Use of Mindful Observer to Extend Simulation Learning Experience.

Simulation is a teaching strategy that allows students to experience patient care situations in a safe environment. After these experiences, students will understand and respond more readily when exposed in clinical practice. An increase in student enrollment meant incorporating larger numbers of students into simulations. Faculty at an associate degree nursing program decided to use the observer role. At the time, mindfulness was being integrated throughout the curriculum. Use of a mindful observer during simulations resulted in an effective learning strategy as reported by students.

Active Learning Strategies to Enhance Nursing Students' Knowledge of Pharmacology.

This article presents the author's experience using gaming and social media to enhance undergraduate nursing students' pharmacology knowledge. Although gaming may help with rote learning, active participation in gaming was not associated with higher exam or final course grades. Active participation in social media, on the other hand, was associated with higher exam and final course grades.

Impact of a Simulated Clinical Day With Peer Coaching and Deliberate Practice: Promoting a Culture of Safety.

Nursing education is challenged to shift from task-based proficiencies to higher level competencies with patient safety as a priority. Using a quasi-experimental pretest/posttest design, a simulation-based, peer-coached, deliberate practice clinical substitution was implemented to compare nursing students' knowledge, skills, and attitudes for promoting safety. Our findings demonstrated improved knowledge and skill acquisition in the intervention and control groups. The former trended toward improved team communication attitudes and enteral medication skill performance. Additional research with larger samples is needed to further investigate this innovative strategy.

Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students.

AIM: The focus of this research study was the evaluation of the effectiveness of using high-fidelity simulations to replace 50 percent of traditional clinical experiences in obstetrics, pediatrics, critical care, and mental health nursing. BACKGROUND: Increasing student admissions to nursing programs require additional clinical learning opportunities to accommodate extra students. METHOD: Three schools with associate degree nursing programs partnered to identify, implement, and evaluate a creative solution to this dilemma. The resulting quasi-experimental study investigated if substituting half of the conventional clinical experiences with simulations was as effective as traditional clinical activities in obstetrics, pediatrics, mental health, and critical care. One hour of simulation counted for two hours of clinical time. RESULTS Findings indicated combining simulations with conventional clinical experiences resulted in significantly higher scores on the pre-graduation exit exam than traditional clinical experiences alone. CONCLUSIONS: Findings have implications for articulation and basic students in associate degree nursing programs.

Variability of Passing Grades in Undergraduate Nursing Education Programs in New York State.

AIM: The purpose of this descriptive study was to provide information about passing grades and their corresponding numeric grades for undergraduate nursing programs in New York State. An additional purpose was to report on differences in grading between faculty teaching in associate versus baccalaureate nursing programs, full-time versus adjunct faculty, and tenured versus nontenured faculty. BACKGROUND: There is a paucity of research on grade variability in undergraduate nursing programs. METHOD: Three hundred eighty-four full-time and 96 adjunct faculty responded to an invitation to complete an online survey. RESULTS: Grades are not uniformly awarded across institutions. Passing grades ranged from 70 to 85 percent (C- to B+, respectively), with a mean of 74.79 percent. CONCLUSION: Wide variations in grades in different institutions across the country may undermine grade point average as a reliable measure of education, making it difficult to evaluate individual student performance.

Effect of simulation on the development of critical thinking in associate degree nursing students.

AIM: The purpose of this study was to explore the development of critical thinking for students who received instruction using high-fidelity patient simulation (HFPS) versus low-fidelity simulation (instructor-written case studies). BACKGROUND: Simulated patient care environments have become increasingly more sophisticated in nursing labs, with HFPS fast becoming the standard for laboratory teaching/learning. METHOD: A convenience sample of first-semester associate degree nursing students participated in this quasi-experimental study. One group of students received weekly HFPS patient simulations and the other group received weekly case studies. Both groups took a pre- and posttest using the Health Studies ReasoningTest. RESULTS: Both groups showed an increase in critical thinking skills; however, there was no statistically significant difference between the HFPS and case study groups. CONCLUSION: Results suggest that high- and low-fidelity simulations are both associated with increases in critical thinking scores.

Evidence-based reflective teaching practice: a preceptorship course example.

AIM: This preceptorship course case study employed an evidence-based reflective teaching practice perspective based on a nursing process framework to develop, implement, and evaluate assignment efficacy directly related to course objectives. BACKGROUND: Journaling and article analysis had been used to assess development of role socialization, critical thinking, and self-reflective practice. These activities were found to be ineffective; new assignments were needed to address essential issues and allow for evaluation of assignment efficacy. METHOD: Based upon contextual constructivism, four assignments were developed focused on learning goals, nursing skills, assumptions/biases, and role socialization.Assignment efficacy was evaluated via anonymous exploratory surveys. RESULTS: Student reports identified that assignments met learning outcomes. Methods for improvement in instructional practice were identified and revisions made. CONCLUSION: Participation in evidence-based reflective teaching practice can enhance reflective practice in students through appropriate assignment development, advancing the discipline of nursing education.

The simulated clinical environment as a platform for refining critical thinking in nursing students: a pilot program.

AIM: This research explores the use of clinical simulations as a platform for stimulating critical thinking in nursing students. BACKGROUND: This study takes place in an associate degree nursing program with a clinical group of nursing students. METHOD: Utilizing a faculty partnership approach, information was presented to the clinical group. Students were divided into small groups to create simulation scenarios. RESULTS: Students were able to appreciate complexity of care and research differential diagnoses as they applied to care and management of changes in client condition scenarios. CONCLUSIONS: Use of a small-group teaching method to develop, implement, and critique clinical simulation scenarios facilitated critical thinking and clinical judgment of nursing students.

Development and evaluation of web-based animated pedagogical agents for facilitating critical thinking in nursing.

The purpose of this study was to evaluate the effectiveness of Web-based animated pedagogical agents on critical thinking among nursing students. A pedagogical agent or virtual character provides a possible innovative tool for critical thinking through active engagement of students by asking questions and providing feedback about a series of nursing case studies. This mixed methods experimental study used a pretest, posttest design with a control group. ANCOVA demonstrated no significant difference between the groups on the Critical Thinking Process Test. Pre- and post-think-alouds were analyzed using a rating tool and rubric for the presence of eight cognitive processes, level of critical thinking, and for accuracy of nursing diagnosis, conclusions, and evaluation. Chi-square analyses for each group revealed a significant difference for improvement of the critical thinking level and correct conclusions from pre-think-aloud to post-think-aloud, but only the pedagogical agent group had a significant result for appropriate evaluations.

An initial investigation of the applicability of the Dreyfus skill acquisition model to the professional development of nurse educators.

AIM: This investigation represents an attempt to design and validate a skill acquisition model for the nurse educator role. BACKGROUND: The preparation and role development of nurse educators has become a significant focus for the profession.The NLN Nurse Educator Competencies and skill acquisition theory provide a basis for studying skill acquisition among nurse educators. METHOD: A total of 339 nurse educators from North Carolina and West Virginia were surveyed using an instrument designed to assess skill among nurse educators. RESULTS: The survey discriminated among five levels of skill (novice, advanced beginner, competent, proficient, and expert). Participants reported a proficient level of total skill acquisition and a proficient level for each of the eight NLN Nurse Educator Competencies. Internal consistency for the survey tool was high at .977. CONCLUSION: Results of this study add to the body of knowledge of skill acquisition, role development, and transition.The study provides a unique method to study skill acquisition.

Effects of an intervention plan on nursing student success.

Student attrition from nursing programs due to academic failure negatively affects students, nursing programs, and the health care industry. The purpose of this retrospective study was to determine the success of an intervention plan for practical nursing (PN) and associate degree nursing (ADN) students who were at risk for failure in coursework compared with outcomes from years without the plan. Records of 384 students were accessed. A 6% decrease in involuntary withdrawal due to academic failure with the intervention plans was noted. Sixty-four percent of the PN students and 86% of the ADN students with a plan completed the program. Ninety-six percent of the PN students and 84% of ADN students in intervention plans were successful on the NCLEX(®) on the first attempt. A statistically significant difference (p < 0.001) between traditional and nontraditional students in program completion existed prior to the intervention, which was eliminated with implementation of the intervention plans.

Social cognitive theory, metacognition, and simulation learning in nursing education.

Simulation learning encompasses simple, introductory scenarios requiring response to patients' needs during basic hygienic care and during situations demanding complex decision making. Simulation integrates principles of social cognitive theory (SCT) into an interactive approach to learning that encompasses the core principles of intentionality, forethought, self-reactiveness, and self-reflectiveness. Effective simulation requires an environment conducive to learning and introduces activities that foster symbolic coding operations and mastery of new skills; debriefing builds self-efficacy and supports self-regulation of behavior. Tailoring the level of difficulty to students' mastery level supports successful outcomes and motivation to set higher standards. Mindful selection of simulation complexity and structure matches course learning objectives and supports progressive development of metacognition. Theory-based facilitation of simulated learning optimizes efficacy of this learning method to foster maturation of cognitive processes of SCT, metacognition, and self-directedness. Examples of metacognition that are supported through mindful, theory-based implementation of simulation learning are provided.

Dual degree partnership in nursing: an innovative undergraduate educational model.

We report the success of a unique articulation Dual Degree Partnership in Nursing (DDPN) model. The process used to establish and implement this approach is described. Unlike typical 2+2 agreements between associate degree (AD) and bachelor degree (BS) nursing education programs, the DDPN is designed with a 1+2+1 sequence. Intended to attract high school students, this model provides the opportunity to earn two degrees (AD and BS) while experiencing a 4-year campus living and learning environment. This configuration was accomplished without compromising the integrity of either of the established programs. After collecting data over the past 6 years, this model demonstrates popularity with the traditional-aged student, as well as success from an academic perspective. Statistics on retention, graduation, and NCLEX® pass rates indicate the feasibility and success of the model. Based on the findings, the potential for replication is promising for other colleges interested in a similar collaboration.

Nurses' critical role in identifying sepsis and implementing early goal-directed therapy.

Nurses play a critical role in detecting early sepsis-related manifestations and improving adherence to implementation of early goal-directed therapy. Educating staff about sepsis management through translation of best practices is critical to improving sepsis-related outcomes.

Peer tutoring program for academic success of returning nursing students.

High attrition rates among students in associate degree nursing programs are a concern for faculty, administrators, and students. Programs offering academic and emotional support for students at risk for failing a clinical course may decrease attrition rates and improve academic performance. A peer tutoring program was developed for returning nursing students who were unsuccessful in a previous clinical course. Peer tutors met with returning students weekly to review course work, complete case studies and practice NCLEX questions. Trusting, supportive relationships developed among students and a significant increase in grades was noted at the end of the course for 79% of students. Implementation of peer tutoring was beneficial for returning students, tutors, and the nursing program and may be valuable in other courses where academic achievement is a concern.

A conceptual model to support curriculum review, revision, and design in an associate degree nursing program.

In light of declining NCLEX-RN first-write pass rates and the National League for Nursing call to transform nursing education, faculty at an associate degree nursing program in the southeastern United States began the process of intensive critique of its curriculum and program outcomes. Based on in-depth analysis and assessment of program outcomes, a conceptual framework was created to guide curriculum revision, development, and implementation processes. The framework serves as a guide for ongoing and systematic curriculum review and revision based upon evaluation findings. The basis of the conceptual framework was the result of an extensive literature review and an incorporation of the faculty-created philosophy.

Students' perceptions of their learning experiences using high-fidelity simulation to teach concepts relative to obstetrics.

In this era of expanding technology, amidst a shortage of nursing faculty and clinical sites, there has been increasing emphasis on the use of simulation to enhance clinical learning. The purpose of this qualitative, descriptive study was to describe students' self-perceptions of their learning experiences using high-fidelity simulation in teaching concepts relative to obstetrics. A sample of 60 second-year associate of science in nursing (ASN) students attended simulation experiences in obstetrics in addition to required clinical time in a hospital. At the end of each simulated learning experience, students audiotaped their reflections of the experience. Content analysis was done to identify themes in the students' perceptions relative to their learning. Three themes were identified from the analysis: the nonthreatening environment, enhancement of learning, and feeling prepared for practice.

Evaluating the impact of scenario-based high-fidelity patient simulation on academic metrics of student success.

Despite the ongoing nursing shortage, nurse educators are responsible for preparing students to practice in highly complex health care systems. As nurse educators explore new learning strategies to support an increase in student admissions, they must also evaluate the impact of these strategies on the quality of the educational experience. The study reported here evaluated the impact of scenario-based, high-fidelity patient simulation used to increase student admissions in an associate degree and baccalaureate nursing program in north-central Texas upon students' sense of their own clinical competence, graduating grade point average (GPA), and performance on standardized exit examinations. These are measures commonly used by nurse educators as metrics of success.

The Virtual Clinical Practicum: an innovative telehealth model for clinical nursing education.

The Virtual Clinical Practicum (VCP) involves a clinical nursing education delivery strategy that uses video teleconferencing technology to address time, distance, and resource barriers. Technology-delivered education can augment the existing curriculum by increasing student access to clinical experts in specialty areas, thus supporting efficient use of faculty resources. This article describes the implementation of the VCP process and student perceptions of its effectiveness and usefulness. The VCP was shown to be a successful method of clinical nursing education, offering students exposure to clinical situations not available by other means. Opportunities for dialogue, critical reflection, and synthesis allowed students to experience the benefits of a traditional experience, enhanced through technology and tailored to the specific needs of the students. Respondents overwhelmingly recommended further use of the VCP to augment existing clinical nursing education methods.