Simulation in New Zealand: what have you done for me lately? New Zealand Association for Simulation in Healthcare (NZASH) white paper.

Medical simulation has become an integral aspect of modern healthcare education and practice. It has evolved to become an essential aspect of teaching core concepts and skills, common and rare presentations, algorithms and protocols, communication, interpersonal and teamworking skills and testing new equipment and systems. Simulation-based learning (SBL) is useful for the novice to the senior clinician. Healthcare is a complex adaptive system built from very large numbers of mutually interacting subunits (e.g., different professions, departments, equipment). These subunits generate multiple repeated interactions that have the potential to result in rich, collective behaviour that feeds back into the organisation. There is a unique opportunity in New Zealand with the formation of Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Maori Health Authority and the reorganisation of the healthcare system. This viewpoint is a white paper for the integration of SBL into our healthcare system. We describe our concerns in the current system and list our current capabilities. The way SBL could be implemented in pre- and post-registration phases of practice are explored as well as the integration of communication and culture. Interprofessional education has been shown to improve outcomes and is best done with an interprofessional simulation curriculum. We describe ways that simulation is currently used in our system and describe other uses such as quality improvement, safety and systems engineering and integration. The aim of this viewpoint is to alert Te Whatu Ora and Te Aka Whai Ora of the existing infrastructure of the simulation community in New Zealand and encourage them to invest in its future.

Student Nurse Experiences of Learning from Clinical Practice and Simulations in New Zealand: A Descriptive Qualitative Study.

BACKGROUND: In New Zealand, finding quality learning opportunities in the clinical setting is often challenging. In response, using simulation as an alternate learning environment has been proposed. Literature related to the substitution of clinical experience with simulation is relatively sparse and, in New Zealand, non-existent. PURPOSE: This study sought to answer the foundational issue of how students experience learning in the simulation and clinical environment. The research question was: 'how do nursing students in New Zealand experience simulation and clinical practice as an environment for learning?' METHODS: This research used a descriptive qualitative design based on in-depth semi-structured interviews with twelve nursing students and written reflective stories from students' clinical practice. FINDINGS: Students' experiences in the two learning environments were different. These differences were associated with relational care, predictability, responsibility and managing critical incidents. CONCLUSIONS: Each environment offered nursing students valuable, yet unique learning opportunities. The key to educating nursing students is ensuring that both simulations and clinical practice are appropriately placed in the nursing curriculum while recognising their strengths and weaknesses.

A unique disaster response in aged residential dementia care: Can the experience inform future care models?

AIMS AND OBJECTIVES: To understand how staff who chose to live-in with residents in a level 3 dementia care unit perceived the experience, in particular, their perceptions of how residing on site affected resident well-being. BACKGROUND: COVID-19 has been especially devastating in aged residential care (ARC) facilities. In March 2020, when the threat became realised in New Zealand, one residential dementia care facility implemented a unique response to the imminent threat of COVID-19. Eight staff members made the decision to live on site during the lockdown, ensuring residents' risk of contracting the virus was significantly reduced as carers would not go outside of the facility. DESIGN: A qualitative descriptive inquiry. METHODS: Seven staff who chose to live-in, and the facility manager, participated in semi-structured, face-to-face interviews at the ARC. Audio-recorded interviews were transcribed verbatim and analysed using a thematic analysis approach. COREQ guidelines were adhered to in the reporting of this study. RESULTS: An overarching motif which emerged from the findings was the articulation of an 'all in this together' attitude which fostered feelings of camaraderie and collaboration which enhanced the experience for staff individually, and as a group. Themes identified were as follows: (a) A 'safe' but challenging choice, (b) Benefits for the staff and (c) Positive outcomes for the residents. CONCLUSION: This crisis inadvertently brought about an enhanced 'dementia-friendly', person-centred communal environment. RELEVANCE TO CLINICAL PRACTICE: This study identified themes that deepen our understanding of caring for vulnerable populations during a pandemic and beyond. Given the success of this 'live-in' innovation, consideration must be given to applying these findings more generally when planning care models for best outcomes for residents receiving rest home level dementia care. How we care for people in disaster situations reflects the heart of the caring workforce, but such innovation may be extended to usual care where indicated.

Simulations in undergraduate nursing programmes in New Zealand: current status and next steps.

Introduction: There is an increasing global tendency to use simulations in nursing education. This research examined the current status of simulation programs in undergraduate nursing schools in New Zealand. The goal was to gain a better understanding of how simulations are currently implemented in nursing schools and to identify the associated opportunities and challenges. Methods: 16 nursing schools in New Zealand deliver undergraduate nursing education. 10 of these schools selected a nursing leader who was involved in the schools' simulation program to complete an online survey. The survey questions were designed to explore the nature of simulations in nursing schools, and the opportunities and challenges experienced in the implementation of these programmes. Data analysis: Survey data were analysed and presented as summary statistics (frequencies and percentages). Responses to short questions were thematically analysed and common themes were identified. The analysis was divided into demographic characterises and main results. Results: The key outcomes of the study have shown the prevalence of various simulation modalities in nursing schools in New Zealand. The analysis also suggests that the current practices associated with the integration of simulations into nursing education in New Zealand are fragmented and sporadic. Challenges shared across all institutions include inadequate resourcing of simulation programs, poor curriculum integration and programme alignment; a lack of shared understanding of what constitutes simulation and the extent to which simulation modalities achieve learning outcomes. Conclusions: The outcome of this study has contributed to a better understanding of the prevalence and nature of simulation programs in undergraduate nursing schools in New Zealand. It has also provided insights into the different opportunities and challenges associated with implementing these programmes in nursing schools. Furthermore, the research has identified important conceptual and theoretical issues related to the broad discourse on the use of simulations in undergraduate nursing education.