Virtual Reality Simulation Applications in Pre-Licensure Psychiatric Nursing Curricula: An Integrative Review.

The integrative review's objective is to determine the effectiveness of incorporating virtual reality (VR) simulation teaching methods in pre-licensure psychiatric nursing curricula. While the demand for skilled nurses has increased, the COVID-19 pandemic exacerbated nursing educational resource shortages and reduced the number of qualified applicants accepted into nursing schools. Psychiatric assessment and communication skills are difficult to obtain. VR simulation may present an effective solution to enhancing nursing students' psychiatric education. The integrative review was the study design. Tailored search terms were applied to the following databases: PubMed, PsycINFO, ERIC, and CINAHL Plus with Full Text. The databases were searched by title and abstract during the period January 1, 2011, through October 14, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to search strategies and results. The selected articles were evaluated using the Johns Hopkins research evidence appraisal tool. Eleven studies met the inclusion criteria for the integrative review. Study results were categorized into two main themes: (a) pedagogical approach and (b) usability. Three sub-themes emerged: (a) knowledge, (b) attitudes, and (c) skills. VR was found to be effective in increasing nursing students' knowledge; improving communication and decision-making skills; and impacting attitudes toward patients living with mental illness. VR was found to be the same as or superior to traditional and other simulation methods in teaching psychiatric nursing education to pre-licensure students. While convenient, virtual reality use involves managing technical difficulties and considering safety. VR simulation is an effective pedagogical approach for psychiatric nursing curricula and offers a potentially cost-effective alternative to traditional learning and other simulation methods.

Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.

Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

Durability of second-generation extensively porous-coated stems in patients age 50 and younger.

UNLABELLED: Early versions of uncemented femoral total hip stems were often associated with thigh pain thought to be due to micromotion between the implant and bone in the distal uncoated regions. An extensively coated stem was introduced in 1992 to reduce that risk. We therefore asked whether second-generation extensively porous-coated cementless femoral stems in patients younger than 50 years of age would (1) be durable in terms of revisions; (2) provide high functional scores and reduce thigh pain; and (3) show radiographic signs of durability, including a reduction in stress shielding. We prospectively followed all 100 patients (115 hips) age 50 and younger treated with primary cementless total hip arthroplasties using a second-generation extensively porous-coated femoral stem between June 1994 and December 1999. The average age was 39.6 years (range, 17-50 years). The stems were mated to cementless acetabular components. Ninety patients were followed for a minimum of 5 years (mean, 8.6 years; range, 5-10 years). One stem was revised after a periprosthetic fracture. None were revised for loosening and all stems demonstrated bony ingrowth at last followup. No acetabular shell was revised for loosening and none was radiographically loose. Six acetabular liners were revised for wear (three each were 22-mm and 26-mm heads). This second-generation extensively porous-coated stem was durable at 5- to 10-year followup in this young active population. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.