Predictors of Nursing Clinical Judgment in Simulation.

ABSTRACT: This was a pilot study of novice and expert nurses participating in a simulation to determine the predictors of clinical judgment. Covariates included age, nursing experience, simulation experience, and six measures of pupil dilation as a measure of stress with scores on the Lasater Clinical Judgment Rubric as the dependent variable. A stepwise linear regression found years of RN experience was the only predictor of better clinical judgment. Despite evidence of stress, only years as a nurse was a statistically significant predictor.

Time-to-Task Validation in Sequential Simulations as a Component of Nursing Student Competency.

BACKGROUND: Time goals have not been tested as a component of nursing competence. METHODS: Using a known-groups approach, a multisite study was performed on prelicensure nursing students (novices) and experienced nurses (experts) who participated in 2 simulations of patient deterioration with time goals. Video capture was achieved with an eye tracker. RESULTS: While all novices did not achieve the time goals in both simulations, there was a significant improvement between the 2 simulations (P = .04). Experts were more successful in achieving the time-to-task goals in both simulations (44% and 95%, respectively). Statistical significance was found between the novice and expert groups in achieving the time goal for both simulations (P < .01). CONCLUSIONS: This study was able to differentiate the expert group as being more proficient in a timed assessment, although the novices showed improvement between 2 simulations. This illustrates an opportunity for skill development among novices in managing patient deterioration amenable to time as an objective assessment.

Validation of time to task performance assessment method in simulation: A comparative design study.

BACKGROUND: There is a lack of objective and valid measures for assessing nursing clinical competence which could adversely impact patient safety. Therefore, we evaluated an objective assessment of clinical competence, Time to Task (ability to perform specific, critical nursing care activities within 5 min), and compared it to two subjective measures, (Lasater Clinical Judgement Rubric [LCJR] and common "pass/fail" assessment). DESIGN/METHODS: Using a prospective, "Known Groups" (Expert vs. Novice nurses) comparative design, Expert nurses (ICU nurses with >5 years of ICU experience) and Novice nurses (senior prelicensure nursing students) participated individually in a simulation of a patient in decompensated heart failure. Fourteen nursing instructors or preceptors, blinded to group assignment, reviewed 28 simulation videos (15 Expert and 13 Novice) and scored them using the LCJR and pass/fail assessments. Time to Task assessment was scored based on time thresholds for specific nursing actions prospectively set by an expert clinical panel. Statistical analysis consisted of Medians Test and sensitivity and specificity analyses. RESULTS: The LCJR total score was significantly different between Experts and Novices (p < 0.01) and revealed adequate sensitivity (ability to correctly identify "Expert" nurses; 0.72) but had a low specificity (ability to correctly identify "Novice" nurses; 0.40). For the subjective measure 'pass/fail', sensitivity was high (0.90) but specificity was low (0.47). The Time to Task measure had statistical significance between Expert and Novice groups (p < 0.01) and sensitivity (0.80) and specificity (0.85) were good. CONCLUSION: Commonly used subjective measures of clinical nursing competence have difficulties with achieving acceptable specificity. However, an objective measure, Time to Task, had good sensitivity and specificity in differentiating between groups. While more than one assessment instrument should be used to determine nurse competency, an objective measure, such as Time to Task, warrants further study.

Learning style impact on knowledge gains in human patient simulation.

INTRODUCTION: Human patient simulation (HPS) is a widely used method of teaching in nursing education. While it is believed that a student's learning style impacts knowledge gains in HPS, there is little evidence to support this. This study sought to determine the impact of learning style on knowledge gains after a heart failure (HF) simulation experience in pre-licensure nursing students. METHODS: A convenience sample of four cohorts of prelicensure nursing students (n=161) were recruited from three Baccalaureate Schools of Nursing at the same point in their curriculum (age 25.7±6.6 years; gender=85.5% female) and participated in HPS using a HF simulation on a high-fidelity manikin. Learning style was assessed by the Kolb Learning Style Inventory (LSI) and pre- and post-HPS knowledge measured by parallel, validated, knowledge tests. The LSI identifies 4 learning styles, (Assimilating Diverging, Accommodating, and Converging). In some cases, learners present a balanced learning profile-an emphasis of all four equally. Statistical analysis consisted of t-tests and ANOVA. RESULTS: HF knowledge scores post-HPS compared to pre-HPS scores revealed a mean improvement of 7 points (p<0.001) showing evidence of learning. Within group score increases between the pre-test and post-test were seen for the Assimilating (66.68±20.87 to 83.35±12.59; p=0.07), Diverging (61.95±11.08 to 69.86±12.33; p<0.01) and balanced profiles (64.4±12.45 to 71.8±10.14; p<0.01), but not for Converging or Accommodating profiles (73% of sample). Post-hoc paired t-tests revealed a large effect size for the Assimilators (0.91) and moderate effect sizes for both the Divergers and balanced profiles (0.67 and 0.65, respectively). CONCLUSION: These findings confirm that knowledge gains occur with HPS and provide evidence that HPS is an effective teaching methodology for nursing students identifying with most types of learning styles.

The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students.

UNLABELLED: Human patient simulation (HPS) is becoming a popular teaching method in nursing education globally and is believed to enhance both knowledge and critical thinking. OBJECTIVE: While there is evidence that HPS improves knowledge, there is no objective nursing data to support HPS impact on critical thinking. Therefore, we studied knowledge and critical thinking before and after HPS in prelicensure nursing students and attempted to identify the predictors of higher critical thinking scores. METHODS: Using a one-group, quasi-experimental, pre-test post-test design, 154 prelicensure nursing students (age 25.7± 6.7; gender=87.7% female) from 3 schools were studied at the same point in their curriculum using a high-fidelity simulation. Pre- and post-HPS assessments of knowledge, critical thinking, and self-efficacy were done as well as assessments for demographics and learning style. RESULTS: There was a mean improvement in knowledge scores of 6.5 points (P<0.001), showing evidence of learning. However, there was no statistically significant change in the critical thinking scores. A logistic regression with 10 covariates revealed three variables to be predictors of higher critical thinking scores: greater "age" (P=0.01), baseline "knowledge" (P=0.04) and a low self-efficacy score ("not at all confident") in "baseline self-efficacy in managing a patient's fluid levels" (P=.05). CONCLUSION: This study reveals that gains in knowledge with HPS do not equate to changes in critical thinking. It does expose the variables of older age, higher baseline knowledge and low self-efficacy in "managing a patient's fluid levels" as being predictive of higher critical thinking ability. Further study is warranted to determine the effect of repeated or sequential simulations (dosing) and timing after the HPS experience on critical thinking gains.

Learning from mistakes in a simulated nursing leadership laboratory.

Human patient simulation in nursing education has become an accepted and expected form of pedagogy. Research on the use of human patient simulation to evaluate student performance, however, is still at an early stage. The vast majority of these sources report the unit of analysis as the nurse-patient dyad (one nurse-one patient) situated in an infrequently occurring, high-risk, or costly event such as a code blue, and the literature reveals little evidence on the efficacy of the use of simulation for the care of multiple patients. The teaching innovation, discussed herein, involving a simulation, used a leadership scenario of a routine day in an acute-care hospital unit. The aim of the project was to provide a high-fidelity simulation of the competing demands on a nurse's time and attention while caring for multiple patients. Working as a team, using principles of prioritization, delegation, scope of practice, and communication, senior baccalaureate nursing students assumed the various roles of interdisciplinary team members as they moved through staged sequences of changing patient and unit conditions. This was followed by debriefing session that prompted the students to identify their errors in judgment, including sending the wrong patient to the operating room, failing to rescue a patient, and failing to delegate critical tasks to other nursing team members.

Predictors of knowledge gains using simulation in the education of prelicensure nursing students.

Gains in knowledge and self-efficacy using human patient simulation (HPS) in the education of prelicensure nursing students have been reported. However, the predictors of improved learning outcomes using this teaching methodology are not known. Using a two-group (participated in HPS, did not participate in HPS), repeated-measures, experimental design, we examined the predictors of higher scores on a Knowledge Questionnaire in 162 students (age = 25.7 ± 6.6, gender = 85.5% female) from four prelicensure cohorts at three nursing schools. Statistical analysis consisted of t-tests, ANOVA and stepwise logistic regression. Covariates included age, gender, learning style, baseline critical thinking, baseline self-efficacy, group membership (control or experimental), and school. Membership in the experimental group was the only statistically significant independent predictor (P < .001) of knowledge gains among the covariates entered into the regression analysis. Members of the control group were two times less likely than those in the experimental group to be in the higher scored group (P < .001), yet this changed once the control group participated in HPS. Our findings show that HPS can independently improve test scores. This study provides evidence that HPS; is an effective teaching methodology for prelicensure nursing students regardless of age, learning style, or critical thinking ability.

Human patient simulation: state of the science in prelicensure nursing education.

Nurse educators strive to engage students in an active learning process. Human patient simulation (HPS) may provide an interactive learning experience for nursing students. However, the current literature and research published on HPS is restricted and lacks objective evidence supporting this educational method in prelicensure nursing education. Studies with large numbers of participants and clearly defined, objective, and validated data collection methods are rare. Despite the lack of empirical evidence for HPS, many are embracing a technology and form of education in which the efficacy is still in question. This article reviews the current research in the areas of HPS value perceptions and studies of HPS impact on knowledge and knowledge transfer among nurses.

What do we know about adherence and self-care?

Despite advances in healthcare, heart failure patients continue to experience complications that could have been prevented or treated. This occurs because the only way that a therapeutic or preventive regimen can be effective, assuming that the patient's condition has been accurately diagnosed and appropriately treated, is if the patient implements self-care behaviors and adheres to the treatment regimen. However, it is widely accepted that this does not occur in many or even most instances. This article provides an overview of the current evidence related to adherence and self-care behaviors among heart failure patients and describes the state of the science on interventions developed and tested to enhance self-care maintenance in this population. Our review of literature shows that effective interventions integrate strategies that motivate, empower, and encourage patients to make informed decisions and assume responsibility for self-care. Gaps in current evidence support the need for additional research on ways to improve adherence and self-care for patients who are at an increased risk of poor adherence, including those with cognitive and functional impairments and low health literacy.