Lasater clinical judgment rubric reliability for scoring clinical judgment after observing asynchronous simulation and feasibility/usability with learners.

BACKGROUND: There is strong evidence supporting using the Lasater Clinical Judgment Rubric (LCJR) for scoring learners' clinical judgment during in-person simulation performance and clinical experience reflections. However, a gap exists for using LCJR to evaluate clinical judgment after observing asynchronous simulation. OBJECTIVE: We aimed to determine the reliability, feasibility, and usability of LCJR for scoring learners' written reflections after observing expert-modeled asynchronous simulation videos. DESIGN/SETTING/PARTICIPANTS: We used a one-group, descriptive design and sampled pre-licensure, junior-level bachelor's learners from the Southwestern United States. METHODS: Participants observed eight expert-modeled asynchronous simulation videos over one semester and provided written responses to clinical judgment prompts. We scored clinical judgment using LCJR. We studied reliability by measuring internal consistency of 11 clinical judgment prompts and interrater reliability with two raters. This study also investigated feasibility and usability of the asynchronous simulation learning activity using descriptive statistics. Feasibility included time learners spent completing written responses and time raters spent evaluating written responses. Learners reported usability perceptions using an instructor-developed survey. RESULTS: Sixty-three learners completed 504 written responses to clinical judgment prompts. Cohen's kappa ranged from 0.34 to 0.86 with a cumulative κ = 0.58. Gwet's AC ranged from 0.48 to 0.90, with a cumulative AC = 0.74. Cronbach's alpha was from 0.51 to 0.72. Learners spent on average 28.32 ± 12.99 min per expert-modeling video observation. Raters spent on average 4.85 ± 1.34 min evaluating written responses for each participant. Learners reported the asynchronous learning activity was usable. CONCLUSIONS: Nurse educators can reliably use LCJR for scoring learners' clinical judgment after observing asynchronous expert-modeled simulation. Logistically, learners complete the reflective learning activity and faculty use LCJR to measure clinical judgment in feasible time. Further, participants perceived the asynchronous learning activity usable. Nurse educators should utilize this learning activity for evaluating and tracking observer clinical judgment development.

Effect of Multiple-Patient Simulation on Baccalaureate Nursing Students' Anxiety and Self-confidence: A Pilot Study.

BACKGROUND: Multiple-patient simulation (MPS) allows nursing students to develop leadership skills. Limited research examining student outcomes following MPS exists. PURPOSE: This pilot study investigated the impact of MPS on (1) anxiety with transition to practice, (2) anxiety with clinical decision-making, (3) self-confidence with clinical decision-making, and (4) perceptions about MPS as a learning strategy. METHODS: Twenty-two senior baccalaureate nursing students participated in this 2-group mixed-methods study. Data were collected before and after a leadership course using the State-Trait Anxiety Inventory, Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale, and a researcher-developed perceptions survey. RESULTS: Self-confidence with clinical decision-making significantly increased for all participants regardless of group assignment. Anxiety and anxiety with clinical decision-making decreased without significant changes. No significant differences were found between groups. Qualitative findings yielded 3 themes: preparation for clinical practice, overcoming anxiety, and confidence. CONCLUSION: Research investigating additional student outcomes after MPS with larger, more diverse samples is needed.

Cognitive load experienced by nurses in simulation-based learning experiences: An integrative review.

BACKGROUND: Simulation based learning experiences help nurses gain skills necessary for independent practice. However, increased cognitive load placed on learners in simulation may affect learning outcomes. OBJECTIVES: The purpose of this integrative review was to synthesize what is known about nurses' cognitive load in simulation and summarize measurement approaches. DATA SOURCES: A search of CINAHL, Medline, ProQuest Nursing and Allied Health, and ERIC databases was limited to peer-reviewed studies published after 2006 in the English language, using the key words nurse, simulation, and cognitive load. REVIEW METHODS: Whittemore and Knafl's (2005) integrative review method was used. Studies investigating advanced practice nurses or interprofessional teams were excluded. RESULTS: Database and reference lists searches identified a total of 3077 records, and 20 met inclusion criteria. Simulation fidelity, time pressure, dual-tasking, interruptions, task complexity, distractions, and mismatched simulation objectives to learner ability increase nurses' cognitive load. However, past experience, pre-briefing, repeated scenarios, and worked-out modeling optimize cognitive load. Subjective and objective cognitive load measures help researchers understand cognitive load and define its relationship with other variables. CONCLUSIONS: Simulation impacts nurses' cognitive load. Varying simulation designs to optimize cognitive load will improve learning outcomes. Future nursing simulation research should utilize well-validated cognitive load measures and measure cognitive load alongside other variables to further understand how cognitive load affects simulation outcomes.

TIDES: examining the influence of temporal individual differences on multitasking in educational simulation.

BACKGROUND: The majority of tasks nurses complete in acute care settings are time-sensitive. Due to complex patient needs, nurses' multitasking behavior is of growing importance. Situations involving multitasking behavior typically require nurses to switch their attention among multiple tasks and patients in a rapid fashion. Research suggests temporal individual differences such as time urgency, polychronicity, and time perspective influence decision-making. The factors suggest that balanced time perspective may facilitate multitasking. Given novice nurses commit errors related to multitasking, we evaluated the relationship between temporal individual differences, cognitive workload, and multitasking behaviors in a simulation setting. METHODS: A one-group repeated measures design was used to evaluate the relationship between multitasking, demographic factors, cognitive workload, and temporal individual differences. One hundred sixty fourth-year, prelicensure nursing students independently completed two 45-min multiple patients simulations involving care of three interactive patient simulators. Participants completed the Multitasking Preference Inventory, Time Perspective Inventory, Experiences of Time survey, and Time Urgency Scale before simulation. A summary Creighton Simulation Evaluation Instrument score was used to represent multitasking. Participants completed the Task Load Index to represent cognitive workload. We calculated deviation from balanced time perspective and measured its correlation with multitasking. Regression models calculated how much variance deviation from balanced time perspective, demographic factors, and cognitive workload contributed to multitasking. RESULTS: Standardized test scores were more predictive of multitasking than deviation from balanced time perspective (ß = 0.19, t = 2.48, p = 0.0142). As deviation from balanced time perspective increased, multitasking behaviors decreased (r = - 0.17), participants reported a higher sense of urgency (r = 0.39), and they had more frustration after simulation (r = 0.22). Deviation from balanced time perspective did not influence cognitive workload. CONCLUSIONS: Nursing students who demonstrate multitasking behaviors tend to have a more balanced time perspective. Knowing students' deviation from balanced time perspective may help educators anticipate who will need more assistance with multitasking in simulation. Nursing students frequently wait until just before graduation to provide care for multiple patients; including mention of deviation from balanced time perspective in simulation preparation may help senior nursing students become more self-aware and ultimately improve behavioral performance.

Simulation in Undergraduate Education.

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

A Randomized Trial of Multiple-Patient Simulation Preparation to Improve Novice Nurses' Competence and Self-Efficacy.

AIM: The purpose of the study was to determine best practices for multiple-patient simulation (MPS) preparation and frequency to improve behavioral performance in nursing students. BACKGROUND: MPS provides a safe environment for novice nurses to practice priority setting, delegation, and multitasking, but evidence for best practices is needed. METHOD: A multisite, blinded, randomized trial was conducted to evaluate the effect of three simulation preparation methods (expert modeling, voice-over PowerPoint, and reading assignments) on students' competence and self-efficacy for providing care to multiple patients in the simulation lab. Participants (n = 73) were enrolled in capstone clinical courses at two schools of nursing. RESULTS: Though there was no difference in raw change in competence score among the study groups, there was a statistically significant difference in pretest and posttest scores. The change in self-efficacy did not correlate with the change in competence. CONCLUSION: These findings will help educators understand how novice nurses benefit from repeated MPS activities.

Effectiveness of Simulation Preparation on Novice Nurses' Competence and Self-Efficacy in a Multiple-Patient Simulation.

This study examined the influence of three simulation preparation methods (expert modeling/intervention, voice-over PowerPoint/active control, and reading assignments/passive control) on improving novice nurses' competence and self-efficacy for providing care to multiple simulated patients. Both competence and self-efficacy were measured at baseline and following a five-week intervention. Twenty senior pre-licensure nursing students participated in the trial. One-way ANOVAs and parametric/nonparametric correlations were used. Voice-over PowerPoint and expert modeling resulted in greater improvements in self-efficacy compared with traditional reading assignments as simulation preparation. However, there was no relationship between change in competence and self-efficacy over time.

Comparison of expert modeling versus voice-over PowerPoint lecture and presimulation readings on novice nurses' competence of providing care to multiple patients.

Due to today's complex needs of hospitalized patients, nurses' competence and strategies to improve competence are of growing importance. Simulation is commonly used to influence competence, but little evidence exists for comparing how presimulation assignments influence competence. A randomized control trial was used to compare the efficacy of three simulation preparation methods (expert modeling/intervention, voice-over PowerPoint/active control, and reading assignments/passive control) on improving competence for providing care to multiple patients among senior undergraduate novice nurses. Competence was measured at two time points (baseline and following a 5-week intervention) by two blinded raters using the Creighton Simulation Evaluation Instrument. Twenty novice nurses participated in the trial. No significant differences were noted in raw improvements in competence among the three groups, but the expert modeling (Cohen's d=0.413) and voice-over PowerPoint methods (Cohen's d=0.226) resulted in greater improvements in competence, compared with the passive control.

Effectiveness of simulation for improvement in self-efficacy among novice nurses: a meta-analysis.

The influence of simulation on self-efficacy for novice nurses has been reported inconsistently in the literature. Effect sizes across studies were synthesized using random-effects meta-analyses. Simulation improved self-efficacy in one-group, pretest-posttest studies (Hedge's g=1.21, 95% CI [0.63, 1.78]; p<0.001). Simulation also was favored over control teaching interventions in improving self-efficacy in studies with experimental designs (Hedge's g=0.27, 95% CI [0.1, 0.44]; p=0.002). In nonexperimental designs, consistent conclusions about the influence of simulation were tempered by significant between-study differences in effects. Simulation is effective at increasing self-efficacy among novice nurses, compared with traditional control groups.

Psychometric testing on the NLN Student Satisfaction and Self-Confidence in Learning, Simulation Design Scale, and Educational Practices Questionnaire using a sample of pre-licensure novice nurses.

BACKGROUND: In 2006, the National League for Nursing published three measures related to novice nurses' beliefs about self-confidence, scenario design, and educational practices associated with simulation. Despite the extensive use of these measures, little is known about their reliability and validity. METHODS: The psychometric properties of the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire were studied among a sample of 2200 surveys completed by novice nurses from a liberal arts university in the southern United States. Psychometric tests included item analysis, confirmatory and exploratory factor analyses in randomly-split subsamples, concordant and discordant validity, and internal consistency. RESULTS: All three measures have sufficient reliability and validity to be used in education research. There is room for improvement in content validity with the Student Satisfaction and Self-Confidence in Learning and Simulation Design Scale. CONCLUSION: This work provides robust evidence to ensure that judgments made about self-confidence after simulation, simulation design and educational practices are valid and reliable.