Nursing Education Leaders Decision-Making During a Pandemic Crisis.

ABSTRACT: Academic nursing leaders faced unprecedented decision-making during the recent global pandemic. Although some universities had emergency response plans, many did not, and those that did have plans did not address the specific needs of nursing education programs. This descriptive survey study sought to describe the decision-making and response of nursing education leaders during the pandemic and provide recommendations for the future. Themes identified in the study include preparedness, emergency response, uncertainty, leadership and policy, and communication. Results of the study provide nursing program administrators with insights for preparing to lead in future emergencies.

The impact of covid-19 on the regulation of nursing practice and education.

To adapt to the environment resulting from a worldwide pandemic, states across the country enacted regulation changes impacting nursing education, entry into practice, and licensure. In this manuscript, the authors collected state board of nursing data from sources including websites and letters from the State Boards to deans, directors, and chairs. Information obtained reflected changes to regulation of practice and regulation of education. As the pandemic continues, associate degree educators will need to continue to stay abreast of nursing regulation changes made to meet healthcare workforce needs while also ensuring public safety.

Impact of immersive virtual reality simulations for changing knowledge, attitudes, and behaviors.

BACKGROUND: Virtual reality has promise as a training method within the affective domain, but investigation is still needed for intention to change behaviors based on social determinants of health. OBJECTIVE: The objective of this study was to describe the self-reported changes in knowledge and/or attitudes and planned behavior changes by healthcare workers for their future care of persons with challenges to their social determinants of health following completion of a first-person virtual reality experience. DESIGN: A descriptive qualitative design was used. SETTINGS: This study was conducted in clinics and private practice settings in Ohio (United States). PARTICIPANTS: This study was conducted with 206 healthcare workers. METHODS: Participants completed a virtual reality simulation followed by qualitative, open-ended questions about changes to their knowledge, attitudes, and behaviors. Responses were analyzed using a content analysis method. RESULTS: Four overarching themes were derived from the qualitative data: (1) Acknowledgement of Social Determinants of Health, (2) An Improved Provider Experience for Patients, (3) Patient as a Person with Complex Needs, and (4) The Learning Experience. CONCLUSION: Findings suggest virtual reality has strong merits for impacting affective domain of learning demonstrated by increased empathy. Virtual reality along with increased empathy also helps improve attitudes and behaviors for the betterment of patients.

Development of a Scale to Measure Synergy: A Tool to Evaluate Team-Based Learning in Nursing.

AIM: The purpose of this study was to develop and pilot an instrument to assess group synergy and team-based learning among nursing students. BACKGROUND: Little is known on how to evaluate soft nursing skills such as synergy. METHOD: Nurse faculty were recruited through purposive and snowball sampling to serve on an expert panel. Using the DeVillis framework, three rounds of data were collected using semistructured online surveys. The resulting scale of 34 items was piloted with teams of undergraduate nursing students taking part in a simulation experience. RESULTS: Item-content validity index ranged from .8 to 1.0 for each item. Scale-content validity index average was .93; scale-content validity index universal was .62. Exploratory factor analysis identified three factors. CONCLUSION: This study suggests that synergy is multifactorial and can be assessed by faculty. However, further testing of the scale is needed.

Evaluation of two simulation methods for teaching a disaster skill.

Introduction: With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed. Methods: A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self- Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination. Results: A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination. Conclusions: Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.

A strengths, weaknesses, opportunities, and threats analysis- A study of Association of Community/Public Health Nursing Educators members.

OBJECTIVE: Aims of this study were to identify the Association of Community/Public Health Nursing Educators members' demographics, educational preparation, and research competencies; and, to complete a strengths, weaknesses, opportunities, and threats (SWOT) analysis. METHODS: A descriptive-correlational design was employed. Primary data collection was via electronic survey. Authors developed a survey focusing on demographics and aligning Benner's theory with research skills/experience. SWOT and gap analyses were performed. RESULTS: A 27.2% response rate (N = 352) revealed a lack of diversity among 70% doctorally prepared membership, perceived competence with interprofessional collaboration (80%), and applying research to practice (80%). Doctorally prepared members reported experience using longitudinal designs (p = .05). PhD-prepared members reported experience using psychometrics and evaluations (p = .05). SWOT revealed a lack of service engagement. Gap analysis offered solutions to execute strategic goals. CONCLUSIONS: Association of Community/Public Health Nursing Educators may enhance future direction by advancing member diversity, professional development, collaborative scholarship, and mentoring.

Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation.

Adoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants.

Anxiety and Stress in Live Disaster Exercises.

INTRODUCTION: Nurses play critical roles in disaster response, often preparing through simulated exercises. According to The NLN Jeffries Simulation Theory, simulations can lead to anxiety in participants that affects learning. The objective of this research was to measure and describe anxiety and stress levels of participants in a live disaster-training exercise. METHODS: A quasiexperimental/descriptive design using quantitative methods (amylase, cortisol levels) and qualitative methods (survey, focus groups) was used with a convenience sample of senior nursing students taking part in a disaster exercise. Participants completed self-reports of anxiety before and after the exercise using the State-Trait Anxiety Inventory (pre/post). Following the training, participants provided saliva samples for analysis of cortisol and amylase levels to measure physiological stress levels. Participants were also invited to take part in a focus group after exercise participation. RESULTS: A total of 22 participants were recruited. Significant elevation of self-reported anxiety levels was found on the State-Anxiety Inventory comparing pre- with post-training, but no Trait-Anxiety changes were noted. Amylase and cortisol levels were within normal ranges. Themes emerging from qualitative analysis include preparation, uncertainty, teamwork, realism, and decision making. DISCUSSION: Disaster training may be anxiety provoking and stressful. ED nurses should consider how to include best practice approaches for simulation in design of exercises to prepare for the increasing number of multicasualty events.

Effects of Virtual Reality Simulation on Worker Emergency Evacuation of Neonates.

OBJECTIVE: This study examined differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Learning outcomes included a) knowledge gained, b) confidence with evacuation, and c) performance in a live evacuation exercise. METHODS: A longitudinal, mixed-method, quasi-experimental design was implemented utilizing a sample of NICU workers randomly assigned to VRS training or CUs. Four VRS scenarios were created that augmented neonate evacuation training materials. Learning was measured using cognitive assessments, self-efficacy questionnaire (baseline, 0, 4, 8, 12 months), and performance in a live drill (baseline, 12 months). Data were collected following training and analyzed using mixed model analysis. Focus groups captured VRS participant experiences. RESULTS: The VRS and CU groups did not statistically differ based upon the scores on the Cognitive Assessment or perceived self-efficacy. The virtual reality group performance in the live exercise was statistically (P<.0001) and clinically (effect size of 1.71) better than that of the CU group. CONCLUSIONS: Training using VRS is effective in promoting positive performance outcomes and should be included as a method for disaster training. VRS can allow an organization to train, test, and identify gaps in current emergency operation plans. In the unique case of disasters, which are low-volume and high-risk events, the participant can have access to an environment without endangering themselves or clients. (Disaster Med Public Health Preparedness. 2019;13:301-308).

A Concept Analysis of Synergy for Nursing Education.

Background and Purpose: Synergy is a term found widely throughout the sciences. There is a need for improved methods and delivery of instruction that supports learners in their pursuit of academic goals and facilitates their transition into the professional role. Critical for students is teamwork training, both as team members and facilitators. Some teams have outcomes greater than their own individual efforts, while others do not. One possible explanation for this phenomenon is synergy. A concept analysis was conducted to define synergy in the context of nursing education and to gain insight on its impact on learning. Using Walker and Avant's (2011) method, definitions, uses, attributes, antecedents, consequences, and empirical referents were identified. Methods: Six databases were searched, using the keyword synergy (syntactic variations) and search terms (nursing, education, student, learning, training, collaboration, teamwork, and cooperation) with the parameter of English language (1980-2017). Articles were delimited through duplication removal, title, and abstract review. Thirty articles were selected for review based upon the use of synergy within the context of education. Results: Synergy is demonstrated whengroup outcomes exceed the results of individual efforts. Attributes are mutuality of support, actions, goalswith greater than individual effects, and teaching strategies. Consequences are greater problem-solving, creativity, and goal attainment than are accomplished individually. Implications for Practice: Incorporating synergy into nursing education can promote teamwork and collaboration and facilitate learners to collaborate inter-professionally. Recommendations are to research synergy within nursing education.

Effectiveness of Two Varying Levels of Virtual Reality Simulation.

AIM: The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination. BACKGROUND: Little is known about the use of VRS in providing disaster education, including retention. METHOD: Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months. RESULTS: Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive. CONCLUSION: VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

The Student Experience With Varying Immersion Levels of Virtual Reality Simulation.

With increasing use of virtual reality simulation (VRS) in nursing education and given the vast array of technologies available, a variety of levels of immersion and experiences can be provided to students. This study explored two different levels of immersive VRS capability. Study participants included baccalaureate nursing students from three universities across four campuses. Students were trained in the skill of decontamination using traditional methods or with VRS options of mouse and keyboard or head-mounted display technology. Results of focus group interviews reflect the student experience and satisfaction with two different immersive levels of VRS.

Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations.

Effectiveness of positive pressure ventilation during newborn care unit evacuation.

OBJECTIVE: Assess the utility of high fidelity simulation in understanding effectiveness of bag-valve ventilation in a simulated newborn intensive care unit vertical evacuation. PARTICIPANTS: A total of 70 participants, (13 teams of 4-6 staff) including physicians, nurses, respiratory therapists and other support personnel participated in a 90-min evacuation sessions. METHODS: Two wireless high-fidelity newborn mannequins (Gaumand ScientificR) provided real-time data of ventilation support during a NICU evacuation exercise. Trained evaluators also recorded data related to performance. Following the exercises, the simulator data were downloaded and analyzed for rate and consistency of respirations. RESULTS: Using the data from the simulators and evaluator comments, it was found the infants received proper airway management during the evacuation only 58% of the time. This study highlights the need for ongoing training for NICU staff around safe, effective, coordinated, and timely care of these fragile newborns in the event of an evacuation.

National Disaster Health Consortium: Competency-Based Training and a Report on the American Nurses Credentialing Center Disaster Certification Development.

As the largest profession of health care providers, nurses are an integral component of disaster response. Having clearly delineated competencies and developing training to acquire those competencies are needed to ensure nurses are ready when disasters occur. This article provides a review of nursing and interprofessional disaster competencies and development of a new interprofessional disaster certification. An overview of a standardized disaster training program, the National Disaster Health Consortium, is provided as an exemplar of a competency-based interprofessional disaster education program.

Learning and Retention Using Virtual Reality in a Decontamination Simulation.

AIM: The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention. BACKGROUND: Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy. METHOD: A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination. RESULTS: Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills. CONCLUSION: VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.

Learning Outcome Measurement in Nurse Participants After Disaster Training.

OBJECTIVE: The National Disaster Health Consortium is an interprofessional disaster training program. Using the Hierarchical Learning Framework of Competency Sets in Disaster Medicine and Public Health, this program educates nurses and other professionals to provide competent care and leadership within the interprofessional team. This study examined outcomes of this training. METHODS: Training consisted of a combination of online and on-site training. Learning outcomes were measured by using the Emergency Preparedness Information Questionnaire (EPIQ) pre/post training and participant performance during live functional exercises with the use of rubrics based on Homeland Security Exercise and Evaluation principles. RESULTS: A total of 64 participants completed the EPIQ before and after training. The mean EPIQ pre-training score of 154 and mean post-training score of 81 (reverse-scored) was found to be statistically significant by paired t-test (P<0.001). Performance was evaluated in the areas of triage, re-triage, surge response, and sheltering. Greater than 90% of the exercise criteria were either met or partially met. Participants successfully achieved overall objectives in all scenarios. CONCLUSIONS: Disaster response requires nurses and other providers to function in interprofessional teams. Educational projects, like the National Disaster Health Consortium program, offer the potential to address the need for a standardized, interprofessional disaster training curriculum to promote positive outcomes. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

Evacuation performance evaluation tool.

OBJECTIVE: Hospitals conduct evacuation exercises to improve performance during emergency events. An essential aspect in this process is the creation of reliable and valid evaluation tools. The objective of this article is to describe the development and implications of a disaster evacuation performance tool that measures one portion of the very complex process of evacuation. DESIGN: Through the application of the Delphi technique and DeVellis's framework, disaster and neonatal experts provided input in developing this performance evaluation tool. Following development, content validity and reliability of this tool were assessed. SETTING: Large pediatric hospital and medical center in the Midwest. PARTICIPANTS: The tool was pilot tested with an administrative, medical, and nursing leadership group and then implemented with a group of 68 healthcare workers during a disaster exercise of a neonatal intensive care unit (NICU). RESULTS: The tool has demonstrated high content validity with a scale validity index of 0.979 and inter-rater reliability G coefficient (0.984, 95% CI: 0.948-0.9952). CONCLUSIONS: The Delphi process based on the conceptual framework of DeVellis yielded a psychometrically sound evacuation performance evaluation tool for a NICU.

Fostering Learning Through Interprofessional Virtual Reality Simulation Development.

This article presents a unique strategy for improving didactic learning and clinical skill while simultaneously fostering interprofessional collaboration and communication. Senior-level nursing students collaborated with students enrolled in the Department of Interactive Media Studies to design a virtual reality simulation based upon disaster management and triage techniques. Collaborative creation of the simulation proved to be a strategy for enhancing students' knowledge of and skill in disaster management and triage while impacting attitudes about interprofessional communication and teamwork.