A comparison of learning outcomes from two poverty simulation experiences.

OBJECTIVES: Five nationally representative U.S. federal data sources consistently showed the link between poverty and poor health outcomes. To determine the modality effective in teaching students about poverty and health, this study compared the attitudes toward poverty of students participating in the Community Action Poverty Simulation (CAPS) and the poverty table-top simulation (Dwell™). METHODS: In this quasi-experimental study, undergraduate and graduate nursing students and physical therapy students participated in either CAPS or a table-top simulation (TTS) depending on their semester of enrollment in the relevant course. The Undergraduate Perception of Poverty Tracking Survey (UPPTS) was administered before and after each simulation. RESULTS: The analysis included 118 matched pairs. Using MANOVA tests, the authors found no group difference in the overall change of attitude after the simulations (p = .232). However, by the subscale analyses, TTS significantly increased students' willingness to help (p = .008, η2  = 0.058) and their empathy toward those living in poverty (p = .039, η2  = 0.039). CONCLUSION: TTS participants had more elements of improvement, but both modalities were found to change participants' attitudes.

Human Simulation in Nursing Education.

Although, human simulation methodology has its origins in medical education, nursing education has increased its use of simulated patient (SP) methodology to improve the education of nursing students across the curricula. This chapter will review the history of human simulation, introduce the human simulation continuum, and review different applications of SP methodology in undergraduate and graduate nursing education.

Twitter as a tool to enhance student engagement during an interprofessional patient safety course.

Twitter and other social media forums are gaining popularity in both the academic and conference arenas as tools to increase participant engagement, attention and interaction. While Twitter has been used successfully to engage college students, it has not been explored for use in an interprofessional curriculum. We sought to explore it as a method to foster student engagement. During a weeklong interprofessional patient safety course we invited students and faculty to participate in a Twitter conversation. It was found that this form of social media successfully captured a "behind the scenes" conversation and the experiences of the students which would have not been otherwise captured. This information is guiding future interprofessional educational programming in both the medical and nursing schools.

Insights Into Learning Among Physical Therapy, Medical, and Nursing Students Following a Simulation-Based, Interprofessional Patient Safety Course.

As the need for a strong interdisciplinary approach in the delivery of healthcare services becomes increasingly vital, interprofessional education (IPE) is essential to equip healthcare professionals of the future to deliver better care. IPE encounters using simulation-based education can be a powerful tool in inculcating pre-professional students with foundational tools for successful interprofessional work. This qualitative study explores the learning that occurs during IPE encounters that include nursing, physical therapy, and medical students. The results of this work highlight how important IPE encounters are in uncovering and changing cross-disciplinary notions about knowledge, skills, role, and team contributions. Specifically, our analysis demonstrated that there are common misunderstandings about contemporary roles, knowledge, and skills of physical therapists among both nursing and medical students that can be corrected in IPE encounters. Results also demonstrated that careful planning can bolster opinions of the value of activities embedded as part of a larger course. Moreover, planning and attention to the specific educational needs of all students may prevent any group feeling that their educational needs were not fully met across all disciplines. The findings support the consideration that IPE can be an important method to instill foundational interprofessional knowledge, skills, and attitudes to promote a foundation from which to establish strong career-long interprofessional collaborations. It is important to lay foundational interprofessional skills and appreciation of the 'other' in pre-licensure curricula, but these efforts should not be limited to only pre-licensure programs and need also to be included as part of on-going professional development education, especially as healthcare education, roles, and responsibilities evolve.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Participation in a System-Thinking Simulation Experience Changes Adverse Event Reporting.

INTRODUCTION: System failures are contributing factors in the thousands of adverse events occurring in US healthcare institutions yearly. This study explored the premise that exposure to a simulation experience designed to improve system thinking (ST) would impact adverse event reporting patterns. METHODS: An intervention-control study was used to explore impacts of participation in a simulation designed to improve ST on adverse event reporting. Each summer Bachelor in Nursing Science students along with medical students participate in a week-long simulation-based interprofessional patient safety course. During the 2017 course, Friday Night in the ER, a table-top simulation designed to develop ST was included. As part of the school nursing's simulation program, students are asked to report adverse events observed or committed during simulation encounters into a simulated adverse event reporting system outside the simulation-based interprofessional patient safety course. Adverse event reporting system data were used to examine patterns of adverse event reporting in control and intervention groups studied. RESULTS: Findings demonstrated differences in proportions of reported adverse events. The proportion of reported adverse events by students with the second and terminal semesters of course work combined and the 2016 and 2018 control groups combined demonstrated statistically significant differences, P < 0.001. Additional analysis revealed that the intervention group reported more medication-related events, whereas the control group reported more failure to rescue and airway-related events. CONCLUSIONS: Exposure to a simulation designed to develop ST seems to impact adverse event reporting. These findings support the idea that ST may change safety monitoring behaviors.

Findings from a human roles terminology survey: consensus or chaos?

Background: Terminology describing humans' roles in simulation varies widely. Inconsistent nomenclature is problematic because it inhibits use of a common language, impacting development of a cohesive body of knowledge. Methods: A literature search was completed to identify terms used to describe roles played by humans in simulation-based education. Based on these findings, a survey was created to explore the terminology used by simulation educators and researchers to describe human roles in simulation and the perceived need for a consistent nomenclature. Results: Results demonstrated wide variability in terminology, including terms such as standardised patient, simulated patient, simulated participants, confederate, embedded actor and scenario role player. Conclusion: Creation of a cohesive body of knowledge for human roles in simulation requires use of common terminology, yet findings suggest a complex landscape of terminology. Building consensus on the terminology describing human roles in simulation can clarify understanding of best practice and allow for advancement in the research and state of the science in simulation-based education.

Reflections on Career Pathways of Simulation-Focused Experts in the Field.

STATEMENT: This article presents reflections of career pathways of simulation researchers as well as a discussion of the themes found in the stories presented. It is the intent of the authors to present and foster a discussion around the ways in which we as a simulation community wish to promote recognition of scholarship among simulation researchers and help support newcomers find success as simulation researchers in academia. We also present recommendations for those considering entering the field based on tactics that were successful and not successful among the scholars who shared their stories.

What participants learn, with, from and about each other during inter-professional education encounters: A qualitative analysis.

BACKGROUND: Safe healthcare requires teamwork and collaboration. To meet the needs of healthcare organizations and professionals, inter-professional education, is no longer an optional educational trend but rather a mandate of accrediting health education agencies. OBJECTIVE: In an effort to better understand the impact of inter- professional educational activities, this study sought to explore via qualitative methods what nursing and medical students learn with, from, and about one another during a week - long simulation-based inter-profession education course. DESIGN: A convenience sample of post-course survey responses from students participating in a week-long, inter-professional, simulation-based patient safety course was used to longitudinally explore what participants learn with, from, and about each other. SETTINGS: The setting for this study was a research university located in the southeast United States. PARTICIPANTS: The participants included a total of 272 second semester accelerated option Bachelor of Nursing students and 599 medical students entering the 3rd year of their program that participated in an annual patient safety course. The study analyzed responses of students to questions in a post-course survey regarding educational outcomes while learning with students from a different profession. RESULTS: In the responses from 871 students collected over four years, the following key themes emerged. Students: 1) articulated learning the importance of contributions of other professions to the healthcare team, 2) expressed an appreciation for areas where their colleagues' training was superior to their own; and 3) identified deficiencies in their own knowledge and skill sets. CONCLUSION: The findings of this study provide a basis for developing more specific curricular content as part of inter-professional education endeavors to strengthen constructive views of healthcare professions, foster a more collaborative shared mental model, and to correct perceived misconceptions.

Adaptive Quizzing Improves End-of-Program Exit Examination Scores.

BACKGROUND: A third of nursing schools use a standardized, end-of-program exit examination requiring minimum passing scores for student progression. Student failures on high-stakes tests have negative implications for students and schools of nursing. Adaptive quizzing has increased grades, graduation rates, and NCLEX-RN passing rates and reduced test anxiety in nursing students. PURPOSE: To diminish the negative effects of high-stakes testing and increase standardized exit examination scores, an undergraduate nursing program incorporated customized adaptive quizzing for nursing students in their final nursing course before graduation. METHODS: End-of-program exit examination scores were compared in a preintervention cohort of students and postintervention cohort assigned individualized adaptive quizzing. RESULTS: Statistically significant increases in end-of-program exit examination scores were evident in groups of students completing the customized adaptive quizzing assignments. CONCLUSION: The use of tailored adaptive quizzing increased exit examination scores, supporting the implementation of customized assignments for remediation.

Comparing Educational Outcomes of Online Module-Based Technology with and without Simulation on Attitudes Toward Care of the Dying in Second Semester BSN Students.

BACKGROUND: Opportunities to provide competent and compassionate End-of Life (EOL) care to patients and families are limited for nursing students. METHOD: A mixed methods approach was used to explore the students' attitudes towards caring for an EOL patient in two groups: an on-line-module only group and an on-line module plus simulation group. RESULTS: Statistically significant effect of time was found across the two conditions (F [1, 69] = 7.83, p = .007), indicating that scores on the FATCOD-B significantly improved regardless of the condition over time. The qualitative responses indicated that the simulation experience was more impactful than the on-line module. CONCLUSIONS: Innovative education modalities described in the study may assist in preparing the future workforce for the myriad of demands related to health, life, and death.

Adverse event reporting following simulation encounters in accelerated and traditional bachelor nursing students.

OBJECTIVE: This study was to investigate the differences in the types, frequency, and perspectives of self-reported adverse events reported following simulation encounters between students enrolled in two Bachelor of Science in Nursing (BSN) programs: accelerated option (AO-BSN) or traditional (T-BSN) and by role (participant or observer) during simulation. METHODS: This study analyzed 6994 adverse event reports entered by students through the simulated adverse event reporting system. RESULTS: The AO-BSN students reported a higher percentage of adverse events coded as errors. In contrast the T-BSN students reported more near misses and sentinel events. Further, the T-BSN students significantly reported more fall related errors, while AO-BSN students reported more confidentiality breach errors. Participants reported more medication errors, whereas observers reported more airway and fall categorized errors. CONCLUSION: The vantage from which adverse events are viewed and educational track appear to alter slightly the perceptions of the precipitating factors leading to committed or observed adverse events.

The Second Society for Simulation in Healthcare Research Summit: Beyond our Boundaries.

STATEMENT: In this article, we report on the Second Society for Simulation in Healthcare Research Summit held in 2017. This meeting succeeded the First Research Summit from 2011 with the goal of advancing the scope of healthcare simulation research. During the one and a half day summit, some of the world's leading experts in simulation, healthcare, and simulation in healthcare convened to discuss ideas about what research goals would be most beneficial to the healthcare simulation community, and what could be done to achieve them. We describe the rationale for the meeting, the organization, the program, and the articles that emerged from the Summit, which are found in this supplemental issue of Simulation in Healthcare.

Impact of Simulation-Enhanced Pharmacology Education in Prelicensure Nursing Education.

Student and novice nurses are susceptible to committing medication errors related to lack of experience. To address medication safety, a quasi-experimental design (N = 120) was used to test the effect of adding simulation to an undergraduate nursing pharmacology course on students' confidence and competence, medication adverse events, and observed medication administration practices. Students who received simulation-enhanced pharmacology demonstrated important improvements in medication administration safety. Implementing simulation in nursing pharmacology curriculum is consistent with recommendations to implement Quality and Safety Education for Nurses competencies into nursing education.

Exploring the impact of mindfulness meditation training in pre-licensure and post graduate nurses.

UNLABELLED: The complex, high stress, technologically laden healthcare environment compromises providers' ability to be fully present in the moment; especially during patient interactions. This "pulling away" of attention (mindlessness) from the present moment creates an environment where decision making can take place in the absence of thoughtful, deliberate engagement in the task at hand. Mindfulness, can be cultivated through a variety of mindfulness practices. Few schools of nursing or hospitals offer mindfulness training, despite study findings supporting its effectiveness in improving levels of mindfulness, and perceived connections with patients and families. METHODS: A mindfulness program developed for this study and tailored to nursing was used to provide the mindfulness training. Pre and post training assessments were completed and included administration of the Freiburg Mindfulness Inventory (FMI) and the Defining Issues Test (DIT) of moral judgment version 2. RESULTS: A statistically significant improvement in the FMI scores p=0.003 was found. The pre-licensure group did not show a statistically significant improvement in their FMI scores pre to post training (p=0.281), however the post graduate group did (p=0.004). Statistically significant pre - post scores were found in two schemas of the DIT-2 (P [Post conventional] score, p=0.039 and N2 [Maintaining norms] score, p=0.032). CONCLUSIONS: Mindfulness training improves mindfulness and some aspects of ethical decision making in the groups studied as part of this project. The findings of this study are promising and further demonstrate the merits of a mindfulness practice, however aspects of mindfulness training would need to be addressed prior to launching a full scale attempt to incorporate this into a work life or some other quality improvement program.

Interprofessional Simulation Olympics as a platform to assess team work knowledge acquisition.

Introduction: Several years ago an on-stage competition called SimWars was introduced to the simulation community. This concept was adopted into a patient safety course as a way to further engage students and named Sim Olympics. We sought to evaluate it as a platform for assessment of learning in students who participated as audience members. Methods: A non-equivalent groups design was used to assess whether students could be taught to recognise features of effective teamwork, including a pair of expert raters. One-way repeated measures analysis of variance was used to compare students' attitudes toward interprofessional education (IPE) education, teamwork and simulation, before and after the course. Results: Student scores compared to expert scores showed good agreement. For team 1 there were no statistical differences noted (M=19.58, SD=4.34 given by the students, M=17.50, SD=2.12 given by the experts), t (192)=1.26, p=0.264. There was also no difference for team 2 (M=15.173, SD=5.52 given by the students, M=19.50, SD=3.53 given by the experts), t (173)=0.863, p=0.354. A premeasure and postmeasure of students' attitudes towards IPE education, teamwork and simulation, also showed significant time effect, p<0.001. Conclusions: Medical and nursing students were able to demonstrate their learning of teamwork dynamics by discerning differences between great teamwork and good teamwork as proficiently as seasoned experts. Findings of this study may further support the use of observation as a method to evaluate learning.

Enfoque «Pit Crew» en la asistencia de pacientes con sospecha de infección por coronavirus / Pit Crew approach in the care of patients with suspected coronavirus infection

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