Joint and individual effectiveness of galvanic cutaneous stimulation and tactile stimulation at decreasing Simulator Adaptation Syndrome.

This research was focused on investigating the effectiveness of galvanic cutaneous stimulation and tactile stimulation jointly and individually at mitigating Simulator Adaptation Syndrome. Forty drivers (mean age = 23.1 ± 3.4 years old, twenty women) participated in a driving simulation experiment. Total scores of the Simulator Sickness Questionnaire, head movements (an index of body balance), and driving performance variables were compared across four different stimulation conditions: i) baseline (where no stimulation was presented), ii) galvanic cutaneous stimulation and iii) tactile stimulation deployed individually, and iv) both techniques deployed jointly. The results showed that both techniques presented in conjunction alleviate Simulator Adaptation Syndrome and improve driving performance more effectively than when they are presented in isolation. Importantly, reduced head movements were only revealed when galvanic cutaneous stimulation was applied. We concluded that the reduction of this syndrome is due to an improvement of body balance (elicited by galvanic cutaneous stimulation), and a distraction from the symptoms (elicited by tactile stimulation). We encourage the use of both techniques simultaneously to decrease Simulator Adaptation Syndrome.

Impact of high fidelity simulation on perceptions and professional skills in obstetrics.

BACKGROUND: In our country, the introduction of simulation as a teaching tool for obstetric emergencies is very recent. Several studies are being developed to evaluate its benefit in the continuing education of health professionals. OBJECTIVE: To evaluate the impact of a continuing medical education program based on High fidelity simulation drills (HFS) on professional skills in obstetrics. METHODS: 91 Learners were able to benefit from HFS continuing education program. Mean job tenure was 7.94 years [1-40]. RESULTS: We were able to highlight a positive impact of level 1 with satisfaction rates of more than 90%. 92% of participants said they left with tools applicable in the function framework. Midwives and emergency physicians were the most satisfied. The general evaluation before the beginning of the training had revealed an average score of 7.12/20 [2/20-13/20]. The variance of scores initially obtained was significantly related to the profession of the learner (p <0.0001, R = 0.61). We found significant improvement in post-training scores (p = 0.0001) and a mean difference of +1.46 [-6, +8.66]. These results highlight a level 2 impact of HFS training on learners' knowledge.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service.

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

The effect of mannequin fidelity on the achievement of learning outcomes for nursing, midwifery and allied healthcare practitioners: Systematic review and meta-analysis.

BACKGROUND: Simulation has demonstrated superiority over purely didactic instruction in multiple contexts, and educationalists have embraced this modality for enhancing access to clinical skills. However, there remains uncertainty if increasing the realism (fidelity) of simulation equipment heightens performance. To address this within nursing and allied health, this review examines if increasing equipment fidelity improves learning outcomes. METHODS: A systematic search of; CINAHL, Academic Search Complete, AMED; British Education Index, ERIC, MEDLINE, PsycARTICLES, PsycINFO, Maternity and Infant Care, INTERMID, Google Scholar, American Doctoral Dissertations, EThOS, ClinicalTrials.gov and ISRCTN registers was conducted for trials comparing two or more fidelity levels for knowledge, psychomotor or affective/non-technical outcomes. Data extraction and quality appraisal were performed and independently verified. Subgroup meta-analyses were undertaken (where viable), at post-intervention, intermediate, and long-term assessment time-frames. RESULTS: 18 RCTs and quasi-experimental trials containing ~1192 participants met the inclusion criteria. Almost ¾ of included trials exhibited high risk-of-bias. Training on higher-fidelity mannequins was associated with improved performance immediately post-intervention when compared with training on lower-fidelity mannequins for knowledge (p < 0.00001) and psychomotor outcomes (p < 0.00001). A similar directional effect for affective/non-technical skills was considered less robust due to substantial weaknesses in available studies. During follow-up testing at intermediate (1-3 weeks) and long-term (1-6 months) data points, there was insufficient evidence to determine any advantage in the use of higher fidelity mannequins. Repeated-intervention training was also insubstantially reported. CONCLUSION: Higher-fidelity mannequins exhibited modest advantages when testing closely followed training. However results need to be confirmed using a larger number of high quality RCTs. A greater body of research using repeated-interventions and extended time-frames is also required before the influence of sustained training with alternative mannequins can be fully elucidated.

Relaxation before Debriefing during High-fidelity Simulation Improves Memory Retention of Residents at Three Months: A Prospective Randomized Controlled Study.

BACKGROUND: High-fidelity simulation is known to improve participant learning and behavioral performance. Simulation scenarios generate stress that affects memory retention and may impact future performance. The authors hypothesized that more participants would recall three or more critical key messages at three months when a relaxation break was performed before debriefing of critical event scenarios. METHODS: Each resident actively participated in one scenario and observed another. Residents were randomized in two parallel-arms. The intervention was a 5-min standardized relaxation break immediately before debriefing; controls had no break before debriefing. Five scenario-specific messages were read aloud by instructors during debriefings. Residents were asked by telephone three months later to recall the five messages from their two scenarios, and were scored for each scenario by blinded investigators. The primary endpoint was the number of residents participating actively who recalled three or more messages. Secondary endpoints included: number of residents observing who recalled three or more messages, anxiety level, and debriefing quality. RESULTS: In total, 149 residents were randomized and included. There were 52 of 73 (71%) residents participating actively who recalled three or more messages at three months in the intervention group versus 35 of 76 (46%) among controls (difference: 25% [95% CI, 10 to 40%], P = 0.004). No significant difference was found between groups for observers, anxiety or debriefing quality. CONCLUSIONS: There was an additional 25% of active participants who recalled the critical messages at three months when a relaxation break was performed before debriefing of scenarios. Benefits of relaxation to enhance learning should be considered for medical education.

Blending virtual with conventional learning to improve student midwifery skills in India.

India's state of Bihar has suboptimal quality of pre-service training for auxiliary nurse midwives. To address this, state government of Bihar implemented a blended training model to supplement conventional classroom teaching with virtual training. A 72-hour virtual training package with updated content on key maternal and newborn health practices was developed for final year students and broadcasted from one instructor location simultaneously to two auxiliary nurse midwives training centres. This pre-post intervention study compared skills of two auxiliary nurse midwife student cohorts. Eighty-five students from pre-intervention cohort of academic year 2012-13, received only conventional teaching during the final year. The 51 students in the post-intervention cohort from successive academic year 2013-14, received a combination of the both conventional and virtual training. The two cohorts were objectively assessed on identified midwifery skills. A passing score was set at achieving 75% or higher. The students exposed to blended learning scored 32.57 points (p = <0.001) more than their counterparts, who received only conventional teaching. In the post-intervention cohort, 55% students (N = 28) passed as compared to none in the pre-intervention cohort. We found blended learning approach effectively improved access to quality training, and identified key midwifery skills of auxiliary nurse midwife students from remote locations.

Medidas de acurácia da resposta disfuncional ao desmame ventilatório: subsídios para metodologia e aprimoramento do raciocínio diagnóstico através da simulação clínica / Accuracy measures os dysfunctional response to weaning: subsidies for methodology and improvement of diagnostic reasoning through clinical simulation

OBJETIVO: Analisar as medidas de acurácia diagnóstica da Resposta Disfuncional ao Desmame Ventilatório e os seus desfechos na extubação de pacientes de terapia intensiva e aplicar as medidas de acurácia da Resposta Disfuncional ao Desmame Ventilatório, utilizando- se a metodologia da simulação clínica. MÉTODO: Um estudo longitudinal do tipo coorte prospectiva com abordagem quantitativa. LOCAL: unidade de terapia intensiva de um hospital de ensino no Sudeste do Brasil e laboratório de simulação clínica em Portugal. PACIENTES: A amostra selecionada no estudo foi constituída por 46 pacientes ventilados mecanicamente. Em cada paciente foram verificadas as características definidoras em cinco tempos distintos, desmembrados em intervalos de 5, 10, 15, 30 e 60 minutos. Nesse caso, cada paciente era avaliado por cinco vezes, totalizando um quantitativo de 230 avaliações. MEDIDAS E PRINCIPAIS RESULTADOS: As principais causas de reintubação foram hipoxemia e aumento do trabalho respiratório. Prevalência de Insucesso foram de 14 eventos (33,3%) e a prevalência da RDDV foram de 13 eventos (30,95%). No total, foram obtidos 35 eventos, considerando-se a RDDV e os desfechos clínicos. A associação entre resposta disfuncional na extubação e o insucesso na extubação apresentou, por meio do teste do qui-quadrado um valor de 16,098 (p=0,00006). Os indicadores clínicos que mais se destacaram pelas métricas de acurácia diagnóstica foram: desconforto respiratório, respiração abdominal paradoxal, aumento da concentração respiratória, uso importante da musculatura acessória, ruídos adventícios respiratórios, percepção aumentada de oxigênio e fadiga. O desmame foi conduzido pela equipe multiprofissional (médicos, enfermeiros e fisioterapeutas). O desmame foi conduzido pela equipe multiprofissional (médicos, enfermeiros e fisioterapeutas). As características preditivas foram calculadas a partir dos testes de regressão logística e demonstraram que ruídos adventícios respiratórios, desconforto respiratório e uso importante da musculatura acessória respiratória foram estatisticamente significativas e constituíram o modelo de regressão. Apresentado modelo de regressão logística entre a variável dependente - presença de RDDV - e cada uma das variáveis independentes, os indicadores clínicos e desfechos da extubação orotraqueal. Essa análise permitiu identificar se a relação entre as variáveis testadas era distribuída ao acaso. Dessa forma, obteve-se a relação entre cada variável independente e a variável desfecho insucesso na extubação, sendo medida a força de associação através do teste do qui-quadrado, Odds Ratio (O.R.) e por seu intervalo de confiança (IC) de 95%. Os impactos gerados pelo insucesso de desmame e extubação são multifacetados e constituem indicadores de qualidade em UTIs, pois há aumento das infecções e da mortalidade hospitalar, o que onera expressivamente os custos da internação. A extubação deve ser guiada por julgamento clínico e dados objetivos para minimizar o risco de reintubações. Por meio da simulação clínica, construiu-se um caso clínico com bases conceituais e metodológicas na teoria do duplo processamento, por meio do qual foram desenvolvidas as cenas, a partir das habilidades esperadas dos enfermeiros, durante a simulação. A elaboração e a validação do cenário clínico para a simulação foram importantes para reduzir incertezas na sua construção. CONCLUSÕES: O estudo permitiu a distinção entre o constructo clínico da RDDV, numa avaliação das respostas apresentadas à experiência da extubação orotraqueal, na perspectiva de uma visão holística, e o insucesso de extubação, num modelo mais voltado à terapia e processos fisiopatológicos.

OBJECTIVE: To analyze the diagnostic accuracy measures of the Dysfunctional Ventilatory Weaning Response and their outcomes in extubation of intensive care patients and apply the measures of accuracy of the Dysfunctional Ventilatory Weaning Response using the clinical simulation methodology. METHOD: A prospective cohort longitudinal study with a quantitative approach. SETTING: Intensive care unit of a teaching hospital in southeastern Brazil and clinical simulation laboratory in Portugal. PATIENTS: The sample selected in the study consisted of 46 mechanically ventilated patients. In each patient, the defining characteristics were verified at five different times, broken down at intervals of 5, 10, 15, 30 and 60 minutes. Therefore, each patient was evaluated five times, for a total of 230 evaluations. MEASURES AND MAIN RESULTS: The main causes of reintubation were hypoxemia and increased respiratory work. Failure prevalence was 14 events (33.3%) and the prevalence of DVWR was 13 events (30.95%), in total, 35 events were obtained, considering DVWR and clinical outcomes. The association between dysfunctional response in extubation and failure in extubation showed, through the chi-square test, a value of 16.098 (p = 0.00006). The clinical indicators that most stood out for the metrics of diagnostic accuracy were respiratory distress, paradoxical abdominal breathing, increased respiratory concentration, important use of accessory muscles, adventitious respiratory sounds, increased oxygen perception and fatigue. Weaning was carried out by the multiprofessional team (doctors, nurses and physiotherapists). Predictive characteristics were calculated from logistic regression tests and demonstrated that adventitious respiratory sounds, respiratory distress and important use of respiratory accessory muscles were statistically significant and constituted the regression model. A logistic regression model was presents between the dependent variable- presence of DVWRr- and each of the independent variables, the clinical indicators and outcomes of orotracheal extubation. This analysis made it possible to identify whether the relationship between the variables tested was randomly distributed. Thus, the relationship between each independent variable and the outcome variable extubation failure was obtained, and the strength of association was measured using the chi-square test, OddsRatio (OR) and its 95% confidence interval (CI). The impacts generated by the failure of weaning and extubation are multi-faceted and constitute quality indicators in ICUs, since there is an increase in infections, in-hospital mortality and significantly increase the costs of hospitalization. Extubation should be guided by clinical judgment and objective data to minimize the risk of reintubations. Through clinical simulation, a clinical case was constructed with conceptual and methodological bases in the double processing theory, through which scenes were developed, based on the skills expected of nurses during the simulation. The elaboration and validation of the clinical scenario for the simulation was important to reduce uncertainties in its construction. CONCLUSIONS: The study allowed the distinction between the clinical construct of DVWR, in an evaluation of the responses presented, the experience of orotracheal extubation, from the perspective of a holistic view and the extubation failure, in a model more focused on therapy and pathophysiological processes.

OBJETIVO: Analizar las medidas de precisión diagnóstica de la Respuesta Ventilatoria Disfuncional al Destete y sus resultados en la extubación de pacientes de terapia intensiva, y aplicar las medidas de precisión de la Respuesta Ventilatoria Disfuncional al Destete utilizando simulación clínica. MÉTODO: Estudio longitudinal tipo cohorte prospectivo con abordaje cuantitativo. LUGAR: Unidad de terapia intensiva de hospital de enseñanza del Sudeste de Brasil y laboratorio de simulación clínica en Portugal. PACIENTES: Muestra integrada por 46 pacientes en ventilación mecánica. Fueron verificadas en cada paciente las características definitorias en cinco momentos distintos, separados en intervalos de 5, 10, 15, 30 y 60 minutos. Consecuentemente, cada paciente fue evaluado cinco veces, habiéndose realizado en total 230 evaluaciones. MEDIDAS Y RESULTADOS PRINCIPALES: Las principales causas de reintubación fueron: hipoxemia y aumento del trabajo respiratorio; El fracaso se manifestó en 14 eventos (33,3%), la prevalencia de RVDD se expresó en 13 eventos (30,95%). En total se registraron 35 eventos, considerando la RVDD y los resultados clínicos. La asociación entre respuesta disfuncional en extubación y fracaso en extubación presentó, según resultados del test Chi-cuadrado, valor de 16,098 (p=0,00006). Los indicadores clínicos más destacados en las mediciones de precisión diagnóstica fueron: incomodidad respiratoria, respiración abdominal paradojal, aumento de concentración respiratoria, uso significativo de musculatura accesoria, ruidos adventicios respiratorios, percepción aumentada de oxígeno y fatiga. El destete fue dirigido por el equipo multiprofesional (médicos, enfermeros y fisioterapeutas). Fue presentada la regresión logística entre la variable dependiente - presencia de RVDD- y cada variable independiente, los indicadores clínicos y resultados de la extubación ortotraqueal. Dicho análisis permitió identificar si la relación entre las variables testeadas tenía distribución aleatoria. Así, se obtuvo la relación entre cada variable independiente y la variable resultante en fracaso en la extubación, midiéndose la fuerza asociativa por test de Chi-cuadrado, Razón de Chances (OR) e intervalo de confianza (IC) del 95%. Los impactos determinados por el fracaso del destete y extubación presentan múltiples facetas y constituyen indicadores de calidad en UTIs, al existir incremento de infecciones, mortalidad hospitalaria y manifiesto aumento de costos de internación. La extubación debe orientarse por juicio clínico y datos objetivos, para minimizar el riesgo de reintubaciones. Se construyó un caso clínico mediante simulación con bases conceptuales y metodológicas de la teoría del doble procesamiento. En base al mismo se elaboraron escenarios, partiéndose de las habilidades esperadas de los enfermeros durante la simulación. La elaboración y validación del escenario clínico de la simulación resultó importante para reducir la incertidumbre en su construcción. CONCLUSIONES: El estudio permitió distinguir entre el constructo clínico de la RVDD, en una evaluación de las respuestas manifestadas ante la experiencia de la extubación ortotraqueal en la perspectiva de una visión holística, y el fracaso de la extubación en un modelo más orientado a la terapia y a procesos fisiopatológicos.

Using simulation to improve the capability of undergraduate nursing students in mental health care.

INTRODUCTION: Mental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment. INTERVENTION: Undergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges. METHODS: Using a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting. RESULTS: Students who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting. DISCUSSION: This study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.

Computer Imagery and Neurological Rehabilitation: On the Use of Augmented Reality in Sensorimotor Training to Step Up Naturally Occurring Cortical Reorganization in Patients Following Stroke.

This work promotes the use of computer-generated imagery -as visual illusions- to speed up motor learning in rehabilitation. In support of this, we adhere the principles of experience-dependent neuroplasticity and the positive impact of virtual reality (VR) thereof. Specifically, post-stroke patients will undergo motor therapy with a surrogate virtual limb that fakes the paralyzed limb. Along these lines, their motor intentions will match the visual evidence, which fosters physiological, functional and structural changes over time, for recovery of lost function in an injured brain. How we make up such an illusion using computer graphics, is central to this paper.