Creating a National Standard for Prelicensure Clinical Evaluation in Nursing.

BACKGROUND: Measuring clinical outcomes in prelicensure students is desired by key stakeholders but is fraught with challenges. There are currently no standardized, psychometrically validated clinical-outcome measures available for prelicensure nursing programs, requiring each program to design its own measures. METHOD: We conducted a review of the potential antecedents of this gap, as well as models for standardized clinical outcome measures and recommendations from within health-professions education. RESULTS: There are benefits to pursuing a standardized clinical outcome tool, including an improved student learning experience and unifying our communication regarding graduate nurse preparation to valued stakeholders. CONCLUSION: Nursing education has a unique opportunity to emulate our colleagues in medicine and pharmacy by working at the national level to create a standardized tool using current psychometric methods for development and validation. [J Nurs Educ. 2021;60(12):686-689.].

Discharge Processes: What Evidence Tells Us Is Most Effective.

The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching. Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient's care needs at home. Not only are readmissions a preventable cost, more importantly, but they also are a negative patient experience signifying to our patients that they are unable to optimally care for themselves or that their disease or healing is not something they can care for alone. The following is a review of Agency for Healthcare Research and Quality's IDEAL discharge process, common problems in discharge teaching, and nursing's responsibilities with assessing a patient and his or her caregiver for discharge readiness. IDEAL is a structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmissions rates.

Computer-based or human patient simulation-based case analysis: which works better for teaching diagnostic reasoning skills?

AIM: The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation. BACKGROUND: Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases. METHOD: A total of 54 nursing students participated in two case analyses using human patient and computer-based simulations. Participant performance and diagnostic reasoning skills were analyzed. RESULTS: Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer-based simulation. CONCLUSION: Both human patient and computer-based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.

Description and preliminary evaluation of a diabetes technology simulation course.

BACKGROUND: We aim to provide data on a diabetes technology simulation course (DTSC) that instructs internal medicine residents in the use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring system (CGMS) devices. METHODS: The DTSC was implemented during calendar year 2012 and conducted in the institution's simulation center. It consisted of a set of prerequisites, a practicum, and completion of a web-based inpatient CSII-ordering simulation. DTSC participants included only those residents in the outpatient endocrinology rotation. Questionnaires were used to determine whether course objectives were met and to assess the satisfaction of residents with the course. Questionnaires were also administered before and after the endocrine rotation to gauge improvement in familiarity with CSII and CGMS technologies. RESULTS: During the first year, 12 of 12 residents in the outpatient endocrinology rotation completed the DTSC. Residents reported that the course objectives were fully met. The mean satisfaction score with the course ranged from 4.0 to 4.9 (maximum, 5), with most variables rated above 4.5. Self-reported familiarity with the operation of CSII and CGMS devices increased significantly in the postrotation survey compared with that on the prerotation survey (both p < .01). CONCLUSIONS: In this pilot program, simulation-based education increased the perceived familiarity of residents with CSII and CGMS technologies. In light of these preliminary findings, the course will continue to be offered, with further data accrual. Future work will involve piloting the DTSC approach among other types of providers, such as residents in other specialties or inpatient nursing staff.

Through the lens of instructional design: appraisal of the Jeffries/National League for Nursing Simulation Framework for use in acute care.

As human patient simulation becomes more prevalent in acute care settings, clinical experts are often asked to assist in developing scenarios. Although the Jeffries/National League for Nursing Simulation Framework has been used in academic settings to guide the instructional design of clinical simulations, its use in acute care settings is less known. This framework incorporates a consideration of contextual elements, design characteristics, and outcomes. An external validation study applying the framework within the context of acute care showed its overall strength as well as elements that were problematic. The implications derived from the study of the design characteristics in a hospital setting can be used by nurses who are considering either adopting or adapting this framework for their own practice.

Development of computer-based training to enhance resident physician management of inpatient diabetes.

BACKGROUND: Treating hyperglycemia promotes better outcomes among inpatients. Knowledge deficits about management of inpatient diabetes are prevalent among resident physicians, which may affect the care of a substantial number of these patients. METHODS: A computer-based training (CBT) curriculum on inpatient diabetes and hyperglycemia was developed and implemented for use by resident physicians and focuses on several aspects of the management of inpatient diabetes and hyperglycemia: (1) review of importance of inpatient glucose control, (2) overview of institution-specific data, (3) triaging and initial admission actions for diabetes or hyperglycemia, (4) overview of pharmacologic management, (5) insulin-dosing calculations and ordering simulations, (6) review of existing policies and procedures, and (7) discharge planning. The curriculum was first provided as a series of lectures, then formatted and placed on the institutional intranet as a CBT program. RESULTS: Residents began using the inpatient CBT in September 2008. By August 2009, a total of 29 residents had participated in CBT: 8 in family medicine, 12 in internal medicine, and 9 in general surgery. Most of the 29 residents confirmed that module content met stated objectives, considered the information valuable to their inpatient practices, and believed that the quality of the online modules met expectations. The majority reported that the modules took just the right amount of time to complete (typically 30 min each). CONCLUSIONS: Improvement in inpatient diabetes care requires continuous educational efforts. The CBT format and curriculum content were well accepted by the resident physicians. Ongoing assessment must determine whether resident practice patterns are influenced by such training.