Intention and motivation to pursue higher education among registered nurses and midwives: a cross-sectional study during COVID-19.

OBJECTIVES: To determine the intention and motivation of nurses and midwives to pursue their higher education considering several factors. METHODS: This is a cross-sectional study were a 16-item online survey was distributed using a convenience sampling method to approximately 12,000 nurses and midwives between May - July 2021. RESULTS: A total of 513 eligible nurses and midwives participated in the study. Most of the respondents were females (76.61%), with a bachelor's degree (72.3%) and well experienced (11-15 years) (35.4%). Most nurses and midwives are highly motivated to pursue higher education (79.14%). The most motivating factor for the respondents is their professional goals (85.2%), While the most dissuading factor was the cost. Regarding COVID-19, about 28% of the respondents said that the COVID-19 pandemic has a negative effect on their desire to go for higher education. CONCLUSIONS: The nurses and midwives were highly motivated to pursue higher education regardless of their demographic status, available resources, and barriers. Furthermore, the eagerness of the nurses and midwives to pursue higher education, which is rooted in their desire to grow in their profession.

Sidelined during COVID-19: a narrative inquiry into how simulationists experienced the pandemic.

BACKGROUND: In the simulation community, colleagues who are no longer clinically practicing were often proximal to the COVID-19 response, not working in the frontlines of patient care. At the same time, their work as simulationists changed dramatically or was halted. This research explored the experiences of those simulationists who have clinical backgrounds but did not provide direct patient care during the initial pandemic response. The aim of this study was to allow those simulationists to share and have their stories heard. METHODS: This qualitative research used a narrative approach to answer the research question: What were the experiences of those in the simulation community who did not contribute to the frontline patient care response during the early stages of the pandemic? A semi-structured questionnaire aimed at eliciting a story was disseminated through online simulation discussion boards. Data was collected through PHONIC with options to type or speak responses. Responses were analyzed using an inductive analytical process to identify themes or patterns in the narratives. RESULTS: Thirty-six respondents completed the survey between August 1, 2020 and November 30, 2020. Narrative arcs were identified that illustrated the events, actions, thoughts and feelings representative of experiences shared by many simulationists. Two major themes emerged: Challenges and Opportunities. Challenges included feelings of guilt; frustration; overwhelmed, stressed and exhausted; being away from the action, being unused and underappreciated. Opportunities included leadership (evolution and innovation), personal development, and being a part of something. CONCLUSIONS: The findings reflect a snapshot in time of how simulation was viewed and used in the world during a pandemic through the personal stories of simulationists with clinical backgrounds who did not provide direct patient care. Sharing these narratives may inform future simulation development; however, it is vitally important that the emotions are recognized and acknowledged. Managers should ensure mental health resources and support are available to all staff, including those not deployed to the frontline.

Learning Outcomes Attributed to Prelicensure Clinical Education in Nursing: A Systematic Review of Qualitative Research.

BACKGROUND: Educators agree that clinical experiences are vital to the development of a graduate nurse; however, there is little research on student learning outcomes related to these experiences. PURPOSE: The purpose of this systematic review was to examine qualitative studies of student learning in traditional clinical models. METHODS: A systematic review was conducted following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Nine electronic databases were searched using 43 search terms. Full-text review was completed on 109 articles, with 26 undergoing critical appraisal. RESULTS: Only 6 qualitative studies reported learning outcomes attributed to clinical education models, focusing on experiences in foreign clinical placements, nurse-run clinics, the night shift, transition to professional identity, practicing as a clinical dyad, and development of caring skills. CONCLUSIONS: The results of the systematic review of qualitative research that studied outcomes of prelicensure clinical education were insufficient to provide recommendations for traditional clinical education that are supported by evidence.

Meeting Undergraduate Nursing Students' Clinical Needs: A Comparison of Traditional Clinical, Face-to-Face Simulation, and Screen-Based Simulation Learning Environments.

BACKGROUND: Nurse educators expanded replacement of traditional clinical practice and face-to-face simulation experiences with screen-based simulation (SBS) during the COVID-19 (coronavirus disease 2019) pandemic. PURPOSE: The purpose of this research was to understand the student experience when learning in 3 types of clinical education environments. METHODS: This quantitative descriptive survey study used the Clinical Learning Environment Comparison Survey 2.0 (CLECS 2.0) to compare prelicensure nursing students' perceptions of learning in 3 clinical learning environments. RESULTS: The CLECS 2.0 was completed by 113 participants from 3 countries. Most scores were highest for the traditional clinical practice environment, and all were lowest for the SBS environment. CONCLUSIONS: The findings are concerning as discussions about whether SBS can replace traditional clinical practice hours unfolds. The findings support the need for concentrated efforts to improve specific areas of the SBS experience.

Cultural Considerations in Debriefing.

SUMMARY STATEMENT: Culture influences how we communicate, teach, and learn. Debriefings are laden with cultural influences. Without attention to cultural considerations, accepted debriefing techniques might not reach the desired outcome and, in certain cultures, may even harm teacher-learner relationships. We explore cultural considerations in healthcare simulation debriefing and offer guidance for debriefers to gain awareness of potential cultural biases.

Traditional Clinical Outcomes in Prelicensure Nursing Education: An Empty Systematic Review.

BACKGROUND: Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students. METHOD: A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria. RESULTS: No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes. CONCLUSION: No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136-142.].

Simulation-based education programme for upskilling non-critical care nurses for COVID-19 deployment.

Background: The coronavirus disease 2019 (COVID-19) crisis created pressure on healthcare institutions to be prepared with maximum workforce and bed capacity. Clinical education during COVID-19 has high risk of disease transmission to learners due to contamination of equipment, supplies and surfaces, in addition to increased clinical-related stress and fear. Simulation-based education (SBE) has potential to help manage the pandemic by rapidly upskilling nurses' clinical responsibilities. Methods: Upskilling of 445 non-critical care nurses was conducted using SBE between 14th March and 30 May 2020. Training consisted of completing a mandatory online critical care awareness module, followed by 3 hours of critical care simulation-based scenarios using demonstration and return-demonstration approach. Results: All 445 non-critical care nurses completed required modules and simulation experiences. The critical care simulation-based upskilling programme was evaluated as an effective way to learn how to manage critically ill patients. The majority of evaluation items were rated over 95% for effectiveness of the education; four items were less than 95% (88-94%). Lower rated items considered training and practice time, improved competency and commitment to apply learning. Conclusion: Rapidly developed and implemented upskilling of critical care nurses was effectively accomplished with SBE. However, learners noted the need for longer learning times and increased practice opportunity to improve competency. Lack of intent to apply the patient care techniques requires further study. SBE has potential as an effective educational method for rapid preparedness in future crisis.

Cultural considerations in debriefing: a systematic review of the literature.

Background: Conversations are influenced by cultural perceptions, beliefs and values. Debriefing is a learning conversation. Without cross-cultural engagement or culturally relevant teaching, learning may be compromised and may result in an outcome opposite of that intended. Objective: This systematic review explores cultural considerations in healthcare simulation debriefing. We sought to explore findings that could help debriefers create culturally responsive and inclusive debriefings. Study selection: Studies were included if they were peer-reviewed articles in any language and focused on healthcare simulation debriefing and global cultural considerations. Research study methods included qualitative, quantitative or both. The review included any health-related profession and level of learner. Findings: Three studies met the criteria. The purposes of the three studies were significantly different and did not directly study cultural considerations in debriefing. Conclusions: The learner-educator relationship is at risk and learning may be negatively impacted without addressing cultural awareness. More studies are needed to fully describe the effect of culture on successful debriefing.

Operationalizing a simulation program: Practical information for leadership.

Failure to ensure organizational readiness for curricular integration of simulation can result in a costly and ineffective simulation program. Organizational leaders who are aware of the principles of changemaker leadership and specific operational considerations are best positioned to ensure a quality simulation program. To assist these leaders, this article provides practical information derived from dissection of the Standard of Best Practice: SimulationSM : Operations, including topics of strategic planning, financial resources, expert personnel, resource management systems, policies and procedures, and systems integration. Additionally, an introduction to a foundational tool to spearhead change is offered, and characteristics of the changemaker leader needed to develop and sustain an effective and efficient simulation program are highlighted. Understanding the criteria necessary for effective simulation operations and early recognition of the conditions and variables that can influence organizational culture is of utmost importance to ensure programmatic success.

Incorporating the Reflective Pause in Simulation: A Practical Guide.

Many articles exist today espousing the value of debriefing following a simulation or gaming event. Although debriefing, a reflection-on-action strategy, is important, a useful reflection strategy may accentuate the reflection-in-action process that is arguably even more important than the debriefing. In this article, we explain a concept called the reflective pause and how it can be used during simulation cases to lead the learners to the objectives and enhance the learning process. We provide a review of the literature concerning reflection-in-action and ways that the reflective pause may be used during key learning events. The reflective pause is relatively absent from the simulation-based education lexicon. Used effectively, the reflective pause may become one of the most valuable learning strategies in a simulation educator's tool belt. [J Contin Educ Nurs. 2020;51(1):32-38.].

Development and Psychometric Evaluation of the Facilitator Competency Rubric.

AIM: The purpose of the study was to evaluate the psychometric properties of the Facilitator Competency Rubric (FCR). BACKGROUND: The FCR was developed to fill a deficit in tools available to holistically evaluate competency of simulation facilitators. METHOD: The FCR has five constructs: preparation, prebriefing, facilitation, debriefing, and evaluation. Benner's novice-to-expert theory was used to categorize subcomponents. Expert panel validation was sought. Participants from four baccalaureate nursing programs completed 107 observations of facilitators using the FCR. RESULTS: Interrater reliability as assessed using generalizability theory was good. G coefficients ranged from good to excellent (.80 to .99). FCR items appeared to be well constructed. Term, day of the week, time of day, and simulation type were significant predictors of the FCR global score. CONCLUSION: The FCR is a valid, reliable tool that can be used for formative or summative evaluation of simulation facilitators. Scores can guide and prioritize faculty development.

Development and Psychometric Evaluation of the Simulation Culture Organizational Readiness Survey.

Expensive high-fidelity simulators sit unused in nursing programs worldwide. One cause of this is failure to ensure organizational readiness to integrate simulation into the curriculum. The Simulation Culture Organizational Readiness Survey (SCORS) was developed to assist administrators in evaluating institutional and program readiness for simulation integration. Psychometric analysis finds the SCORS to be a valid, reliable tool for use by administrators to determine organizational readiness for simulation integration.

A brief simulation intervention increasing basic science and clinical knowledge.

BACKGROUND: The United States Medical Licensing Examination (USMLE) is increasing clinical content on the Step 1 exam; thus, inclusion of clinical applications within the basic science curriculum is crucial. Including simulation activities during basic science years bridges the knowledge gap between basic science content and clinical application. PURPOSE: To evaluate the effects of a one-off, 1-hour cardiovascular simulation intervention on a summative assessment after adjusting for relevant demographic and academic predictors. METHODS: This study was a non-randomized study using historical controls to evaluate curricular change. The control group received lecture (n l=515) and the intervention group received lecture plus a simulation exercise (n l+s=1,066). Assessment included summative exam questions (n=4) that were scored as pass/fail (≥75%). USMLE-style assessment questions were identical for both cohorts. Descriptive statistics for variables are presented and odds of passage calculated using logistic regression. RESULTS: Undergraduate grade point ratio, MCAT-BS, MCAT-PS, age, attendance at an academic review program, and gender were significant predictors of summative exam passage. Students receiving the intervention were significantly more likely to pass the summative exam than students receiving lecture only (P=0.0003). DISCUSSION: Simulation plus lecture increases short-term understanding as tested by a written exam. A longitudinal study is needed to assess the effect of a brief simulation intervention on long-term retention of clinical concepts in a basic science curriculum.

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.