Stroke Admission Simulation: Engaging Novice and Expert Nurses.

In today's changing health care climate, clinical nurse educators are being challenged to educate nurses with a wide range of experience. This article describes the development and facilitation of a low-fidelity simulation used to educate nurses about identified gaps in standardized care during stroke admissions on a medical-surgical stroke unit at Legacy Emanuel Medical Center. The simulation was developed for use by novice and expert medical-surgical stroke nurses simultaneously. With the use of Bloom's Revised Taxonomy (Anderson et al., 2001), roles within the simulation were tailored to encourage the learning of nurses with varying levels of expertise. Overall, learners appeared to benefit from the class, which included the stroke admission simulation. Mean test scores increased from 55% pretest to 80% posttest. Additionally, 98% of learners found the simulation and lecture moderately helpful or extremely helpful. [J Contin Educ Nurs. 2024;55(3):113-119.].

Leadership Competencies of the Medical-Surgical Nursing Specialist Nurse.

OBJECTIVE: To identify the leadership competencies of Medical-Surgical Nursing Specialist Nurses. METHODS: A quantitative, descriptive study using the Leadership Competencies Questionnaire. 311 Portuguese Medical-Surgical Nursing Specialist Nurses participated. Data analysis involved descriptive and inferential statistical analysis using the Statistical Package for Social Sciences (SPSS), version 22.0. RESULTS: Study participants had an above-average self-perception on the scale (mean = 3.5) in all leadership roles, recognizing their leadership competencies. The leadership competencies of Medical-Surgical Nursing Specialist Nurses are balanced across all roles: Mentor (5.80 ± 1.02); Coordinator (5.53 ± 0.86); Facilitator (5.38 ± 1.04); Innovator (5.34 ± 0.88); Director (5.31 ± 1.10); Producer (5.30 ± 0.98); Monitor (5.15 ± 1.00); Corrector (4.79 ± 1.29). CONCLUSIONS: Specialized nursing practice enhances nurses' self-perceived leadership competencies. Nurses see themselves as leaders focused on internal support and facilitation of collective effort and opportunities for skill development.

A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes: Critical Implications for Practice.

OBJECTIVE: The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors. BACKGROUND: Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role. METHODS: A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies. RESULTS: Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores ( R2 = 0.37). CONCLUSIONS: Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.

Medical-Surgical Nursing.

This specialty provides fertile ground for professional development.

Peripheral Intravenous Catheter Insertion Competence and Confidence in Medical/Surgical Nurses.

The objective of this study was to implement an evidence-based practice project to improve peripheral intravenous catheter (PIVC) insertion confidence and competence and to improve first-attempt success. The researcher used a blended online learning module and live simulation to increase PIVC insertion confidence and competence. Internal application of a blended curriculum model improved the first-attempt PIVC insertion success of nurses. A validated confidence assessment was completed by participants (n = 38) preintervention, immediately postintervention, and 30 days postintervention. A Mann-Whitney U test determined that nurses' confidence was significantly higher immediately following the intervention compared with preintervention (P = .003), and the increase was sustained 30 days after the intervention (P < .001). While placing a PIVC in simulation, the observer measured competence using a validated tool verifying 28 steps required, with a 76% success rate for all 28 steps. Nurses' self-reported first-attempt PIVC success increased significantly from the preintervention survey to the 30-day postintervention survey (P = .00004).

Medical-surgical nurses' EBP beliefs and competencies.

BACKGROUND: The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies. AIMS: The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies. METHOD: A descriptive, cross-sectional design employing survey methodology was used. RESULTS: A total of 1,709 medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2 EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p = .001) or Pathway to Excellence (p = .006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001). LINKING EVIDENCE TO ACTION: Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.

Communicating Data, Information, and Knowledge in the Nursing Handoff.

Miscommunication occurring during the nursing handoff continues to be a primary cause of sentinel events and adverse patient outcomes. The primary purpose of the nursing handoff is to communicate essential patient data, information, and knowledge to ensure the safe continued continuity of care. The aim of this study was to examine the content of the nurse-to-nurse change-of-shift handoff communication in terms of data, information, and knowledge for both bedside and nonbedside handoffs of a patient who has experienced a clinical event. The setting was an urban medical center on a medical-surgical floor. The sample consisted of one nurse giving and one nurse receiving the handoff (n = 19 registered nurses). Five bedside and five nonbedside handoffs were audio recorded and analyzed using content analysis. The handoff overall contained 34.7% data, 51.7% information, and 13.6% knowledge. The nonbedside handoff compared with the bedside handoff contained a substantially higher percentage of data and less information. The percentage of knowledge being communicated in both the nonbedside and bedside handoff was low at 13.6% and 13.7%, respectively. The percentage of data compared with the percentage of knowledge in the handoff places the nurses at greater risk of experiencing cognitive lapses due to cognitive overload.

[Design and Application of Board Game Learning: An Example for Medical-Surgical Nursing Course].

Board games are currently widely used in various courses, including in the teaching of cardiopulmonary cerebral resuscitation for neonatal and infants. They are generally deemed as useful in teaching concepts such as empathy and interpersonal communication skills that are relatively difficult to understand. However, board games have rarely been used in medical-surgical nursing courses. The main reason for this may be because of many different systems in medical-surgical nursing courses complicate the process of designing relevant / useful scheme of board games. In general, college students have a weak conception of diseases because they have not yet entered clinical practice and their knowledge construction is based on traditional teaching methods. Using different teaching methods to construct knowledge may increase students` understanding of a disease and help them better understand content. In this article, the author uses different teaching strategies to increase students` knowledge. Concept mapping, board games, and human figures were designed to construct the knowledge of students in each system and to assist students to reintegrate disease knowledge in order to reinforce learning efficacy. This learning method may help improve students` understanding of textbook-based knowledge and enhance students` self-learning and future clinical practice.

Examining the meaning of the language used to communicate the nursing hand-off.

The miscommunication and inconsistent recall of patient information due to cognitive lapses that occur during the hand-off between healthcare providers account for 80% of sentinel events in acute care. Cognitive lapses are a consequence of the nurse experiencing cognitive overload, which impedes the nurse's ability to recall relevant information during and after the hand-off communication. The primary cognitive and human factor contributing to cognitive overload in the hand-off is language. The purpose of this study was to examine the meaning of the language used to communicate the nurse-to-nurse change of shift hand-off occurring at bedside and nonbedside on a medical-surgical unit in an urban medical center. A qualitative descriptive design was used. The sample was 10 audio-recorded hand-offs (five bedside and five nonbedside), with a total of 19 nurses participating. A natural language process program was used to analyze the data. The hand-off is a narrative story centered on communicating patient information delivered with a high degree of confidence. The hand-off is focused on past and current events with minimal focus on future or anticipated events. The drive to communicate is minimally based on concern, fear, or danger. There is a difference in the language used to communicate the nursing hand-off message at bedside as compared to the nonbedside hand-off.

Academic and Nonacademic Predictors of BSN Student Success on the HESI Exit Exam.

First-time success rate on the NCLEX-RN examination has significant implications for BSN students, faculty, and schools of nursing. Many nursing programs utilize standardized examinations such as the HESI Exit Exam to quantify student success on knowledge of nursing concepts and to prepare students for success on the NCLEX-RN. Nursing faculty must be able to identify predictors of student success early in the nursing program in order to offer appropriate support and remediation. The purpose of this retrospective, correlational study was to determine predictive variables of BSN student success on the HESI Exit Exam in a southeastern university. Students who reported higher test anxiety scored significantly lower on the HESI Exit Exam. Higher medical-surgical I HESI examination scores, higher medical-surgical II HESI examination scores, higher obstetrics HESI examination scores, and higher final grade point average were significant predictors of students' HESI Exit Exam scores and accounted for 39% of the variance in the scores. Results from this study suggest implementing remediation based on HESI Specialty Exam scores and interventions aimed at reducing test anxiety.

Undergraduate nursing student academic resilience during medical surgical clinical practicum: A constructivist analysis of Taiwanese experience.

BACKGROUND: Nursing students often experience a reality shock in the course of their practicums that can significantly impact their studies. PURPOSE: This study aimed to explore the academic resilience of undergraduate nursing students during their Adulting Nursing practicums and identify protective factors to mitigate their impact. METHODS: The constructivist grounded theory approach enabled us to explore nursing students' academic resilience in their practicums. Purposive and theoretical sampling was used to recruit 19 participants. Individual in-depth interviews were audio-recorded and transcribed verbatim. The constant comparative method directed theoretical sampling. The criteria of credibility, originality, resonance, and usefulness were considered to ensure the quality and trustworthiness of the study. RESULTS: The main challenges were related to facilitators, the environment, and application of techniques. Students reported feelings of 'walking on thin ice' and doubts about their decision to pursue a nursing career. Academic resilience was identified as the ability to maintain optimism while facing challenges. Participants concluded that overcoming their ignorance through practical learning was an important outcome of the process of developing academic resilience. CONCLUSION: The findings highlight the need for facilitators to re-examine their teaching strategies and provide supplementary support to help students to improve their academic resilience.

Development of the Simulation-Positive Learning Evaluation (SIM-PLE) rubric for use in medical-surgical nursing high fidelity simulations.

Clinical nurse educators in a BSN program developed the SIM-PLE (Simulation-Positive Learning Evaluation) rubric to evaluate student performance in simulation. A pilot study was conducted over two semesters with junior level medical-surgical classes made up of approximately 110-130 students each semester, and the tool was revised and re-evaluated. Inter-rater reliability testing utilized 69 SIM-PLE rubric student evaluations (N = 69). Inter-rater reliability was assessed with comparison of lead faculty with three other instructors utilizing two raters for each simulation experience. The intraclass correlation coefficient (ICC) suggested high inter-rater reliability. The t-test difference was not significant. One-way analysis of variance (ANOVA) showed a significant difference in the Collaboration subcategory score. Univariate ANOVA indicated both raters scored consistently with each other overall and that they both scored JR1 differently than JR2. The pilot study and testing of interrater reliability of the rubric revealed positive findings. The role of the rubric in providing formative feedback during debrief sessions empowered students to analyze their own performance and/or experience to self-correct or improve their future practice based on these experiences.

Facilitating Multiple Medical-Surgical Nursing Practicum Groups During Simulation Laboratory Days.

ABSTRACT: This novel approach incorporates the facilitation of multiple clinical groups through a weekly simulation laboratory day during a medical-surgical nursing practicum rotation. Using a combination of nursing skills education practice stations, along with simulation learning experiences, 93 students from 12 clinical groups were able to rotate through two high-fidelity simulation learning experiences and one new skill station each week throughout the semester.

Effect of Clinical Reasoning Seminars on Medical-Surgical Specialty HESI Examination Scores.

BACKGROUND: Clinical reasoning and clinical judgment have been identified as essential skills for the delivery of quality patient care. PURPOSE: The purpose of this study was to determine the impact of clinical reasoning seminars (CRSs) on medical-surgical specialty HESI examination scores of high-risk students. METHODS: A retrospective correlational design was used for this study, which involved a review of medical-surgical HESI scores for 115 junior-level baccalaureate nursing students who were identified as academically high-risk and who participated in a series of CRSs. RESULTS: The participation in CRSs by high-risk students did not have a statistically significant impact on the medical-surgical HESI scores. Students who attended CRSs, however, had a higher mean medical-surgical HESI score than students who did not attend any CRSs. CONCLUSION: Although statistical differences were not found, it appears that high-risk students may have benefitted from participation in CRSs.

Mental strain and changes in psychological health hub among intern-nursing students at pediatric and medical-surgical units amid ambience of COVID-19 pandemic: A comprehensive survey.

COVID-19 pandemic brings with it a new reality and changes in the context of traditional nursing clinical training. Intern-nursing students face challenges in providing care for suspected and confirmed patients with COVID-19. This cross-sectional descriptive study aimed to explore the mental strain and changes in the psychological health hub among the intern-nursing students during COVID-19 pandemic. A sample of 150 intern-nursing students from 13 pediatric and medical-surgical units at Alexandria University Hospitals completed the Middle East Respiratory Syndrome COVID-19 Staff Questionnaire and rated their psychological distress on the General Health Questionnaire. Study results revealed that the most stressful factors were related to possibility of getting COVID-19 infection (2.89 ± 0.39) and transmitting it to their families (2.72 ± 0.62). Moreover, the availability of cure or vaccine for the disease was the most important motivational factor to participate in future outbreaks (2.64 ± 0.77). Regarding intern-nursing students' psychological health hub, 77.3% of them felt under strain, worthless and depressed (64.7%, 62.7%) since the influx of COVID-19 pandemic. Binary logistic regression indicated that students' age (23-24), clinical experience (8 months) and clinical placement in adults' units served as risk factor for developing psychological distress while, male gender and training in pediatric units were protective factors. Designating an emergency psychiatric unit for ongoing monitoring and providing psychological first aids to the vulnerable health care providers is recommended.

Original Research: Family Presence During Resuscitation: Medical-Surgical Nurses' Perceptions, Self-Confidence, and Use of Invitations.

BACKGROUND: Family presence during resuscitation (FPDR) upholds family-centered care principles and can result in better family member outcomes; yet it isn't routinely implemented by nurses. Prior studies have examined predictors of support for FPDR among nurses caring for high acuity patients, but limited research involves medical-surgical nurses. This is problematic because resuscitation occurs in all inpatient settings. PURPOSE: This study sought to examine the personal, professional, and workplace factors associated with medical-surgical nurses' perceptions, self-confidence, and use of invitations regarding FPDR. It also aimed to explore potential barriers to FPDR and nurses' educational preferences, in order to inform the design of interventions that might improve FPDR implementation in this practice setting. METHODS: A cross-sectional survey design was used to examine which factors are predictors of medical-surgical nurses' FPDR perceptions, self-confidence, and use of invitations. Data on nurses' perceptions of barriers and educational preferences were collected via survey as well. RESULTS: The sample of 51 medical-surgical nurses reported overall neutral perceptions of FPDR. Yet 63% had never invited family members to experience resuscitation. The most significant predictor of more favorable perceptions, higher self-confidence, and greater use of invitations was having prior experience with FPDR. Analysis of perceived barriers indicates that these can be addressed through providing nurses with supportive FPDR policies and education. But only 14% of participants reported that their facility or unit had a written FPDR policy and just 16% had ever received any FPDR education. CONCLUSIONS: FPDR is not commonly practiced on medical-surgical units. Providing medical-surgical nurses with experience, policies, and education is recommended to improve FPDR implementation rates in this practice setting.

Workflow and decision making of operating room nurses: integrative review.

OBJECTIVE: Identify workflow factors in the operating room and their implications, which influence nurses' decision making. METHOD: Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications. RESULTS: The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification. CONCLUSIONS: Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.

The Discharge Lounge: A Patient Flow Process Solution.

BACKGROUND: Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage. LOCAL PROBLEM: Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting. METHODS: Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles. INTERVENTIONS: After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written. RESULTS: The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased. CONCLUSION: The DL is an effective tool to improve patient flow and decrease hospital overcrowding.

Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors.

Critical thinking affects patient safety in critical situations. Nurses, in particular, intensive care unit (ICU) nurses, need to develop their critical thinking skills. The present article seeks to compare the level of critical thinking in medical-surgical and ICU nurses and investigate the factors explaining it. A cross-sectional study was conducted on 120 medical-surgical and ICU nurses (60 per group). Data were collected using the California Critical Thinking Skills Test and analyzed in SPSS-16 using independent samples t-test, ANOVA, and the regression analysis. The mean critical thinking score was 8.68 ± 2.84 in the ICU nurses and 9.12 ± 2.99 in the medical-surgical nurses. No significant differences were found between the two groups in terms of the critical thinking score and the scores of its domains. The results of the regression analysis showed that demographic variables explain only 8% of the variations in critical thinking score, as only gender explains nurses' critical thinking score. The results revealed poor critical thinking scores in the nurses working in medical-surgical wards. Investigating the reasons for the poor scores obtained and using educational strategies such as PBL, conceptual map, participation in interdisciplinary rounds, the development of clinical guidelines and participation in continuing education conferences are recommended for developing critical thinking skills in nurses.