Conceptualizing Student Experiences of Psychological Safety in Simulation: A Grounded Theory Study.

BACKGROUND: Simulation-based learning activities have become more prevalent in prelicensure nursing curricula. When following the Simulation Standards of Best Practice, optimal learning conditions can be achieved, including the creation of a psychologically safe learning environment. Yet, the process of how students come to feel psychologically safe during a simulation experience remains unknown. METHOD: A grounded theory approach was used to conceptualize the basic social process by which nursing students feel psychologically safe during a simulation learning experience. RESULTS: Six categories emerged from the data: (1) being nervous; (2) having a good instructor; (3) learning; (4) coming together; (5) being in debriefing; and (6) leaving on a positive note. The core category of putting myself out there emerged as the basic social process. CONCLUSION: The social process of psychological safety in simulation develops within nursing students as the result of interplay among several dimensions of the learning experience. [J Nurs Educ. 2024;63(7):427-433.].

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review.

The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

Outcomes of Telehealth for Wound Care: A Scoping Review.

OBJECTIVE: To synthesize the literature on delivering wound care via telehealth and compare clinical, healthcare utilization, and cost outcomes when wound care is provided via telehealth (telewound) modalities compared with in-person care. DATA SOURCES: An electronic search of PubMed, CINAHL, and Cochrane Clinical Trials databases for articles published from 1999 to 2019 was conducted using the following MeSH search terms: telewound, wound, wound care, remote care, telehealth, telemedicine, eHealth, mobile health, pressure injury, and ulcer. STUDY SELECTION: Articles were included if they were a scientific report of a single study; evaluated a telehealth method; identified the type of wound of focus; and provided data on clinical, healthcare utilization, or cost outcomes of telewound care. In total, 26 articles met these criteria. DATA EXTRACTION: Data were extracted and grouped into 13 categories, including study design, wound type, telehealth modality, treatment intervention, and outcomes measured, among others. DATA SYNTHESIS: Of the 26 studies, 19 reported on clinical outcomes including overall healing and healing time; 17 studies reported on healthcare utilization including hospitalizations and length of stay; and 12 studies reported costs. CONCLUSIONS: Evidence regarding the use of telewound care is weak, and findings related to the impact of telewound care on outcomes are inconsistent but indicate that it is not inferior to in-person care. Greater use of telehealth as a result of the COVID-19 pandemic points to further development of navigation and education models of telehealth for wound care. However, additional studies using rigorous research design and leveraging robust sample sizes are needed to demonstrate value.

Using the NCSBN Transition to Specific Practice Competency Tool to Develop a Multiple Patient Simulation.

ABSTRACT: Because of complexities of clinical practice and limitations in the clinical setting, prelicensure nursing students may not develop competencies necessary for safe entry into practice. Multiple patient simulation (MPS) is an effective teaching strategy to gain these competencies. The National Council of State Boards of Nursing Transition to Practice Specific Competency Tool was used to assess and identify gaps in students' knowledge and skills when designing an MPS. This unique approach allowed faculty to customize the MPS to meet the needs of students and potentially increase their readiness for practice.

Being present: Examining the efficacy of an Internet Mantram Program on RN-delivered patient-centered care.

BACKGROUND: The COVID-19 pandemic highlighted nurses' compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed. PURPOSE: The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans. METHODS: A one group pre-/post-test design was used to assess change in nurses' perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans' perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data. FINDINGS: Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout. DISCUSSION: For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.

Establishing psychological safety in simulation: Faculty perceptions.

BACKGROUND: A psychologically safe learning environment is defined as one where individuals feel comfortable to take interpersonal risks without fear of negative consequences. Despite knowledge of best practice for simulation, there is a lack of knowledge regarding how nursing faculty perceive and establish psychological safety in a simulated learning environment. OBJECTIVES: The purpose of this study was to explore nursing faculty's perceptions of psychological safety as it exists within a simulation learning environment for pre-licensure nursing students. DESIGN: Mixed methods with online survey data collection. SETTINGS/PARTICIPANTS: Purposive sampling was used to recruit simulation nursing faculty who had previously participated in the National League for Nursing Leadership Development Program. Faculty were recruited from the United States and Canada. METHODS: Data were collected using a series of open-ended questions through the online survey tool, SurveyGizmo. Content analysis was utilized to discover how faculty established psychological safety during the pre-brief, scenario, and debriefing phases of simulation. Three researchers independently, then collaboratively, reviewed the data, identifying themes and patterns across each phase. RESULTS: Thirty-seven nursing faculty participated in the study. Across the phases of pre-brief, scenario, and debriefing, five themes emerged: (1) Setting the Stage; (2) It's ok, It's Simulation; (3) Everyone is Here to Learn; (4) Planned Strategies; and (5) Facilitator as Observer. CONCLUSIONS: Faculty perceive that they play a role in establishing a psychologically safe learning environment during all three phases of a simulation experience. Scenarios are purposefully designed to emotionally protect students while they participate in unfamiliar encounters. Strategies are implemented throughout all three phases to facilitate student risk-taking as part of the learning process. Faculty watch for verbal and non-verbal cues by students signaling a potentially psychologically unsafe learning environment, and intervene to protect them if necessary.

Alerting Doctors About Patient Life Challenges: A Randomized Control Trial of a Previsit Inventory of Contextual Factors.

Objective. Effective care attends to relevant patient life context. We tested whether a patient-completed inventory helps providers contextualize care and increases patients' perception of patient-centered care (PCC). Method. The inventory listed six red flags (e.g., emergency room visits) and if the patient checked any, prompted for related contextual factors (e.g., transportation difficulties). Patients were randomized to complete the inventory or watch health videos prior to their visit. Patients presented their inventory results to providers during audio-recorded encounters. Audios were coded for physician probing and incorporating context in care plans. Patients completed the Consultation and Relational Empathy (CARE) instrument after the encounter. Results. A total of 272 Veterans were randomized. Adjusting for covariates and clustering within providers, inventory patients rated visits as more patient-centered (44.5; standard error = 1.1) than controls (42.7, standard error = 1.1, P = 0.04, CARE range = 10-50). Providers were more likely to probe red flags (odds ratio = 1.54; confidence interval = 1.07-2.22; P = 0.02) when receiving the inventory, but not incorporating context into care planning. Conclusion. A previsit inventory of life context increased perceptions of PCC and providers' likelihood of exploring context but not contextualizing care. Information about patients' life challenges is not sufficient to assure that context informs provider decision making even when provided at the point of care by patients themselves.

Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites.

PURPOSE: "Patient context" indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient "contextual factors," if overlooked, result in an inappropriate plan of care, a medical error termed a "contextual error." The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. METHOD: This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients' abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. RESULTS: Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. CONCLUSIONS: Contextual factors in patients' lives may be essential to address for effective care planning. The rubric developed can serve as a "contextual differential" for clinicians to consider when addressing challenges patients face when planning their care.

Development and initial validation of the Respirator Comfort, Wearing Experience, and Function Instrument [R-COMFI].

Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs. Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model (PCM) analysis. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait. The final instrument was completed by 165 health care personnel from 3 Veterans Health Administration facilities, and data were analyzed using Rasch PCM. Seven items were removed because they: (1) violated the assumption of independence; (2) were mis-fitting; and/or (3) were deemed not relevant. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items. Until now, to our knowledge no instrument with evidence supporting its reliability and validity to assess discomfort and tolerance of FFRs among health care personnel has been published. A 21-item psychometrically sound measure of comfort and tolerability of FFRs, Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), was developed. The significance of developing such an instrument is that it will help identify respirators that are likely to have better adherence in practice settings. The R-COMFI may be used within and beyond the VA healthcare system as a psychometrically sound instrument to evaluate the comfort and tolerability of respirators, including developmental prototypes.

A Rasch Rating Scale Analysis of the Presence of Nursing Scale-RN.

The phenomenon of nursing presence encompasses the emotional connection between nurse and patient, and technical skills performed by the nurse. The Presence of Nursing Scale-RN version (PONS-RN) was developed to measure nurses' perceptions of their ability to be present to their patients. This study summarizes the process of re-evaluation of the psychometric properties of the PONS-RN instrument. A sample of 76 registered nurses providing direct patient care responded to the 31-item questionnaire. The Rasch rating scale model was used for assessing construct validity of PONS-RN data. A principal component analysis (PCA) of residuals supported appropriateness of the subscales defined by a 2-dimensional structure. The results of item and person fit analysis, rating scale functioning analysis and reliability analysis have demonstrated that the thirty-one item Presence of Nursing Scale-RN instrument yielded measures with high validity and reliability as two sub-scales.

Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy.

Guidelines on long-term opioid therapy recommend frequent reassessment of harm, efficacy, and misuse of these potentially harmful and sometimes ineffective medications. In primary care, there is a need for a brief, patient-reported instrument. This report details the initial steps in the development of such an instrument. An interdisciplinary team of clinician-scientists performed four discrete steps in this study: (1) conceptualization of the purpose and function of the instrument, (2) assembly of an item pool, (3) expert rating on which items were most important to include in the instrument, and (4) modification of expert-selected items based on a reading level check and cognitive interviews with patients. A diverse panel of 47 subject matter experts was presented with 69 items to rate on a 1-9 scale in terms of importance for inclusion in the instrument. The panel highly rated 37 items: 8 related to harm, 4 related to efficacy, and 25 related to misuse. These 37 items were then tested for patient comprehension and modified as needed. Next steps in development will include further item reduction, testing against a gold standard, and assessment of the instrument's effect on clinical outcomes.

Traditional or Translational Research for Nursing: More PhDs Please.

In this column, the authors focus on the need for more PhD-prepared nurses as opposed to nurses receiving the Doctor of Nursing Practice (DNP). This would help to to facilitate an understanding between traditional research and translational research. The idea of a need for collaboration between these two terminal degrees is highlighted. To that end, the history and intent of the research doctorate and the practice doctorate are entertained along with a brief description of the traditional and translational research processes.

Nursing presence: putting the art of nursing back into hospital orientation.

Nursing presence, the "doing for" and "being with" patients, embodies the holistic work of the registered nurse. However, nursing presence is seldom reflected in hospital orientation curricula. Programs traditionally orient nurses to policies and psychomotor tasks but exclude emphasizing how to "be with" patients. This article describes how one Midwestern academic medical center incorporated both the art and science of nursing into orientation.

Group mentoring: a story of transition for undergraduate baccalaureate nursing students.

BACKGROUND: Group mentoring has been endorsed as an effective method of supporting novice professionals across disciplines. In one university, faculty revised the undergraduate nursing curriculum to include a group mentoring course as a requirement of students during the four semesters they are enrolled in the nursing program. OBJECTIVES: The purpose of this study was to explore the lived experience of undergraduate nursing students participating in a group mentoring course. DESIGN: This study used a hermeneutic interpretive phenomenological method. SETTING AND PARTICIPANTS: Data were collected from 22 undergraduate nursing students enrolled in group mentoring courses at a private Midwestern university in the United States. METHODS: At the end of each semester of mentoring, students provided written responses to five open-ended questions about their experiences of participating in the mentoring courses. RESULTS: Four themes emerged: conversation, communication, connection, and cohesion. CONCLUSION: Group mentoring was an effective way to support nursing students as they transitioned from undergraduate student to novice professional nurse.

Preceptors and new graduate nurse orientees: implications of psychological type compatibility.

The relationship between preceptor and new graduate nurse (NGN) orientee can be a critical factor in NGNs' satisfaction with choice of profession and place of employment. A research study was conducted with NGN orientees (n = 218) and preceptors (n = 159) to investigate characteristics of psychological type as determined by the Myers-Briggs Type Indicator. Preliminary descriptive data regarding participants' Myers-Briggs Type Indicator characteristics is presented, and suggestions are offered for working with orientees during orientation in both classroom sessions and clinical units.

Development and psychometric assessment of the Presence of Nursing Scale.

Nursing presence has been conceptualized in the literature. However, no instrument has been developed to measure it. The purpose of this study was to develop a scale to measure patients' perceptions of nursing presence and to examine its psychometric properties. A conceptual definition of nursing presence was operationalized and integrated into the 25-item Presence of Nursing Scale and tested on 330 hospitalized patients. Reliability and validity of the Presence of Nursing Scale were supported when tested with this sample. The study represents the first time the phenomenon of nursing presence has been measured.

The top ten list: lessons learned from teaching a study abroad course.

In response to the need for culturally competent care, faculty can instill in students the desire to become culturally competent practitioners by providing the opportunity to participate in a short-term study abroad immersion experience. While this strategy is not considered cutting-edge or revolutionary, changing global dynamics warrant rethinking this curricular option. Nurse faculty conducted two short-term study abroad courses in Croatia. Students explored health care and nursing education in this Eastern European country and participated in a service-learning project. Based on their experiences, the authors offer five dos and five don'ts for planning and implementing a successful study abroad course.

The research environment: the challenge of getting true data.

The environment in which research is conducted can present many challenges to data collection. This is the story of a research project that was designed to investigate the influence of personality type on the satisfaction of preceptors and new graduate nurses with the orientation process. Despite many adaptations in the data collection protocol, the researchers were not able to obtain enough data from participants to answer the research question. Challenges presented by the data collection site are described and suggestions are offered for consideration.

Becoming a nurse researcher: the importance of mentorship.

This column is concerned with the mechanics of transitioning from being a new doctoral graduate to being a researcher with a solid program of study. To clarify these mechanics, the authors discuss the roles of being a research mentor, the expectations of being a mentee, and practical tips for sustaining a successful relationship.

Learning style preference and student aptitude for concept maps.

Acknowledging that individuals' preferences for learning vary, faculty in an undergraduate nursing program questioned whether a student's learning style is an indicator of aptitude in developing concept maps. The purpose of this research was to describe the relationship between nursing students' learning style preference and aptitude for concept maps. The sample included 120 undergraduate students enrolled in the adult health nursing course. Students created one concept map and completed two instruments: the Learning Style Survey and the Concept Map Survey. Data included Learning Style Survey scores, grade for the concept map, and grade for the adult health course. No significant difference was found between learning style preference and concept map grades. Thematic analysis of the qualitative survey data yielded further insight into students' preferences for creating concept maps.