Measuring the impact of a 'point of view' disability simulation on nursing students' empathy using the Comprehensive State Empathy Scale.

BACKGROUND: Although empathy is an integral component of professional practice and person-centred care, a body of research has identified that vulnerable patients groups frequently experience healthcare that is less than optimal and often lacking in empathy. AIM: The aim of this study was to examine the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury. SETTING AND PARTICIPANTS: A convenience sample of 390 nursing students from a cohort of 488 participated in the study, giving a response rate of 80%. Students undertook the simulation in pairs and were randomly allocated to the role of either a person with Acquired Brain Injury or a rehabilitation nurse. The simulated 'patients' wore a hemiparesis suit that replicated the experience of dysphasia, hemianopia and hemiparesis. DESIGN: Characteristics of the sample were summarised using descriptive statistics. A two-group pre-test post-test design was used to investigate the impact of the simulation using the Comprehensive State Empathy Scale. t-Tests were performed to analyse changes in empathy pre post and between simulated 'patients' and 'rehabilitation nurses'. RESULTS: On average, participants reported significantly higher mean empathy scores post simulation (3.75, SD=0.66) compared to pre simulation (3.38 SD=0.61); t (398)=10.33, p<0.001. However, this increase was higher for participants who assumed the role of a 'rehabilitation nurse' (mean=3.86, SD=0.62) than for those who took on the 'patient' role (mean=3.64, SD=0.68), p<0.001. CONCLUSION: The results from this study attest to the potential of point-of-view simulations to positively impact nursing students' empathy towards people with a disability. Research with other vulnerable patient groups, student cohorts and in other contexts would be beneficial in taking this work forward.

"They have no idea of what we do or what we know": Australian graduates' perceptions of working in a health care team.

Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to 'knowing about' and 'working with' other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.

Interprofessional education for the quality use of medicines: designing authentic multimedia learning resources.

It is claimed that health care students who learn together will be better prepared for contemporary practice and more able to work collaboratively and communicate effectively. In Australia, although recognised as important for preparing nursing, pharmacy and medical students for their roles in the medication team, interprofessional education is seldom used for teaching medication safety. This is despite evidence indicating that inadequate communication between health care professionals is the primary issue in the majority of medication errors. It is suggested that the pragmatic constraints inherent in university timetables, curricula and contexts limit opportunities for health professional students to learn collaboratively. Thus, there is a need for innovative approaches that will allow nursing, medical and pharmacy students to learn about and from other disciplines even when they do not have the opportunity to learn with them. This paper describes the development of authentic multimedia resources that allow for participative, interactive and engaging learning experiences based upon sound pedagogical principles. These resources provide opportunities for students to critically examine clinical scenarios where medication safety is, or has the potential to be compromised and to develop skills in interprofessional communication that will prepare them to manage these types of situations in clinical practice.

Examining the impact of high and medium fidelity simulation experiences on nursing students' knowledge acquisition.

AIM: This paper describes a study that measured and compared knowledge acquisition in nursing students exposed to medium or high fidelity human patient simulation manikins. BACKGROUND: In Australia and internationally the use of simulated learning environments has escalated. Simulation requires a significant investment of time and money and in a period of economic rationalisation this investment must be justified. Assessment of knowledge acquisition with multiple choice questions is the most common approach used to determine the effectiveness of simulation experiences. METHOD: This study was conducted in an Australian school of nursing; 84 third year nursing students participated. A quasi-experimental design was used to evaluate the effect of the level of manikin fidelity on knowledge acquisition. Data were collected at three points in time: prior to the simulation, immediately following and two weeks later. RESULTS: Differences in mean scores between the control (medium fidelity) and experimental (high fidelity) groups for Tests 1, 2 and 3 were calculated using independent t tests and were not statistically significant. Analysis of covariance (ANCOVA) was conducted to determine whether changes in knowledge scores occurred over time and, while an improvement in scores was observed, it was not statistically significant. CONCLUSION: The results of this study raise questions about the value of investing in expensive simulation modalities when the increased costs associated with high fidelity manikins may not be justified by a concomitant increase learning outcomes. This study also suggests that multiple choice questions may not be the most appropriate measure of simulation effectiveness.

The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills.

This paper describes the conceptual design and testing of an Interactive Computerised Decision Support Framework (ICDSF) which was constructed to enable student nurses to "think like a nurse." The ICDSF was based on a model of clinical reasoning. Teaching student nurses to reason clinically is important as poor clinical reasoning skills can lead to "failure-to rescue" of deteriorating patients. The framework of the ICDSF was based on nursing concepts to encourage deep learning and transferability of knowledge. The principles of active student participation, situated cognition to solve problems, authenticity, and cognitive rehearsal were used to develop the ICDSF. The ICDSF was designed in such a way that students moved through it in a step-wise fashion and were required to achieve competency at each step before proceeding to the next. The quality of the ICDSF was evaluated using a questionairre survey, students' written comments and student assessment measures on a pilot and the ICDSF. Overall students were highly satisfied with the clinical scenarios of the ICDSF and believed they were an interesting and useful way to engage in authentic clinical learning. They also believed the ICDSF was useful in developing cognitive skills such as clinical reasoning, problem-solving and decision-making. Some reported issues were the need for good technical support and the lack of face to face contact when using e-learning. Some students also believed the ICDSF was less useful than actual clinical placements.

Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program.

The growth in numbers of culturally and linguistically diverse students entering nursing programs in Australia presents challenges for academic and clinical staff, and most importantly the students themselves. In this paper we present the findings from a pilot study designed to explore these issues and to develop strategies to address them. This study used a qualitative explorative approach to gain rich in-depth data. Eleven culturally and linguistically diverse students, three clinical facilitators, and four academic staff participated in focus group interviews. Four major themes emerged: level of English language competence, feelings of isolation, limited opportunities for learning, and inadequate university support. The issues we identified led to a meaningful discussion of the political, financial, social and intercultural context that they are entrapped in. This paper provides educators, clinicians, policy makers and researchers with an insight where and how they commence to break the trap and highlights, the need for further research into the perspectives of Australian students' who study and socialise with their international peers.

The development and psychometric testing of the Satisfaction with Simulation Experience Scale.

AIM: This paper reports the development and psychometric testing of the Satisfaction with Simulation Experience Scale, an instrument designed to measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins. BACKGROUND: Student satisfaction is important to engaged and meaningful learning and it facilitates active and purposeful participation in simulation experiences. There are suggestions that student satisfaction may have some correlation with performance. Few studies have explored in a rigorous way the impact of manikin fidelity on nursing students' satisfaction with simulation experiences. METHOD: The items for the Satisfaction with Simulation Experience Scale were identified following a critical review of the literature. Content validly was established by use of an expert panel. During 2009 and 2010 the instrument was tested with second year (n=268) and third year nursing students (n=76) from one Australian university. Exploratory factor analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in satisfaction levels between groups were analysed using an independent t test. Responses to an open ended question were categorised using thematic content analysis. RESULTS: The scale demonstrated satisfactory internal consistency (alpha 0.77). Exploratory factor analysis yielded a three-component structure termed Debriefing and Reflection, Clinical Reasoning, and Clinical Learning; each subscale demonstrated high internal consistency: 0.94; 0.86; 0.85 respectively. Mean satisfaction scores were high for each group. However, statistically significant differences were not apparent between second or third year students exposed to medium and high fidelity manikins. Content analysis identified 13 main categories including supplementing versus replacing clinical placements and the need for increased exposure to simulation sessions. CONCLUSION: The results of this study indicate that simulation is highly valued by students, irrespective of the level of fidelity. This raises questions about the value of investing in expensive simulation modalities. The Satisfaction with Simulation Experience Scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.

The 'five rights' of clinical reasoning: an educational model to enhance nursing students' ability to identify and manage clinically 'at risk' patients.

Acute care settings are characterised by patients with complex health problems who are more likely to be or become seriously ill during their hospital stay. Although warning signs often precede serious adverse events there is consistent evidence that 'at risk' patients are not always identified or managed appropriately. 'Failure to rescue', with rescue being the ability to recognise deteriorating patients and to intervene appropriately, is related to poor clinical reasoning skills. These factors provided the impetus for the development of an educational model that has the potential to enhance nursing students' clinical reasoning skills and consequently their ability to manage 'at risk' patients. Clinical reasoning is the process by which nurses collect cues, process the information, come to an understanding of a patient problem or situation, plan and implement interventions, evaluate outcomes, and reflect on and learn from the process. Effective clinical reasoning depends upon the nurse's ability to collect the right cues and to take the right action for the right patient at the right time and for the right reason. This paper provides an overview of a clinical reasoning model and the literature underpinning the 'five rights' of clinical reasoning.

A comparison of novice and expert nurses' cue collection during clinical decision-making: verbal protocol analysis.

BACKGROUND: The type of cues used during clinical decision-making contexts is not well understood. Further, there are conflicting findings in relation to how novice and expert nurses use cues. OBJECTIVE: The aim of this study was to determine if there were differences between novice and expert nurses in the range and type of cues selected as well as how cues were clustered together when making clinical decisions while caring for post-operative patients in an Intensive Care Unit. METHOD: The sample consisted of four novice and four expert nurses caring for patients post Abdominal Aortic Aneurysm surgery in an Intensive Care Unit. Data were collected using a think aloud (TA) process while participants cared for patients, followed by retrospective interviewing, to generate verbal protocols. The verbal protocols were analysed using content analysis to examine various aspects of decision-making, including number and type of cues used and cue clustering. The decision tasks attended in the real world of practice were described in detail to illuminate the use of cues in context. RESULTS: Expert nurses collected a wider range of cues than novice nurses, almost twice as many different cues. The expert nurses also clustered more cues together to identify patient status when making decisions. Expert nurses were more proactive in collecting relevant cues and anticipating problems that may help identify patient problems. CONCLUSIONS: In the real world of practice expert nurses collect a broader range of cues to assess patient status than novice nurses. This differs to expert nurses cue collection in simulations where expert nurses may select only those cues that are necessary for the identified problem. This difference, if identified in other studies, may have important implications for nursing research and education.

Comparing personality characteristics of juvenile sex offenders and non-sex offending delinquent peers: a preliminary investigation.

There exists a paucity of research on psychopathology among Juvenile Sex Offenders (JSOs) as measured by standardized instruments, particularly as compared to nonclinical and other clinical populations. The current investigation involved a comparison of scores on the Minnesota Multiphasic Personality Inventory-Adolescent Version (MMPI-A) between a group of JSOs and non-sex offending delinquent peers. Thirty-six youth from a staff-secure residential facilitate participated, 18 JSOs and 18 non-sex offending delinquent peers. Results revealed that the mean score on clinical Scale 4 (Psychopathic Deviant) was in the clinically significant range for non-sex offending peers and not for JSOs, although the difference between the mean scores was not statistically significant. Chi-square analysis indicated that a significantly greater number of non-sex offending delinquents had scores in the clinical range on this scale as compared to JSOs. Results are discussed in the context of current research on psychopathology among JSOs.

Decision-making in clinical nursing: investigating contributing factors.

BACKGROUND: This article describes the results of a study which investigated the contextual factors influencing clinical decision-making. Education and experience have been suggested by some as having a positive effect on clinical decision-making, and have been listed as being of high importance. Values, knowledge, clinical setting and stress have also been identified as being important to decision-making, with various rankings given by different researchers. AIM: The study was undertaken to determine relationships between occupational orientation (value to role), educational level, experience, area of practice, level of appointment, age and clinical decision-making in Australian nurses. The predictive ability of each factor on clinical decision-making was determined. METHOD: This correlational study examined Australian nurses' decision-making about some common nursing interventions and 'occupational orientation', educational level, experience, level of appointment, area of clinical speciality and age. A model was constructed using stepwise selection regression to predict the 'weight' of each variable in clinical decision-making. RESULTS: Education and experience were not significantly related to decision-making. The factor that accounted for the greatest variability to clinical decision-making was holding a professional occupational orientation, followed by level of appointment, area of clinical speciality, and age in that order. CONCLUSION: In contrast to other studies, experience and educational level were not found to influence decision-making strongly, the value of role was the most significant predictor. The model developed, however, only accounted for a low amount of variability in decision-making. The findings indicate that there are other factors affecting clinical decision-making that still require identification.