to compassion. CONCLUSION: Compassion is a complex concept that can be influenced by biological, psychological and socio-contextual factors. Further consideration of these factors is required to support nurses to facilitate compassion through humanising approaches to care. The findings of this study advance the existing evidence to inform future policy, practice, education and research.

The influence of culture, structure, and human agency on interprofessional learning in a neurosurgical practice learning setting: a case study.

The World Health Organization supports the notion that interprofessional learning (IPL) improves healthcare outcomes and contributes to safe, effective, and high-quality care. Consequently, IPL is an integral component within most UK undergraduate healthcare programs. Although much is written about IPL, research to date has mainly focused on the classroom or simulation lab as a setting for IPL. Less is known about how the practice learning environment influences the experiences and outcomes for those involved. A case study research design, situated within a critical realist framework, was undertaken which aimed to better understand how IPL was facilitated for undergraduate healthcare students within a neurosurgical practice learning setting. Interviews, non-participatory observations, and secondary documentary data were used as the methods of data collection to inform the case. Thematic analysis was undertaken, and the findings clustered into overarching themes of culture, structure, and human agency, facilitating a more in-depth exploration of the complex interplay between the factors influencing IPL in the study setting. IPL was supported within the setting which operated as an 'interprofessional community of practice,' facilitating student engagement and investing in its staff for the benefit of the patients who had complex neurological needs. A practice-based IPL Multi-Dimensional Assessment Tool was also created to enable colleagues in practice learning environments worldwide to better understand their capability and capacity for the facilitation of practice-based IPL.

Developing and sustaining nurses' service improvement capability: a phenomenological study.

BACKGROUND: Service improvement to enhance care quality is a key nursing responsibility and developing sustainable skills and knowledge to become confident, capable service improvement practitioners is important for nurses in order to continually improve practice. How this happens is an under-researched area. AIM: A hermeneutic, longitudinal study in Northern England aimed to better understand the service improvement lived experiences of participants as they progressed from undergraduate adult nursing students to registrants. METHOD: Twenty year 3 student adult nurses were purposively selected to participate in individual semi-structured interviews just prior to graduation and up to 12 months post-registration. Hermeneutic circle data analysis were used. FINDINGS: Themes identified were service improvement learning in nursing; socialisation in nursing practice; power and powerlessness in the clinical setting; and overcoming service improvement challenges. At the end of the study, participants developed seven positive adaptive behaviours to support their service improvement practice and the 'model of self-efficacy in service improvement enablement' was developed. CONCLUSION: This study provides a model to enable student and registered nurses to develop and sustain service improvement capability.

Patient safety from executive hospital management to wards: A qualitative study identifying factors influencing implementation.

AIM: To examine the journey of safety initiatives from executive hospital management to ward. BACKGROUND: Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these. METHOD: Naturalistic study design within a large NHS Hospital Trust. Using semi-structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives. RESULTS: While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified. CONCLUSIONS: Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.

A constructivist grounded theory study to explore compassion through the perceptions of individuals who have experienced nursing care.

AIM: To explore compassion from the perceptions of individuals with personal experience of nursing care. BACKGROUND: Although compassion is considered integral to professional nursing, increasing reports of care experiences illustrating a lack of compassion have challenged this. Despite political and professional guidance to reaffirm compassion as an underpinning philosophy of contemporary nursing practice, this provides limited insight into what compassion may involve. Contemporary evidence to inform understanding of compassion predominately arises from the professional perspective. This knowledge gap supported the rationale to explore compassion from the individual perspective. DESIGN: Constructivist grounded theory, underpinned by the theoretical perspectives of symbolic interactionism and social constructionism. METHODS: Data were collected via 11 individual interviews, a focus group discussion and three additional individual interviews during 2013-2015. Initial and focused coding, constant comparative analysis, conceptual mapping, theoretical memos and diagrams supported data analysis until theoretical sufficiency was determined. FINDINGS: Inter-related data categories emerged: Self-Propensity for Compassion, Attributes for Compassion, Socialising for Compassion, Conditions for Compassion; and Humanising for Compassion (core category). CONCLUSION: Compassion is a complex phenomenon, constructed by individuals through their personal experiences of nursing care and life experiences in the social world. In this study, participants perceived that compassion was fundamentally embodied by experiences of a humanising approach to nursing care. These humanising experiences were thought to be influenced by biological, psychological and socio-contextual factors. The study provides additional insight into compassion that requires further investigation with individuals in other care contexts, nurses and healthcare professionals.

Collaborative child home injury prevention in Thailand: An action research study.

Child home accidental injury is a global health issue, and promoting child safety is a pediatric nursing challenge worldwide. Planning child home accidental injury prevention requires understanding of factors influencing parents' behavior. Evidence suggests that participatory health promotion positively influences behavior; however, research on Thai parents is limited. This qualitative, action research study aimed to understand Thai parents' experiences of participating in a collaborative child home accidental injury prevention program and its influence on their behavior. Eight parental mother/father couples from one Thai province consented to participate, providing a wide range of data via in-depth individual interviews and self-assessment questionnaires. Thematic analysis of interview transcripts yielded three themes: collaborative learning, parental behavior change, and reflective learning extends beyond families. Participants reported that workshop participation improved their child home accidental injury-prevention behavior. The present study can inform pediatric nursing, child health-care practice, and child health policy in Thailand and beyond.

The lived experience of first year undergraduate student nurses: A hermeneutic phenomenological study.

INTRODUCTION: This study gives insight into the experiences and perceptions of one group of undergraduate nursing students as they make the transition into Higher Education and the nursing profession, during the first year, of their three-year programme. Research has shown that first year undergraduate experience is complex and challenging for any student. For undergraduate nursing students, the process of achieving additional professional practice competencies required for United Kingdom nursing registration adds additional responsibility and potentially, more pressure. Few studies have considered student nurses' lived experiences during their first year of study in any depth. STUDY AIM: This study aimed to understand how one group of undergraduate nursing students perceived their experiences of the transition into higher education and nursing profession. DESIGN: Framed within an interpretive philosophical paradigm, a hermeneutic phenomenological approach enabled the exploration of participants' lived experiences. SETTING AND PARTICIPANTS: The study took place at a Higher Education Institution approved nurse education provider in the North of England, United Kingdom (UK). Following ethical approval, ten first year student nurses from a range of different backgrounds gave informed consent to participate. METHODS: Over a one year period between 2013 and 2014 participants provided data at three points during their first year (four months, eight months and twelve months) via semi-structured, digitally recorded individual interviews (n=30) and digital recordings of critical incident accounts as they occurred (n=30). Data was transcribed verbatim, systematically thematically analysed drawing on hermeneutic phenomenological principles and verified for thematic accuracy by participants in 2015. FINDINGS: Five themes emerged from the data: uncertainty; expectations; learning to survive; seeking support; and moving forward. Findings identify that the participants had developed skills to survive however considerable variation in their experience, influenced motivation and behaviour. They developed their own skills of coping to deal with the demands of academic life and those of the practice setting. An explanatory student journey model demonstrated that developing self-efficacy was key to their successful transition through the first year of undergraduate study. CONCLUSIONS: Understanding the first year student nurse perspective and insight into their coping strategies are key to supporting a positive learning journey. Positive feedback from nurse educators, a growing sense of nursing community and motivation to succeed facilitates their internalisation of nursing identity, norms and values and an active pursuit of learning towards graduate status and becoming a nurse.

Locality, loneliness and lifestyle: a qualitative study of factors influencing women's health perceptions.

The contribution of women to the achievement of global public health targets cannot be underestimated. It is well evidenced that within families, women are a key influence on the health and well-being of their children and partners. However, geographical differences in women's health inequalities persist and research focusing specifically on women's perceptions of locality factors influencing their own health and well-being is scarce. This paper presents an interpretive, qualitative research study undertaken in 2011 with a group of women living in one locality in the North East of England in the United Kingdom which aimed to better understand their health and well-being perceptions and locality influences on it. Fifteen women participated in two focus groups and six individual, semi-structured interviews. Thematic analysis yielded four key themes: health and well-being perceptions; mental resilience; low income and choice; and influence of place. The influence of women's geographical location in relation to amenities and services and loneliness were recurring factors in the discussion, each influencing lifestyle. It was evident that women in their local context were themselves assets through which their own physical and mental health could be improved. However, women's perceptions of protective factors and their influences on health and well-being varied. Connecting with women in the context of their immediate living circumstances and understanding their perceptions as individuals are important first steps in the process of gaining consensus and mobilising their assets to collectively build healthy local communities.

Facilitating classroom based interprofessional learning: a grounded theory study of university educators' perceptions of their role adequacy as facilitators.

The provision of inter professional learning (IPL) within undergraduate programmes is now well established within many Higher Education Institutions (HEIs). IPL aims to better equip nurses and other health professionals with effective collaborative working skills and knowledge to improve the quality of patient care. Although there is still ambiguity in relation to the optimum timing and method for delivering IPL, effective facilitation is seen as essential. This paper reports on a grounded theory study of university educators' perceptions of the knowledge and skills needed for their role adequacy as IPL facilitators. Data was collected using semi structured interviews with nine participants who were theoretically sampled from a range of professional backgrounds, with varied experiences of education and involvement in facilitating IPL. Constant comparative analysis was used to generate four data categories: creating and sustaining an IPL group culture through transformational IPL leadership (core category), readiness for IPL facilitation, drawing on past interprofessional learning and working experiences and role modelling an interprofessional approach. The grounded theory generated from this study, although propositional, suggests that role adequacy for IPL facilitation is dependent on facilitator engagement in a process of 'transformational interprofessional learning leadership' to create and sustain a group culture.

Action learning sets in a nursing and midwifery practice learning context: a realistic evaluation.

Action learning sets (ALS) are used widely for organisational and workforce development, including in nursing (Anderson and Thorpe, 2004; Pounder, 2009; Young et al., 2010). In the United Kingdom, a multi-faceted educational Pilot programme for new nurses and midwives was implemented to accelerate their clinical practice and leadership development (NHS Education Scotland, 2010). Action Learning Sets were provided for peer support and personal development. The Realistic Evaluation study reported in this paper explored issues of context, mechanism and outcome (Pawson and Tilley, 1997) influencing the action learning experiences of: programme participants (recently qualified nurses and midwives, from different practice settings); and programme supporters. A range of data were collected via: online questionnaires from 66 participants and 29 supporters; three focus groups, each comprising between eight and 10 programme participants; and one focus group with three action learning facilitators. The qualitative data pertaining to the ALS are presented in this paper. Thematic data analysis of context, mechanism and outcome configurations, generated five themes: creating and sustaining a collective learning environment; challenging constructively; collective support; the role of feedback; and effectiveness of ALS. Study outcomes suggest nursing and midwifery action learning should (a) be facilitated positively to improve participants' experience; (b) be renamed to avoid learning methodology confusion; and (c) be outcome focused to evidence impact on practice.

Interprofessional service improvement learning and patient safety: a content analysis of pre-registration students' assessments.

A culture of continuous service improvement underpins safe, efficient and cost-effective health and social care. This paper reports a qualitative research study of assessment material from one cohort of final year pre-registration health and social care students' interprofessional service improvement learning experience. Initially introduced to the theory of service improvement, students were linked with an interprofessional buddy group, and subsequently planned and implemented, if possible, a small scale service improvement project within a practice placement setting. Assessment was by oral project presentation and written reflection on learning. Summative assessment materials from 150 students were subjected to content analysis to identify: service user triggers for service improvement; ideas to address the identified area for improvement; and perceptions of service improvement learning. Triggers for service improvements included service user disempowerment, poor communication, gaps in service provision, poor transitions, lack of information, lack of role clarity and role duplication, and differed between professions. Ideas for improvement included both the implementation of evidence based best practice protocols in a local context and also innovative approaches to problem solving. Students described both intrapersonal and interprofessional learning as a result of engaging with service improvement theory and practice. Service improvement learning in an interprofessional context has positive learning outcomes for health and social care students. Students can identify improvement opportunities that may otherwise go undetected. Engaging positively in interprofessional service improvement learning as a student is an important rehearsal for life as a qualified practitioner. It can help students to develop an ability to challenge unsafe practice elegantly, thereby acting as advocates for the people in their care. Universities can play a key support role by working collaboratively with service organisations; role modelling effective interprofessional working; and supporting research to measure the impact of education on practice.

Maintaining equilibrium in professional role identity: a grounded theory study of health visitors' perceptions of their changing professional practice context.

AIMS: This article reports the study of a group of United Kingdom health visitors' interactions with their changing practice context, focusing on role identity and influences on its stability. BACKGROUND: United Kingdom policies have urged health visitors to refocus their role as key public health nurses. Reduced role identity clarity precipitated the emergence of different models of health visiting public health work. An inconsistent role standard can lead to role identity fragmentation and conflict across a group. It may precipitate individual role crisis, affecting optimum role performance. METHODS: Seventeen health visitors in two United Kingdom community healthcare organizations participated in a grounded theory study, incorporating constant comparative analysis. Direct observations and individual interviews were undertaken between 2002 and 2008. RESULTS/FINDINGS: Four interlinked categories emerged: professional role identity (core category); professional role in action; interprofessional working; and local micro-systems for practice; each influencing participants' sense of identity and self-worth. The Role Identity Equilibrium Process explains interactive processes occurring at different levels of participants' practice. CONCLUSION: Re-establishing equilibrium and consistency in health visiting identity is a priority. This study's findings have significance for other nurses and health professionals working in complex systems, affected by role change and challenges to role identity.

Learning to work collaboratively: nurses' views of their pre-registration interprofessional education and its impact on practice.

One of the challenges of contemporary health care is the need for health and social care professionals to work differently to meet the complex needs of patients/clients. However it cannot be assumed that these professionals have been prepared with the skills and confidence to collaborate effectively, outside of traditional professional boundaries. Interprofessional education (IPE) is well established as an effective learning and teaching approach to prepare practitioners for collaborative practice at the point of qualification (DOH 2001; Hale 2003; Morison et al., 2003; Department of Health 2006; Hammick et al., 2007). The phenomenological study reported in this paper sought to follow up a group of newly qualified adult nurses at six months post-qualification. These nurses had undertaken a pre-registration curriculum in which classroom-based interprofessional learning was well embedded and formally assessed within their three year programme. Data from eight in depth interviews were analysed and five key themes were emerged: common understanding of IPE; teaching and learning; understanding of professional roles; stereotypes; influence of the practice environment. The outcome of the study suggested IPE should be as practice focused as possible to improve its relevance to nursing practice. This study contributed to the development of an innovative curriculum which provides the opportunity for nurses to integrate IPE theory within their collaborative working practice.

In-patient benzodiazepine withdrawal: comparison of fixed and symptom-triggered taper methods.

Fixed and symptom-triggered taper methods during in-patient benzodiazepine withdrawal treatment were compared using a randomized controlled design. Forty-four benzodiazepine users seeking in-patient withdrawal treatment at two substance use treatment clinics in Adelaide, Australia were recruited. Measurements included the Severity of Dependence Scale and the SF-36. A scale comprising six items from the Clinical Institute Withdrawal Assessment Scale--Benzodiazepines (CIWA-B) was used to measure withdrawal symptoms. Participants were randomized to receive a fixed diazepam tapering regime or diazepam only in response to withdrawal symptoms (symptom-triggered group). Results showed that there were no significant differences between treatment groups in terms of withdrawal severity, duration of in-patient treatment, amount of diazepam administered, treatment attrition and benzodiazepine use at follow-up. Both groups showed a reduction in benzodiazepine dosage of 86% over the first 8 days which was maintained at 1 month post-discharge. Although there were improvements in some subscales of the SF-36 between baseline and follow-up, values were significantly below age-matched norms at both time-points. This study showed that benzodiazepine users entering treatment have relatively poor health and that symptom-triggered taper methods incorporating flexible dosing and flexible treatment duration are as effective as fixed dose taper methods for in-patient benzodiazepine withdrawal treatment.