A scoping review of the globally available tools for assessing health research partnership outcomes and impacts.

BACKGROUND: Health research partnership approaches have grown in popularity over the past decade, but the systematic evaluation of their outcomes and impacts has not kept equal pace. Identifying partnership assessment tools and key partnership characteristics is needed to advance partnerships, partnership measurement, and the assessment of their outcomes and impacts through systematic study. OBJECTIVE: To locate and identify globally available tools for assessing the outcomes and impacts of health research partnerships. METHODS: We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL + , PsychINFO) with an a priori strategy from inception to June 2021, without limits. We screened studies independently and in duplicate, keeping only those involving a health research partnership and the development, use and/or assessment of tools to evaluate partnership outcomes and impacts. Reviewer disagreements were resolved by consensus. Study, tool and partnership characteristics, and emerging research questions, gaps and key recommendations were synthesized using descriptive statistics and thematic analysis. RESULTS: We screened 36 027 de-duplicated citations, reviewed 2784 papers in full text, and kept 166 studies and three companion reports. Most studies originated in North America and were published in English after 2015. Most of the 205 tools we identified were questionnaires and surveys targeting researchers, patients and public/community members. While tools were comprehensive and usable, most were designed for single use and lacked validity or reliability evidence. Challenges associated with the interchange and definition of terms (i.e., outcomes, impacts, tool type) were common and may obscure partnership measurement and comparison. Very few of the tools identified in this study overlapped with tools identified by other, similar reviews. Partnership tool development, refinement and evaluation, including tool measurement and optimization, are key areas for future tools-related research. CONCLUSION: This large scoping review identified numerous, single-use tools that require further development and testing to improve their psychometric and scientific qualities. The review also confirmed that the health partnership research domain and its measurement tools are still nascent and actively evolving. Dedicated efforts and resources are required to better understand health research partnerships, partnership optimization and partnership measurement and evaluation using valid, reliable and practical tools that meet partners' needs.

Change fatigue in nursing: An integrative review.

AIMS: To synthesize the empirical and theoretical literature on change fatigue in nursing, including how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. BACKGROUND: Change fatigue refers to the overwhelming feelings of stress, exhaustion and burnout associated with rapid and continuous change across healthcare organizations. Change fatigue can affect nurses' wellbeing, yet there is a distinct lack of literature which synthesizes the relationship between cumulative organizational change and nurses' wellbeing. DESIGN: Integrative review following Toronto and Remington and Whittemore and Knafl methodology. DATA SOURCES: Searches were conducted in CINAHL, Embase, Medline, APA PsycInfo, Scopus, Business Source Complete and ProQuest Dissertations & Theses Global in January 2022. REVIEW METHODS: A comprehensive search was conducted to identify literature on change fatigue in nursing. Included literature were critically appraised for methodological quality. Data from each article were abstracted and thematically analysed. RESULTS: Twenty-six articles were included in this review, including 14 empirical studies, 10 theoretical papers and two literature reviews. Five main themes described in the literature included: definitions, preceding factors, associated behaviours, consequences and mitigation strategies for change fatigue. CONCLUSION: This review highlights the impact of rapid and continuous change on nurses and nursing practice. Further research is needed to explore the relationship between change fatigue and burnout, understand how and why nurses withdraw or avoid change, and to develop a metric to measure change fatigue when considering new change initiatives. IMPACT: Findings from this review generated an improved understanding of how change fatigue affects nurses, the nursing profession and strategies to prevent and overcome it. This paper provides practical recommendations for future research, direction for nursing educators and leaders, and encourages nurses to practice political agency with change management. PATIENT OR PUBLIC CONTRIBUTION: This project was an integrative review of the literature therefore no patient or public contribution was necessary.

Evaluating fundamental care knowledge to inform educational leadership.

AIM: To explore undergraduate nursing students' understanding of fundamental care and identify educational leadership opportunities to deepen students' understanding of fundamental care concepts. DESIGN: Sequential-explanatory mixed methods study. METHODS: We conducted a cross sectional survey (n = 202) and focus groups (n = 24) to explore undergraduate nursing students' ability to identify fundamental care needs. All data were collected between November 2020 and April 2021. Survey data were analysed using descriptive and inferential statistics and focus group data were thematically analysed. RESULTS: Year One students scored significantly lower in their ability to identify fundamental care needs compared with students in other years, even after controlling for route, gender and age. Post-degree students scored significantly higher than direct entry or transfer students. Students ≤19 years of age had significantly lower scores compared with students ≥25 years of age. Our focus group findings highlighted that students were often unable to define fundamental care, but they identified learning about various components of fundamental care in a variety of ways. While students understood that fundamental care was required in all settings, they were challenged in providing this care in acute and virtual settings. Students shared several suggestions to support fundamental care skills development across the curriculum. CONCLUSIONS: There is a need for a clear definition and description of the fundamentals of care that is used consistently by faculty, students and curriculum documents. It is important to encourage and support educators to share real-world nursing stories, offer students time to share their personal experiences, develop creative learning opportunities and foster student reflection to deepen students' understanding of the fundamentals of care. IMPACT: Educators need support to meaningfully incorporate fundamentals of care learning opportunities across multiple care settings. Educational leaders can use these findings to develop or adapt their curricula to support fundamental care skill development.

Interpretive description in applied mixed methods research: Exploring issues of fit, purpose, process, context, and design.

As mixed methods research approaches become increasingly more common, it is imperative they are conducted in a thoughtful and rigorous manner to yield useful results. While researchers have begun to explore the use of various qualitative research methodologies in mixed methods research, there is a gap in literature discussing the philosophical congruence of using interpretive description in mixed method studies, and how to ensure rigor while integrating interpretive description results. Our purpose in writing this article is to discuss the issues of fit, purpose, process, context, and design when using interpretive description in mixed methods research approaches by drawing on examples from the literature. Further, we explore the contributions that interpretive description can make in a mixed methods inquiry. This article offers a first step in using a purposeful approach to mixed methods interpretive description studies to increase transparency and rigor in this relatively new methodology.

Interprofessional socialization: a concept analysis.

We report a concept analysis of the term interprofessional socialization, conducted using the Walker and Avant approach. Our literature search resulted in 27 publications with meaningful insights regarding interprofessional socialization, published between 1994-2022. We identified five defining attributes of interprofessional socialization: (a) learning about other professionals and the roles they play on interprofessional teams, (b) recognizing the value of collaborating with other professionals, (c) identifying a common goal shared across professions, (d) breaking down barriers between professional silos, and (e) developing dual identity: a professional identity and an interprofessional identity. We identified antecedents, consequences, empirical referents, and cases to better illustrate the concept. Insights from this concept analysis provided the foundation for a conceptual definition. Interprofessional socialization is an iterative process in which members from different professions come together to learn about and value each other's perspectives and contributions, while dispelling misconceptions and prejudices, continuously working toward formation of a dual identity: one for professional identity and one for interprofessional identity. Future research is needed to explore how interprofessional socialization changes over the course of a career and how efforts to increase interprofessional socialization across healthcare settings might impact interprofessional initiatives throughout healthcare systems.

How are health research partnerships assessed? A systematic review of outcomes, impacts, terminology and the use of theories, models and frameworks.

BACKGROUND: Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual, psychometric and pragmatic characteristics, could improve the quantification, measurement and reporting partnership outcomes and impacts. This cascading review was undertaken as part of a coordinated, multicentre effort to identify, synthesize and assess a vast body of health research partnership literature. OBJECTIVE: To systematically assess the outcomes and impacts of health research partnerships, relevant terminology and the type/use of theories, models and frameworks (TMF) arising from studies using partnership assessment tools with known conceptual, psychometric and pragmatic characteristics. METHODS: Four electronic databases were searched (MEDLINE, Embase, CINAHL Plus and PsycINFO) from inception to 2 June 2021. We retained studies containing partnership evaluation tools with (1) conceptual foundations (reference to TMF), (2) empirical, quantitative psychometric evidence (evidence of validity and reliability, at minimum) and (3) one or more pragmatic characteristics. Outcomes, impacts, terminology, definitions and TMF type/use were abstracted verbatim from eligible studies using a hybrid (independent abstraction-validation) approach and synthesized using summary statistics (quantitative), inductive thematic analysis and deductive categories (qualitative). Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS: Application of inclusion criteria yielded 37 eligible studies. Study quality scores were high (mean 80%, standard deviation 0.11%) but revealed needed improvements (i.e. methodological, reporting, user involvement in research design). Only 14 (38%) studies reported 48 partnership outcomes and 55 impacts; most were positive effects (43, 90% and 47, 89%, respectively). Most outcomes were positive personal, functional, structural and contextual effects; most impacts were personal, functional and contextual in nature. Most terms described outcomes (39, 89%), and 30 of 44 outcomes/impacts terms were unique, but few were explicitly defined (9, 20%). Terms were complex and mixed on one or more dimensions (e.g. type, temporality, stage, perspective). Most studies made explicit use of study-related TMF (34, 92%). There were 138 unique TMF sources, and these informed tool construct type/choice and hypothesis testing in almost all cases (36, 97%). CONCLUSION: This study synthesized partnership outcomes and impacts, deconstructed term complexities and evolved our understanding of TMF use in tool development, testing and refinement studies. Renewed attention to basic concepts is necessary to advance partnership measurement and research innovation in the field. Systematic review protocol registration: PROSPERO protocol registration: CRD42021137932 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137932 .

Pragmatism as a philosophical foundation to integrate education, practice, research and policy across the nursing profession.

AIM: A discussion of the philosophy of pragmatism and how it can underpin and integrate nursing education, practice, research and policy across the nursing profession. BACKGROUND: Although the concepts of plurality, truth, fallibilism, subjectivity and meliorism have been discussed across foundational philosophical literature, the relation of these concepts across various facets of the nursing profession have not been thoroughly articulated in the nursing literature. DESIGN: Critical theoretical reflection. DATA SOURCES: In this article, we draw from literature written on the philosophy of pragmatism from 1907 through to 2021. IMPLICATIONS FOR NURSING: We propose an integrative approach for the nursing profession where education, practice, research and policy speak and contribute to each other through a lens of pragmatism. In this approach, education has a relationship with practice and practice has a direct line to research where nurses on the front lines can engage with pragmatic inquiry. Researchers in return can inform frontline nurses and policymakers of evidence emerging in areas pertinent to practice. These relationships are made possible through integrated knowledge translation by including all stakeholders at every point of knowledge generation. Each facet of the nursing profession is filled with stakeholders of nursing knowledge, who are invested in its utility. Although it requires focused effort to integrate knowledge across the profession, pragmatism calls for action in the face of challenges in hope for a stronger body of nursing knowledge and ultimately profession. CONCLUSION: Pragmatism is an apt philosophy to underpin and integrate nursing education, practice, research and policy across the nursing profession.

A Dog with an Office: The Process of Embedding a Wellness Dog Intervention in a University Setting.

Universities are places to promote the wellbeing of people who learn, work, and live within them. This article reports on an innovative, holistic, and embedded wellness dog program that was developed by the Faculty of Nursing to support the wellbeing of students, faculty, and staff. The innovation included a collaborative partnership between two faculties (the faculties of Veterinary Medicine and Nursing), and the targeted purchase, training, and socialization of a wellness dog. Pet wellness programs have the potential to be an important mental health intervention on university campuses. While the program was postponed due to COVID-19, the purpose of this article is to share processes used to create the wellness dog program, with suggestions regarding implementation and evaluation.

Nursing students' experiences and perceptions of an innovative graduate level healthcare grand challenge course: a qualitative study.

Nursing leaders are increasingly required to create and implement innovative solutions to address challenges in the workplace. However, the present-day education of graduate nurses may not adequately prepare them for entrepreneurial approaches to problem solving required in today's complex healthcare environments. To fill this gap, we designed, implemented, and evaluated a Healthcare Grand Challenge course for graduate nurses interested in developing their leadership skills. Following the course, students were invited to participate in a qualitative research study to explore their experiences and perceptions of the course and identify how they used the knowledge and skills developed through the course in their leadership practices. This study provides key lessons for future offerings of grand challenge courses while highlighting the influence of grand challenge courses on current and future nursing leadership practice.

A grounded theory of clinical nurses' process of coping during COVID-19.

AIMS AND OBJECTIVES: To explore clinical nurses' process of coping during COVID-19 and develop a grounded theory that can be used by leaders to support clinical nurses during a disaster. BACKGROUND: The COVID-19 pandemic has provoked widespread disruption to clinical nurses' work. It is important to understand clinical nurses' processes of coping during disasters to support the nursing workforce during events such as global pandemics. DESIGN: We employed the Corbin and Strauss variant of grounded theory methodology, informed by symbolic interactionism, and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS: Data collection entailed semi-structured interviews with experienced clinical nurses (n =20) across diverse settings. We analysed data by identifying key points in the nurses' coping processes inductively building concepts around these points. RESULTS: The predictor of nurses' outcomes in this grounded theory was their confidence in their ability to cope during the pandemic. When nurses lacked confidence, they experienced working in the context of acute COVID-a state of chaos and anxiety, with negative consequences for nurses. However, when nurses were confident in their abilities to cope with the pandemic, they experienced working in the context of chronic COVID, a calmer state of acceptance. There were many workplace factors that influenced nurses' confidence, including adequacy of personal protective equipment, clear information and guidance, supportive leadership, teamwork and adequate staffing. CONCLUSIONS: Understanding clinical nurses' experience of coping during COVID-19 is essential to maintain the nursing workforce during similar disasters. RELEVANCE TO CLINICAL PRACTICE: Nurse leaders can target areas that support nurses' confidence, such as adequate PPE and staffing. In turn, increased confidence enables clinical nurses to cope during disasters such as a global pandemic.

'The office of disaster management' nurse managers' experiences during COVID-19: A qualitative interview study using thematic analysis.

AIM: The purpose of this study was to understand the experiences of nurse managers during the COVID-19 pandemic. BACKGROUND: There is a growing body of knowledge about the experiences of clinical nurses during COVID-19. However, there is less evidence about the experiences of nurse managers during the pandemic. METHODS: Eight nurse managers, from acute care and outpatient settings, completed semistructured interviews about how their roles had changed during the pandemic, how they felt about these changes, and what had gone well or been difficult. Each participant was interviewed once, for 20-60 min. We used thematic analysis methods to analyse the interview transcripts. FINDINGS: Nurse managers had to coordinate care in a context of uncertainty and guidance that changed frequently. Participants found that their roles and responsibilities either expanded to include more duties, or they were asked to take on a completely new role, with no orientation or training. Nurse managers were expected to provide support to their staff and patients, but did not necessarily receive support themselves. Participants were expected to plan simultaneously for care during the pandemic and for a return to normal working conditions. These factors contributed to challenging and difficult participant experiences of managing during COVID-19. CONCLUSION: Nurse managers' experiences during COVID-19 are influenced by changes to their roles and the support they received. Nurse managers continue to support high-quality care despite working a difficult context. IMPLICATIONS FOR NURSING MANAGEMENT: Where possible, nurse managers can be supported to extend their roles or receive additional education and support if they are required to take on new responsibilities. Nurse managers require support in order to be a resource for their staff.

Transition in Care from EMS Providers to Emergency Department Nurses: A Systematic Review.

Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. Methods: We conducted a mixed-methods systematic review that included searches of electronic databases (DARE, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Joanna Briggs Institute EBP), gray literature databases, organization websites, querying experts in emergency medicine, and the reference lists cited in included studies. All English-language studies of any design were eligible for inclusion. Two reviewers independently screened titles/abstracts and full-texts for inclusion and methodological quality, as well as extracted data from included studies. We used narrative and thematic synthesis to integrate and explore relationships within the data. Results: In total, 8,348 studies were screened and 130 selected for full text review. The final synthesis included 20 studies. Across 15 studies of moderate-to-high methodological quality, 6 factors influenced transitions: different professional lenses, operational constraints, professional relationships, information shared between the professions, components of the transition process, and patient presentation and involvement. Three interventions were identified in 6 methodologically weak studies: (1) transition guideline (DeMIST, Identification, Mechanism/Medical complaint, Injuries/Information related to the complaint, Signs, Treatment and Trends - Allergies, Medication, Background history, Other information [IMIST-AMBO]) with training, (2) mobile web-based technology (EMS smartphone and geographic information system location data), and (3) a new clinical role (ED ambulance off-load nurse dedicated to triaging and assessing EMS patients). There were mixed findings for the effectiveness of transition guidelines and the new clinical role. Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given review findings that interdisciplinary communication and relationships can be challenging.

Healthcare Providers' Perceptions of Single-Room Versus Traditional Maternity Models: A Concurrent Mixed-Methods Study.

While many hospitals have transitioned from traditional maternity care to a single-room maternity model, little is known about how healthcare providers' practice differs between the models. This mixed-methods study compared healthcare providers' job satisfaction and team collaboration between traditional and single-room maternity care and explored how each model shaped providers' practice. Data were collected via questionnaires and interviews with healthcare providers from 2 hospitals. Independent t tests, Mann-Whitney U tests, and thematic analysis were used in analysis; findings were then triangulated. No difference was found in team collaboration and job satisfaction scores between single-room (n = 84) and traditional (n = 42) maternity care; however, providers described different means toward satisfaction and collaboration in the interviews (n = 18). Single-room maternity care providers valued interprofessional teamwork, patient/family involvement, and continuity of care. Traditional maternity care providers enjoyed specialization but described teamwork as uniprofessional and disconnected across professions; transfers between units weakened communication and fragmented care. While single-room maternity care providers described less tension and a more holistic patient-family journey, further research must be undertaken to examine whether and how interprofessional collaboration and communication impact patient and health system outcomes.

Mixed methods systematic review exploring mentorship outcomes in nursing academia.

AIMS: The aim of this study was to report on a mixed methods systematic review that critically examines the evidence for mentorship in nursing academia. BACKGROUND: Nursing education institutions globally have issued calls for mentorship. There is emerging evidence to support the value of mentorship in other disciplines, but the extant state of the evidence in nursing academia is not known. A comprehensive review of the evidence is required. DESIGN: A mixed methods systematic review. DATA SOURCES: Five databases (MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO) were searched using an a priori search strategy from inception to 2 November 2015 to identify quantitative, qualitative and mixed methods studies. Grey literature searches were also conducted in electronic databases (ProQuest Dissertations and Theses, Index to Theses) and mentorship conference proceedings and by hand searching the reference lists of eligible studies. REVIEW METHODS: Study quality was assessed prior to inclusion using standardized critical appraisal instruments from the Joanna Briggs Institute. A convergent qualitative synthesis design was used where results from qualitative, quantitative and mixed methods studies were transformed into qualitative findings. Mentorship outcomes were mapped to a theory-informed framework. RESULTS: Thirty-four studies were included in this review, from the 3001 records initially retrieved. In general, mentorship had a positive impact on behavioural, career, attitudinal, relational and motivational outcomes; however, the methodological quality of studies was weak. CONCLUSION: This review can inform the objectives of mentorship interventions and contribute to a more rigorous approach to studies that assess mentorship outcomes.

Delegate, Collaborate, or Consult? A Capstone Simulation for Senior Nursing Students.

Clinical experiences are educational and fulfilling for both students and faculty; however, challenges arise in providing students with a variety of experiences where the leadership skills of prioritizing, collaborating, consulting, and delegating care can be developed. This article reports on a capstone simulation created to develop and sustain the prioritization, organization, and delegation skills of fourth year nursing students. Through the introduction of a multipatient simulation prior to graduation, nursing students will have a better understanding of the high-level leadership skills practicing registered nurses must possess in today's demanding health care environment.

Nursing students learning transfer from classroom to clinical practice: An integrative review.

AIM: The aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice. BACKGROUND: As nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students' learning transfer has not yet been synthesized. DESIGN: This integrative review was conducted using the Whittemore and Knafl framework. REVIEW METHODS: Eight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute's critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. RESULTS: Twenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students' ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators. CONCLUSIONS: The information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students' learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.

Students and simulation facilitators' experiences and perceptions of a distraction and interruption simulation: a mixed-methods study.

BACKGROUND: While distractions and interruptions are leading causes of errors during medication preparation, most nursing students are not taught how to manage distractions in a highly-interruptive environment. To help prepare nursing students to manage distractions and interruptions in clinical practice, we developed, implemented, and evaluated a medication preparation distraction and interruption simulation. OBJECTIVES: To explore student and simulation facilitators experiences and perceptions of a distraction and interruption simulation. DESIGN: A sequential explanatory mixed-methods design was adopted including surveys, interviews, and focus groups. SETTING: A mid-sized research intensive western Canadian university. PARTICIPANTS: A total of 112 third year nursing students who engaged in the distraction and interruption simulation, and five simulation facilitators who facilitated the distraction and interruption simulation, participated in this study. METHODS: Students were invited to complete a cross sectional survey following the distraction and interruption simulation and were then invited to participate in focus groups. Simulation facilitators were invited to participate in one-on-one interviews following facilitating the distraction and interruption simulation. All data were collected between June and December 2020. RESULTS: Data from surveys, interviews, and focus groups were delineated into 4 themes related to the phases of the simulation. The prebriefing provided an overview of the simulation and helped create psychological safety that was imperative for learning about potential medication errors when being distracted and interrupted. The simulation scenario had a high degree of fidelity and helped students implement strategies to manage distractions and interruptions. The structured debrief provided an opportunity for meaningful reflection. The impact of the simulation was apparent as students articulated the balance between speed versus safety and new strategies developed to manage distractions and interruptions in clinical practice. CONCLUSION: This study supports the use of simulation to develop key skills for managing distractions and interruptions during medication preparation in clinical practice.

Undergraduate nursing simulation facilitators lived experience of facilitating reflection-in-action during high-fidelity simulation: A phenomenological study.

BACKGROUND: Reflective practice is an essential step to learning in high-fidelity simulation, yet, reflection-in-action is an often overlooked yet important opportunity to support student learning. OBJECTIVES: To explore and describe the lived experience of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. DESIGN: A descriptive phenomenological study. SETTING: A western Canadian province. PARTICIPANTS: Undergraduate nursing simulation facilitators with experience in nursing education and simulation facilitation. METHODS: We conducted 11 semi-structured interviews and utilized Colaizzi's seven step process of analysis to discover the essence of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. RESULTS: Simulation facilitators were able to identify reflection-in-action during high-fidelity simulation when students paused, collaborated, shared their thinking aloud, and changed their course of action. Barriers to reflection-in-action included learner fear and anxiety, poor simulation design, and inadequately prepared students and facilitators. Simulation facilitators supported reflection-in-action through prebriefing, facilitator curiosity, and providing cue, prompts, and facilitated paused. Some of the noted benefits to reflection-in-action include promoting collaborative learning, building confidence and critical thinking, and embedding reflection into practice. CONCLUSIONS: The insights from this research can be used to guide reflection-in-action strategy development and future research in high-fidelity simulation.