Considerations for Culturally Congruent Healthcare for Simulation in Bedside Clinical Practice.

This article provides practical recommendations for creating and implementing culturally appropriate and culturally congruent healthcare simulation applications for bedside providers that adhere to best practices and reporting standards. Framed within the 11 criteria for simulation design outlined in the Healthcare Simulation Standards of Best Practice, the article provides a summary of these criteria, highlighting the lessons learned from their application in a Health Resources and Services Administration-sponsored public health grant 6 U4EHP46217-01-01, Public Health Simulation-Infused Program.

Nurturing a Nursing Workforce: Developing and Implementing Role-Play.

Nurses' demands and challenges can sometimes lead to burnout, compassion fatigue, and a lack of focus on self-care. Implementing innovative strategies, such as role-play, may be instrumental in nurturing and rejuvenating the health care workforce. Role-play simulations offer a promising method to support essential skills and practices for health care workers. Using health care simulation is a widely accepted method to enhance critical thinking and decision-making among health care professionals. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards Committee in 2021 released the Healthcare Simulation Standards of Best Practice (HSSOBP), providing a structured framework to build and implement quality simulation-based education. These standards guide simulation scenarios' development, implementation, and evaluation, ensuring they align with educational objectives and promote experiential learning. This article describes role-play and how to develop and implement role-play scenarios built upon the HSSOBP.

Remembering to Resume: A Randomized Trial Comparing Combined Interruption Management Training and Simulation-Based Education to Simulation-Based Education Alone.

AIM: This study aimed to determine if purposeful presimulation interruption management training impacts cognitive load and successful completion of simulation objectives more than the experience alone. BACKGROUND: Practicing nurses are frequently interrupted, increasing the risk for error and task time. Novices are particularly vulnerable to interruption consequences. METHOD: A between-subjects design and block randomization of prelicensure baccalaureate nursing students ( n = 146) was used to compare group differences in cognitive load, use of interruption management strategies, and completion of simulation required elements. Potential relationships between outcomes and age, mindfulness, and experience were explored. RESULTS: An analysis of covariance demonstrated significantly lower perceived mental demand for those receiving training. Older learners and those receiving training implemented more interruption management strategies. CONCLUSION: Combining simulation-based education (SBE) with purposeful training enhances interruption management more than SBE alone. Frequent interruption training and SBE are recommended to enhance risk awareness.

Social Determinants of Health in Graduate Nursing Simulation Education: An Integrative Review.

BACKGROUND: This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH). METHODS: The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science. RESULTS: Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023. CONCLUSION: The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity.

Exploring Health Care Disparities in Maternal-Child Simulation-Based Education.

AIM: The purpose of this study was to explore student experiences within a health care disparity simulation, embedded in maternal-child content. BACKGROUND: Health care disparities related to race and ethnicity in the maternal-child population are daunting among African American and Hispanic women. METHOD: Participants completed the Simulation Effectiveness Tool-Modified, a rapid-fire huddle questionnaire, and a demographic instrument. All students participated in structured debriefing. RESULTS: Student responses ( n = 69) demonstrated effectiveness in learning via this scenario. CONCLUSION: The rapid-fire huddle and debriefing are important elements when health care disparities are introduced into nursing curricula.

Accessibility and utilisation of telehealth services among older adults during COVID-19 pandemic in the United States.

The removal of regulatory and reimbursement barriers during the COVID-19 pandemic in the United States presented opportunities to explore the potential of telehealth to improve access to and use of healthcare among underserved populations. Therefore, we examined factors associated with accessibility and utilisation of telehealth among older adults during the COVID-19 pandemic. We analysed the nationally representative Medicare Current Beneficiary Survey COVID-19 Supplement File of community-dwelling Medicare beneficiaries aged ≥65 years (n = 5,189), administered from 5 October 2020, through 15 November 2020. Two survey-weighted multivariable logistic regression models were used to assess the association between factors (i.e., socio-demographics, co-morbidities and digital access/literacy) and whether (1) beneficiaries' regular providers offered telehealth during the COVID-19 pandemic, and (2) those being offered telehealth used it. Furthermore, subgroup analyses by residing area and income status were conducted. Of study beneficiaries, 83.6% reported their regular providers offered telehealth during COVID-19. Disparities in accessibility of telehealth by sociodemographic status were observed [e.g., those living in a non-metro area (versus metro) were 7.1% (marginal effect [ME] = -7.1%; p < 0.01) less likely to report accessibility of telehealth]. Beneficiaries who had no access to internet (ME = -8.2%; p < 0.001) and had not participated in video/voice calls/conferencing prior (versus participated) (ME = -6.6%; p < 0.001) were less likely to report having access to telehealth. Among those being offered telehealth services, 43.0% reported using telehealth services. Hispanic and Non-Hispanic Black beneficiaries (e.g., Black versus White; ME = 11.3%; p < 0.01) and those with co-morbidities (versus 0-1 condition) (e.g., 2-3 co-morbidities, ME = 7.3%; p < 0.01) were more likely to report using telehealth services when offered. Similar results were observed in the subgroup analyses regarding disparities in accessibility and utilisation of telehealth. The accessibility and utilisation of telehealth have increased amidst the pandemic; however, disparities in accessibility of telehealth were observed. A telehealth triage protocol is needed to ensure underserved patients continue to receive appropriate care.

Self-debriefing in healthcare simulation: An integrative literature review.

OBJECTIVES: Debriefing is an essential component of simulation-based education. In-person, facilitator-led debriefing may not always be practical for newer forms of simulation, such as individual virtual simulations. Self-debriefing addresses the issue of practicality, but evidence of implementation and design are unknown. The aims of this review were to explore the use and design of self-debriefing in healthcare simulation and to identify to what extent self-debriefing found in the literature align with the INACSL Standards of Best Practice for debriefing. DESIGN: Integrative review. DATA SOURCES: Peer-reviewed studies indexed within CINAHL, MEDLINE, PsycINFO, ERIC, Education Full Text (H.W. Wilson), Education Source, and Academic Search Premier databases. REVIEW METHODS: A comprehensive database search was conducted using PRISMA guidelines. The INACSL Standard of Best Practice: Simulation Debriefing was used as a framework for analysis. Ten articles were appraised and analyzed for this review. RESULTS: Alignment to best practice standards and presence of required criteria varied in self-debriefing designs. Self-debriefs used with graduate-level learners and self-debriefs with higher alignment to standards showed equivalent performance gains when compared to instructor-led debriefs. None of the studies measured reflection capacity despite it being a recommendation. CONCLUSION: Findings indicate that well-designed self-debriefing provides equivalent outcomes to instructor-led debriefing. Best practice recommendations, such as promoting reflection, are underexplored in self-debriefing research.

Comparison of Clinical Options: High-Fidelity Manikin-Based and Virtual Simulation.

BACKGROUND: Minimal evidence compares nursing student outcomes when replacing clinical hours with manikin-based high-fidelity patient simulation (HFPS) or virtual simulation. PURPOSE: The study aims were to compare differences in outcomes: (1) between 2 intervention groups (HFPS or virtual simulation) when replacing 25% of pediatric/obstetrics clinical hours and (2) pass/fail for clinical practice between the intervention groups and a face-to-face clinical group (control). METHODS: A quasi-experimental study was conducted to determine differences in knowledge between intervention groups participating in 6 pediatric/obstetrics simulation scenarios. RESULTS: No differences in composite knowledge were found between simulation groups (P = .319). There also was no difference in clinical practice pass/fail among the groups. CONCLUSIONS: HFPS and virtual simulation were equally effective in achieving learning goals.

Considerations for the Effective Integration of Virtual Simulation in the Undergraduate Nursing Curriculum.

ABSTRACT: Nursing education employs a cadre of strategies to address faculty shortages, increased student admissions, and the decreased availability of clinical sites. Virtual simulation provides an innovative way to provide a robust learning experience that can be used in conjunction with or in lieu of some portion of clinical experiences. The authors highlight how virtual simulation can be used and outline considerations for educators considering virtual simulation integration.

Using Experiential Learning in Escape Rooms to Deliver Policies and Procedures in Academic and Acute Care Settings.

ABSTRACT: Puzzle rooms, recently termed "escape rooms," have been in existence for several years and are increasing in popularity in the United States. These experiential learning rooms create an inviting learning environment for both the academic and acute care learner. Learners are placed in strategic cooperative learning groups to promote teamwork, collaboration, critical thinking, and communication. Participation in an escape room can be used to reinforce policies and procedures that are standard in nursing practice. Overall acceptance of this novel idea in nursing was positive for registered nurse, student, and community member outcomes; evaluations were affirmative for learning engagement.

An Examination of Simulation Prebriefing in Nursing Education: An Integrative Review.

AIM: The aim of the integrative review was to examine the prebriefing phase of simulation as the foundation for the learning experience of nursing students and to determine effective prebriefing activities to enhance learning. BACKGROUND: There are currently no frameworks or specific time allotments for prebriefing comparable to those implemented for debriefing. METHOD: Eight electronic databases were searched for the period 2012 to 2019. Six studies were selected based on relevance and inclusion. Whittemore and Knafl's integrative review framework was used for data analysis. RESULTS: The studies reviewed answer how to effectively prepare students for simulation to enhance their learning and have a positive effect on clinical judgment and self-confidence; yet, prebriefing is not considered the foundation of the simulation experience. CONCLUSION: A well-designed prebriefing process is essential to high-quality simulation experiences. Standardization of this process has yet to be established.

The Physical-Virtual Patient Simulator: A Physical Human Form With Virtual Appearance and Behavior.

INTRODUCTION: We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse). METHODS: We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board-approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed. RESULTS: Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories. CONCLUSIONS: We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.

Early Recognition of Pediatric Sepsis Simulation Checklist - An Exploratory Study.

PURPOSE: To report on the modification and exploration of a 21-item Early Detection of Pediatric Sepsis Assessment Checklist aimed at improving nursing students' recognition of key factors that contribute to early detection of sepsis in pediatric patients through clinical simulation. DESIGN AND METHODS: One hundred and thirty-one undergraduate, pre-licensure nursing students were evaluated using the adapted 21-item Early Detection of Pediatric Sepsis Assessment Checklist in simulation using high-fidelity manikins. Categorical Principle Component Analysis was used to evaluate for factor structure, with items accounting for <0.20 of the variance were dropped from the loadings. RESULTS: Two factors emerged from the analysis: assessment and deterioration, accounting for 68% of the variance. Factor one, assessment, contained nine items (α = 0.77; λ = 3.36). Factor two, deterioration, contained seven items (α = 0.72; λ = 2.85). Five items did not load and were dropped from the factor structure, resulting in a 16-item checklist. CONCLUSIONS: Two factors emerged from the analysis which is key to improving the early detection of pediatric sepsis. Assessment, factor one, accounted for the nursing students' central skills of recognizing baseline vital signs and timely medication administration. Deterioration, factor two, contained items reflecting the recognition of changes from baseline that require action. Conceptually, these factors reflect the most central points in the early detection of signs in pediatric patients at risk for sepsis. PRACTICE IMPLICATIONS: This checklist forms a valuable tool to assess the knowledge of pre-licensure students and may possibly be extended as a tool to assess the clinical readiness and performance of new graduates through the safety and supervision allotted by simulation.

Using Simulation With Nursing Students to Promote Affirmative Practice Toward the Lesbian, Gay, Bisexual, and Transgender Population: A Multisite Study.

AIM: The aim of this research was to evaluate the impact of a transgender simulation on nursing students' affirmative practice when caring for a transgender person. BACKGROUND: There is a paucity of research that assesses the attitudes of nursing students toward lesbian, gay, bisexual, and transgender (LGBT) persons and a deficit in nursing curricula regarding LGBT content. METHOD: A nonexperimental, pretest-posttest design was used to evaluate nursing students' affirmative practice when caring for a transgender patient using the Gay Affirmative Practice Scale. RESULTS: A Wilcoxon signed-rank test revealed a statistical significance in Gay Affirmative Practice scores after the simulation with a small effect size. These results suggest that the transgender simulation supported nursing students' attitudes and affirmative practice when providing nursing care to a transgender person. CONCLUSION: Experiential learning in nursing education is an effective approach to teach cultural competence and sensitivity in caring for vulnerable populations.

Students' Perceptions of the Psychological Well-Being of a Transgender Client Through Simulation.

BACKGROUND: The need to address mental health concerns for transgender clients is imperative. Nursing curricula must prepare students to provide holistic care for individuals within this community. The purpose of this study was to explore undergraduate nursing students' experiences providing mental health care for a transgender client through simulation. METHOD: Focus group interviews were conducted with data analyzed using content analysis. RESULTS: The three categories that emerged were limited experience addressing mental health needs, intervening with client anxiety with the subcategories of prioritizing care and collaboration, and therapeutic nurse-client relationship with the subcategory of therapeutic communication. CONCLUSION: Nursing students must be prepared to provide holistic care for transgender individuals. Simulation allowed students to assess the client and evaluate their therapeutic communication in a safe learning environment. Further understanding of mental health care needs of transgender clients is essential for the promotion of their well-being. [J Nurs Educ. 2017;56(12):741-744.].

Using simulation to address care of the transgender patient in nursing curricula.

This descriptive study explored the use of simulation as a means to increase cognitive and reflective practice as well as determining if simulation can alter perceptions and attitudes related to the lesbian, gay, bisexual and transgender (LGBT) community. This manuscript describes how student nurses perceive their role when providing care to and, more specifically, the care of transgender patients. The research question asks: How does a transgender simulation impact the attitudes and beliefs of nursing students related to the LGBT community? One-hundred and fifty-nine students, with a subset of 120 students attending a school in central Florida and 50 students attending a Connecticut programme, participated in the completion of the instruments. The Gender Affirmative Practice (GAP) scale was used to evaluate their attitudes and practice concerning LGBT issues. Findings suggest that the majority of the students rarely or never discuss pertinent sexual orientation issues. Students are not comfortable creating a climate that allows for self-identification by gay/ lesbians, despite admitting to being open and accepting the LGBT community with their faculty. Limitations were based on multisite location and the use of the GAP. It is important for nursing students, and healthcare providers, to acknowledge and recognise the unique vulnerabilities of transgender persons who are seeking healthcare. The exposure to transgender individuals in a clinical setting may be limited; therefore, the use of simulation will offer the opportunity to examine their beliefs and reflect on their attitudes towards this population. Simulation incorporating mental health issues is a newer training technique in which psychosocial aspects of healthcare are addressed.

Enhancing Empathy in Undergraduate Nursing Students: An Experiential Ostomate Simulation.

AIM: The aim of this study was to implement and evaluate an experiential learning simulation created to enhance nursing students' empathy during patient care encounters. BACKGROUND: The investigators proposed that an ostomy simulation experience would be an efficient method for providing this educational content. METHOD: Content analysis was conducted on essays using Krippendorff's technique to quantify the simulation. RESULTS: Each unit of measure, or paper, contained between 1 to 14 empathic comments. Of the total sample, 22.8 percent had three or five empathic comments; 10 percent had four, and 9 percent had six or more comments per paper. Eighty-five percent of participants felt this simulation experience was beneficial for enhancing empathy in clinical practice. CONCLUSION: The assignment was an effective, objective method that utilized simulation to teach empathy to baccalaureate nursing students.

Simulation: Introduction to Correctional Nursing in a Prison Setting.

Simulation can be used to introduce students to critical nursing skills that reduce errors, enhance nurse-patient communication, and improve safety and security when caring for patients in the correctional setting. The interactive environment creates scenarios in a realistic fashion that include experiences that nursing students may encounter in a correctional facility setting, such as aggressive clients, gang-related activities, and noncompliant personalities. Orientation prior to entering the facilities is the key to safety, reducing student anxiety, and enhancing the student's ability to learn. The simulation scenario designed for the correctional setting provides an environment for the teaching and learning of correctional nursing skills and multidisciplinary collaboration. Scenarios are embedded with communication, safety, delegation, and critical thinking education goals. Student evaluations are assessed and reported.