Two-by-Two Factorial Design.

•In simulation research, we are often interested in comparing the effects of more than one independent variable.•Factorial designs allow investigators to efficiently compare multiple independent variables (also known as factors).•An example and resources are described for using a two by two factorial design in simulation research.

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.

An innovative academic-practice partnership to enhance the development and training of military nurses.

Academic-practice partnerships have been identified by the American Association of Colleges of Nursing as a best practice for advancing the profession of nursing in a collaborative manner by sharing goals, knowledge, and respect in a mutually beneficial line of effort. Training military nurses poses a unique challenge to academia and military nurse corps to produce competent nursing professionals who are also effective military officers. The academic-practice partnership between the United States Army Cadet Command's ROTC program and the University of San Francisco's School of Nursing is a prime example of such a partnership. Through the innovative month-long nurse summer training internship program, Army nursing students work one-on-one with an experienced Army nurse preceptor to receive an intense clinical experience with a minimum of 150 h of hands-on patient care in a military medical treatment facility. This example of cognitive apprenticeship learning provides an adjunct to nursing program curricula in addition to an introduction of the roles and responsibilities of a military officer. This academic-practice partnership helps develop a strong group of novice nurses who are confident leaders and critical thinkers that easily make the transition from academia to professional practice.

Using Student-Produced Video to Validate Head-to-Toe Assessment Performance.

BACKGROUND: This study explored third-semester baccalaureate nursing students' perceptions of the value of using student-produced video as an approach for learning head-to-toe assessment, an essential clinical nursing skill taught in the classroom. METHOD: A cognitive apprenticeship model guided the study. The researchers developed a 34-item survey. A convenience sample of 72 students enrolled in an applied assessment and nursing fundamentals course at a university in the western United States provided the data. RESULTS: Most students reported a videotaping process that worked, supportive faculty, valuable faculty review of their work, confidence, a sense of performance independence, the ability to identify normal assessment findings, and few barriers to learning. CONCLUSION: The results suggested that a student-produced video approach to learning head-to-toe assessment was effective. Further, the study demonstrated how to leverage available instructional technology to provide meaningful, personalized instruction and feedback to students about an essential nursing skill. [J Nurs Educ. 2018;57(3):154-158.].

Student-Directed Video Validation of Psychomotor Skills Performance: A Strategy to Facilitate Deliberate Practice, Peer Review, and Team Skill Sets.

Background Essential nursing skills for safe practice are not limited to technical skills, but include abilities for determining salience among clinical data within dynamic practice environments, demonstrating clinical judgment and reasoning, problem-solving abilities, and teamwork competence. Effective instructional methods are needed to prepare new nurses for entry-to-practice in contemporary healthcare settings. Method This mixed-methods descriptive study explored self-reported perceptions of a process to self-record videos for psychomotor skill performance evaluation in a convenience sample of 102 pre-licensure students. Results Students reported gains in confidence and skill acquisition using team skills to record individual videos of skill performance, and described the importance of teamwork, peer support, and deliberate practice. Conclusion Although time consuming, the production of student-directed video validations of psychomotor skill performance is an authentic task with meaningful accountabilities that is well-received by students as an effective, satisfying learner experience to increase confidence and competence in performing psychomotor skills.

Student QSEN Participation During an Adult Medical-Surgical Rotation.

With the six QSEN competencies woven throughout the baccalaureate nursing curriculum, which includes high-fidelity simulation, the aim of this research was to uncover deficits in QSEN-related clinical opportunities. Pre-licensure BSN nursing students enrolled in a sophomore-level medical-surgical rotation augmented with 25 percent simulation were observed directly, with time-on-task for each QSEN competency recorded and tabulated. The students were found to spend little time addressing several of the six competency areas in both clinical and simulation settings. Fully integrated classroom, simulation, and clinical experiences need to be considered in an effort to offer a full spectrum of QSEN-based knowledge and skill theory and practice for pre-licensure nursing students.

Academic-Practice Partnerships for Unemployed New Graduates in California.

In California, academic-practice partnerships offer innovative transition programs to new registered nurse (RN) graduates who have not yet found positions in nursing. This report describes the formation of 4 partnerships between 1 or more schools of nursing and clinical practice sites that included hospitals and nonacute care settings, such as hospice, clinics, school districts, and skilled nursing facilities. Factors facilitating the partnerships included relationships established as nurse leaders from practice and academia came together to address previous workforce issues, positive interpersonal experiences, an independent convening and coordinating organization, a shared understanding of the employment challenge faced by new RN graduates, and a shared vision for its solution. Partnerships face continuing challenges that include sustaining engagement, resource constraints, and insufficient nursing leadership succession planning. Partnership benefits include improved relationships between academia and practice, a forum to address contemporary issues in nursing education and practice advances, and stimulation of a reassessment of how to integrate ambulatory, transitional, and community-based nursing into prelicensure education.

Preceptor and Self-Evaluation Competencies Among New RN Graduates.

Four transition-to-practice programs for new RN graduates who had not yet found employment in nursing were based on the Quality and Safety Education for Nurses (QSEN) competencies of knowledge, skills, and attitudes (KSAs). To support consistent evaluation of participants by preceptors, a 35-item tool was developed that used a 4-point scale to assess selected behaviors. This article describes the initial reliability and validity testing of the tool, which had good internal consistency, with a Cronbach's alpha of 0.92 for preceptor evaluation of participants and 0.82 when used as a self-evaluation tool. Six content experts evaluated the tool's face validity; it successfully discriminated between junior-level baccalaureate nursing students and nursing faculty. Although the tool does not exhaustively reflect the QSEN KSAs, it provides a way to assess competencies among new nurse graduates.

Comparison of student experience with critical events during simulation and acute care hospital rotations.

An exploratory study was conducted to determine critical events for adult patients and to verify critical events that nursing students experienced in their nursing programs. Sophomores and juniors were surveyed regarding frequency of exposure to critical events. Sophomores reported greater differences between simulation and clinical practice, with most in simulation. Juniors were more balanced in exposure to critical events, in both clinical practice and simulation. This information provides feedback on critical events, clinical experiences, and how to use simulation to lessen the experience gap.

Economic aspects of community-based academic-practice transition programs for unemployed new nursing graduates.

Four partnerships between schools of nursing and practice sites provided grant-funded 12- to 16-week transition programs to increase confidence, competence, and employability among new RN graduates who had not yet found employment in nursing. Per capita program costs were $2,721. Eighty-four percent of participants completing a postprogram employment survey became employed within 3 months; 55% of participants became employed at their program practice site. Staff development educators may find this model a useful adjunct to in-house nurse residency programs for new RN graduates.

Preparing new nurse graduates for practice in multiple settings: a community-based academic-practice partnership model.

Responding to local and national concerns about the nursing workforce, the California Institute for Nursing and Health Care worked with private and public funders and community health care partners to establish community-based transition-to-practice programs for new RN graduates unable to secure nursing positions in the San Francisco Bay Area. The goals were to retain new RN graduates in nursing and further develop their skills and competencies to increase their employability. Leaders from academic and inpatient, ambulatory, and community-based practice settings, as well as additional community partners, collaboratively provided four 12- to 16-week pilot transition programs in 2010-2011. A total of 345 unemployed new nurse graduates enrolled. Eighty-four percent of 188 respondents to a post-program survey were employed in inpatient and community settings 3 months after completion. Participants and clinical preceptors also reported increases in confidence and competence.

Collaborative academic-practice transition program for new graduate RNs in community settings: lessons learned.

In 2010-2011, leaders from California academic and practice settings and additional community partners collaboratively developed four 12- to 16-week transition programs for 345 new registered nurse (RN) graduates who had not yet found employment as nurses. Program goals were to increase participants' confidence, competence, and employability and expand the employment landscape to nontraditional new graduate settings. One program focused exclusively on community-based settings and was completed by 40 participants at clinics and school sites; all participants secured RN jobs. Key lessons learned go beyond the impact for participants and relate to changing the nursing culture about career path models for new graduates, troubleshooting regulatory issues, the potential for new graduates to help transform nursing, and advancing academic-practice partnerships and supporting practice sites. The community-based transition program continues to provide opportunities for new RN graduates and model an approach for transforming nursing practice.

Competence gaps among unemployed new nursing graduates entering a community-based transition-to-practice program.

Multiple reports document competence gaps among employed new RN graduates. Less is known about the competence and confidence of new RN graduates who have not yet found employment in nursing. As part of an academic/practice partnership model, 4 collaboratives provided transition-to-practice programs for newly graduated and licensed, but unemployed, RNs. The authors describe the new nurses' characteristics on program entry and discuss implications for nursing education and practice.

Comparison of Quality and Safety Education for Nurses (QSEN)-related student experiences during pediatric clinical and simulation rotations.

Nurse educators are challenged with providing meaningful clinical experiences for students. However, patient safety regulations constrain what nursing students are able to accomplish in the pediatric setting. So, what are students actually doing in their clinical rotation? This pilot observational study was undertaken to provide a snapshot of the experiences available to nursing students that develop the six Quality and Safety Education for Nurses (QSEN) competencies. Students were directly observed during pediatric clinical and pediatric simulation rotations, and their time-on-task was calculated and categorized. Three of the six QSEN competencies were observed more often than the others during both the simulation and clinical experiences. Much work needs to be done to include all QSEN-related knowledge and skills into prelicensure clinical rotations.

Using integrated simulation in a nursing program to improve medication administration skills in the pediatric population.

AIM: The purpose of this evaluative study was to determine the overall influence of a mixed educational approach on student knowledge and self-confidence with pediatric intravenous medication administration. BACKGROUND: There are diminishing opportunities for students to practice IV medication administration in pediatric patients. Nurse educators must find ways to effectively train students that ready them for the real world of patient care while reducing risk. METHOD: After lecture and pretesting, junior-level students spent approximately 50 hours in a pediatric unit and 40 hours in a high-fidelity pediatric simulation completing scenarios with medical prescribing and system-based pharmaceutical error, unpredictable medication administration dilemmas, and acute drug reactions.After the clinical rotation, students completed a posttest and self-confidence survey. RESULTS: . Results revealed a rise in knowledge and student self-reporting of confidence of essential medication administration skills for the pediatric population. CONCLUSIONS: A clinical rotation enhanced with simulation provides a rich learning environment without endangering patients. It allows students to experience risk-free problem-solving while giving faculty a more predictable process to assess acquisition of skills.

Patient safety manifesto: a professional imperative for prelicensure nursing education.

Nurses in practice and students in training often fear hurting a patient or doing something wrong. Experienced nurses have developed assessment skills and clinical intuition to recognize and intervene to prevent patient risk and harm. Beginning nursing students have not yet had the opportunity to develop an awareness of patient risk, safety concerns, or a clear sense of their accountability in the nurse role as the primary advocate for patient safety. In this Safety Manifesto, the authors call for educators to critically review their prelicensure curricula for inclusion of teaching and learning activities that are focused on patient safety and offer recommendations for curricular changes with an emphasis on integration of instructional strategies that develop students' skills for clinical reasoning and judgment.