Clinical Simulation in Nursing最新文献

Rural hospitals providing obstetric care are expected to maintain a broad variety of knowledge, skills, and abilities with low volume of occurrences, yet have limited access to continuing education and hands-on experience for high-risk situations. Women and their families experience healthcare disparities for adequate obstetrical care due to maternal deserts. To overcome these disparities, the interdisciplinary Perinatal Simulation Outreach Team (PSOT) has utilized in situ simulation to provide rural hospitals with continuing education opportunities since 2018 to reduce perinatal mortality rates, decrease maternal health disparities, and improve the quality of birth experiences. The criteria of the Healthcare Simulation Standards of Best Practice™ Simulation Design is used as a blueprint for PSOT program development. Program evaluations show in situ is a valuable learning experience that has enhanced teamwork and provided continuing education to make evidence-based practice changes for quality, safe patient care.

Background

Improving self-efficacy for nursing students to manage aggressive behaviours in clients with dementia supports better outcomes for clients. No studies have been conducted on the use of immersive virtual reality as a potential tool.

Method

A mixed-methods, randomized control trial explanatory design compared perceived self-efficacy for practical nursing students who used the CareGiVRTM virtual reality application with those who did not, using the Inventory of Geriatric Nursing Self-Efficacy (IGNSE) along with qualitative focus groups.

Results

Forty-six students (49%) participated in the quantitative component. Fifteen students elected to participate in the follow-up qualitative focus groups. Findings indicate participants who used the CareGiVRTM application reported statistically significant higher levels of perceived self-efficacy post-intervention and when compared with those in the control group following their clinical rotation. Four themes were identified: getting real-world experience, a safe place to practice, meeting the client where they are at, and a tool not a replacement.

Conclusion

Immersive virtual reality can be an effective tool to increase perceived self-efficacy for managing aggressive behaviours in clients with dementia in practical nursing students.

Background

A forensic sexual assault nurse examiner (SANE) provides specialized care for individuals who have experienced sexual assault. Because the training of new SANEs is critical for expanding the workforce, simulation and debriefing are used due to limited clinical learning opportunities with assault survivors. Debriefing following the simulation requires an expert SANE, yet very often these clinicians are new to debriefing; little is known about how expert SANEs learn to debrief.

Method

A 90-minute focus group interview was conducted with three experienced SANEs who had completed a five-video debriefing training and conducted at least two debriefings with novice SANE trainees.

Results

Inductive qualitative content analysis resulted in two primary categories and six sub-categories that described the process of expert SANEs learning to debrief.

Conclusion

Expert SANEs compared learning to debrief to learning a new language. Participants described how reflective debriefing and trauma-informed interviewing both emphasize the importance of creating a safe and supportive environment, fostering open communication, promoting self-awareness and learning, empowering individuals, and adopting a non-judgmental approach.

Healthcare simulation has emerged as an invaluable tool for training healthcare professionals, fostering clinical skills, and enhancing patient safety. In the context of simulation-based education, various debriefing modalities have been employed to maximize learning outcomes. This article examines four debriefing modalities—self-reflection, self-debriefing, facilitated debriefing, and tele-debriefing within the healthcare simulation setting. The article explores the circumstances under which each modality is appropriate, highlights the benefits they offer, and discusses the barriers that may impede their effectiveness. By comparing and contrasting these modalities, educators and practitioners can make informed decisions about the most suitable debriefing approach for their specific simulation scenarios.

Aim/Objective

This study's aim was to examine the use of simulation technologies in the form of standardized patients to enhance gender affirming assessment skills in a sample of undergraduate nursing students.

Background

Lack of provider knowledge regarding gender affirming care impacts health care for individuals who identify as lesbian, gay, bisexual, transgender, queer, and people with other expansive identities (LGBTQ+).

Design

A pre- and post-survey was used to evaluate a LGBTQ+ competency-based simulation scenario using standardized patients.

Methods

The simulation intervention was incorporated into an undergraduate medical surgical-nursing course with 70 students. Prior to taking part in the simulation experience, students completed an educational module in an open-source learning management system. The educational module compiled by the researcher included a glossary of LGBTQIA+ terms, readings, and Sexual Orientation and Gender Identity videos, a PowerPoint and a script for interviewing. On the day of the simulation students took a pre-simulation survey that was number coded in order to provide an anonymous identifier. After participating in the simulation scenario students used the same number, that coded their pre-simulation survey, to code their post-simulation survey.

Results

Wilcoxon-signed ranks test revealed that there were no significant differences between the pre- and postsurvey as a composite. However, one of the individual questions regarding addressing sexual orientation and another question regarding perceived competence in providing care demonstrated significance and trending toward significance. Also, noteworthy, were the positive student responses regarding the simulation experience.

Conclusion

Finding's from the standardized patient simulation has the potential to inform continual education interventions designed to strengthen competency at all levels of nursing practice in the provision of LGBTQ+ competent and affirming care.

Introduction

Simulation-based learning is robust, but the COVID pandemic created opportunities for novel modalities, including Artificial Intelligence Virtual Simulated Patient (AI-VSP) scenarios.

Methods

Between 2019 and 2022, the following health professional students experienced AI-VSP at one US university: (a) “Headache” scenario: 24 Family Nurse Practitioner (FNP) and 48 Physician Assistants (PA) students, (b) “Insomnia” scenario: 64 Bachelor of Science in Nursing (BSN) and 47 Accelerated Bachelor of Science in Nursing (ABSN) students. Each individually conducted a brief strongly encouraged encounter and subsequently optionally participated in our study.

Results

When asked about the scenario's realism, positive answers were 50% (FNP), 16% (PA), 63% (BSN), and 87% (ABSN). Also, 41% FNP, 52% PA, 65% BSN, and 82% ABSN felt capable of creating diagnoses and treatment plans as thoroughly as they would with human patients. Regarding improving diagnostic abilities, favorable responses were 73% (FNP), 74% (PA), 72% (BSN), and 90% (ABSN). When asked whether they would recommend AI-VSP encounters to others, 91% (FNP), 84% (PA), 93% (BSN), and 90% (ABSN) agreed.

Conclusions

AI-VSP scenarios were well accepted by students and demonstrated significant promise as a complementary simulation-based learning modality.

Background

Psychological safety is a foundational element for effective simulation-based experiences across all healthcare education. This project describes a novel tool the authors developed to visually enhance psychological safety for advanced practice nursing students. The “Simulation Tool to Enhance Psychological Safety” (STEPS) is essentially a photo cube with images that depict evidence-based constructs related to psychological safety. STEPS was designed and evaluated by simulation education experts.

Methods

STEPS was employed in simulation for advanced practice nursing students (N = 56). Pre and post surveys were conducted using the Psychological Safety Survey and open-ended responses.

Results

Findings revealed students’ responses on psychological safety improved post the STEPS intervention. Students’ comments also reflected they found STEPS valuable for enhancing psychological safety.

Conclusions

STEPS is an innovative visual aid that in combination with facilitators’ actions can foster psychological safety for learners in simulation-based experiences. We plan to further evaluate the tool in simulations across nursing programs.

Aim

The objective of this SR of SR is to answer the question: Is simulation effective for the acquisition of socio-emotional skills related to health care?

Background

Simulation has become a relevant methodology for the training of socioemotional skills; however, the effectiveness of this methodology is difficult to interpret due to the diversity of results obtained to date.

Methods

Searches were conducted in Medline, Scopus, Web of Science, and Cochrane Library databases for systematic reviews with meta-analyses published from 2011 to 2022. The searches were completed between December 2021 and January 2022. Study quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO (CRD42022339156).

Results

A total of 1285 studies were examined, of which seven systematic reviews were selected, yielding 88 studies with 8658 participants. The most commonly used methodologies were standardized patient (28.4%) and high-fidelity simulation (26.1%). The training consisted of an average of 3.6 sessions, with a mean duration of 153.8 minutes. The most trained socioemotional skills were communication (34.4%), self-efficacy (30.5%), and self-confidence (13.3%). Most studies (78.4%) reported statistically significant results favorable to the intervention group in all skills trained.

Conclusion

Simulation is an effective methodology for training a wide range of social and emotional competencies in students and health science professionals.

Background

"Cannot ventilate, cannot intubate" is a challenging airway emergency that can lead to negative patient outcomes. Screen-based simulation (SBS) as a learning adjunct could help anesthesia providers improve decision-making skills in difficult airway situations. The goal of this project was to evaluate the usability of a newly designed SBS for learning and reinforcing difficult airway management.

Methods

Seven anesthesia and simulation experts were recruited for this pre-post design project. Participants were pre-briefed, watched scenario one, selected interventions for difficult airway, and time-to-decision was recorded. After debriefing, participants completed a second scenario and time-to-decision was recorded again. A post-simulation survey was conducted to evaluate application usability and gather participant feedback.

Results

All seven participants (100%) completed simulations with a mean System Usability Score of 90.83 (SD = 6.65) and median score of 90, both of which indicated superior usability. The time-to-decision in scenario two decreased significantly (p < .05) between the two scenarios.

Conclusion

In approximately 40 hours and on a low budget, a user-friendly SBS was developed to effectively improve time-to-decision in difficult airway situations.

Background

Obstetric nursing students have less opportunity to practice due to limited clinical placement sites and safety concerns, which leads to inadequate clinical judgment. Previous studies used simulation as a learning method but there was a lack of structured activities for learning, which is a vital aspect to support clinical judgement development. The study aim was to investigate the effect of an Experiential Learning Simulation-Based Learning Program on clinical judgment among nursing students.

Methods

A quasi-experimental two-group pre-test post-test design was employed. The participants were 44 nursing students. The intervention comprised three obstetrics nursing clinical scenarios in antepartum, peripartum, and postpartum periods guided by Kolb's Experiential Learning Theory that included concrete experiences, reflective observations, abstract conceptualization, and active experimentation. Clinical judgment was assessed through a questionnaire.

Results

After the program, the experimental group had higher scores of clinical judgment than the control group. Significant differences in the clinical judgment scores were noted between groups.

Conclusions

The Experiential Learning Simulation-Based Learning Program demonstrated effectiveness in increasing clinical judgment among nursing students.