An Unfolding Tabletop Simulation Training Exercise on Disaster Planning for Nursing Students.

BACKGROUND: Disaster planning is an essential component for nursing students to learn. PROBLEM: Clinical experiences of disasters are typically unavailable for nursing students. Increasing frequency of disaster events around the globe has made disaster planning knowledge and skills a critical component in nursing education and professional practice. APPROACH: An unfolding tabletop disaster planning exercise was created as a simulation training strategy meant to strengthen essential disaster response skills. The exercise involves 5 realistic scenarios related to a mass casualty event, taking students from the disaster site to the hospital-based disaster response. OUTCOMES: Implementation of a tabletop disaster planning simulation in one nursing program replaced the traditional lecture-based disaster content. CONCLUSION: An unfolding tabletop disaster planning simulation is a comprehensive, interactive, sustainable, and low-cost teaching strategy that draws on nursing students' fundamental knowledge. Students had the opportunity to practice clinical skills required during a disaster, such as communication, prioritization, teamwork, and delegation.

Moral Distress Experienced by US Nurses on the Frontlines During the COVID-19 Pandemic: Implications for Nursing Policy and Practice.

Introduction: The ongoing COVID-19 pandemic represents the largest contemporary challenge to the nursing workforce in the 21st century given the high stress and prolonged strain it has created for both human and healthcare supply resources. Nurses on the frontlines providing patient care during COVID-19 have faced unrivaled psychological and physical demands. However, no known large-scale qualitative study has described the emotions experienced by nurses providing patient care during the first wave of the COVID-19 pandemic in the US. Objective: Therefore, the purpose of this study was to qualitatively describe the emotions experienced by US nurses during the initial COVID-19 pandemic response. Methods: One hundred individual interviews were conducted with nurses across the United States from May to September of 2020 asking participants to describe how they felt taking care of COVID-19 patients. All interviews followed a semi-structured interview guide, were audio recorded, transcribed, verified, and coded by the research team. Results: Participants narratives of the emotions they experienced providing patient care during COVID-19 unequivocally described (1) moral distress, and moral distress related (1.1) fear, (1.2) frustration, (1.3) powerlessness, and (1.4) guilt. In sum, the major emotional response of nurses across the US providing patient care during the pandemic was that of moral distress. Conclusion: Investments in healthcare infrastructures that address moral distress in nurses may improve retention and reduce burnout in the US nursing workforce.

Creating an Asynchronous Telehealth Simulation for Advance Nursing Practice Students.

The ongoing use of telehealth services following the COVID-19 pandemic demonstrates its sustainability and how our health care system is transforming. To increase student learning, an asynchronous telehealth simulation as a learning strategy in an online advanced pharmacology course was developed. This innovative strategy allowed students to practice clinical decision-making and collaboration skills electronically to prepare them for the increased use of telehealth medicine. Integrating a prerecorded simulation-based experience using a web-based teleconference tool and embedding it within the Learning Management System is a simple, sustainable model for nursing faculty and students with various levels of technology proficiency.

Integration of Motivational Interviewing Within Prelicensure Nursing Programs: A National Survey.

BACKGROUND: Vital to the nurse-patient partnership is the use of active listening and a clear understanding of the patient's health care goals. Motivational Interviewing is an evidence-based, patient-centered communication technique that assists patients in self-identifying and committing to health behavior change. PURPOSE: This study explored whether, where, and how Motivational Interviewing is integrated into current prelicensure nursing curricula. METHODS: An exploratory, descriptive study incorporated a researcher-developed survey. RESULTS: Participants (N = 112) represented 5 types of prelicensure nursing programs from across the United States. Forty-one participants reported using Motivational Interviewing within their program with accreditation being the primary rationale. Seventy-one participants reported not integrating Motivational Interviewing within their program with lack of knowledge being the primary rationale. CONCLUSION: Further research on optimizing the integration of Motivational Interviewing educational content and practice into all levels and specialty areas of nursing education would help to identify best practices.

Envisioning Nursing Education for a Post-COVID-19 World: Qualitative Findings From the Frontline.

BACKGROUND: This study sought to qualitatively describe the implications of coronavirus disease 2019 (COVID-19) on nursing education and provide recommendations for curricular changes expressed by frontline nurses practicing during the first wave of the pandemic. METHOD: Nurses throughout the United States (N = 100) completed the study protocol. The study sample was diverse and included White (37%), Black (20%), Latinx (20%), Asian (14%), multiracial (7%), and Native American (2%) participants; the sample also included transgender and nonbinary nurses (2%). Thematic network analysis was used to determine the implications of COVID-19 for nursing education. RESULTS: Findings included four distinct themes: teamwork and communication, flexibility and critical thinking, leadership and using your voice, and advocacy and policy. CONCLUSION: Shifting nursing education curriculum to focus on these key attributes will help better prepare new nurses to be adaptable in practice settings, thereby improving nursing care, clinical outcomes, and the well-being of the communities that nurses serve. [J Nurs Educ. 2021;60(12):668-673.].

A Simulated Perioperative Clinical Day for Prelicensure Nursing Students.

BACKGROUND: The inclusion of perioperative clinical learning experiences in prelicensure nursing education reinforces foundational nursing skills. However, perioperative experiences in clinical settings are not consistently available for student learning. METHOD: An unfolding perioperative simulation day was created as an alternate to traditional clinical learning. Three simulation-based experiences were designed to include nursing care of the patient during the preoperative, intraoperative, and postoperative phases of the perioperative experience. RESULTS: Implementation of a perioperative simulation as an alternative to traditional clinical learning in one prelicensure program had positive effects on students' ability to achieve learning outcomes, to collaborate, and to improve self-confidence. CONCLUSION: A simulated perioperative clinical day provides an engaging learning experience, reinforcing foundational clinical skills such as patient safety, infection control, patient mobility, teamwork, and communication. [J Nurs Educ. 2021;60(7):386-390.].

Exploring student perceptions of virtual simulation versus traditional clinical and manikin-based simulation.

BACKGROUND: The COVID-19 pandemic immediately changed the way nursing programs provide clinical experiences for pre-licensure nursing programs. Healthcare organizations closed access to clinical experiences for nursing students and universities immediately shifted to remote learning and online virtual simulation. PURPOSE: This research examined students' perceptions of virtual simulation in meeting their learning needs when compared to traditional clinical experiences and manikin-based simulation environments. METHODS: A retrospective multi-site exploratory, descriptive design had 97 participants complete the Clinical Learning Environment Comparison Survey 2.0 after having experienced virtual simulation. A Kruskal-Wallis test was used to examine differences among participants when grouped by degree program and level/term within the nursing program. RESULTS: Traditional clinical experiences met students' perceived learning needs for all degree programs of study for subscale items of communication, nursing process, holism, critical thinking, and self-efficacy. When grouped by level/term, traditional clinical experiences met all students' perceived learning needs for every subscale item. Manikin-based simulation met students' perceived learning needs for subscale items of critical thinking and teaching-learning dyad while virtual simulation met perceived learning needs for subscale items of nursing process, critical thinking, self-efficacy, and teaching-learning dyad. CONCLUSION: While traditional clinical learning experiences remains the "gold standard", manikin-based and virtual simulation do meet specific important learning needs.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study.

AIM: The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID-19 pandemic in the United States. BACKGROUND: Ambiguity in ever-evolving knowledge on how to provide care during COVID-19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID-19. METHODS: Utilizing qualitative descriptive methodology, semi-structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol. FINDINGS: Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID-19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse-to-nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support. CONCLUSION: Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data-driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Effective communication is critical to support nurses through extended periods of crisis. COVID-19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses' presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision-making during unprecedented emergencies such as the COVID-19 pandemic.

An Online Asynchronous Physical Assessment Lab (OAPAL) for Graduate Nursing Students Using Low-Fidelity Simulation With Peer Feedback.

Physical assessment courses typically include a didactic component and a skills laboratory component. It is a challenge to create laboratory components in fully online nursing courses. This article reports on the use of an online asynchronous physical assessment laboratory using low-fidelity simulation with peer feedback to teach physical assessment skills to postlicensure nursing students in a fully online advanced health assessment course within an RN to MS program. Students found the online asynchronous physical assessment laboratory favorable, relevant, and engaging and believed it advanced their current skills.

Peer Coaching Integrated in Simulation: Improving Intraprofessional Teamwork.

Poor communication in healthcare is recognized as a leading cause of medical errors. There is a call from national healthcare organizations for nursing education to focus on higher level competencies. Teamwork and collaboration is one of these competencies and should be a priority in nursing education. It is imperative that nurses function with open communication, mutual respect, and shared decision-making as members of the intra professional team. The traditional clinical practice setting is typically not conducive for an entire clinical group to fully practice these skills. Integrating peer coaching in simulation provides students with the opportunity to practice open communication, provide mutual respect, and share decision making to solve patient problems in a safe environment.

Telehealth Simulation With Motivational Interviewing: Impact on Learning and Practice.

BACKGROUND: The Patient Protection and Affordable Care Act increased numbers of insured individuals and demands for health care cost reductions. A national call for nursing education to focus on health promotion activities exists. Nurse educators can address this shift in health care by including motivational interviewing (MI), a health promotion technique, in the curriculum. METHOD: This exploratory descriptive pilot survey examined postlicensure nursing students' perceptions and self-reported behaviors following an online synchronous telehealth simulation-based experience in which they practiced MI. RESULTS: The survey yielded a 45% (n = 10) response rate. All participants agreed the experience was beneficial to their learning and provided insights on a new clinical practice environment. Eighty percent of participants would have liked to have learned MI in their prelicensure program, and 50% of participants have integrated it in their current practice. CONCLUSION: This tele-health simulation-based experience positively affected the learning and behaviors of postlicensure nursing students. [J Nurs Educ. 2019;58(4):221-224.].

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.

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.

Virtual Simulated Care Coordination Rounds for Nursing Students.

Implementation of the Affordable Care Act has nursing education reflecting on paradigm shifts in order to prepare nursing students for the evolving health care environment. The traditional focus of nursing education on nursing care in acute care settings does not provide learning experiences in care coordination and transitional care management skills. Virtual simulated care coordination rounds, using the National League for Nursing Advancing Care Excellence resources, offer nursing students an innovative experience in care coordination and transition care management.