Clinical Simulation in Nursing - Articles in Press

High-Fidelity Simulation: How Are We Using the Videos? - Corrected Proof

2012-05-21

Abstract: Background: High-fidelity simulation equipment offers opportunities for video recordings to be used to enhance the education of student nurses. These videos are often set aside without full consideration of their potential value.Method: To illustrate multiple uses of video recordings, this article reports a descriptive secondary analysis of video recordings obtained from a larger simulation study. The video recordings of 26 baccalaureate student nurses were examined for behaviors related to safety (washing hands, raising cribside rails, assuring accuracy of intravenous fluids, donning gloves to check the diaper, measuring wound drainage on abdominal dressing).Results: The safety behaviors were satisfactorily performed by 34.6% to 84.6% of students.Conclusion: The video recordings effectively highlighted behaviors in need of further teaching and reinforcement for best pediatric practice.

Why Your TeamSTEPPS™ Program May Not Be Working - Corrected Proof

Timothy C. Clapper, Grace M. Ng — 2012-05-14

Abstract: Team Strategies and Tools to Enhance Performance and Patient Safety® (TeamSTEPPS™) is a patient safety tool developed by the defense industry and based on four competencies: leadership, communication, situational monitoring, and mutual support. Unfortunately, there are barriers that prevent TeamSTEPPS from reaching its full potential, including: (a) lack of administrative support and resources, (b) lack of training focus to address hierarchal differences and incivility at all levels of health care practice and administration, (c) inadequate TeamSTEPPS instruction and simulation practices, and (d) educators' resistance to change from crew resource management concepts. Suggestions for improvement include providing command and health care agency emphasis for the TeamSTEPPS program, providing adequate material and personnel resources, designing training that is geared to trainer implementation at the departmental level, prioritizing and saturating training, and striving toward a just culture.

An Analysis of Simulation Resources, Needs, and Plans in Florida - Corrected Proof

Mary Lou Sole, Mary Elizabeth “Betsy” Guimond, Christina Amidei — 2012-04-20

Abstract: Background: An assessment of statewide resources related to simulation equipment, use, and plans was conducted to identify resources and needs.Methods: Administrators of nursing programs and hospitals were contacted to participate in the online statewide survey of simulation resources.Results: Nursing programs substituted an average of 5.1% of clinical hours with simulation experiences. Schools owned more equipment than hospitals did, including twice as many high-fidelity simulators. Schools were more likely than hospitals were to have space designated for simulation and to hire simulation coordinators. Funding and sustainability of simulation were cited as major concerns by the majority of respondents.Conclusions: Application and availability of simulation resources vary. Schools of nursing had more equipment and personnel resources than hospitals did. Sustainable funding for simulation was important to all end users. Opportunities for partnerships and research were identified.

Traditional Clinical Versus Simulation in 1st Semester Clinical Students: Students Perceptions After a 2nd Semester Clinical Rotation - Corrected Proof

Nancy L. Oldenburg, Catherine Maney, Donna J. Plonczynski — 2012-04-20

Abstract: Background: Traditional clinical experiences are being supplemented with high-fidelity simulation (HFS) in many nursing programs. The immediate and long-term impact on students' perception of clinical competence is not known.Method: Surveys were administered to 1st-year nursing students following their first-semester clinical experiences in either a traditional or an HFS setting. Differences between the two groups were compared by analysis of the results of a survey of perceived clinical competence. The comparison was made again for the cohorts following their second-semester hospital-based clinical experiences.Results: Significantly higher scores were reported by the HFS group initially, but this difference was less pronounced following second-semester hospital-based clinical experiences.Conclusions: Students with first-semester HFS experiences had initial higher perceptions of competence. Further research is needed to demonstrate the short- and long-term impact of simulated experiences on perceived competence, as well as on clinical performance.

The Nurse Attorney's Role: Linking Legal Concepts to an Obstetrical Simulation - Corrected Proof

Mary J. Rock, Gina L. Schaar, Constance F. Swenty — 2012-04-16

Abstract: Clear communication is an integral factor in delivering safe, quality patient care. Nurses face even greater communication challenges when delivering care to non–English-speaking patients. Using the new Joint Commission Guidelines, which promote nursing care that is culturally and linguistically sensitive, nursing faculty used a high-fidelity simulation to address the legal issue of obtaining informed consent from a non–English-speaking patient. This article describes the nurse attorney's role during a high-fidelity simulation that provided BSN students an opportunity to care for a culturally diverse population.

Using Plan Do Study Act to Transform a Simulation Center - Corrected Proof

Judy Irene Murphy — 2012-04-16

Abstract: This article describes one school's transformation of clinical education in the simulation center. The school used Plan Do Study Act (PDSA) to shift its focus from skills training to quality improvement, patient safety, and professionalism. The PDSA quality improvement model was selected to frame the transformation and infuse quality into the curriculum. Each phase of the PDSA process is fully described. The project goals were met, and future goals were identified. The levels of technology and innovative instruction were advanced with administrative and financial support. Updating our simulation center's physical environment, using active learning strategies, and promoting a culture of safety have greatly enhanced the student learning experience.

Home Visit Simulation Using a Standardized Patient - Corrected Proof

Yeoun Soo Kim-Godwin, Kae Rivers Livsey, Debbie Ezzell, Carol Highsmith — 2012-04-06

Abstract: Background: The use of standardized patients (SPs) in home health applications in nursing education is relatively new. This study analyzes student perceptions of a home visit simulation experience as part of community health clinical rotations.Method: This descriptive study explores the effectiveness of student satisfaction, self-confidence, and the effectiveness of student learning in a home visit simulation with an SP. Study participants included 76 undergraduate nursing students from a Southeastern university enrolled in a senior-level community health nursing course.Results: The findings of the quantitative and qualitative data indicated that students were highly satisfied with their simulated home visit experience and generally felt confident in their ability in learning during the simulation.Conclusions: Use of the SP during the home visit simulation was well received by students as a valuable learning experience and could be expanded for use in community health and other clinical courses.

Improving Consistency of Assessment of Student Performance during Simulated Experiences - Corrected Proof

2012-04-05

Abstract: Assessment of student practicum performance is a complex process, fraught with difficulties. The challenges associated with assessment of performance are multifactorial. The authors contend that these challenges have three main foci: the difficulty in determining which behaviors are necessary and sufficient to demonstrate competence, the potential subjectivity of evaluators, and the possible alteration of student performance based on the expectations of individual faculty members. An innovative strategy was implemented to improve consistency among nurse educators during simulated clinical experiences. This article describes the development of an orientation process for users of a simulation evaluation instrument, the C-SEI©. Furthermore, this orientation process may provide a framework for nurse educators to improve consistency of evaluation in any realm of student performance.

The Effectiveness of Combined Training Modalities on Neonatal Rapid Response Teams - Corrected Proof

Deborah Kilday, LeeAnna Spiva, Julia Barnett, Cathy Parker, Patricia Hart — 2012-03-30

Abstract: Background: The constantly changing situations facing rapid response teams (RRTs) are confirmation that an effective training program is critical in achieving optimal patient outcomes.Method: A pilot study using a quasi-experimental, pre–post test design and a simulation observational method was used to determine the effectiveness of a combined team training program on neonatal RRTs' perceived teamwork and safety culture, perceived emergency teamwork during resuscitation, knowledge level, and team performance.Results: Statistically significant increases were shown in team performance, knowledge, and emergency teamwork posttraining. Teamwork and safety climate also increased, although not significantly.Conclusion: Findings support a combined team training program as an effective approach for neonatal RRTs.

Comparison of Two Simulation Methods on Chinese BSN Students’ Learning - Corrected Proof

Ai Ling Wang, Joyce J. Fitzpatrick, Marcia A. Petrini — 2012-03-19

Abstract: Background: High-fidelity simulation has been demonstrated to be an efficient teaching method, although high-fidelity manikins are more expensive than low- or moderate-fidelity simulation manikins. This study was designed to explore differences in outcomes related to use of moderate-fidelity versus high-fidelity simulations in Chinese nursing education.Method: A comparative, quasi-experimental design was employed among 59 junior students in a BSN program in the People’s Republic of China.Results: The moderate-fidelity simulation received significantly higher scores in students’ satisfaction and self-confidence ratings, while the high-fidelity simulation showed better implementation of the simulation design elements.Conclusion: Both simulation methods had beneficial outcomes for students. There is a need for additional research evaluating these simulation interventions.

Human Patient Simulation Versus Written Case Studies for New Graduate Nurses in Nursing Orientation: A Pilot Study - Corrected Proof

Joan Roche, Denise Schoen, Arlene Kruzel — 2012-03-16

Abstract: Introduction: Professional nurse educators in acute care are challenged to increase the level of clinical performance of new graduate nurses. There is little research on the most effective method available to facilitate this process completed the quasi-experimental pilot study.Method: This quasi-experimental pilot study compared the clinical performance, satisfaction with orientation, and employment outcomes of two groups of new graduate nurses: one group completing human patient simulation (HPS) scenarios and one group completing written case studies on the same complex clinical cases. The stratified purposive sample included twenty new graduate nurses.Results: There were no differences in satisfaction with orientation or retention between the two groups. There were no differences in assessment, interventions, or communication performance between the two groups. The experimental group (HPS) performed better on safety behaviors than the control group (written case studies).Conclusions: The pilot data on safety performance provided insights for a larger study comparing these two teaching methods.

Testing Ajzen’s Theory of Planned Behavior for Faculty Simulation Development - Corrected Proof

Amy L. Jones, Nancy Fahrenwald, Angie Ficek — 2012-03-01

Abstract: Background: Ajzen’s theory of planned behavior (TPB) guided this evaluation of a Summer Simulation Training Fellowship program for baccalaureate nursing faculty. The 2-day curriculum integrated simulation pedagogy with TPB-derived strategies.Methods: A 24-item survey measured pre–post test changes in TPB-derived subscales. The dependent t test was used (N = 11).Results: There were nonsignificant changes in the subscales. Intention to teach with SimMan™ in the next year did not increase, but general intention to use simulation improved (p = .005). There were significant changes in individual subscale items.Conclusions: The Summer Simulation Training Fellowship program needs further testing.

Simulation to Improve Pediatric Patient Outcomes: University and Hospital Collaborative - Corrected Proof

Kimberly P. Stephens, Nancy R. Mosser — 2012-02-27

Abstract: A collaborative venture between a local university in southwestern Pennsylvania and a rural community hospital enhanced learning and improved pediatric patient outcomes. The partnership led to the development and implementation of an evidence-based pediatric peripheral intravenous (PIV) insertion program. Through the use of simulation technology and debriefing techniques at the pediatric PIV insertion program, pediatric PIV insertion skills of the medical–surgical nursing staff improved, as evidenced by a decreased number of pediatric PIV insertion attempts.

Structured Debriefing and Students’ Clinical Judgment Abilities in Simulation - Corrected Proof

2012-02-20

Abstract: Background: Debriefing is a critical component of clinical simulation, yet there are limited studies that demonstrate the outcomes of debriefing on learners’ clinical judgment.Method: Using the Lasater Clinical Judgment Rubric, this mixed-method study examined the effects of structured debriefing after 2 clinical simulation experiences on 86 junior-level baccalaureate nursing students’ clinical judgment. Debriefing for Meaningful Learning© was the method used for the structured debriefing sessions.Results: The mean clinical judgment scores of the intervention group were higher and improved more over time compared with the mean scores of those in the control group; however, the differences were not statistically significant.Conclusions: Data generated from focus group interviews suggest that students perceived the structured debriefing sessions as being learner-focused discussions that provided a holistic approach that included a review of knowledge, technical skills, and their reactions and emotions about the learning experiences.

Six Challenges Encountered in the Opening of a Multi-Institutional, Interprofessional Simulation Center - Corrected Proof

Lance Baily, Miriam Bar-on, Carolyn Yucha, Shirlee J. Snyder — 2012-02-20

Abstract: The Clinical Simulation Center of Las Vegas opened in August 2009 after 3 years of planning. This unique center is a multi-institutional, interprofessional collaboration between two schools of nursing, University of Nevada Las Vegas and Nevada State College, and the University of Nevada School of Medicine. This article discusses the challenges faced before and during the center’s first year of operation, as well as lessons learned in the process, regarding (a) the move into the new space, (b) position descriptions and staff adjustments, (c) the scheduling of center space, (d) integration of three institutions, (e) incorporation of simulation into training curricula, and (f) faculty development and interprofessional training. It concludes with a look at challenges that the Clinical Simulation Center of Las Vegas may face in the future.

Multidisciplinary, Team-Based Learning: The Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLE©) Approach - Corrected Proof

Carolynn Masters, Valerie O’Toole Baker, Holly Jodon — 2012-02-10

Abstract: Students in health profession programs are traditionally educated in “silos” throughout their program of study caring for patients in Episodic periods of time. Upon graduation, they are expected to function as part of the health care team, collaborating with others to care for patients from the initial point of contact to discharge. This article describes the Simulated Interdisciplinary to Multidisciplinary Progressive-Level Education (SIMPLE©) approach. The objective is to provide students from multiple disciplines the opportunity to collaboratively care for a patient from the initial point of contact through discharge following Agency for Health Care Research and Quality (AHRQ) TeamSTEPPS and best practice guidelines in a simulated learning environment.

History and Development of the Simulation Evaluation Tool (SET) - Corrected Proof

2012-02-10

Abstract: Background: There has been a lack of reliable and valid instruments measuring human patient simulation effectiveness reported in the literature. Two related studies addressing this concern are described.Methods: A multi-phased pilot investigation at a single nursing program (N=161) and a follow-up multi-site national study (N=645) evaluated the reliability of the Simulation Effectiveness Tool (SET) as a measure of the effectiveness of a simulated clinical experience (SCE).Results: Findings from the pilot study resulted in a revision of the original 20-item evaluation tool to a 13-item 3-point ordinal scale instrument. Two subscales, “confidence” and “learning” were noted with Chronbach's alpha of .88 (confidence) and .87 (learning).Conclusions: The calculated Chronbach's alpha (.93) from the multi-site investigation indicated that the 13-item SET is a reliable instrument and shows promise for measuring simulation effectiveness.

Testing a Mnemonic on Response Skills during Simulated Codes - Corrected Proof

2012-02-10

Abstract: Background: Baccalaureate nursing students rarely have the opportunity to practice emergency response skills. Simulation gives students the ability to practice emergency procedures in an environment that is safe.Method: Nursing students’ skills accuracy and confidence ratings were assessed before and after an instructional module that incorporated a mnemonic, named ABCD-COPIME, to improve emergency response techniques to a simulated code blue scenario. Seven nursing students completed 7 trials of responding to a code blue simulation. After each trial, skill accuracy was assessed with a skills checklist, and after Trials 1, 4, and 7, each student’s confidence was measured by self-report. A 20-minute intervention introducing the ABCD-COPIME mnemonic was inserted after Trial 3.Results: Both skills accuracy and self-reported confidence ratings significantly increased after introduction of the mnemonic (95% improvement in mean skills accuracy scores). Furthermore, analyses revealed that these changes were not due to practice effects.Conclusion: This study supports the accumulating body of evidence that suggests that simulated training exercises are important for improving skills and confidence in responding to emergency situations. Moreover, results suggest that the ABCD-COPIME mnemonic training technique substantially improves both the skills accuracy of students and their self-reported confidence when responding to a code blue simulation.

Passing the Baton: Using Simulation to Develop Student Collaboration - Corrected Proof

Lynn Senette, Maureen O'Malley, Thomas Hendrix — 2012-01-20

Abstract: Background: There is scant research about the effectiveness of teaching collaborative handoff strategies.Method: Following a collaborative simulation, this pilot project used a quasi-experimental, 2-group, posttest design to (a) identify differences between nursing and paramedic students' perceptions of collaboration, (b) determine satisfaction and intention-to-act, and (c) compare communication preferences.Results: Responses were positive for collaboration, satisfaction, and intention-to-act. Nursing students showed increased preference for structured formats. Qualitative themes included interaction, experience, uncertainty, realism, and mental models.Conclusions: Collaborative simulation is potentially useful as a teaching–learning strategy to improve handoff communication.

Using Problem-Based Learning Scenarios to Prepare Nursing Students to Address Incivility - Corrected Proof

Cynthia M. Clark, Sara M. Ahten, Rosemary Macy — 2012-01-20

Abstract: Introduction: Incivility may be a problem for nursing students as they progress through their nursing education and enter the workplace. Nursing faculty are challenged to construct meaningful learning experiences to address the problem and consequences of incivility.Method: A problem-based learning scenario and Kirkpatrick’s model for evaluation were used to address incivility and the “reality shock” between what students learn about the practice of nursing and the interactions they may experience in the workplace.Results: Students expressed a favorable reaction to the scenario and reported being better prepared to address incivility in the workplace.Conclusions: Problem-based learning scenarios are an effective teaching strategy for instructing nursing students on the topic of incivility.

Using Objective Structured Clinical Evaluation for Simulation Evaluation: Checklist Considerations for Interrater Reliability - Corrected Proof

Mary Cazzell, Carol Howe — 2012-01-20

Abstract: Background: Reliability of simulation outcome measurements is infrequently reported in nursing education. The purpose of this study was to establish interrater reliability of a checklist for a pediatric medication administration objective structured clinical evaluation.Method: Two raters scored 207 videotaped nursing student objective structured clinical evaluation performances using a 14-item checklist. Item interrater reliability statistics were calculated.Results: Adequate interrater reliability was obtained on six items from the cognitive and psychomotor domains of learning. Unacceptable interrater reliability was obtained on four items from the affective domain.Conclusion: Results verified the difficulty of quantitatively measuring affective domain behaviors and the need for consistency in rater roles.

Simulating Nursing School to Engage High School Students - Corrected Proof

Ceil Flores, Mary Jane Ashe — 2012-01-20

Abstract: With the growing number of minority citizens receiving health care, increasing the number of minority students who will become nurses is important. Minority representation in professional nursing is low, and innovative steps are needed to encourage enrollment into nursing programs. A large university in the southwest United States has taken a proactive role by conducting a summer camp that introduces high school students to the profession of nursing. Campers learned foundational skills and applied them using an infant simulation scenario. End-of-camp simulation revealed active learning occurred. Simulation was an effective strategy to educate high school campers.

Simulating Simulation: Promoting Perfect Practice With Learning Bundle–Supported Videos in an Applied, Learner-Driven Curriculum Design - Corrected Proof

Alice Blazeck, Gretchen Zewe — 2012-01-19

Abstract: In professional practice, patient safety hinges on accurate nursing assessment and surveillance, disciplined clinical reasoning, communication, and skilled interventions, as reported by the Institute of Medicine. While critical to patient safety, skilled interventions are often taught in isolation, with insufficient practice for mastery. To prevent such segregation, the learning-bundle approach uses a hybrid of appropriate learning tools supporting a weekly scaffolding of applied theory, lab, and clinical. Key to the success of this bundled approach is sufficient opportunity for deliberate practice with the creation of learner-driven perfect practice simulation videos.

Masters Nursing Students' Perceptions of an Innovative Simulation Education Experience - Corrected Proof

Michelle A. Kelly, Margaret Fry — 2012-01-19

Abstract: Background: Simulation was introduced into a master of nursing course, embedded within patient safety and clinical practice contexts. Student groups developed, enacted, and debriefed simulation scenarios from lived experiences. The study aimed to explore masters students' perceptions of the innovative simulation education strategy.Method: A 2-year qualitative, exploratory study retrospectively analyzed students' written reflections about the innovative educational strategy and application of simulation for clinical practice.Results: The study enrolled 21 participants. Five themes emerged from the analysis: a new awareness of the extent and range of simulation activities; building teams and meaningful work; supported, realistic, and extended learning; sharing and reconstructing “clinical stories”; and using simulation in practice.Conclusion: Masters nurses highly valued the innovative simulation education strategy to develop authentic scenarios and identified a wide range of clinical applications and ways to initiate simulation in the workplace.

Implementation of Mental Health Simulations: Challenges and Lessons Learned - Corrected Proof

Shoni Davis, Jayne Josephsen, Rosemary Macy — 2012-01-19

Abstract: Boise State University School of Nursing faculty faced several challenges and learned important lessons in attempting to implement mental health simulations with standardized patients when clinical practicums with actual patients were no longer an option. Challenges faced included (a) establishing strategies to recruit a large pool of authentic standardized patients, (b) determining the optimal level of complexity for each simulation, and (c) providing useful feedback to students about noted deficiencies while at the same time making the reflections a positive experience. Important lessons are shared that may help other faculty avoid similar challenges.

How Often do BSN Students Participate in Pediatric Critical Events during Simulation and Hospital Rotations? - Corrected Proof

Susan Pauly-O’Neill, Susan Prion, Judith Lambton — 2012-01-16

Abstract: Background: With nursing students’ limited access to pediatric patients. coupled with an expectation that the novice nurse be proficient in managing deteriorating patient conditions, nurse educators may choose to supplement students’ clinical rotation with simulation. The question remains, What experiences are “available” in clinical, and which ones are rarely seen and therefore should be simulated?Method: A list of 18 pediatric critical events was rated by pediatric nurse experts as not important, somewhat important, very important, or vitally important for the novice nurse to recognize, report, and intervene in. Students were asked to report on the number of times they intervened to correct these critical events in both the clinical arena and the simulation laboratory. Students were also asked to rate their confidence in performing these interventions after their clinical and their simulation experiences.Results: The survey results indicate that students had significantly more experiences with most of the pediatric critical events in the simulation lab than in the pediatric inpatient unit. For each of the pediatric critical events, the mean comfort level was higher after simulation than after clinical.Conclusions: A mixed educational model is effective in introducing students to the competencies expected of the novice nurse.

Evaluating An Interprofessional Pediatrics Educational Module Using Simulation - Corrected Proof

2012-01-16

Abstract: Background: High-fidelity simulation (HFS) has been shown to be effective in health sciences education for practicing team approaches to managing complex care. Interprofessional (IP) collaboration contributes to patient well-being. This prospective study was conducted to evaluate an interprofessional pediatrics educational module using HFS.Methods: Nursing and medical students (N = 96) attended one asthma exacerbation simulation and a second on sepsis. Performance of basic pediatric skills and team skills was evaluated using a checklist. Participants (N = 86) completed a survey regarding their confidence performing pediatric skills and their comfort with IP communication and collaboration. Fifty-three nursing students completed the scenarios in non-IP groups.Results: Team skills improved significantly for the IP groups between the two scenarios (p < .001), but not for the non-IP groups. Pediatric skills scores were lower than team scores in both sessions for all groups.Conclusion: HFS may be a useful strategy to teach interprofessional teamwork in pediatrics.

Debriefing Experience Scale: Development of a Tool to Evaluate the Student Learning Experience in Debriefing - Corrected Proof

Shelly J. Reed — 2012-01-12

Abstract: Background: Debriefing represents the reflection phase of the simulation process, in which feelings are resolved and learning is solidified, but the nursing student experience during debriefing is largely unknown.Method: The Debriefing Experience Scale was developed from debriefing literature and expert opinion. This scale was used in 2 research studies and refined through the use of factor analysis.Results: The resulting scale, divided into 4 subscales, consists of 20 items defining the nursing student debriefing experience.Conclusions: The Debriefing Experience Scale the potential to assist in providing further insight.

Effectiveness of a Role-Modeling Intervention on Student Nurse Simulation Competency - Corrected Proof

Barbara Aronson, Barbara Glynn, Timothy Squires — 2012-01-09

Abstract: Novice nurses are often inadequately prepared to respond to complex, patient care situations where patients' conditions deteriorate. Exposure to a video-taped intervention that role-models and reinforces expected behavior of an expert nurse before participation in a simulation may improve student nurse performance in a cost-effective manner. The primary purpose of this quasi-experimental pre-test, post-test study was to assess the preliminary effectiveness of a theory based role-modeling intervention on enhancing student nurse competency in responding to a simulated response to rescue event. Performance was measured by a previously validated Heart Failure Simulation Competency Evaluation Tool © (HFSCET). Total mean scores on the HFSCET for the pre-test (59.08) and post-test (87.08) were significantly different (p = .000); students performed better on the post-test after exposure to the role-modeling intervention. A power analysis indicated a large effect size (effect size = .926; alpha = 0.50; power = 0.991). Students who had a greater number of days between the intervention and the post-test had a lower score. This innovative intervention based on established learning theory may change the way educators prepare novice students to achieve expected clinical competencies in graded simulation performance assessments.

A Hospital and University Partnership Model for Simulation Education - Corrected Proof

Brenda Senger, Lynn Stapleton, Mary Sue Gorski — 2011-12-15

Abstract: Nursing has been given the challenge to develop innovative methods for clinical education. Human patient simulation is a creative a way for students and staff nurses to improve clinical reasoning and refine psychomotor skills in a safe and controlled environment. Practice–education partnerships can provide a unique framework for multi-institutional nursing education. This article describes the development of a practice–education partnership between a small nursing program and a local community hospital; human patient simulation was used to provide a combined multi-institutional training program for professional staff nurses and student nurses. Feedback from students and staff nurses regarding this training program was positive, noting improved confidence and greater appreciation for teamwork. Nurse educators considered the benefits and challenges associated with a multi-institutional educational framework and affirmed the value of a practice–education partnership.

Comparison of Three Simulation-Based Teaching Methodologies for Emergency Response - Corrected Proof

2011-12-15

Abstract: Background: The purpose of this study was to compare the effects of 3 simulation methodologies (low-fidelity, computer-based, and full-scale) on the outcomes of emergency response knowledge, confidence, satisfaction and self-confidence with learning, and performance. Additionally, interrater reliability was assessed for the Emergency Response Performance Tool (ERPT).Method: An experimental, pretest–posttest, control-group design was used to evaluate the effects of the 3 teaching methodologies. In all, 28 participants enrolled in a Critical Care Orientation program participated in the study. Each participant was randomized to 1 of the 3 groups. Participants completed pre- and posttest written examinations and confidence questionnaires, the Student Satisfaction and Self-Confidence in Learning instrument, and baseline and posttest performance assessments.Results: No significant differences were found among the 3 groups in emergency response knowledge, confidence, or performance. There were significant differences in participants’ results on the Student Satisfaction and Self-Confidence in Learning instrument, with the full-scale simulation group rating the highest in satisfaction and self-confidence. The interrater reliability for the ERPT ranged from 0.58 to 1.0.Conclusions: Although the statistical findings did not support the hypothesis that critical care RNs who receive full-scale simulation training will score higher in knowledge, confidence, and performance, this study advances the current knowledge base of simulation-based education and research. The ERPT can be a reliable measure for assessing performance in full-scale simulation. However, further studies with larger sample sizes are warranted.

Using Standardized Patients to Teach Leadership Competencies - Corrected Proof

Patricia A. Sharpnack, Laura Goliat, Kathleen Rogers — 2011-12-12

Abstract: Faculty at a Midwestern college designed a simulation experience that used standardized patients to help students develop leadership skills and increase awareness of quality and safety competencies required of the new graduate. Students were responsible for task delegation, prioritization decisions, and allocation of resources for a team of patients. Standardized assessment scores and student mindfulness of leadership and quality and safety proficiencies showed improvement. Independent parametric testing results indicate a significant increase in the group that was administered the standardized assessment after the simulation, t(64) = 3.55, p < .01). Student evaluations suggest the use of complex scenarios involving standardized patients provided an opportunity to apply leadership principles to realistic patient care experiences.

Developing Cultural Competency in Life and Simulation: A Year in Qatar as an Exemplar - Corrected Proof

Colette Foisy-Doll — 2011-10-24

Abstract: Globalization is creating rich opportunities for nurse educators to interact in teaching and learning environments with people from all over the world. When the author accepted a job in the Middle East for the University of Calgary, Qatar, as clinical assessment and simulation manager, she fully expected an amazing experience. What ensued was profound lesson in valuing the importance of culture and cultural competence in education and, in simulation learning and in life. Adaptations in the delivery of simulation learning experiences in the nursing curriculum at the University of Calgary, Qatar, are highlighted in this non–research-based, personal account by an experienced simulation educator. The most salient cultural learning experiences are described.

Integrative Learning Through Simulation and Problem-Based Learning - Corrected Proof

Nuala Walshe, Sinéad O'Brien, Siobhan Murphy, Irene Hartigan — 2011-10-13

Abstract: Background: An integrative framework was used to guide the teaching, learning, and assessment approach taken in a final-year undergraduate nursing module.Method: Students participated in three cycles of problem-based learning and associated simulations. An assessment rubric focused on patient assessment, clinical decision making, and technical and communication skills was used by students and assessors to score simulation performances. This study evaluated the trajectory of assessor and student self-assessed simulation performance scores over the course of the module.Results: Descriptive statistics for assessors' scores show a mean improvement in all 4 competencies and for overall performance. Students' self-assessed scores do not show a mean improvement but are more closely aligned with assessor scores for later simulations.

Simulation Apprenticeship: A Southern California Experience - Corrected Proof

Terry A. Larsen — 2011-10-10

Abstract: Although an experienced simulation educator, the author was given the opportunity to improve her expertise by attending an apprenticeship in Southern California at a large regional medical center's simulation center. Cutting-edge technology, interdisciplinary collaboration, and both manikin-based and standardized patients helped accomplish her learning goals.

The Effect of Preparation on Anxiety and Performance in Summative Simulations - Corrected Proof

Laura T. Gantt — 2011-09-14

Abstract: Background: Historically, studies that looked at how anxiety affects simulation performance have not included information about how students were prepared for those experiences. There is little research into best practices for preparing nursing students for evaluative simulation experiences. The purpose of this study was to examine how preparation for simulation affects anxiety and how anxiety affects simulation performance.Method: Thirty-nine student nurses were alternately assigned to experimental and control groups. Both groups received the Spielberger State-Trait Anxiety Inventory before and after evaluative simulations. The experimental group received an additional supervised simulation practice with focused debriefing. The groups were compared to determine differences.Results: No significant differences were found between experimental and control groups' trait anxiety scores at the time of enrollment, nor were there differences found between groups on state anxiety scores either at enrollment or during the period around the summative evaluations.Conclusions: This study provides evidence about what is helpful and necessary to ensure that students are adequately prepared for evaluative scenarios.

Effectiveness of Human Patient Simulator as A Classroom Teaching Strategy - Corrected Proof

Deborah A. Beyer — 2011-09-12

Abstract: Background: The majority of simulation studies have small groups using a human patient simulator in lieu of or as practice before attending clinical experiences with actual patients. In order to increase the use of and exposure to the simulator, the human patient simulator was used in the classroom with 45 associate degree nursing students as a teaching strategy.Methods: A pre–post test design was used to see if there was significant learning that occurred after the classroom simulation. A questionnaire was given to determine if the students were satisfied with this teaching strategy.Results: The results showed that significant learning occurred and that the students positively rated the classroom simulation.Conclusions: Simulation activities may be able to be used in larger groups such as in a theory classroom as an interactive, engaged teaching strategy.

A Descriptive Analysis of Nursing Student Communication Behaviors - Corrected Proof

Eileen R. O'Shea, Michael Pagano, Suzanne H. Campbell, Gregory Caso — 2011-09-12

Abstract: This article describes a pilot study to examine communication behaviors in nursing simulations. The nursing and communication faculty researchers used an interdisciplinary descriptive approach to examine 55 student nurses in 19 video recordings of patient simulations. The results demonstrated that using an interdisciplinary process can lead to a more diverse and thorough assessment of communication skills. This study supports the need for psychometrically sound evaluation tools for the measurement of communication behaviors of nursing students during simulation scenarios.

Developing a New State of the Art Simulation Learning Center - Corrected Proof

RuthAnne Kuiper, Anne Zabriskie — 2011-09-07

Abstract: Coordinating and facilitating the creation of a new Simulation Learning Center is a daunting task. This article reports the planning, developing, building, and implementing of a simulation laboratory within a new School of Nursing building. The Activity Model of technology adoption describes the activities in the timeline that are divided into six specific work phases. A move-in schedule displays the essential activities that were sequentially carried out to effectively coordinate the transition into a new space to begin an academic year. The take away points and lessons learned during each of the phases are summarized as well as future considerations for growth of the Center.

Simulation and Psychomotor Skill Acquisition: A Review of the Literature - Corrected Proof

Jennifer Gunberg Ross — 2011-09-07

Abstract: Decreased opportunities for skill practice and mounting concerns that graduate nurses are not competent in basic psychomotor skills requires nurse educators to reevaluate methods to teach these skills. Simulation offers a fresh approach to psychomotor skills education allowing the student to integrate knowledge from all three learning domains while practicing the skill. This article discusses the current state of the science on the use of simulation for psychomotor skill acquisition. This literature review identifies that limited empirical evidence exists to support the efficacy of simulation to teach psychomotor skills, most notably within the discipline of nursing. The existing data stem from studies with limitations that affect the interpretation and generalizability of the results. These findings suggest the need for further research in the area of simulation and psychomotor skill acquisition within nursing education.

Simulation Decreases Nursing Student Anxiety Prior to Communication With Mentally Ill Patients - Corrected Proof

Janene Luther Szpak, Kirstyn M. Kameg — 2011-09-07

Abstract: Introduction: The purpose of the study was to investigate the impact of high-fidelity human simulation on nursing student anxiety prior to attending clinical and interacting with a mentally ill patient.Method: This quantitative, nonrandomized, quasi-experimental study was implemented with three groups of undergraduate nursing students who were enrolled in a psychiatric nursing course. The students participated in a 2-hour lecture on therapeutic communication techniques, followed by a simulation experience depicting a depressed patient or an anxious patient in alcohol withdrawal. A sample of 44 students participated by completing a demographic questionnaire, a pre- and postanxiety visual analogue scale, pre- and post–State-Trait Anxiety Inventory, and a Simulation Evaluation Survey. Data were collected during two semesters in 2010.Results: The findings support the use of high-fidelity human simulation to aid in decreasing nursing students' anxiety prior to communicating with patients experiencing mental illness.

Second Life®: A New Strategy in Educating Nursing Students - Corrected Proof

2011-09-05

Abstract: The purpose of this article is to discuss how the University of Michigan School of Nursing designed and implemented a virtual hospital unit in Second Life® to run virtual simulations. Three scenarios were developed about topics that represent areas that contribute to patient safety, as well as key student learning challenges. Fifteen students completed a 6-question survey evaluating their experience. Comments indicated students did identify the potential benefits of the Second Life® simulation. The Second Life® platform may also provide avenues for learning in the clinical arena for a multitude of health care professionals. The opportunity to simulate emergent, complex situations in a nonthreatening, safe environment allows all members of the team to develop critical communication skills necessary to provide safe patient care.

Distance Learning and Clinical Simulation in Senior Baccalaureate Nursing Education - Corrected Proof

2011-08-18

Abstract: Background: This study evaluates the effectiveness of combining distance education, point-to-point video teleconferencing (P2PVTC), and remote operation of a human patient simulator to connect a simulator technology specialist and instructors with the human patient simulator and distant trainees.Methods: Didactic material was delivered via an online course management system. Simulation at a distance was carried out using a Laerdal SimMan, P2PVTC, and remote desktop control. Data were collected and included health care knowledge gained (via pre- and posttest scores) and measures of participant satisfaction.Results: Participants evaluated the course favorably (p < 0.05) with the exception of their satisfaction with presimulation materials (p = 0.086). On a Likert scale of 1 (very low) to 10 (very high), six of the seven students (87%) rated their workshop experience as “very high.”Conclusions: Combining distance learning with high-fidelity human patient simulation at a distance is feasible. Participants acknowledged the value of simulation at a distance, but the low sample size prevented the generalizability of results.

Development of the Obstetric Nursing Self-Efficacy Scale Instrument - Corrected Proof

Mary Elizabeth Guimond, Mary Colleen Simonelli — 2011-08-08

Abstract: Background: The objective of this study is the development of the Obstetric Nursing Self-Efficacy (ONSE) Scale instrument and the reporting of psychometric data gathered from a pilot completed in fall 2009 at 2 major universities.Method: The ONSE is an 18-item instrument designed with the use of Bandura’s social-cognitive theory. Instrument development consisted of 2 rounds of expert review. The average content validity index of the scale was .91.Results: For preliminary reliability testing, students (N = 20) completed the ONSE survey after participating in a 45-hour clinical rotation in obstetric nursing. A range of split-half reliability scores was calculated at .85 to .96. For preliminary validity testing, students (N = 46) completed the ONSE pre- and postsimulation. Paired t tests revealed a statistically significant improvement in self-efficacy scores for both pre- and posttest scores.Conclusion: The findings were encouraging for initial validity and reliability testing of the ONSE as an instrument to measure self-efficacy of students caring for obstetric patients.

Second Life® as a Clinical Conference Environment: Experience of Students and Faculty - Corrected Proof

Melinda Hermanns, Carol Kilmon — 2011-08-08

Abstract: The purpose of this article is to discuss the students’ and faculty members’ experience of using Second Life® during a psychiatric mental health clinical conference. The clinical conference is explained, as well as the process in which students were oriented to the use of Second Life. The students’ and faculty members’ experience, obstacles encountered, and lessons learned are also presented.

HPS more effective than CD-ROM for improving cognition and performance - Corrected Proof

2011-08-08

Abstract: Background: Military health care personnel need to have knowledge and skills relative to caring for patients on the battlefield. No studies have compared the two strategies of using the human patient simulator (HPS) and a CD-ROM in caring for combat injuries.Method: A prospective, pre–post test, experimental, mixed design (within and between) was used to determine whether there were statistically significant differences in HPS and CD-ROM educational strategies in lower-level, higher-level cognition, critical thinking, and performance.Results: A repeated analysis of variance and a least significant difference post hoc test were used to analyze the data. The HPS group performed better than the CD-ROM and control groups relative to all the variables (p < .05).Conclusion: The HPS method of instruction is a more effective method of teaching than the CD-ROM approach.

Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice - Corrected Proof

2011-08-08

Abstract: Background: Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years.Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires.Results: Students reported improved levels of satisfaction, greater learning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition.Conclusion: Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice.

Standardized Patients Versus Simulated Patients: Is There a Difference? - Corrected Proof

Christopher Churchouse, Chris McCafferty — 2011-08-08

Abstract: The rapid development of simulation as a modality for education has created some confusion in terms, especially when applied to standardized patients and simulated patients. Some authors report them as being the same, whereas others define them in a different context, causing confusion for facilitators and researchers. The purpose of this article is to offer a discussion and definition of the roles of a standardized patient and a simulated patient and to define the differences between the two genres.

From Static Lab to Simulation Lab: Students Reflect on Their Learning - Corrected Proof

Sherrilyn Coffman — 2011-08-05

Abstract: Background: Nursing faculty are challenged to incorporate use of low, moderate, and high-fidelity simulators into the curriculum and to evaluate student learning. This study compares students’ perceptions of learning across levels of simulation.Method: Colaizzi’s descriptive phenomenological method was used, with data collection at two times: (a) after a static lab using low-fidelity task trainers and (b) after a simulation lab incorporating high-fidelity manikins. Students were asked to describe their learning after each lab. Written comments were analyzed, and themes from each time were compared. Findings were taken back to participants for validation.Results: Students’ comments indicated a progression of learning from the what, when, how, and why of psychomotor skills in the static lab to more complex concepts such as assessing, prioritizing, relating information, and formulating therapeutic interventions in the high-fidelity simulation lab.Conclusions: Study results confirm that students are able to recognize progression in learning, from performing psychomotor skills to making clinical judgments, as they engage in strategically planned lab experiences.

Baccalaureate Student Perceptions of Integrating Simulation as a Teaching Strategy in an Acute and Critical Care Nursing Course - Corrected Proof

Jesus (Jessie) Casida, LaVonne Shpakoff — 2011-08-05

Abstract: Background: This article describes the context and student perceptions of integrating simulation into the baccalaureate acute and critical care nursing course.Method: A total of 209 teaching evaluation tools completed by senior students from 2007 to 2010 were analyzed retrospectively.Results: The response agreement on specific items was high; in addition, the effectiveness of simulation as a teaching strategy was elaborated by three themes that emerged from students’ comments: (a) More simulation experience is needed, (b) simulation should be introduced early in the program, and (c) simulation is a great way to learn.Conclusion: Simulation is an effective teaching strategy that can be successfully integrated throughout the baccalaureate nursing curriculum.