Weight bias reduction intervention among nurse practitioner students using simulation-based experiences.

ABSTRACT: Few nurse practitioner (NP) programs include obesity and weight bias education in their curriculum. However, NPs will likely provide care for people living with obesity, many of whom have been discriminated against based on their weight by previous providers, and many NP students may feel unprepared to navigate weight management competently. This pilot study included a weight bias reduction (WBR) intervention, which included a simulation-based experience (SBE) with a standardized participant (SP) and educational activities embedded within the NP curriculum. Nineteen NP students participated in this pilot study, but only seven students had matching data for preintervention to postintervention scores. There were no statistically significant differences in preintervention and postintervention Attitudes Toward Obese Persons (ATOP) or Beliefs About Obese Persons (BAOP) scores. Despite this small sample size and not achieving statistical significance, SBE-SP holds promise to depict realistic patient encounters to improve NPs' attitudes and beliefs toward persons with obesity and to reduce weight bias. Therefore, incorporating SBE-SP may be a feasible component of the NP curriculum.

Diagnostic Reasoning Competency and Accuracy by Nurse Practitioner Students Following the Use of Structured Reflection in Simulation: A Mixed-Methods Experiment.

AIM: The aim of this study was to examine the effect of structured reflection used during a simulated patient's diagnostic workup on diagnostic reasoning competency and accuracy and explore participants' cognitive bias experience and perceived utility of structured reflection. BACKGROUND: Reasoning flaws may lead to diagnostic errors. Medical learners who used structured reflection demonstrated improved diagnosis accuracy. METHOD: Embedded mixed-methods experiment examined diagnostic reasoning competency and accuracy of nurse practitioner students who did and did not use structured reflection. Cognitive bias experience and perceptions of structured reflection's utility were explored. RESULTS: Diagnostic Reasoning Assessment mean competency scores and categories were not changed. Accuracy trended toward improvement with structured reflection. The theme, diagnostic verification, prompted diagnosis change by both structured reflection users and control participants. CONCLUSION: Despite no changes in quantitative outcomes, explicit users of structured reflection believed that this strategy is helpful to their reasoning, and control participants used the strategy's components with the same noted benefits.

ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT.

Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.

Diagnostic Reasoning Outcomes in Nurse Practitioner Education: A Scoping Review.

BACKGROUND: Diagnostic reasoning is the process of collecting, considering, and analyzing information to determine a diagnosis. Educational strategies that structure diagnostic reasoning exposure, experience, and evaluation are hypothesized to improve diagnostic safety. However, few studies measure diagnostic reasoning outcomes in nurse practitioner education. This review sought to identify the educational interventions intended to improve diagnostic reasoning competency, determine which components of reasoning are evaluated, and examine how they are measured. METHOD: Four databases were searched, and 12 studies were identified that met the inclusion criteria. RESULTS: Simulation was the most common intervention. The most frequently measured diagnostic reasoning components were information gathering, differential diagnosis, and leading diagnosis. Checklists and patient management problems were the most used assessment method. CONCLUSION: More studies are needed to assess the reasoning processes of hypothesis generation, problem representation, and diagnostic justification. Within simulation, methods capable of capturing these components include think-aloud, global assessments, checklists, and note evaluation. [J Nurs Educ. 2022;61(10):579-586.].

Nurse Faculty Administrators' Experiences of Communication, Cooperation, Coordination, and Collaboration During Educational Disruption.

AIM: The primary purposes of the study were to describe nurse faculty administrators' experiences of rapid transition and disruption in nursing education during the COVID-19 pandemic. BACKGROUND: The disruption and shift to remote learning for nursing education programs posed challenges for these administrators. METHOD: A descriptive survey methodology with a convenience sample was used with the Four Cs of Disaster Partnering framework. RESULTS: The findings revealed that key elements of the Four Cs framework played a role in the successful adaptation to new learning environment realities. Time was an overarching finding. Connectedness with faculty, staff, and students was a significant challenge. CONCLUSION: The application of the Four Cs of Disaster Partnering framework demonstrated utility for examining academic nurse administrators' preparedness.

Nursing Students' Self-Efficacy in Immigrant Health.

BACKGROUND: The United States has the largest, most diverse immigrant population. Nurses will care for immigrant clients in all areas of nursing practice. PURPOSE: The purpose of this study was to determine nursing students' self-efficacy in working with immigrant clients following a service-learning experience. METHODS: A pre-/posttest descriptive study was used to measure students' self-efficacy in cultural aspects of screening, providing health education, and assisting with health care access prior to and after a voluntary service-learning experience at a resettlement agency. RESULTS: Statistical significance was found in overall scale score and in all 19 individual items except 2 related to working with (P = .21) and communicating with (P = .49) the health care team. Overall, pretest and posttest results revealed that students' self-efficacy working with immigrant clients was improved. CONCLUSION: Collaborating with an immigrant resettlement program to provide a structured immigrant health learning experience for prelicensure nursing students can improve self-efficacy in working with immigrant clients.

A Quantitative Research Study Protocol to Advance Simulation Science in Nursing Education.

AIM: This article describes a quantitative simulation study protocol and identifies important methodological considerations for future high-level, rigorous quantitative simulation studies. BACKGROUND: Quantitative simulation research studies have been found to be lacking in their conceptualization, study design, and measurement of outcomes, with small samples and lack of rigor in overall study methods. METHOD: This protocol reflects research priorities of organizations that drive simulation science and nursing education, published standards of simulation best practice, and use of research methodology within and outside the simulation literature, which includes psychometrically sound instruments and outcomes of importance to cognitive and simulation science. RESULTS: The protocol was a multisite, longitudinal study, guided by the integrative model of clinical judgment, with a high degree of intervention fidelity to measure the study outcomes of clinical judgment and clinical competence. CONCLUSION: To advance simulation science, rigorous study protocols, reflective of the one described in this article, are needed.

Internal Reliability Estimates of the Lasater Clinical Judgment Rubric Among New-to-Practice Nurses in a Simulated Setting.

ABSTRACT: Clinical judgment among new-to-practice nurses is critical for safe patient care. The Lasater Clinical Judgment Rubric (LCJR) is a known instrument in undergraduate nursing education research. This study evaluated the internal consistency reliability and changes in the LCJR in a sample of 17 new-to-practice nurses in a simulated setting across four measurements. Cronbach's alpha reliability for the LCJR was .90. Effect sizes (η2) ranged from .01 to .45, with only the reflecting subscale demonstrating an effect. Study team and study participants' self-ratings on the LCJR were compared; team members' ratings were significantly lower than participants' self-ratings.

Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses.

AIM: This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses. BACKGROUND: Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses. METHOD: Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points. RESULTS: The simulation program had a large effect on the intervention group's clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time. CONCLUSION: Replication of the study with a randomized controlled trial and large sample size is warranted.

TeamSTEPPS Curricular-Wide Integration: Baccalaureate Nursing Students' Knowledge, Attitudes, and Perceptions.

BACKGROUND: To promote safe patient care, nurses must work collaboratively with members of the interprofessional health care team. PURPOSE: The purposes of this study were to explore the effect of a curricular-wide integration of TeamSTEPPS training on baccalaureate nursing students' teamwork knowledge and attitudes and to describe students' perceptions of TeamSTEPPS curricular-wide integration. METHODS: In this quasi-experimental, mixed-methods study, the experimental group engaged in a curricular-wide integration of TeamSTEPPS throughout the baccalaureate nursing program, whereas the control group received no TeamSTEPPS training. RESULTS: The experimental group had significantly higher teamwork knowledge than the control group after training. The curricular-wide integration of TeamSTEPPS was positively received by students. CONCLUSIONS: This study demonstrated the feasibility and benefits of integrating TeamSTEPPS teamwork training throughout a baccalaureate nursing curriculum, as well as the knowledge gained by students because of this curricular-wide integration. With further research, TeamSTEPPS could offer an evidence-based approach to promote the interprofessional teamwork knowledge and skills nursing students need for safe patient care.

A College of Nursing's Upward Spiral During a Global Pandemic.

BACKGROUND: In March 2020, COVID-19 forced institutions of higher education, faculty, staff, and students to transition to emergency remote learning. This unprecedented time provided the opportunity to reenvision the delivery of nursing education and operation of the college of nursing, using the principles of the four Cs of interorganizational partnering as a guide supported by positive organizational scholarship. METHOD: The Villanova University Fitzpatrick College of Nursing designed and implemented strategies to provide seamless learning opportunities for students in undergraduate and graduate nursing programs, while providing necessary support and future planning for the upcoming academic year. RESULTS: Online and virtual learning platforms integrated into curricula assisted students to meet course objectives and program outcomes. Strategies for effective communication, collegiality, and collaboration within and among the college, university, and nursing community served as mechanism for innovation. CONCLUSION: Communication, cooperation, coordination, and collaboration, along with positive organizational strategizing and support contributed to a successful transition during the COVID-19 pandemic; many of the approaches implemented during the emergency transition will continue into the future.[J Nurs Educ. 2020;59(12):675-682.].

Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review.

BACKGROUND: The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy. OBJECTIVES: The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error. DATA SOURCES: The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies. CONCLUSIONS: The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research. IMPLICATIONS FOR PRACTICE: There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.

The Realities of Collaboration: An Academic and Practice Partnership in Simulation Education With Nurse Residents.

This article details the collaborative effort between a team of academic nurse educators with educators in a practice setting in the planning and implementation of a simulation-focused study to develop clinical judgment and clinical competency among new-to-practice nurses enrolled in a nurse residency program. Competing priorities between achieving the aims of the study and initiatives within the healthcare system are detailed, and suggestions for future joint research-focused efforts between academic and practice-based educators are offered.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development.

AIM: The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment. BACKGROUND: A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX. METHOD: Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners. RESULTS: Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection. CONCLUSION: Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

Psychometric Evaluation of the Nursing Students' Attitudes Toward Nursing Education Research Questionnaire.

BACKGROUND AND PURPOSE: While nursing students' attitudes about research are generally positive, little is known about their attitudes toward education research. The purpose of this study was to test the psychometric properties of the newly developed Nursing Students' Attitudes toward Nursing Education Research Questionnaire (NSANERQ). METHODS: The 25-item NSANERQ was adapted from an existing tool measuring nursing students' attitudes toward nursing research. Content and construct validity, and internal consistency and test-retest reliability were evaluated. Content validity was assessed using a panel of five experts. Internal consistency reliability and construct validity were assessed in a sample of 156 senior, junior, and sophomore baccalaureate nursing students with a mean age of 20.55 years. A separate sample of 49 freshmen baccalaureate nursing students with a mean age of 18.35 years was used to assess test-retest reliability. Both samples were predominantly female, White, and non-Hispanic/non-Latino. RESULTS: The NSANERQ demonstrated excellent content validity (S-CVI = 0.92), good internal consistency reliability (α = .88), and acceptable test-retest reliability (r = 0.71) over 2 weeks. Exploratory factor analysis resulted in a six-factor solution, which was confirmed through confirmatory factor analysis. CONCLUSIONS: The NSANERQ is a valid and reliable instrument that can be used to measure students' attitudes toward nursing education research.

Simulation for Clinical Preparedness in Pediatric Emergencies: A Pilot Study.

Positive outcomes for pediatric in-hospital cardiopulmonary arrest remain low with little change in mortality rates. Infrequently used clinical knowledge and skills decline quickly, contributing to poor quality of resuscitation. The aim of this pilot study exploring the outcomes of repeated pediatric mock code simulations with structured debriefing demonstrated statistically significant differences in participants' knowledge of pediatric emergencies, with no significant decline in resuscitation skills. This provides an evidence-based approach for professional development educators working with nurses on pediatric emergencies.

Innovative Approach to Address Disability Concepts and Standardized Patients With Disability in an Undergraduate Curriculum.

BACKGROUND: Despite a growing population of people with disabilities (PWD), health care professionals, including nurses, receive little educational preparation to provide health care to them. To address this issue in nursing education, the faculty of a school of nursing designed and implemented an innovative teaching strategy that can be adopted by other nursing programs and faculty. METHOD: A systematic plan was developed and implemented to integrate standardized patients with disabilities (SPWD) into an existing undergraduate nursing program. Steps included careful planning, review, and modification of existing simulation-based scenarios, obtaining buy-in of faculty across the curriculum, recruitment and training of PWD to be SPWD, and implementation of the project. RESULTS: The program in which all undergraduate nursing students have repeated contact with SPWD has been successfully implemented throughout the curriculum. CONCLUSION: The project addressed the multiple calls to improve the preparation of health care professionals to provide quality care to PWD. [J Nurs Educ. 2018;57(12):760-764.].