Engagement in Distance Healthcare Simulation Debriefing: A Concept Development and Framework.

SUMMARY STATEMENT: Understanding distance health care simulation debriefing is crucial in light of the increased use of and emerging technology in remote education for reasons of accessibility, global collaboration, and continuous professional development. This article is a confluence of a number of previously published studies designed to serve as a foundation to develop the concept of "engagement in health care distance simulation debriefing" using the Schwartz-Barcott & Kim hybrid mixed methods model. The model uses 3 phases: theoretical (a realist systematic review of the literature), fieldwork (3 exploratory studies and 2 pilot experimental studies), and analytical (analysis of the theoretical and fieldwork findings through expert discussion). This study defines the concept of "engagement in health care simulation distance debriefing" through exploration of its uses and analysis in literature, interviews, and expert review. The hybrid approach to the analysis provided rigor to generate a new, reflective conceptual model. This conceptual model defines the complexity in engagement during distance debriefing and helps shape the development of simulationists and debriefers, leading to more effective distance simulations and debriefings.

Asthma Academy for Family Caregivers: A Quality Improvement Project.

Background: Asthma affects one in every 12 children in United States with significant prevalence in underserved groups. Family caregiver education is essential to improve childhood asthma control. The literature suggests that family caregivers' lack of knowledge about asthma management affects their children's health outcomes. An evidence-based education program that improves caregivers' asthma knowledge may improve the family's well-being. Objectives: The goal of the Asthma Academy project is to improve the disease management of children with asthma by providing an in-person family caregiver education program. The main objectives are to (a) improve family caregivers' asthma knowledge, (b) enhance their confidence in asthma management, and (c) evaluate caregivers' satisfaction with the education program. Method: This quality improvement project used an in-person educational program with an asthma education video resource for caregivers of children with asthma. Results: The family caregivers' asthma knowledge improved significantly after the education. The confidence levels in caring for children with asthma increased. Caregivers' satisfaction with the Asthma Academy education session was favorable. Conclusions: The Asthma Academy was an acceptable and effective delivery method of education for family caregivers of children with asthma in the in-patient setting. Empowering family caregivers of vulnerable children through asthma education may improve child health outcomes and mitigate complications from asthma. Implications for Nursing Nurses and clinicians are steward of providing patient education. Individualized, patient-tailored education is recommended.

A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education: A Systematic Review.

ABSTRACT: With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: ( a ) research study (of any design), ( b ) focused on learners in health professions, and ( c ) compared VR with traditional simulation. Studies were excluded for the following reasons: ( a ) not a research study, ( b ) focused on learners outside health professions, ( c ) used screen-based or computer-based simulation, ( d ) used a task trainer, and ( e ) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.

Improving Telenursing Skills Through Simulation-Based Education.

Background: Preparing graduate-level nurses to provide care via telehealth could both increase access to care and decrease healthcare costs. However, many nursing schools do not provide telehealth experiences, especially at the graduate level. Objective: The aim of this project is to incorporate telehealth simulations in the doctor of nursing practice (DNP) curriculum at the University of Miami School of Nursing and Health Studies. Methods: This quality improvement project used a posttest-only design. The Ottawa Model of Research Use guided the project. DNP students completed a peer-to-peer telehealth simulation scenario via Zoom. Results: DNP students demonstrated confidence with an average score of 2.875 out of 3. DNP students' teaching performance scores were 2.7 out of 3. DNP students demonstrated effective overall telehealth performance with a mean score of 13.74 out of 15. Conclusion: DNP students may benefit from increased opportunities to practice telehealth, including the use of peer-to-peer simulation, to be aptly prepared for contemporary nursing practice.

Addressing hypertension among Haitian adults with insufficient access to quality healthcare: A discursive review.

AIM: The purpose of this article is to summarize research targeting hypertension and healthcare access among adults living in rural Haiti. BACKGROUND: Hypertension is a significant public health problem that impacts one in five persons globally. It is the leading cause of cardiovascular-related conditions such as stroke and myocardial infarction and accounts for most global non-communicable disease-related deaths. Limited healthcare access and social determinants of health are known contributors to poor health outcomes among persons with hypertension. Among Haitians, there are stark health disparities between those who live in urban versus rural areas. DESIGN: A discursive review. RESULTS: Several issues are identified as barriers to proper hypertension prevention and management. However, after examining the effective interventions, we found that social determinants of health such as transportation costs, lack of field care facilities close to patients, roadway conditions, political disturbance, and ineffective leadership and policies are major barriers to controlling hypertension in Haiti. Although Haiti has received help from international organizations, strengthening its internal infrastructure is paramount in improving healthcare access. DISCUSSION: The review concludes that Haitians living in rural parts of Haiti are less likely to receive healthcare to manage non-communicable diseases such as hypertension. Similar to other developing countries, a heightened awareness is needed to address the lack of healthcare access for those living in rural communities. IMPACT TO NURSING PRACTICE: Nurses and other healthcare professionals working with populations in Haiti should become aware of the barriers and facilitators that promote sufficient healthcare access. To achieve this goal, nurses must understand the social determinants and other factors that serve as barriers for achieving access to quality care for this vulnerable population. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or drafting of this discursive paper.

Use of Text Messaging to Help Family Caregivers: An Integrative Review.

Text messaging is a promising family-centered intervention to promote health and prevent illness among children. Little is known about the effectiveness of texting parents of children with chronic conditions on health outcomes. The aims of this integrative review were to determine what ways texting has been used as an intervention to help family caregivers and examine the outcomes from the use of texting to help family caregivers. Applying Whittemore and Knafl's method of integrative review, 16 studies were reviewed. The majority of studies suggested that text message-based health interventions were feasible and acceptable for parents of children with chronic conditions. Of the studies that examined effectiveness of the interventions, six studies noted effectiveness, four studies noted results signifying no differences, and two studies obtained insignificant results. Although the state of the science regarding health providers' use of text messaging to support parents of children with chronic illness is in its early stage, text messaging demonstrates potential to assist parents to better manage their child's chronic disease. More research is warranted in the future to determine the effectiveness as well as best practices in text messaging.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

AIM AND OBJECTIVE: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND: With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION: Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

From Bedside to Webside: Telehealth Education for Doctoral Nursing Students.

BACKGROUND: Telehealth has become a ubiquitous tool for healthcare providers. However, concepts of telehealth are missing from many Doctor of Nursing Practice (DNP) curricula. This quality improvement project aimed to evaluate telehealth education implementation into a Doctor of Nursing Practice curriculum. METHODS: The Iowa Model of Evidenced-Based Practice to Promote Quality Care guided the quality improvement project. An online module regarding telehealth was developed based on the American Telemedicine Association (ATA), the Health Resources and Services Administration (HRSA), and HealthIT.gov and was integrated into an existing course. Students completed a pre and posttest regarding telehealth knowledge and levels of satisfaction with the online module. RESULTS: Thirty-seven students participated in the program. Mean knowledge scores increased from 4.9 to 8.6, and the modal for satisfaction and self-confidence was strongly agree. CONCLUSION: As telehealth is now a mainstream method of clinical practice, schools of nursing must adjust the curriculum to prepare nurses for this form of care delivery. An online module is a sustainable method of providing the foundation of knowledge for future expansion. Practicing via telehealth presents unique strengths and challenges. Nurses must be informed of the nuances and special considerations involved to safely practice using this distinctive care modality.

Cultural Humility Toolkit.

BACKGROUND: Diversity, equity, and inclusion (DEI) are increasingly recognized as core values for nursing education and practice. PURPOSE: The purpose of this article is to offer teaching tools and strategies to integrate cultural humility within the nursing curriculum and create a more inclusive learning environment. APPROACH: Various teaching tools, methods, and strategies are presented. OUTCOMES: Use of ground rules, an environmental assessment, examination of the curriculum landscape and teaching materials, bias awareness activity, modified privilege walk, Modified Monopoly, simulation, low-income community experiences, study abroad, debriefing, and evaluation with valid and reliable tools are suggested. CONCLUSIONS: By threading cultural humility concepts throughout the curriculum, nurse educators have the potential to shape learner perspectives to better appreciate and value diversity.

Healthcare needs and experiences of foreign residents in Japan by language fluency.

OBJECTIVE: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. DESIGN: A quantitative, descriptive design was used. SAMPLE: We surveyed foreign residents in the greater Tokyo area (N = 209). MEASUREMENTS: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. RESULTS: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p = .000). CONCLUSIONS: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them.

Asthma academy: A student nurse-led telehealth education program for low-income family caregivers of children with asthma.

AIMS: The aims of the Asthma Academy study were to (1) evaluate the telehealth performance of DNP students, (2) evaluate the perceived learning experience of DNP students and (3) investigate whether an association exists related to student performance and family caregiver outcomes. DESIGN: A descriptive study was conducted with doctor of nursing practice students. METHODS: Students conducted telehealth visits to help family caregivers of children with asthma and were rated on their performance by two faculty members using a rubric. Student perception data were gathered via survey. RESULTS: Out of a total possible score of 15 points, the mean telehealth performance score of students was 13.38 points. Students indicated the telehealth experience was valuable and that they were satisfied with their learning. This model of leveraging telehealth to bridge nursing students to the community may be adapted to help family caregivers of children with various disease foci.

Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project.

BACKGROUND: Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions. OBJECTIVE: The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions. METHODS: This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts. RESULTS: The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts. CONCLUSION: This practice improvement project demonstrates successful translation of research into practice. IMPLICATIONS FOR NURSING: The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.

Psychometric Testing of an Instrument to Measure Cultural Humility.

INTRODUCTION: As the world increasingly diversifies, there is a need to prepare nurses to care for individuals, families, and communities with contrasting lifeways. Although education about cultural humility is needed, there is no way to measure the construct. The purpose of this study was to develop, validate, and psychometrically test an instrument designed to measure cultural humility. METHOD: The lead author extracted key constructs from previous research to develop the instrument. Six expert faculty validated the instrument. An exploratory factor analysis was conducted with 322 health professional students. RESULTS: All items had an item content validity index of 0.83 or higher. The factor analysis yielded three factors: context for difference in perspective, self-attributes, and outcomes of cultural humility. The instrument was determined reliable (Cronbach's alpha = .85). DISCUSSION: Foronda's Cultural Humility Scale may help researchers better operationalize and evaluate achievement of cultural humility.

Promoting Cultural Humility in Nursing Education Through the Use of Ground Rules.

ABSTRACT: The National League for Nursing advocates for improved efforts related to diversity and inclusion in nursing education. By incorporating cultural humility into teaching and learning processes, faculty may be able to reduce bias and promote the inclusive learning environment necessary to retain diverse nursing students. This article emphasizes the importance of cultural humility in nursing education and presents novel ground rules, based on the literature, for implementation within the classroom to foster an academic environment suitable for students from all backgrounds.

Improving knowledge and decreasing depressive symptoms in caregivers of children with asthma through the asthma academy: A randomized controlled trial.

Background: Caregivers of children with asthma demonstrate higher levels of anxious and depressive symptoms when compared to caregivers of healthy children. Objectives: The objectives of this study were to: 1) Evaluate feasibility and acceptability of two nurse-led, remotely offered interventions for caregivers of children with asthma; 2) Compare effectiveness of two interventions (a virtual education session and a virtual education session supplemented with a telehealth visit) in relation to caregiver outcomes, and 3) Assess the preliminary effect of the interventions on caregivers' knowledge of asthma, sleep, anxiety and depressive symptoms. Methods: A mixed methods approach was used inclusive of a qualitative, descriptive design and randomized controlled trial design. Caregivers were provided virtual education and telehealth visits and evaluated from pre-posttest. Results: The intervention was found to be feasible and acceptable. Both the virtual education session and telehealth visit were effective. The intervention had a significant effect on caregiver's asthma knowledge and depressive symptoms (p<.05), but did not affect caregiver's sleep or anxiety. Qualitative analysis of the virtual educational session revealed themes of 1) valuable learning experience, 2) more medication education needed, and 3) appreciated remote format. Qualitative analysis of the telehealth visits revealed themes of 1) educational, helpful, and worthwhile and 2) virtual offering was easy and convenient. Conclusions: Remotely conducted, nurse-led interventions such as virtual education sessions and telehealth visits are a feasible, acceptable, and effective way to improve caregiver outcomes.