Pharmacologic Therapy to Mitigate Acute Agitation in the Emergency Department: Case Reports of Diverse Patient Presentations.

Nurses in the emergency department often encounter patients exhibiting signs of aggressive behavior. Nurses need to know the pharmacologic treatment appropriate for the patient scenario to ensure safety for the patient and the emergency department team. This case review examines 4 common scenarios where a patient exhibits aggressive behavior. After each case review is a discussion about the appropriate pharmacologic therapy for that patient. The cases portrayed are fictional but based on experience and previous observations.

A Systematic Review of the Use of Standardized Patients as a Simulation Modality in Nursing Education.

AIM: The objective of the study was to search, extract, appraise, and synthesize studies using standardized patients (SPs) in nursing academia to determine how this modality of simulation is being used. BACKGROUND: SPs are a common simulation modality used in nursing education. METHOD: This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Five databases were searched as well as keywords to retrieve nonindexed citations for the period January 2011 to September 2016. The inclusion criteria included nurses, a simulated experience with SPs, and original research published in English. RESULTS: Sixty-five studies were identified and analyzed. CONCLUSION: More randomized controlled trials and studies with power analyses and validated measurement instruments are needed. Studies that compare SPs to high-fidelity simulators are also desired to determine optimal student learning outcomes and standardize best practices in simulation.

Promoting Interprofessional Collaborative Practice Through Simulation.

A 12-week program was developed to educate nursing, medicine, and physician assistant faculty on the principles and best practices of simulation. The goal was to facilitate team building and collaborative practice through the implementation of an interprofessional (IP) simulation experience for students. Workshops focused on IP communication involving seminar-based instruction, discussion, and the progressive development of an IP simulation based on a National League for Nursing Advancing Care Excellence for Seniors scenario. During the final session, students participated in the simulation while faculty evaluated and revised the scenario to best meet the needs of students from the three disciplines.

Challenges and Resources for New Critical Care Transport Crewmembers: A Descriptive Exploratory Study.

OBJECTIVE: The purpose of this study was to identify the challenges new crewmembers experience in the critical care transport (CCT) environment and to determine the most valuable resources when acclimating to the transport environment. To date, no study has focused on the unique challenges nor the resources most effective in CCT training. METHODS: This descriptive exploratory study was conducted with a convenience survey sent to the 3 largest professional CCT organizations: the Association of Air Medical Services, the Air and Surface Transport Nurses Association, and the Association of Critical Care Transport. RESULTS: The study survey responses revealed that more education and training are needed. Novice crewmembers identified areas in safety, communication, environment, and crew resource management as particularly challenging. Responses also validate the need for more simulation training, especially for CCT of low-volume/high-risk patient populations. CONCLUSION: Results of this survey provide valuable insight for improving training effectiveness of health care professionals transitioning to the CCT environment. More information regarding best practice on the frequency and timing of CCT simulation training should be collected, particularly for simulations completed in the transport environment.

Determining Content Validity and Reporting a Content Validity Index for Simulation Scenarios.

AIM: This article aims to assist educators and researchers in determining content validity (CV) and reporting a content validity index (CVI) for simulation scenarios. BACKGROUND: Educators and researchers involved in health care curricula may not recognize the need to validate and/or do not know how to validate a simulation scenario. METHOD: Two methods based on previous research that can be used to determine CV and report a CVI are discussed (Lynn and Lawshe). RESULTS: Simulation scenarios need to be written so experts can fully understand the entirety of content and accurately assess whether items are relevant. Information for a CV template for experts is provided. CONCLUSION: Determining item CV and reporting an overall CVI are important elements necessary to simulation scenarios, especially when the scenario is used in a high-stakes assessment or research.

Exploring the Frameworks, Needs, and Barriers of Interprofessional Education and Simulation in Emergency Medicine.

SUMMARY STATEMENT: This manuscript focuses on interprofessional education (IPE) using simulation and its use between emergency department and emergency medical services personnel. It explores the theoretical frameworks behind IPE and applies them to simulation-based emergency medical services education. There is a notable lack of research on the use of IPE using simulation between these 2 professions. The need for IPE using simulation as well as barriers and recommendations to remove the barriers are discussed.

The Use of Standardized Patients to Teach Communication Skills-A Systematic Review.

OBJECTIVES: The aim of this systematic review was to synthesize research completed between 2011 and 2021 to report the current state of the science on the use of standardized patients (SPs) to teach communication skills. The research question that guided this study was, "Among health care professionals, does the use of SP methodology as a means of teaching communication skills result in improved learner knowledge, skills, attitudes, and/or patient outcomes when compared with other simulation methodologies?" DESIGN: This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Data SourcesFour databases (CINAHL, Ovid Embase, Ovid Medline, and Scopus) were searched using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve nonindexed citations.Review MethodsThe inclusion criteria were broad to complete a comprehensive search of the literature. To be eligible for inclusion, a study had to be original research that compared simulation using an SP to another simulation methodology. The study had to evaluate communication knowledge, skill, attitude, and/or patient outcome with an academic or practicing health care professional. RESULTS: The initial database search strategy yielded 8058 citations. These results were narrowed down to 18 studies through an in-depth analysis of each article using identified inclusion criteria. The SPs were superior to role play in 1 (33%, n = 3) study where knowledge was evaluated, 6 (75%, n = 8) studies where skills were evaluated, and 1 (20%, n = 5) study where attitude was evaluated. The SPs were compared with a manikin in 5 studies. The SPs were superior to a manikin in 3 (60%, n = 5) studies where knowledge was measured and in 1 (100%, n = 1) study where attitude was measured. No study measured the outcome knowledge of an SP to a manikin. Finally, SPs were compared with a virtual SP in 3 studies. When knowledge was evaluated, SPs were superior to a virtual SP in 1 study (100%, n = 1). When skills were evaluated, SPs were superior to a virtual SP in 1 study (50%, n = 2), and when attitude was evaluated, SPs were superior to a virtual SP in no study (0%, n = 2). No study evaluated patient outcomes in the comparison of an SP to another simulation methodology. CONCLUSIONS: Studies show a weak indication that SP-based education is superior to other simulation methodologies in most contexts. However more rigorous studies with larger sample sizes, validated instruments, and effects on patient outcomes are needed to definitively determine the optimal method/modality for teaching communication to health care professionals.

Society for Simulation in Healthcare Guidelines for Simulation Training.

BACKGROUND: Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS: Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE: These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS: Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS: The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.

Using standardized patients to strengthen nurse practitioner competency in the clinical setting.

AIM: This paper serves as the outline for a simulation that nurse educators can use to better prepare graduate students for the clinical setting and ensure the student's essential competencies prior to clinical practicum. BACKGROUND: Educators often struggle with whether nurse practitioner students are sufficiently prepared for their clinical practicum once they have successfully completed the didactic component of their coursework. METHOD: This paper addresses the methods by which one institution uses standardized patients in a simulation laboratory to better prepare the graduate students for their first clinical practicum. The implications of using clinical simulation to enhance both student and faculty learning are addressed. RESULTS: Simulation done prior to a student's clinical practicum prepares the student for patient cases in the clinical setting. CONCLUSION: Clinical simulation can enhance the knowledge, skills, and attitudes that nurse practitioner students need in the clinical setting.

GIFTS: Graduate Interviews using Faculty, Technology, and Students.

This article describes an innovative teaching strategy-GIFTS (Graduate Interviews using Faculty, Technology, and Students)-that can be used to prepare doctoral nursing students for a faculty position interview after graduation. This type of educational strategy is needed in the face of the current nurse faculty shortage. In addition, it can serve to better prepare novice nurse educators who struggle with the transition from clinical practice to academia.

Learning in simulated environments: effect on learning transfer and clinical skill acquisition in nurse practitioner students.

This research study examined whether a transfer of learning (i.e., growth in clinical competency) occurred from the simulation laboratory to the clinical bedside and if it did occur, how. The study design was descriptive research, using 14 acute care nurse practitioner students. Observations were done in the simulation laboratory with a standardized patient and then in the clinical setting with an actual patient. The results showed significant growth in overall clinical competency from the simulation laboratory to the clinical bedside (M(diff) = 0.08, SE = 0.02, t(13) = 3.03, p = 0.01, r = 0.64). A statistically significant correlation was noted between the overall competency scores of students in the simulation laboratory and the overall competency scores in the clinical setting, with r(12) = 0.63, p < 0.01. Three themes emerged from the students' responses regarding how the simulation experience affected their clinical competency.

Practice makes perfect: tips for successful institutional review board submissions.

As the nursing profession seeks to develop evidence-based practice, nurses are being encouraged to embark on research in their institutions. Staff nurses and nurse clinicians often struggle with the process of obtaining institutional review board approval for their projects. When classes are available, the focus is frequently on informing nurses about the federal regulations for protection of human subjects. This article addresses practical strategies for addressing these regulations from the perspective of both the individual nurse and the nursing leader.

The Use of Simulation-Based Education With New Graduate Nurses in Emergency Department and Acute Care Settings: A Scoping Review.

Background The literature questions if newly graduated nurses are truly ready to practice at the bedside. Simulation has been shown to bridge the gap between theory and practice. The purpose of this study was to investigate what is known about the use of simulation education with novice graduate nurses in critical care settings in the hospital. Method A scoping review was conducted using the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Articles published in English between 2015 and September 2021 that focused on simulation education with novice graduate nurses in a critical care setting were included. Results The review yielded six articles. Conclusion The literature is scant on the use of simulation in critical care areas with novice graduate nurses. Additional inquiry is needed related to the role of learners, cost, timing, setting, and educational practices. More studies with stronger research designs and valid and reliable measurement instruments are also needed. Finally, there is a need to better understand the effects of simulation on novice nurse graduates' knowledge and skills as well as patient outcomes. [J Contin Educ Nurs. 2022;53(7):301-306.].

Guidelines and Essential Elements for Prebriefing.

STATEMENT: Simulationists have reported essential elements that need to be included during prebriefing to establish best practices in simulation and support learner success in simulation. However, there is a gap in the literature; there is a need for synthesis of these reported elements.This article reports the current established prebriefing standards and guidelines. It compiles all the elements that are recommended into one document to facilitate educator training. An infographic is included to serve as a cognitive aid and a checklist for facilitators to use in practice. Finally, this article discusses additional areas of inquiry and research that needs to be completed in relation to prebriefing.

State of Interprofessional Education in Nursing: A Systematic Review.

The aim of this systematic review was to synthesize research in the last 5 years to report the current state of the science related to interprofessional education (IPE) in nursing. Findings suggest that more studies with rigorous research designs are needed to compare outcomes for interprofessional interventions and to determine the effectiveness of IPE on patient outcomes.

Use of High-Fidelity Simulation to Increase Knowledge and Skills in Caring for Patients Receiving Blood Products.

Simulation has emerged in health care education programs over the past few decades. Acute-care institutions now provide simulation and high-fidelity simulation (HFS) experiences, nurse development, competency training, and evaluation. The International Association for Clinical Simulation and Learning has established best practice guidelines and a framework for multiple skills, such as blood transfusion. The Institute of Medicine report, To Err Is Human, brought patient safety issues to the forefront. Blood transfusion management is a skill for which HFS can provide a safe environment to educate and evaluate nurse competencies for blood transfusion management processes.

Using Simulation for Clinical Practice Hours in Nurse Practitioner Education in The United States: A Systematic Review.

OBJECTIVES: The National Organization for Nurse Practitioner Faculty (NONPF) does not allow simulation to be used in lieu of traditional clinical hours. The NONPF cites a lack of empirical evidence related to learning outcomes with simulation as rationale for its stance. The purpose of this systematic review was to search, extract, appraise, and synthesize research related to the use of simulation in Nurse Practitioner (NP) education in order to answer the two following questions: 1) What research related to simulation in NP education has emerged in the literature between 2010 and April 2015?, and 2) Of the research studies that have emerged, what level of Kirkpatrick's Training Evaluation Model (1994) is evaluated? DESIGN: This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: A literature search was completed in PubMed and CINAHL using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve non-indexed citations. REVIEW METHODS: The inclusion criteria for this review were broad in order to disseminate information on future research needed. The review considered studies related to NP education that included any form of simulation intervention, e.g. role-playing and standardized patients. The review considered studies that described original research, but no other design restrictions were imposed. The review was limited to studies published in the English language. RESULTS: The database search strategy yielded 198 citations. These results were narrowed down to 15 studies based on identified inclusion criteria. CONCLUSIONS: There is a lack of empirical evidence in the literature to support using simulation in lieu of direct patient care clinical hours in NP education. The evidence in this systematic review affirms NONPF's statement. Five years after the inception of NONPF's position statement, research to support learning outcomes with simulation in nurse practitioner education remains lacking. There is a need to produce rigorous scientific studies in the future in order to provide quantitative support to allow simulation to be counted as clinical hours in NP programs.

Multisite Single-Blinded Randomized Control Study of Transfer and Retention of Knowledge and Skill Between Nurses Using Simulation and Online Self-Study Module.

INTRODUCTION: Obstetric (OB) nurses must be proficient in performing a basic neurologic examination to assess and detect changes in a patients' neurologic status. This study aimed to compare knowledge and skill acquisition for a basic neurologic examination between OB nurses who participated in simulation and those who participated in an online self-study module. Short- and long-term knowledge retention and skill transfer between groups were evaluated. METHODS: Nurses were randomized to either simulation or online self-study module and assessed by direct observation and completion of a standardized instrument by the observer at 3 time points: baseline (time 1), within 7 days of baseline in the clinical setting (time 2), and at 2 months (time 3) using a validated12-item Neurologic Knowledge Assessment and a 14-item performance skill checklist. RESULTS: Among OB nurses, those in the simulation group demonstrated higher levels in both short-term (time 2) [mean (SD), 67.6 (20.2) vs. 29.6 (19.0); P < 0.001] and long-term (time 3) [mean (SD), 46.1 (17.6) vs. 27.5 (15.9); P < 0.001] skill performance compared with nurses in the online self-study module. Nurses in the simulation and online self-study module groups had similar mean levels on Neurologic Knowledge Assessment scores at time 2 (P = 0.86) and time 3 (P = 0.59), but these mean scores were not significant. CONCLUSIONS: The greater transfer of skills by nurses who received simulation education is an important finding because few studies have addressed this level of translation with practicing nurses. There was a lack of differences in short- and long-term knowledge acquisition between nurses in the simulation and online self-study module groups. More research is needed to determine the timing of simulation-based education repetition over time to aid in knowledge and skills retention.

Implementing the standards of best practice for simulation.

The Standards of Best Practice: Simulation are a resource for quality and consistency of simulation, evaluation of outcomes, and improvement of simulation programs. The Standards provide guidelines for practice and a vital framework for strategic planning, research, and faculty development. This article discusses challenges and shares approaches to enhance implementation of the Standards into practice to improve education, increase patient safety, and reduce variability in simulation experiences.