Concept Mapping in Simulation within Nursing Education: A Scoping Review Protocol.

BACKGROUND: Simulation has been found to enhance nursing student knowledge and confidence, as well as to improve clinical performance. The use of concept maps during simulation has been found to play a key role in student learning. There is a need to understand what is known to date about the use of concept mapping in simulation within nursing education. This will help determine the most effective ways to use concept mapping in simulation to foster learning in nursing students. Scoping review question: What is known about the context, processes, and outcomes of concept mapping in simulation within nursing education? METHODS: The scoping review will be conducted in accordance with JBI methodology for scoping reviews and will search the following databases: MEDLINE, CINAHL, PsycMED, EMBASE, and ERIC. This review will consider studies that explore the use of concept mapping in simulation within undergraduate nursing education and will include studies that have used qualitative, quantitative, and mixed methods, as well as literature reviews. Editorials, commentaries, and gray literature will be excluded. Studies published from 1992 onward will be included. The data extracted will include details about the participants, how concept mapping was used within simulation, methods, key findings, and research gaps.

Interprofessional collaboration among first responder students in a simulated disaster exercise.

INTRODUCTION: Interprofessional disaster simulation exercises provide an opportunity for first responder students to learn about disaster response and recovery, to practice their roles and to learn to collaborate with other first responders. With the move to virtual education during the COVID-19 pandemic, a table-top disaster exercise is an alternative format to inperson exercises. To date, most disaster simulation exercises for students have focused on the roles of healthcare providers. As first responders play a critical role in disaster management, there is a need for interprofessional exercises that include students in first responder programs. METHODS: A table-top disaster simulation exercise was held with students from the police (n = 94) and firefighter (n = 30) programs at a large community college in Toronto, Canada, in February 2021. It was held virtually using the Zoom® platform, with college faculty as well as professionals from community partner sites. An evaluation survey that had open- and closed-ended items was administered to students following the event. RESULTS: Thirty-eight percent of the students participated in the survey, and the majority rated the event highly useful and reported that the exercise demonstrated the importance of interprofessional collaboration. Students' responses to the open-ended survey items yielded two themes: understanding roles and performing under duress. DISCUSSION: This evaluation demonstrates the value of using a simulated disaster exercise to teach first responder students about their role in disaster response and recovery, and the importance of interprofessional collaboration.

Evaluation of Nursing Students' Experiences in an Interprofessional Simulated Disaster Exercise.

BACKGROUND: Disaster simulation exercises provide a unique opportunity for nursing students to experience interprofessional collaboration. The limited study of interprofessional education using disaster simulation has focused on two to three health disciplines. In reality, teams comprise members from multiple disciplines in health care and emergency management. METHOD: A simulated disaster was held at a community college in Toronto, Canada. A total of 121 nursing students participated in the event, alongside students and providers from six health care and emergency management professions. A survey was used to evaluate nursing students' experiences. RESULTS: Nursing students (n = 78) reported a high level of satisfaction, and 90% reported the simulation demonstrated the importance of inter-professional practice. Two themes arose from participants' comments: communicating with patients and collaborating with health care and emergency management providers. CONCLUSION: There is a need for follow-up to evaluate the impact of this event on nursing students' future practice. [J Nurs Educ. 2021;60(8):445-448.].

Exploring the Transitional Experience of First-Year Undergraduate Nursing Students.

BACKGROUND: Nursing students encounter various adjustments during their first year of nursing school, including challenging coursework, competing demands, and clinical preparation. Limited research exists on first-year nursing students' experiences and the impact these experiences have on their success. This study examined nursing students' transitional experiences during their first year of university and identified support requirements needed. Meleis' Transition Theory was used to explore students' experiences. METHOD: A qualitative thematic analysis design was used. A convenience sample of first-year nursing students (N = 42) were recruited, and six semistructured focus groups were conducted. RESULTS: The focus group discussions identified four themes: learning through others, confronting postsecondary demands, importance of relationships, and transition of self. CONCLUSION: The study findings highlighted students' transitional experiences regarding knowledge sources, relationships, and perceived supports that would promote a positive transition. The findings can assist faculty in enhancing interventions that support nursing students' success. [J Nurs Educ. 2020;59(5):263-268.].

Measuring health literate discharge practices.

Purpose Health literate discharge practices meet patient and family health literacy needs in preparation for care transitions from hospital to home. The purpose of this paper is to measure health literate discharge practices in Ontario hospitals using a new organizational survey questionnaire tool and to perform psychometric testing of this new survey. Design/methodology/approach This survey was administered to hospitals in Ontario, Canada. Exploratory factor analysis and reliability testing were performed. Findings The participation rate of hospitals was 46 percent. Exploratory factor analysis demonstrated that there were five factors. The survey, and each of the five factors, had moderate to high levels of reliability. Research limitations/implications There is a need to expand the focus of further research to examine the experiences of patients and families. Repeating this study with a larger sample would facilitate further survey development. Practical implications Measuring health literate discharge practices with an organizational survey will help hospital managers to understand their performance and will help direct quality improvement efforts to improve patient care at hospital discharge and to decrease hospital readmission. Originality/value There has been little research into how patients are discharged from hospital. This study is the first to use an organizational survey tool to measure health literate discharge practices.

Development of Indicators to Measure Health Literate Discharge Practices.

Health literate discharge practices meet the health literacy needs of patients and families at the time of hospital discharge and are associated with improved patient outcomes and reduced readmission. A Delphi panel consisting of nurses, other health care providers, and researchers was used to develop a set of indicators of health literate discharge practices based on the practices of Project RED (Re-Engineered Discharge). These indicators can be used to measure and monitor the use of health literate discharge practices.

Work motivation in health care: a scoping literature review.

AIM: The aim of this scoping literature review was to examine and summarize the factors, context, and processes that influence work motivation of health care workers. METHODS: A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence work motivation of health care workers? This scoping review used the Arksey and O'Malley framework to describe and summarize findings. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 2005 and May 2016 were identified using five electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies. Eligible studies were then evaluated by coding findings with descriptive labels to distinguish elements that appeared pertinent to this review. Coding was used to form groups, and these groups led to the development of themes. RESULTS: Twenty-five studies met the eligibility criteria for this literature review. The themes identified were work performance, organizational justice, pay, status, personal characteristics, work relationships (including bullying), autonomy, organizational identification, training, and meaningfulness of work. CONCLUSION: Most of the research involved the use of surveys. There is a need for more qualitative research and for the use of case studies to examine work motivation in health care organizations. All of the studies were cross-sectional. Longitudinal research would provide insight into how work motivation changes, and how it can be influenced and shaped. Several implications for practice were identified. There is a need to ensure that health care workers have access to training opportunities, and that autonomy is optimized. To improve work motivation, there is a need to address bullying and hostile behaviours in the workplace. Addressing the factors that influence work motivation in health care settings has the potential to influence the care that patients receive.

Routines for change: how managers can use absorptive capacity to adopt and implement evidence-based practice.

AIMS: This paper uses the construct of absorptive capacity to understand how nurse managers can facilitate the adoption and use of evidence-based practice within health-care organisations. BACKGROUND: How health-care organisations adopt and implement innovations such as new evidence-based practices will depend on their absorptive, or learning, capacity. Absorptive capacity manifests as routines, which are the practices, procedures and customs that organisational members use to carry out work and to make work-related decisions. METHODS: Using the construct of absorptive capacity as well as a recent literature review of how health-care organisations take on best practices, we illustrate how the uptake and use of new knowledge, such as evidence-based practices, can be facilitated through the use of routines. IMPLICATIONS FOR NURSING MANAGEMENT: This paper highlights routines that nurse managers can use to foster environments where evidence-based practices can be readily identified, and strategies for facilitating their adoption and implementation. CONCLUSIONS: The construct of absorptive capacity and the use of routines can be used to examine the ways in which nurse managers can adopt, implement and evaluate the use of evidence-based practices.

Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol.

INTRODUCTION: Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS: This synthesis will be guided by Pawson and colleagues' 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION: Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.

How do health care organizations take on best practices? A scoping literature review.

AIMS: The aims of this scoping literature review are to examine and summarize the organizational-level factors, context, and processes that influence the use of evidence-based practice in healthcare organizations. METHODS: A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence the uptake, implementation, and sustainability of evidence-based practice in healthcare organizations? This review used the Arksey and O'Malley framework to describe findings and to identify gaps in the existing research literature. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 1991 and March 2014 were identified using four electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies by the primary author. Eligible studies were then analyzed by coding findings with descriptive labels to distinguish elements that appeared relevant to this literature review. Coding was used to form categories, and these categories led to the development of themes. RESULTS: Thirty studies met the eligibility criteria for this literature review. The themes identified were: the process organizations use to select evidence-based practices for adoption, use of a needs assessment, linkage to the organization's strategic direction, organizational culture, the organization's internal social networks, resources (including education and training, presence of information technology, financial resources, resources for patient care, and staff qualifications), leadership, the presence of champions, standardization of processes, role clarity of staff, and the presence of social capital. CONCLUSION: Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit.

BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group. OBJECTIVES: To evaluate the validity and clinical utility of two pain assessment tools, the revised Adult Non-Verbal Pain Scale (NVPS-R) and the Critical Care Pain Observation Tool (CPOT), in a trauma and neurosurgical patient population. METHODS: Patients were assessed using the NVPS-R and CPOT by trained intensive care unit nurses (n=23) and research assistants before, during and after two procedures: turning of the patient (nociceptive procedure) and noninvasive blood pressure cuff inflation (non-nociceptive procedure). Communicative patients were also asked to report their level of pain during each assessment. RESULTS: A total of 66 patients (34 communicative, 32 noncommunicative) were included in the study. CPOT and NVPS-R scores increased significantly when participants were exposed to turning, but not during noninvasive blood pressure measurement (repeated measures ANOVA: CPOT, F=5.81, P=0.019; NVPS-R, F=5.32, P=0.025) supporting discriminant validity. CPOT and NVPS-R scores were significantly higher during the turning procedure for patients who had indicated that they were in pain versus those who were not, indicating criterion validity. Inter-rater reliability was generally higher for the CPOT than NVPS-R. Nurses rated the feasibility of the two tools as comparable but provided higher ratings of acceptability for the CPOT. CONCLUSIONS: While the present study supports the use of the CPOT and the NVPS-R with critically ill trauma and neurosurgical patients, further research should explore the role of vital signs in pain.

Patient satisfaction and documentation of pain assessments and management after implementing the adult nonverbal pain scale.

BACKGROUND: Accurate assessment and management of pain in critically ill patients who are nonverbal or cognitively impaired is challenging. No widely accepted assessment tool is currently in place for assessing pain in these patients. OBJECTIVES: To evaluate the effect of implementing a new pain assessment tool in a trauma/neurosurgery intensive care unit. METHODS: Staff and patient satisfaction questionnaires and retrospective chart reviews were used before and after implementation of the Nonverbal Pain Scale. The questionnaire responses, frequency of pain documentation, and amount of pain medication given were compared from before to after implementation. RESULTS: Most staff (78%) ranked the tool as easy to use. Implementation of the tool increased staff confidence in assessing pain in nonverbal, sedated patients (57% before vs 81% after implementation, P = .02) and increased the number of pain assessments documented by the nursing staff for noncommunicative patients per day in the intensive care unit (2.2 before vs 3.4 after, P = .02). Patients reported decreased retrospective pain ratings (8.5 before vs 7.2 after, P = .04) and a trend toward a decrease in the time required to receive pain medication (38% before vs 10% after requiring >5 minutes to receive medication, P = .06). CONCLUSIONS: Implementation of the Nonverbal Pain Scale in a critical care setting improved patients' ratings of their pain experience, improved documentation by nurses, and increased nurses' confidence in assessing pain in nonverbal patients.

Pain assessment and management for a dialysis patient with diabetic peripheral neuropathy.

More than 50% of all patients with end stage renal disease (ESRD) have pain, and this pain is often due to diabetic peripheral neuropathy. Using a case study of a dialysis patient who has neuropathic pain, this article examines the assessment and management of this pain. Assessment is the essential first step. Patients' self-report of pain is the most reliable and valid indicator of pain intensity. Pain may be managed through the use of non-opioids, opioids and adjuvants. However, for patients with ESRD on dialysis, certain considerations concerning drugs used to manage pain need to be taken into account. Complementary therapies have also been used in pain management in patients with ESRD, and there is a need for greater research in this area.

Patient satisfaction and pain management: an educational approach.

The importance of assessing and managing pain has become paramount in today's hospital environment. Poor pain management is associated with impaired health, decreased patient satisfaction, and increased healthcare costs. This quality improvement project on an internal medicine unit at an urban teaching hospital examined the impact of pain education on patient satisfaction with pain management. Although pain scores did not improve, there were improvements made with respect to patient assessment, patient satisfaction, and nursing knowledge.