Correction to: "Getting Everyone on the Same Page": Interprofessional Team Training to Develop Shared Mental Models on Interprofessional Rounds.

This capsule commentary, Capsule Commentary on Liaw et al., "Getting everyone on the same page": interprofessional team training to develop shared mental models on interprofessional rounds," was to have accompanied the article, DOI: https://doi.org/10.1007/s11606-019-05320-z, which appeared in the December 2019 issue.

"Getting Everyone on the Same Page": Interprofessional Team Training to Develop Shared Mental Models on Interprofessional Rounds.

AIM: This study aimed to evaluate the effect of a team training program to support shared mental model (SMM) development in interprofessional rounds. DESIGN AND PARTICIPANTS: A three-arm randomized controlled trial study was conducted for interprofessional teams of 207 health profession learners who were randomized into three groups. PROGRAM DESCRIPTION: The full team training program included a didactic training part on cognitive tools and a virtual simulation to support clinical teamwork in interprofessional round. Group 1 was assigned to the full program, group 2 to the didactic part, and group 3 (control group) with no intervention. The main outcome measure was team performance in full scale simulation. Secondary outcome was interprofessional attitudes. PROGRAM EVALUATION: Teamwork performance and interprofessional attitude scores of the full intervention group were significantly higher (P < 0.05) than those of the control group. The two intervention groups had significantly higher (P < 0.05) attitude scores on interprofessional teamwork compared with the control group. DISCUSSION: Our study indicates the need of both cognitive tools and experiential learning modalities to foster SMM development for the delivery of optimal clinical teamwork performances. Given its scalability and practicality, we anticipate a greater role for virtual simulations to support interprofessional team training.

The impact of a Web-based educational program on the recognition and management of deteriorating patients.

AIMS AND OBJECTIVES: To evaluate the effectiveness of a Web-based educational program to enhance enrolled nurses' knowledge and skills in the recognition and management of deteriorating patients. BACKGROUND: Ward nurses of different skill levels play a pivotal role in detecting and responding to deteriorating patients. A skill mix of registered nurses, enrolled nurses, licensed practical nurses or healthcare assistants is often employed for the provision of nursing care in acute settings. Non-registered nurses frequently perform bedside care and are in the best position to detect deteriorating patients and initiate immediate actions, including commanding the attention of registered nurses. Education is needed to improve the knowledge and skills of these nurses. DESIGN: A randomised controlled trial with a pretest-post-test design. METHODS: The sample included enrolled nurses from an acute care tertiary hospital. Following a baseline evaluation, the experimental group received a Web-based educational intervention. Pre-post assessment of skills and knowledge was performed with a simulated scenario and a knowledge questionnaire. Sixty-four nurses completed the entire study. RESULTS: Following the intervention, participants from the experimental group were significantly more likely than those in the control group to monitor the patient's respiratory and pulse rates. In addition, they had significantly higher post-test mean scores for knowledge and skills in assessing and managing clinical deterioration and reporting deterioration. CONCLUSION: The Web-based educational intervention significantly improved enrolled nurses' knowledge and skills in the recognition and management of a deteriorating patient in a simulated setting. RELEVANCE TO CLINICAL PRACTICE: Ease of access to the Web-based platform contributed to the feasibility and acceptability of this study, which has the potential to positively impact patient safety.

Effectiveness of a Web-Based Simulation in Improving Nurses' Workplace Practice With Deteriorating Ward Patients: A Pre- and Postintervention Study.

BACKGROUND: Nurses play an important role in detecting patients with clinical deterioration. However, the problem of nurses failing to trigger deteriorating ward patients still persists despite the implementation of a patient safety initiative, the Rapid Response System. A Web-based simulation was developed to enhance nurses' role in recognizing and responding to deteriorating patients. While studies have evaluated the effectiveness of the Web-based simulation on nurses' clinical performance in a simulated environment, no study has examined its impact on nurses' actual practice in the clinical setting. OBJECTIVE: The objective of this study was to evaluate the impact of Web-based simulation on nurses' recognition of and response to deteriorating patients in clinical settings. The outcomes were measured across all levels of Kirkpatrick's 4-level evaluation model with clinical outcome on triggering rates of deteriorating patients as the primary outcome measure. METHODS: A before-and-after study was conducted on two general wards at an acute care tertiary hospital over a 14-month period. All nurses from the two study wards who undertook the Web-based simulation as part of their continuing nursing education were invited to complete questionnaires at various time points to measure their motivational reaction, knowledge, and perceived transfer of learning. Clinical records on cases triggered by ward nurses from the two study wards were evaluated for frequency and types of triggers over a period of 6 months pre- and 6 months postintervention. RESULTS: The number of deteriorating patients triggered by ward nurses in a medical general ward increased significantly (P<.001) from pre- (84/937, 8.96%) to postintervention (91/624, 14.58%). The nurses reported positively on the transfer of learning (mean 3.89, SD 0.49) from the Web-based simulation to clinical practice. A significant increase (P<.001) on knowledge posttest score from pretest score was also reported. The nurses also perceived positively their motivation (mean 3.78, SD 0.56) to engage in the Web-based simulation. CONCLUSIONS: This study provides evidence on the effectiveness of Web-based simulation in improving nursing practice when recognizing and responding to deteriorating patients. This educational tool could be implemented by nurse educators worldwide to address the educational needs of a large group of hospital nurses responsible for patients in clinical deterioration.

Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial.

BACKGROUND: Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice. OBJECTIVE: This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care. METHODS: Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants' clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool. RESULTS: The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving. CONCLUSIONS: Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses' competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.

Using simulation learning through academic-practice partnership to promote transition to clinical practice: a qualitative evaluation.

AIM: To explore the effect of an innovative simulation education programme on nursing students' transition-to-practice experiences. BACKGROUND: Academic-practice partnership is emerging as an important vehicle for improving nursing students' transition-to-practice. Using existing university resources, academic educators and alumni developed an innovative simulation educational programme known as the Simulated Professional Learning Environment (SIMPLE) to align the educational process with the realities of nursing practice. Educators and alumni collaborated to create and facilitate 15 hours of simulation sessions that comprised the learning platform for the SIMPLE programme. DESIGN: This was a descriptive qualitative study. METHOD: Focus groups were conducted in 2012 with 22 final-year nursing students completing their transition-to-practice clinical practicum. The interview transcripts were analysed using content analysis. RESULTS: Three themes were identified from the analysis: 'experiencing the role of staff nurse'; 'knowing how to'; and 'learning from the 'seniors'. Experiencing the role of staff nurse in the programme showed the nursing students what to expect and how to prepare for their roles. Knowing how to focus on holistic patient care, manage 'difficult' clients and communicate with other healthcare professionals were the learning outcomes gained from the programme. Learning from the 'seniors' about hospital work processes positively influenced the nurses' transition-to-practice experiences. CONCLUSION: This study provides support for introducing the simulation education programme as an enhancement during nursing students' final year to improve their transition-to-practice experiences. A stronger collaborative relationship between academic educators and practising nurses could be further fostered by expanding this learning platform.

Simulation-Based Mastery Learning to Facilitate Transition to Nursing Practice.

BACKGROUND: Simulation-based mastery learning (SBML) was developed and implemented to facilitate nursing students' transition to clinical practice. PURPOSE: To evaluate nursing students' perspectives on the impact of SBML on their transition to clinical practice. METHOD: A descriptive qualitative study using focus group discussions was conducted with final-year nursing students who had completed their clinical practicum and SBML. RESULTS: Three themes emerged: authenticity of simulations, whereby students were able to draw some parallels between their simulations and clinical experiences; self-efficacy in clinical practice, which was gained through deliberate practice; and application of cognitive tools, which provided mental frameworks to guide clinical performances. CONCLUSION: This study highlights the need to ensure the fidelity of the simulations to achieve authentic experiences, provide deliberate practice to develop self-efficacy, and use cognitive tools for mental model formation to create a high-quality SBML program to foster better transfer of simulation learning to real-life setting.

Wow, woo, win"- Healthcare students' and facilitators' experiences of interprofessional simulation in three-dimensional virtual world: A qualitative evaluation study.

BACKGROUND: In an age disrupted by COVID-19 pandemic, three-dimensional virtual world (3DVW) offers an opportunity for healthcare students from different higher education institutions to participate in interprofessional education. Despite its growing evidence, there is a need to unravel the complex learning process in order to ensure high quality of interprofessional education delivery. AIM: This study aimed to explore the experiences of healthcare students and facilitators on the use of 3DVW for interprofessional team-based virtual simulation. METHODS: Interprofessional teams, each comprising six different healthcare students (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) and two clinicians who acted as facilitators, logged into the 3DVW from their own remote locations to participate in team-based care delivery that included an interprofessional bedside round and a family conference. A qualitative descriptive study was conducted on a purposive sample of 30 healthcare students and 12 facilitators using focus group discussions and individual interviews. RESULTS: Four themes emerged from their experiences: the "wow experience", authentic experience on collaborative care, ease of learning, and preeminent role of the facilitator. The simulation provided the "wow" experiences through contextual, collaborative and experiential learning approaches. Despite technical challenges, the participants were wooed by the comforts of learning from home and the psychological safety in virtual environment. The facilitators played a critical role in optimizing learning engagement to win learners over. CONCLUSION: Our study explicates how attention to the "wow, woo and win" trilateral factors can transform the interprofessional learning experiences offered by 3DVW simulation. Future developments in the use of this learning technology should include developing the clinicians' facilitation skills and the provision of technical support to make this 3DVW a success calls in winning students' learning engagement.

Design and evaluation of a 3D virtual environment for collaborative learning in interprofessional team care delivery.

BACKGROUND: Collaborative learning in interprofessional team care delivery across different healthcare courses and institutions is constrained by geographical locations and tedious scheduling. Three dimensional virtual environments (3D-VE) are a viable and innovative tool to bring diverse healthcare students to learn together. AIM: The aim of this study is to describe the development of a 3D-VE and to evaluate healthcare students' experiences of their collaborative learning in the environment. METHOD: A mixed methods study design was employed. Participants from six healthcare courses (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) were recruited from three institutions to form six interprofessional teams to participate in team care delivery via a 3D-VE. Pre- and post-tests were conducted to evaluate the students' attitudes toward healthcare teams and interprofessional collaboration. Four focus groups were conducted with 27 healthcare students after they completed questionnaires to evaluate their perceived usability, the sociability of computer-supported collaborative learning, and senses of presence. Interview transcripts were analyzed using thematic analysis. RESULT: The students demonstrated significant improvements in their attitudes toward healthcare teams (p < 0.05) and interprofessional collaboration (p < 0.001) after the collaborative learning. Four themes emerged from the focus group discussions: "feeling real", whereby the students felt immersed in their own roles; the virtual environment was perceived as "less threatening" compared to face-to-face interactions; "understanding each other's roles" among different healthcare professionals; and there were some "technical hiccups" related to sound quality and navigation. The participants reported positively on the usability (mean 3.48, SD 0.64), feasibility (mean 3.39, SD 0.60) and perceived sense of presence (mean 107.24, SD 17.78) of the 3D-VE in supporting collaborative learning. CONCLUSION: Given its flexibility, practicality, and scalability, this 3D-VE serves as a promising tool for collaborative learning across different healthcare courses and institutions in preparing for future collaborative-ready workforces.

Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration.

BACKGROUND: The development of clinical reasoning skills in recognising and responding to clinical deterioration is essential in pre-registration nursing education. Simulation has been increasingly used by educators to develop this skill. OBJECTIVE: To develop and evaluate the psychometric properties of a Clinical Reasoning Evaluation Simulation Tool (CREST) for measuring clinical reasoning skills in recognising and responding to clinical deterioration in a simulated environment. DESIGN: A scale development with psychometric testing and mixed methods study. PARTICIPANTS/SETTINGS: Nursing students and academic staff were recruited at a university. METHOD: A three-phase prospective study was conducted. Phase 1 involved the development and content validation of the CREST; Phase 2 included the psychometric testing of the tool with 15 second-year and 15 third-year nursing students who undertook the simulation-based assessment; Phase 3 involved the usability testing of the tool with nine academic staff through a survey questionnaire and focus group discussion. RESULTS: A 10-item CREST was developed based on a model of clinical reasoning. A content validity of 0.93 was obtained from the validation of 15 international experts. The construct validity was supported as the third-year students demonstrated significantly higher (p<0.001) clinical reasoning scores than the second-year students. The concurrent validity was also supported with significant positive correlations between global rating scores and almost all subscale scores, and the total scores. The predictive validity was supported with an existing tool. The internal consistency was high with a Cronbach's alpha of 0.92. A high inter-rater reliability was demonstrated with an intraclass correlation coefficient of 0.88. The usability of the tool was rated positively by the nurse educators but the need to ease the scoring process was highlighted. CONCLUSIONS: A valid and reliable tool was developed to measure the effectiveness of simulation in developing clinical reasoning skills for recognising and responding to clinical deterioration.

Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.

BACKGROUND: The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses' knowledge and performances in recognising and responding to clinical deterioration. METHOD: The interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants' performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool. RESULTS: A significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001). CONCLUSIONS: A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.