Eye tracking as a debriefing mechanism in the simulated setting improves patient safety practices.

INTRODUCTION: Human patient simulation has been widely adopted in healthcare education despite little research supporting its efficacy. The debriefing process is central to simulation education, yet alternative evaluation methods to support providing optimal feedback to students have not been well explored. Eye tracking technology is an innovative method for providing objective evaluative feedback to students after a simulation experience. The purpose of this study was to compare 3 forms of simulation-based student feedback (verbal debrief only, eye tracking only, and combined verbal debrief and eye tracking) to determine the most effective method for improving student knowledge and performance. METHODS: An experimental study using a pretest-posttest design was used to compare the effectiveness of 3 types of feedback. The subjects were senior baccalaureate nursing students in their final semester enrolled at a large university in the northeast United States. Students were randomly assigned to 1 of the 3 intervention groups. RESULTS: All groups performed better in the posttest evaluation than in the pretest. Certain safety practices improved significantly in the eye tracking-only group. These criteria were those that required an auditory and visual comparison of 2 artifacts such as "Compares patient stated name with name on ID band." CONCLUSIONS: Eye tracking offers a unique opportunity to provide students with objective data about their behaviors during simulation experiences, particularly related to safety practices that involve the comparison of patient stated data to an artifact such as an ID band. Despite the limitations of current eye tracking technology, there is significant potential for the use of this technology as a method for the study and evaluation of patient safety practices.

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

BACKGROUND: Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. PURPOSE: The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. METHODOLOGY: A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. RESULTS: The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. CLINICAL IMPLICATIONS: Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home care resources, avoiding redundancy of resource utilization in this era of strained healthcare resources.

Research regarding methods of assessing learning outcomes.

As the use of simulation-based assessment expands for healthcare workers, there is a growing need for research to quantify the psychometric properties of the associated process and outcome measures.

Error identification and recovery by student nurses using human patient simulation: opportunity to improve patient safety.

This study examined types of errors that occurred or were recovered in a simulated environment by student nurses. Errors occurred in all four rule-based error categories, and all students committed at least one error. The most frequent errors occurred in the verification category. Another common error was related to physician interactions. The least common errors were related to coordinating information with the patient and family. Our finding that 100% of student subjects committed rule-based errors is cause for concern. To decrease errors and improve safe clinical practice, nurse educators must identify effective strategies that students can use to improve patient surveillance.

Patient and family education for fall prevention: involving patients and families in a fall prevention program on a neuroscience unit.

A neuroscience unit in an acute care hospital reported the highest number of falls among the inpatient units. Patient and family education for fall prevention on this unit was added to an existing multifactorial fall prevention program. Through this project, a new fall prevention poster was developed with patient, family, and staff involvement and disseminated throughout the hospital. Using the Plan-Do-Study-Act model to evaluate the project, there were no fall among the patients educated on fall prevention.

Human patient simulation: teaching students to provide safe care.

The use of human patient simulation as a teaching methodology for nursing students has become popular. Using human patient simulation effectively demands paying careful attention to the details of the simulation, debriefing, and evaluation processes. Our experience in designing simulation experiences and evaluating student behaviors confirms the resource-intensive nature of human patient simulation and the need for clear, measurable objectives. When used properly, human patient simulation offers a unique opportunity to teach nursing students important patient safety principles.

Measuring clinical practice parameters with human patient simulation: a pilot study.

Human Patient Simulators (HPS), electronically controlled mannequins as patient models, are increasingly being used in nursing education. However, no studies have validated the influence of systematic practice with HPS on clinical performance of nursing students. This pilot study attempted to identify the nursing clinical practice parameters influenced by HPS by evaluating the clinical performance of 12 senior second degree BSN students in five categories: safety, basic assessment skills, prioritization, problem-focused assessment, ensuing interventions, delegation and communication in a complex two-patient, simulated assignment. Students who practiced with the HPS in addition to their usual clinical training had significantly higher scores than the control group (usual clinical training alone) on Patient Identification (a subcategory of the safety category; p = 0.001), and on Assessing Vital Signs (a subcategory of the basic assessment category; p = 0.009). The control and intervention groups' performances were similar in every other category. Replication of this pilot with a larger sample is recommended.

A partnership between nursing education and practice: using an empowerment model to retain new nurses.

A school of nursing and a health system in Massachusetts developed a unique partnership to create a system to attract and retain new nurses in acute care. The structure of this partnership was designed to increase the faculty of the school of nursing and add to the educational expertise in the department of staff development in the health system's major acute care hospital. The process was developed using an empowerment model. The authors describe the structure, process, and outcomes of this partnership.