Updating the Simulation Effectiveness Tool: Item Modifications and Reevaluation of Psychometric Properties.

AIM: This study evaluated the psychometric properties of the modified Simulation Effectiveness Tool (SET), the SET-M. BACKGROUND: The SET, developed in 2005, was updated to be consistent with INACSL Standards of Best Practice, QSEN practices, and American Association of Colleges of Nursing baccalaureate essentials. METHOD: Undergraduate nursing students from two nursing programs, one with multiple campuses, completed the SET-M following completion of a simulated clinical experience; 1,288 students took part in the study. RESULTS: Exploratory factor analysis was completed using unweighted least squares. Four subscales were identified with acceptable internal consistency: Prebriefing (α = .833), Learning (α = .852), Confidence (α = .913), and Debriefing (α = .908). CONCLUSION: Revisions made to modify the SET to current standards of simulation practice have resulted in the SET-M, which has been shown to be a valid and reliable method of evaluating students' perceptions of the effectiveness of learning in the simulation environment.

Role modeling clinical judgment for an unfolding older adult simulation.

Nurse educators must foster development of clinical judgment in students to help them provide the best care for the increasing population of older adult patients. This article reports qualitative findings from a mixed-methods study that focused on clinical judgment in the simulated perioperative care of an older adult. The sample was composed of treatment and control groups of prelicensure students (N = 275) at five sites. The treatment group watched a video of an expert nurse role model caring for a patient similar to the simulation patient, whereas the control group did not watch the video. Four weeks after simulation, participants cared for real-life, older adult perioperative patients. After the simulated and real-life care experiences, participants completed questionnaires related to clinical judgment dimensions. These two data sets revealed rich findings about the students' simulation learning, affirming the value of expert role models. Transferability of simulation learning to practice was also explored.

Situated peer coaching and unfolding cases in the fundamentals skills laboratory.

Using unfolding case studies and situated peer coaching for the Fundamentals Skills Laboratory provides students with individualized feedback and creates a realistic clinical learning experience. A quasi-experimental design with pre- and post-intervention data was used to evaluate changes in student ratings of the course. An instrument was used to examine students' self-ratings and student comments about each lab. We found that students' ratings of the lab remained high with the new method and self-evaluations of their performance were higher as the semester progressed. Students appreciated the personalized feedback associated with peer coaching and demonstrated strong motivation and self-regulation in learning. By participating in unfolding case studies with situated peer coaching, students focus on safety issues, practice collaborative communication, and critical thinking in addition to performing psychomotor skills.

Mean oxygen saturation in well neonates at altitudes between 4498 and 8150 feet.

PURPOSE: Examine changes in oxygen saturation in well neonates at altitudes from 4498 to 8150 feet with serial measurements at 12 to 24 hours of age, 36 to 48 hours, and, if still hospitalized, at 60 to 72 hours. SUBJECTS: Convenience sample of well newborn infants meeting inclusion criteria of normal cardiopulmonary status (centrally pink with adequate perfusion) and no respiratory distress (absence of grunting, retracting, nasal flaring, or tachypnea-respiration ≤ 60/minute). DESIGN: Nonexperimental, longitudinal, descriptive study. METHODS: Using Masimo Radical SET monitors the SpO2 values were recorded from infant's right upper extremity to obtain a preductal measurement and then from left lower extremity for postductal measurement at study intervals. OUTCOME MEASURE: SpO2 values. RESULTS: The well neonates' birth weights ranged from 1835 to 4740 g [corrected], with 94.3% classified as term and 5.7% classified as preterm. At the data collection intervals based on hours of life, mean SpO2 readings at 4498 feet were 95% to 96.67%, at 6800 feet were 93.91% to 95.36%, at 7851 feet were 91.80% to 94.37%, at 7890 feet were 93.44% to 96.10%, and at 8150 feet were 93.69% to 96.25%. SpO2 readings at sites at or above 6800 feet were significantly lower than those at 4498 feet. No significant differences were noted for sleep state or season. Significant differences were noted in the first and second lower extremity readings between preterm and term neonates, with preterm SpO2 readings higher than term readings. CONCLUSIONS: Mean oxygen saturation levels for well neonates born at higher altitudes are lower than those born at 4498 feet. Neonates born at or above 6800 feet exhibit "normal" oxygen saturation levels between 91% to 96% rather than the expected 97% found at sea level. These reference values for varying altitudes can guide clinicians to avoid hypoxemia or hyperoxia. If routine oxygen saturation screening for detection of critical congenital heart defects is implemented, these results will provide clinicians the mean values specific for additional altitudes, thus preventing unnecessary interventions when results are lower than the expected 97%.

Breast cancer screening in women: An integrative literature review.

PURPOSE: To (a) conduct a thorough search of the literature for breast cancer screening studies utilizing mammography, ultrasound, or breast magnetic resonance imaging (MRI), and (b) critically appraise these studies to aid the nurse practitioner in choosing the most appropriate screening tool for their individual patients. DATA SOURCES: Articles were identified from the following databases: CINAHL, Medline, PubMed, EBSCO, ISI, and Cochrane Library. Reference lists from all articles were reviewed and an authority in breast cancer screening was contacted regarding the reference list. CONCLUSIONS: Breast MRI had a higher sensitivity than mammography and ultrasound in all studies comparing breast MRI. The specificity was lower for breast MRI than for mammography in five out of six studies. The ultrasound had a higher sensitivity than mammography in all five studies examining women with dense breast tissue. IMPLICATIONS FOR PRACTICE: Women who fall into high-risk categories should be screened yearly with breast MRI and mammography. Women with dense breast tissue according to a standardized density score should be screened yearly with ultrasound and mammography. Women in the general population should be screened yearly with mammography.

Patient simulator sessions and critical thinking.

The project purpose was to determine whether measures of critical thinking show differences between three groups (simulator, non-simulator, control) of baccalaureate nursing students. The second purpose was to determine the moderating effect of students' preferred learning style. All groups experienced a moderate to large effect size in critical thinking scores. The corrected model for the total scale gain score was statistically significant but not significant for learning style or group.

Peripheral intravenous catheters started in prehospital and emergency department settings.

The purpose of this study was to determine the rates of phlebitis in trauma patients according to where the peripheral intravenous catheter (PIVC) was inserted in a prehospital setting or in an emergency department setting. Variables investigated also included where the catheter was anatomically placed, the gauge of the catheter, and the patients' Injury Severity Score. The overall phlebitis rate was 5.79%. The rate of phlebitis was 2.92% when started by an RN in the emergency department, 6.09% when started by an intermediate emergency medical technician and 7.78% when started by a paramedic in prehospital setting. There was no significant difference in the rates of phlebitis when a chi-square analysis was performed. In addition, no variables predicted phlebitis no matter where the PIVC was started when a regression analysis was conducted. Even though the Centers for Disease Control and Prevention suggests removing the PIVC within 48 hours if placed under emergency situations, the phlebitis rates of trauma patients in this study meet the benchmark of best practice. Perhaps removing the PIVC within 48 hours of placement should be reconsidered.

Hospital nursing research program: partnership of service and academia.

Hospitals in a nonprofit mountain west corporation conducted a gap analysis to determine readiness for Magnet Recognition. Major gaps included nursing research and availability of consultation and resources for research. Based on the findings, the development of a dynamic research program promoting nursing research and evidence-based practice within hospitals was undertaken. A nursing research council was reestablished with representatives from service and academia. A literature review and analysis of corporate/academia resources were completed. The plan called for a nursing research coordinator position and development of a research budget. Academia continues to be represented on the hospital institutional review board. A semiannual research symposium including poster presentations by nursing staff and nursing students was implemented. The plan calls for development of a research fellowship program and unit-based evidence-based specialists. With administrative support and resources and partnering with nursing academia, nonteaching hospitals can develop successful dynamic nursing research and evidence-based practice programs.

Learning nursing research through faculty-mentored projects.

Baccalaureate nursing educators have incorporated nursing research content into the curriculum for many years. Our university also proposes that students have a faculty-mentored learning experience at least once during their undergraduate education. Student research, guided by a faculty mentor, provides an excellent opportunity for students to learn about and participate in nursing research. The authors describe a unique experience of nursing students working as research assistants in a faculty research project using a human patient simulator.

Institutional issues in the implementation of an international student exchange program.

This article discusses institutional issues related to the development and implementation of an undergraduate student exchange program in nursing. A consortium of four universities in the United States and six nursing schools in three European countries developed an exchange program to teach a common community health module. Thirty-one students from the United States and 30 students from Europe participated in this program, which was funded by the U.S. Department of Education and the European Union. The project commenced with a 3-week meeting of faculty and students to design the 8-week exchange program and cultural preparation module. This article describes institutional issues related to the project. Academic issues, nonacademic issues, and exchange procedures are presented. The extended meeting of faculty and students that occurred early in the funding period was critical to this program's success.

An integrative review of computer-based simulation in the education process.

The purpose of this study was to review quantitative studies related to computer-based simulation and healthcare education and determine the effect of simulation on education and learning. A total of 513 references were retrieved, but only 9 quantitative studies met the inclusion criteria. To synthesize the data, the mean scores and standard deviations of the studies were used to determine the effect size, the index, and the direction of the effect. This review indicates that 75% of the studies showed positive effects of simulation on skill and/or knowledge acquisition. The potential of computer-based simulation as an education augmentation is enormous, but research is needed to determine effective and successful uses of high-fidelity simulations for nursing education.