Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment.

AIM: The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection. BACKGROUND: Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy. METHOD: Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored. RESULTS: Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants. CONCLUSION: Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.

A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education.

AIM: This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies. BACKGROUND: Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods. METHOD: This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science. RESULTS: The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence. CONCLUSION: To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.

Nurse Faculty Administrators' Experiences of Communication, Cooperation, Coordination, and Collaboration During Educational Disruption.

AIM: The primary purposes of the study were to describe nurse faculty administrators' experiences of rapid transition and disruption in nursing education during the COVID-19 pandemic. BACKGROUND: The disruption and shift to remote learning for nursing education programs posed challenges for these administrators. METHOD: A descriptive survey methodology with a convenience sample was used with the Four Cs of Disaster Partnering framework. RESULTS: The findings revealed that key elements of the Four Cs framework played a role in the successful adaptation to new learning environment realities. Time was an overarching finding. Connectedness with faculty, staff, and students was a significant challenge. CONCLUSION: The application of the Four Cs of Disaster Partnering framework demonstrated utility for examining academic nurse administrators' preparedness.

Internal Reliability Estimates of the Lasater Clinical Judgment Rubric Among New-to-Practice Nurses in a Simulated Setting.

ABSTRACT: Clinical judgment among new-to-practice nurses is critical for safe patient care. The Lasater Clinical Judgment Rubric (LCJR) is a known instrument in undergraduate nursing education research. This study evaluated the internal consistency reliability and changes in the LCJR in a sample of 17 new-to-practice nurses in a simulated setting across four measurements. Cronbach's alpha reliability for the LCJR was .90. Effect sizes (η2) ranged from .01 to .45, with only the reflecting subscale demonstrating an effect. Study team and study participants' self-ratings on the LCJR were compared; team members' ratings were significantly lower than participants' self-ratings.

Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses.

AIM: This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses. BACKGROUND: Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses. METHOD: Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points. RESULTS: The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time. CONCLUSION: Replication of the study with a randomized controlled trial and large sample size is warranted.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development.

AIM: The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment. BACKGROUND: A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX. METHOD: Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners. RESULTS: Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection. CONCLUSION: Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

Electronic Charting During Simulation: A Descriptive Study.

Informatics is a core competency for nursing students recognized by several national organizations in healthcare and nursing education. Nurses must be able to use information and technology to communicate and manage knowledge in support of clinical decisions. Many hospitals either limit or deny nursing students' access to the electronic health record during traditional clinical learning. Simulation-based learning experiences are an alternative to traditional clinical experiences. What remains unclear is how nursing programs are incorporating electronic health record platforms within simulation. This study used a descriptive design to survey nursing programs exploring electronic health record use within simulation-based learning experiences in the classroom, skills laboratory, or simulation laboratory settings. Findings of the survey show that 56.2% of participants used an electronic health record in the classroom, skills laboratory, or simulation laboratory for simulation. Electronic health record use is gaining momentum via simulation-based learning experiences and students are not only documenting but also gathering data and appraising patient data for meaningful use to inform patient care decisions and promote clinical readiness.

The Effect of a Formal Mentoring Program on Career Satisfaction and Intent to Stay in the Faculty Role for Novice Nurse Faculty.

AIM: The purpose of this mixed-method study was to explore the influence of a formal mentoring program on career satisfaction of novice full-time nurse faculty in academia. BACKGROUND: The transition from the role of clinician to faculty in an academic setting can be challenging for novice nurse faculty. METHOD: A link to an electronic survey with open-ended questions was emailed to 1435 participants. RESULTS: The response rate was 17.6 percent (N = 124). Mean scores were obtained, and independent t-test were computed to compare scores of faculty who had participated in a mentoring program with scores of nonparticipants. Content analysis of the open-ended answers was conducted, and common themes were identified. CONCLUSION: By examining characteristics that contribute to the success of novice nursing faculty, recruitment and retention of faculty may improve, which is essential due to the worsening nursing faculty shortage.

An Innovative Approach Using Clinical Simulation to Teach Quality and Safety Principles to Undergraduate Nursing Students.

The aim of this learning experience was to enhance students' knowledge of safety practices. A threefold approach was used, which involved viewing a prerecorded scenario in which safety practices were violated and another scenario that consistently depicted safe practice behaviors. Students then performed an environmental safety check of the physical simulated scene and then participated in a debriefing session. The conceptual basis for this project was the teaching-learning strategy "What's Wrong With This Patient," which requires the learner to evaluate a simulated learning environment to identify safety practices that were not followed and suggest strategies to correct these errors.

Persons with Disability: Their Experiences as Standardized Patients in an Undergraduate Nursing Program.

This descriptive qualitative study examined experiences of standardized patients with disabilities (SPWDs) in an undergraduate nursing program through focus group and telephone interviews. Content analysis identified five themes: 1) desire to improve care for others, 2) opportunity to be productive again, 3) joy in seeing students learn, 4) desire for more feedback on performance, and 5) importance of having SPWDs assess accessibility of the facility. SPWDs participated to improve sensitivity of students to disability and appreciated having a voice in educating future nurses. They requested more feedback on their performance and identified accessibility issues in the state-of-the-art nursing school building.

Development and psychometric testing of the Mariani Nursing Career Satisfaction Scale.

BACKGROUND AND PURPOSE: The Mariani Nursing Career Satisfaction Scale (MNCSS) was developed to explore the influence of mentoring on career satisfaction of registered nurses (RNs). A review of the literature revealed no contemporary valid and reliable measure of career satisfaction. METHODS: The MNCSS is a semantic differential of 16 opposite adjective pairs on which participants rate feelings about their nursing career. The MNCSS was used in a pilot study and three major studies exploring career satisfaction of RNs. Validity, reliability, and exploratory factor analysis (FA) were computed to explore the internal structure of the instrument. RESULTS: The newly developed instrument had a content validity index (CVI) of .84 and Cronbach's alpha internal consistency reliabilities of .93-.96 across three major studies. Exploratory FA (N = 496) revealed a univocal instrument with one factor that explains 57.8% of the variance in career satisfaction scores. CONCLUSIONS: The MNCSS is a valid and reliable instrument for measuring career satisfaction. FA of the combined data from three studies yielded one factor that measures the concept of career satisfaction.

ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT.

Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.

Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

ABSTRACT: Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

Nursing Students' Self-Efficacy in Immigrant Health.

BACKGROUND: The United States has the largest, most diverse immigrant population. Nurses will care for immigrant clients in all areas of nursing practice. PURPOSE: The purpose of this study was to determine nursing students' self-efficacy in working with immigrant clients following a service-learning experience. METHODS: A pre-/posttest descriptive study was used to measure students' self-efficacy in cultural aspects of screening, providing health education, and assisting with health care access prior to and after a voluntary service-learning experience at a resettlement agency. RESULTS: Statistical significance was found in overall scale score and in all 19 individual items except 2 related to working with (P = .21) and communicating with (P = .49) the health care team. Overall, pretest and posttest results revealed that students' self-efficacy working with immigrant clients was improved. CONCLUSION: Collaborating with an immigrant resettlement program to provide a structured immigrant health learning experience for prelicensure nursing students can improve self-efficacy in working with immigrant clients.

Diagnostic Reasoning Outcomes in Nurse Practitioner Education: A Scoping Review.

BACKGROUND: Diagnostic reasoning is the process of collecting, considering, and analyzing information to determine a diagnosis. Educational strategies that structure diagnostic reasoning exposure, experience, and evaluation are hypothesized to improve diagnostic safety. However, few studies measure diagnostic reasoning outcomes in nurse practitioner education. This review sought to identify the educational interventions intended to improve diagnostic reasoning competency, determine which components of reasoning are evaluated, and examine how they are measured. METHOD: Four databases were searched, and 12 studies were identified that met the inclusion criteria. RESULTS: Simulation was the most common intervention. The most frequently measured diagnostic reasoning components were information gathering, differential diagnosis, and leading diagnosis. Checklists and patient management problems were the most used assessment method. CONCLUSION: More studies are needed to assess the reasoning processes of hypothesis generation, problem representation, and diagnostic justification. Within simulation, methods capable of capturing these components include think-aloud, global assessments, checklists, and note evaluation. [J Nurs Educ. 2022;61(10):579-586.].

TeamSTEPPS Curricular-Wide Integration: Baccalaureate Nursing Students' Knowledge, Attitudes, and Perceptions.

BACKGROUND: To promote safe patient care, nurses must work collaboratively with members of the interprofessional health care team. PURPOSE: The purposes of this study were to explore the effect of a curricular-wide integration of TeamSTEPPS training on baccalaureate nursing students' teamwork knowledge and attitudes and to describe students' perceptions of TeamSTEPPS curricular-wide integration. METHODS: In this quasi-experimental, mixed-methods study, the experimental group engaged in a curricular-wide integration of TeamSTEPPS throughout the baccalaureate nursing program, whereas the control group received no TeamSTEPPS training. RESULTS: The experimental group had significantly higher teamwork knowledge than the control group after training. The curricular-wide integration of TeamSTEPPS was positively received by students. CONCLUSIONS: This study demonstrated the feasibility and benefits of integrating TeamSTEPPS teamwork training throughout a baccalaureate nursing curriculum, as well as the knowledge gained by students because of this curricular-wide integration. With further research, TeamSTEPPS could offer an evidence-based approach to promote the interprofessional teamwork knowledge and skills nursing students need for safe patient care.