The impact of integrating bioscience and nursing subjects in a first-year nursing curriculum: A retrospective study.

AIM: The aim of this study is to explore the effects of integrating bioscience and nursing units on academic achievement and perception in the first-year nursing curriculum. BACKGROUND: Nursing students have historically found biosciences difficult and struggle to relate it to nursing practice. In response, nursing and non-nursing academics have employed different teaching modes and integration strategies to enhance learning. Despite these efforts, substantial gaps still persist concerning the integration of biosciences within nursing curriculum and the effect of integration on student academic achievement and student perception. DESIGN: Retrospective descriptive. The setting was a large University in Victoria Australia with two undergraduate nursing campuses (metropolitan and non-metropolitan). METHOD: Student academic records and online evaluation surveys that were completed from 2014 to 2019 were examined. Students self-reported their experiences of the unit using a five-point Likert scale and two open-ended questions. Descriptive and inferential statistics were used to analyse the data. Content analysis was used to analyse the two open-response survey items. RESULTS: First-year student records from 2014 to 2016 (pre-integration) and 2017-2019 (post-integration) were examined. Student mean age was 24.5 years (SD 7.2) and 20.9 years (SD 4.8) pre-integration and post-integration respectively. There was a statistically significant decrease in student attrition from pre-integration (n=536, 29.9%) to post-integration (n=358, 20.2%) (p <0.001), and a significant improvement in students' mean academic scores post-integration in the first semester 61.9 (SD 15.9) and 67.0 (SD 14.9) respectively, confidence interval 3.9-6.2 (p <0.001). Student satisfaction with the units improved post-integration, from 77.8% to 85.8% (χ2 = 10.1076) (p=0.001). However, there was no significant difference in students' perception of feeling overwhelmed, and their self-reported ability to link theory to practice. CONCLUSION: Integrating bioscience and clinical nursing practice units in the first-year curriculum can help decrease student attrition rates, improve student academic results and increase student satisfaction which may lead to an overall improvement in student learning experiences.

Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol.

OBJECTIVE: This review will evaluate the experiences of health care professionals in the intensive care unit when families participate in clinician handovers. INTRODUCTION: Families of patients admitted to the intensive care unit report stress and anxiety. Family participation in multidisciplinary rounds in the intensive care unit may improve patient and family outcomes. However, health care professionals have different attitudes toward family participation. Furthermore, there is limited understanding of the barriers, facilitators, and other outcomes of family participation in clinician handovers for the patient, family, and health care professionals. INCLUSION CRITERIA: The review will consider studies involving health care professionals (eg, nurses, physicians, allied health professionals) and any type of family participation, from bedside presence to participation in decision-making. Clinician handovers may be multidisciplinary ward rounds or nursing handovers. Settings may be the adult, pediatric, or neonatal intensive care unit in rural or metropolitan regions in any country. Studies in other clinical contexts will be excluded. METHODS: Databases to be searched include CINAHL, MEDLINE, Scopus, PsycINFO, Embase, Emcare, Web of Science, and ProQuest Central. The search will be limited to articles written in English from 2000 to the present. Two independent reviewers will screen titles and abstracts, assess the full text of selected citations for inclusion, and assess methodological quality. A data extraction tool will be used, and findings will be assigned a level of credibility. Meta-aggregation will be used to synthesize findings. Disagreements between reviewers will be discussed to reach consensus; a third reviewer will be consulted if necessary. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020223011.

Engaging young people as simulated patients: a qualitative description of health professional educators' perspectives.

Background: Real patients in clinical placements are important for learning and may well be the 'gold standard'. However, simulated patients (SPs) are a viable alternative in the absence of this opportunity. While adult SPs contribute to health professions education, child and adolescent simulated patients (CASPs) are less common. This research aims to explore the perspectives of healthcare educators regarding the engagement of young SPs, specifically the identification of barriers and enablers to involving CASPs. Methods: We used an interpretive paradigm of qualitative description. Thirteen interviewees, all educators involved in SP programmes, participated in semistructured interviews. Data were transcribed verbatim and analysed using an inductive thematic approach. Findings: Not all participants saw value in engaging CASPs. A number of barriers and enablers to involving them were acknowledged in six themes: challenges and concerns; logistical barriers; benefits of CASPs; overcoming challenges; an ethical minefield; and child safety. Opinions differed with respect to feasibility and necessity for involving CASPs, particularly in the hospital setting where real patients are accessible. All participants articulated the critical importance of ensuring adequate support and adherence to ethical principles if CASPs were involved. Conclusions: The involvement of CASPs in health professions education is a divisive issue. CASPs' ability to provide a realistic option for supporting learning is recognised yet perhaps not wholly perceived as a feasible alternative to real patients. Their engagement raises critical ethical, practical, logistical and financial challenges.

Power and adolescent simulated patients: A qualitative exploration.

Adolescent simulated patients (SPs) work in an environment where complex and dynamic power relationships are at play. These relationships differ to those encountered in clinical practice. Instead of health professionals exerting their power from a foundation resting on knowledge, to a patient consumed with worry, SPs in simulation scenarios often have less worry and more knowledge than the learner. Combined with this, their role in judging and assessing learner performance adds to their power base. Adolescent SPs also experience power from the opposite perspective; where they have power exerted upon them, with limited ability to resist. This research aims to explore power relationships from adolescent SP's perspectives. Ten adolescent SPs, (10-19 years), participated in semi-structured interviews that were analysed using an interpretive phenomenological approach. Four themes resulted from an in-depth analysis of interview transcripts: 1) Becoming and being a powerful simulated patient; 2) redirection, resistance & responsibility; 3) the power of the role; and 4) a complex maze of interactions. These themes reflect the experiences adolescent SPs are exposed to and the powerful interactions that can result. Whilst there are positive outcomes for adolescent SPs, there is also a risk of harm. Recognizing this is an ethical imperative to ensure adolescent safety during the simulation process.

Listening to young voices: The lived experiences of adolescent simulated patients in health professional education.

BACKGROUND: Learners should be exposed to the core principles of adolescent specific communication and assessment frameworks as part of health professional curricula. How this is done can vary considerably, but the inclusion of adolescents seems an ideal and realistic option. However, securing their participation can be challenging. A viable option to adolescent patients may be adolescent simulated patients. OBJECTIVE: This study describes adolescents' lived experiences of being simulated patients in health professional education. DESIGN & SETTING: An interpretive phenomenological approach involving ten adolescent simulated patients from two health professional education programs in Australia. METHODS: Consenting/assenting adolescents participated in semi-structured audio-recorded interviews. Data was transcribed verbatim and analysed using van Manen's phenomenological approach. RESULTS: Adolescents offered unique insights and intimate knowledge of their lived experiences of simulated patient work. Adolescents reflected upon the often positive but sometimes challenging journey of simulated patient work. The identification of harm, largely unrecognized by adolescents themselves is the most concerning finding of this study. CONCLUSIONS: The experiences of adolescent simulated patients can help to shape the future of their involvement. However, their experiences also reveal myriad challenges. The implications for ethical practice must be reviewed before inclusion of adolescents as simulated patients is a feasible option.

Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.

Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment.

A systematic review: Children & Adolescents as simulated patients in health professional education.

Simulated patients (SP) contribute to health professional education for communication, clinical skills teaching, and assessment. Although a significant body of literature exists on the involvement of adult SPs, limited research has been conducted on the contribution of children and adolescents. This systematic review, using narrative summary with thematic synthesis, aims to report findings related to children/adolescents as simulated patients in health professions education (undergraduate or post-graduate). A systematic review of qualitative and quantitative literature published between 1980 and September 2014 was undertaken using databases including CINAHL, Ovid Medline and Scopus. The lack of literature related to the employment of children and adolescents in nursing education dictated the expansion of the search to the wider health professions. Key search terms related to the employment of children and adolescents in health professional education programs. A total of 58 studies reduced to 36 following exclusion based on abstract review. Twenty-two studies reached full text review; following application of inclusion and exclusion criteria, 15 English language studies involving children and/or adolescents in simulation formed part of this systematic review. Five key themes emerged: Process related to recruitment, duration and content of training programs, support and debriefing practice, ethical considerations, and effects of participation for key stakeholders such as children and adolescents, parent and faculty, and learner outcomes. The results suggest that the involvement of children and adolescents in simulation for education and assessment purposes is valuable and feasible. The review identified the potential for harm to children/adolescents; however, rigorous selection, training and support strategies can mitigate negative outcomes. The ability of children to portray a role consistently across assessments, and deliver constructive feedback remains ambiguous.