A Cost-Utility Analysis Comparing Traditional Clinical, Manikin-Based Simulation, and Screen-Based Virtual Simulation Activities.

BACKGROUND: Simulation activities are used increasingly in nursing education to augment or replace traditional clinical experiences. Educators and regulators are called on to make evidence-based decisions about the use of limited clinical and simulation resources. METHOD: This cost-utility analysis addresses the final aim of a study comparing cognitive learning, patient care performance, and self-perceptions of how well learning needs were met among students who were exposed to 4 hours of traditional clinical experience, 2 hours of manikin-based simulation, or 2 hours of screen-based virtual simulation. The costs of each activity were calculated and divided by a composite measure of the utility of each activity. RESULTS: The cost-utilities for 4 hours of traditional clinical experience, 2 hours of manikin-based simulation, and 2 hours of screen-based virtual simulation were $0.15, $0.62, and $0.38, respectively, in U.S. dollars per unit of utility. CONCLUSION: The data provide evidence for educators and administrators to make effective and efficient use of limited resources to prepare nurses for practice. [J Nurs Educ. 2024;63(2):79-85.].

Evaluation of Simulation Outcomes.

Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.

Incivility and Clinical Performance, Teamwork, and Emotions: A Randomized Controlled Trial.

BACKGROUND: Incivility has been identified as a common occurrence in health care settings. While anecdotal evidence exists that these behaviors negatively impact patient care, more robust evidence is lacking. PURPOSE: This randomized controlled trial investigated the effects of exposure to incivility on clinical performance, teamwork, and emotions. METHODS: Teams of nurses were randomly assigned to a control or experimental group. The experimental group was exposed to incivility. Both groups were then prompted to perform basic life support on a high-fidelity manikin. Teams were scored on cardiopulmonary resuscitation (CPR) performance and teamwork. Individuals completed measures of affect and a cognitive test. RESULTS: There were no differences in CPR, cognitive or teamwork scores, or emotional state. However, 66% of the experimental group had a major error in their CPR performance. None of the control groups made the same error. CONCLUSIONS: These findings support anecdotal evidence that exposure to incivility may contribute to errors in clinical performance.

Integrating the National Council of State Boards of Nursing Clinical Judgment Model Into Nursing Educational Frameworks.

BACKGROUND: Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents the National Council of State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) and discusses the use of the model. METHOD: A multidisciplinary team conducted a qualitative comparative analysis of the relationships between the NCSBN-CJM and the three leading frameworks for providing clinical judgment education to entry-level nurses. RESULTS: The NCSBN-CJM aligns with the Information-Processing Model and the Intuitive-Humanistic Model. The NCSBN-CJM also can be used to assess the Dual Process Reasoning Theory. CONCLUSION: The NCSBN-CJM can assist nurse educators in designing effective tools for assessing clinical judgment by helping them target specific cognitive operations. This flexible model expresses the complexities associated with decision making in a simplified manner to enable better measurement of clinical judgment. [J Nurs Educ. 2019;58(2):72-78.].

Cost-Utility Analysis of Virtual and Mannequin-Based Simulation.

INTRODUCTION: The purposes of this study were to (1) compare learning outcomes between students who participated in mannequin-based simulation activities and students who participated in virtual simulation activities and (2) describe a cost-utility analysis comparing the two types of simulation activities in terms of costs and multiple measures of effectiveness. METHODS: Nursing student participants were randomly assigned to one of two experimental groups to complete either a mannequin-based or virtual simulation activity. The simulation scenario was the same for both groups and involved the care of a hospitalized patient experiencing a chronic obstructive pulmonary disease exacerbation. Participants completed presimulation and postsimulation assessments reflecting qualitative and quantitative measures of learning. A random sample of participants from each group completed a postsimulation performance assessment during which they interacted one on one with a standardized patient. RESULTS: Eighty-four nursing students were enrolled in the study and completed the simulation activities. There were no significant differences in quantitative measures of learning or performance between participants in the mannequin-based and virtual simulation groups. Participants' qualitative responses to postintervention written reflections and questions yielded additional data for describing learning from the two interventions. In the cost-utility analysis, the virtual simulation activity had a more favorable cost-utility ratio of US $1.08 versus the mannequin-based simulation activity's US $3.62. CONCLUSIONS: Healthcare educators striving to make evidence-based decisions about how to best employ simulation pedagogy may consider these findings about the cost utility of various simulation modalities. However, additional research is needed.

Navigating the Hidden Curriculum of Higher Education for Postsecondary Students With Intellectual Disabilities.

Students with intellectual and/or developmental disabilities (IDD) increasingly pursue postsecondary education (PSE). Navigating the hidden curriculum-including meeting prerequisites for PSE and employment, using support systems and community transportation, and carrying out adulthood expectations-is an area of challenge. This exploratory case study examined experiences of students with IDD attending a PSE program and stakeholder perspectives. Thirty-two participants (10 students with IDD, 5 parents or guardians, 4 college administrators, 8 college instructors, 4 occupational therapists, and a transition specialist) were interviewed. Conventional content analysis revealed navigating the hidden curriculum as a key theme and three subthemes: (1) adult-based system navigation, (2) persisting challenges with adaptive behaviors, and (3) disability awareness and disclosure. Limited awareness of disability and supports and services needed for a successful PSE outcome were contributing factors. Occupational therapists have the skills to support students with IDD in skill acquisition to successfully transition to and navigate PSE and the hidden curriculum.