Development of Trigger Films to Explore Nursing Students' Attitudes Toward Patients with Obesity.

Introduction: Given the increased prevalence of obesity and the existence of negative attitudes among health care providers toward patients with obesity (PWO), strategies are needed to assist nursing students in identifying and examining attitudes and beliefs related to the provision of care for individuals with obesity. Nursing school curricula should incorporate effective interventions for students in order to reduce stigmas and to modify negative attitudes and behaviors that interfere with quality nursing care for PWO. This article describes the process of developing and implementing an innovative bariatric sensitivity intervention (BSI) for prelicensure nursing students. Methods: The BSI includes six trigger films that address the multi-faceted aspects of caring for PWO and provoke reflection on obesity-related attitudes and beliefs, as well as a facilitated debrief. Conclusion: We discuss the practical aspects of video production and the successful use of multimedia instruction to affect prelicensure nursing students' behaviors.

Creating Inclusive Learning Environments for Chinese and American Pediatric Nursing Students.

During the COVID-19 pandemic, students from two schools of nursing, in China and the United States respectively, engaged in a transcultural simulation activity to explore how a global healthcare crisis has been managed within their different cultures. This article describes the development and implementation of the project and evaluates student perspectives on the simulation...s influence on increasing awareness of diversity, equity, and inclusion. Data for this project were collected through student verbal and written reflections and faculty comments. Results: Students reported the virtual simulation positively impacted their learning and enjoyed the opportunity to navigate through a virtual scenario collaboratively while discussing cultural similarities and differences. Faculty noted the simulation was valuable and described challenges faced during the development. Conclusions: Students and faculty found the simulation was a meaningful learning experience. Findings suggests that the transcultural simulation improved student knowledge of cultural competence and understanding of diversity, equity, and inclusion constructs.

Why an IPE Team Matters Improvement in Identification of Hospital Hazards: A Room of Horrors Pilot Study.

Purpose: To evaluate student performance in a simulation-based interprofessional learning activity that focused on identifying patient safety hazards in a simulated patient's hospital room. Participants and Methods: Students from nursing, occupational therapy, physiotherapy, radiography, social education, social work, biomedical laboratory science, dental hygiene, and medicine participated in this two-phased study. In the first phase, students worked alone to identify safety hazards. In the second phase, students worked in interprofessional teams. Following each phase, students completed a structured questionnaire to report their findings. In addition, following the first phase, each student wrote down the hazards they identified in an unstructured essay format. Results: Out of 48 intended hazards, individual students identified 10.7% on the open essay and 42.6% on the questionnaire, and interprofessional teams identified 90.1%. Conclusion: The number of hospital hazards identified increased considerably when working in interprofessional teams. A room of horrors exercise expands participants' observational skills. With some modifications, this pilot study can be implemented on a wider scale with the goal of increasing interprofessional students' awareness of hospital hazards.

Nursing Students From China and the United States: Learning Together Through Virtual Simulation.

AIM: The purpose of this project was to connect nursing students from schools of nursing in China and the United States for colearning using virtual simulations. BACKGROUND: With technology and international partnerships, nursing programs can offer global education without students traveling to other countries. METHOD: Virtual simulations were produced by each school for the project. Students completed them in two synchronous 1.5-hour virtual sessions, one month apart. At the end of each session, students completed the Simulation Effectiveness Tool-Modified and the Nurses Clinical Reasoning Scale. RESULTS: Scores on the Simulation Effectiveness Tool-Modified ranged from 75.0 percent to 100 percent on Simulation 1 (video vignettes focused on prioritization) and 88.9 percent to 100 percent on Simulation 2 (computer-based obstetrics case). Most students strongly agreed or agreed that the simulation improved their clinical reasoning skills. CONCLUSION: Virtual simulations allowed students to learn together and develop an awareness of differences in nursing practices across countries.

Outcomes of a holistic admissions process in an Accelerated Baccalaureate Nursing Program.

An accelerated bachelor of science in nursing program adopted holistic admissions practices to increase diversity in the student body. This quality improvement project aimed to compare three cohorts of students accepted before holistic admissions practices to three cohorts accepted after holistic admissions. The authors examined demographic data, on-time graduation rate, licensure exam passing rate, remediation status, and student perceptions expressed on exit surveys. After holistic admissions were implemented, student diversity increased and on-time graduation and licensure exam pass rates were maintained. The need for student remediation decreased after holistic admissions were implemented, and student perceptions of their classmates and the relevance of their schooling to their future professional career increased.

Faculty development workshop on gender-associated incivility in nursing education.

BACKGROUND: Men comprise the minority of entry-level baccalaureate nursing students and are at increased risk of experiencing gender-associated incivility. PROBLEM: Uncivil peer-to-peer behavior can negatively affect students' mental and physical well-being, and learning experience. Nursing faculty must be able to identify and address gender-associated incivility among students. AIM: The purpose of this quality improvement program was to train nursing faculty to prevent, identify, and manage gender-associated incivility in the educational environment. METHODS: A day-long interactive workshop utilizing trigger films, small group discussions, and interactive theater was developed to train nursing faculty to implement proactive and reactive techniques to address uncivil behavior which will enhance the learning environment for all students. Utilizing Kirkpatrick's Model of Evaluation, participants were surveyed at the conclusion of the workshop and four months postworkshop to evaluate their learning and its implementation. RESULTS: Participants gained greater understanding of the impact of gender-associated incivility and felt both empowered and better prepared to manage gender-associated conflict. CONCLUSION: Similar approaches may be useful for schools of nursing that wish to empower their nursing faculty to support an equitable nursing education environment free of gender-associated incivility.

Embracing Disruption: Measuring Effectiveness of Virtual Simulations in Advanced Practice Nurse Curriculum.

Changes in academia have occurred quickly in response to the COVID-19 pandemic. In-person simulation-based education has been adapted into a virtual format to meet course learning objectives. The methods and procedures leveraged to onboard faculty, staff, and graduate nurse practitioner students to virtual simulation-based education while ensuring simulation best practice standards and obtaining evaluation data using the Simulation Effectiveness Tool-Modified (SET-M) tool are described in this article.

Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement Project.

BACKGROUND: The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning. OBJECTIVES: This quality improvement project was designed to implement a post-cardiac surgery resuscitation protocol in a nonacademic, community medical center to enhance nurse knowledge, confidence, and proficiency for optimal patient outcomes. METHODS: The Cardiac Surgical Unit-Advanced Life Support is an evidence-based resuscitation protocol that was implemented using didactic, hands-on training, and SBL. It was evaluated using knowledge surveys, comparisons in nurse confidence and performance measures, and patient outcomes data. RESULTS: Nurses' knowledge gains (ie, mean test scores) on our test were statistically significant between 3 time points (F2,60 = 81.204, P < .001). Knowledge significantly increased from pre-education to immediate post-education (P < .001), but declined from immediate post-education to 3-month post-education assessments (P < .001); however, the 3-month post knowledge mean was still higher than the pre-education knowledge mean (P < .001). Nurses were confident in their ability to apply the protocol, although results failed to show a correlation between confidence and performance ability. Statistical significance for delay in cardiopulmonary resuscitation was found between pre- and post-nursing education patient cardiac arrest events (P = .05). CONCLUSIONS: Didactic and hands-on learning supported knowledge retention over time for cardiothoracic surgical intensive care unit nurses. Improving self-confidence and the application of an unfamiliar resuscitation protocol through SBL and any impact a training program has on patient outcomes will require ongoing practice and more evaluation.

Baseline Cardiopulmonary Resuscitation Skill Performance of Nursing Students Is Improved After One Resuscitation Quality Improvement Skill Refresher.

This article reports the results of baseline cardiopulmonary resuscitation (CPR) skills performance measurements from 467 nursing students. All participants had completed a CPR course. Baseline measurements were compared to performance after one 10-minute refresher training session on the Resuscitation Quality Improvement system. Significant improvements were made after the computer- and practice-based refresher. Findings suggest that staff developers should evaluate the use of audio and visual feedback devices to improve the quality of CPR provided by clinical staff.

Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation: A Quality Improvement Project.

BACKGROUND: Mechanical ventilation is the standard of care after cardiac surgery, but it imposes physiologic and psychological stress on patients. The Society of Thoracic Surgery recommends 6 hours as the goal for extubation, but 60% of our patients were not meeting this metric. OBJECTIVES: The objectives of this project were to decrease cardiac surgery patients' ventilation hours and intensive care unit length of stay using a ventilator weaning protocol. METHODS: An evidence-based ventilator weaning protocol was developed, and nurses were prepared for its implementation using a simulation education program. RESULTS: Ventilator hours were reduced from 7.74 to 6.27 (t = 2.5, P = .012). The percentage of patients extubated in 6 hours increased from 40% to 63.5% (χ = 7.757, P = .005). There was no statistically significant decrease in cardiovascular intensive care unit length of stay (17.15 to 15.99, t = 0.619, P = .537). Nurses' scores on a knowledge test increased significantly from pre (6.11) to post (7.79) (t = -5.04, P < .001). Their perception of confidence increased in weaning from pre (median, 4; IQR, 4,4) to post (median, 4; interquartile range [IQR], 4,5), z = -2.71, P = .007, and also in using the protocol from pre (median, 4; IQR, 3,4) to post (median, 4; IQR, 4,5) (z = -3.17, P = .002). DISCUSSION: Using a nurse-led ventilator weaning protocol resulted in decreased ventilator hours for patients and increased knowledge and confidence for nurses.

Preparing Clinicians for Transitioning Patients Across Care Settings and Into the Home Through Simulation.

Assuring home care staff competencies through simulation has the potential to improve care transitions and clinical outcomes. Recreating a home environment can be used for orientation of home care staff and to meet other learning needs. Lessons learned from the use of simulation in a geriatric nursing course in a prelicensure program can be used to prepare clinicians for transitioning patients across care settings. With simulation, learners can identify challenges in patient safety, pain management, and management of patients' cognitive decline as well as learn how to communicate with patients, family members, and the healthcare team. Simulation, as an interactive pedagogy, provides opportunities for learners to practice assessment, monitoring, and patient care in a controlled, safe, risk-free environment. Following participation in a simulation, learners are given the opportunity to reflect on ways to improve patient care when transitioning from acute to home care settings. Simulations described in this article can be used for orientation of staff to a home healthcare agency because they allow clinicians to hone the skills necessary for patient care in the home. Staff educators can also use simulation to validate staff competencies in caring for patients at home.

Student-Developed Simulations: Enhancing Cultural Awareness and Understanding Social Determinants of Health.

BACKGROUND: National and global initiatives to address the social determinants of health (SDH) are on the rise. On a parallel trajectory, increased cultural awareness is emerging as an integral strategy to improve the understanding of these social contributions to disease states, health inequities, and health disparities. METHOD: Undergraduate nursing students developed modalities and role-played simulations as a teaching and learning strategy. The simulations demonstrated how nurses assess patients' unique needs and offer support and resources regarding patients' socioeconomic, cultural, and environmental needs. RESULTS: The student-developed simulations were an interactive teaching and learning strategy that offered several benefits, such as improved interpersonal skills, learned specific nursing roles, and improved cultural awareness. CONCLUSION: Student-developed simulations are an innovative teaching strategy for improving cultural awareness and learning more about SDH. [J Nurs Educ. 2017;56(4):243-246.].

How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit?

RATIONALE: Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. Although the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare them adequately for this role. OBJECTIVES: To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified. METHODS: Mixed-methods observational study of graduating nursing (n = 51) and medical (n = 93) students who completed two "Room of Horrors" simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students' written hazard descriptions. Fisher's exact test was used to determine differences in frequency of hazards identified between groups. RESULTS: Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73 vs. 2%, P < 0.001), whereas nursing students noted that there was no order for the restraints (58.5 vs. 0%, P < 0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to those in the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous line (10% individuals, P < 0.0001). Nevertheless, teams of students missed many intensive care unit-specific hazards: 54% failed to identify the presence of pressure ulcers; 85% did not notice high tidal volumes on the ventilator; and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis. CONCLUSIONS: Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the intensive care unit. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each other's roles and responsibilities.

Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians.

The purpose of this article is to describe an innovative method to help home care clinicians better communicate with older adults experiencing normal physiologic changes that impact their ability to communicate effectively. Developmental changes such as hearing, speech, vision, and cognition profoundly impede an older adult's ability to communicate with others, potentially undermining the quality of care delivered. The use of trigger films as an educational intervention can assist home care clinicians to improve communication with their patients. Trigger films are 2- to 4-minute video clips that end abruptly, encouraging learners to analyze clinical situations in a safe environment, such as a staff conference room. Trigger films are easy to make with the use of a smart phone and two staff members portraying the role of home care clinician and patient. Allowing discussion after viewing the trigger film places clinicians in an active learning role, thus fostering the sharing of ideas and best practice. Addressing age-related barriers to communication with this modality serves to improve patient interaction and healthcare outcomes. The use of trigger films is another tool that empowers the clinician to provide improved care for patients with communication deficits.

Using Trigger Films as a Bariatric Sensitivity Intervention: Improving Nursing Students' Attitudes and Beliefs About Caring for Obese Patients.

Nurse educators are uniquely positioned to improve obesity-related attitudes and beliefs among prelicensure nursing students. A bariatric sensitivity intervention using 6 trigger films with facilitated debriefing was designed and delivered to 70 first-semester baccalaureate nursing students. Attitudes and beliefs significantly improved immediately after the intervention on 3 of the 5 attitude measures and on the belief measure. Improvements in beliefs/attitudes were sustained 30 days after the intervention but may require content reinforcement throughout the curriculum for long-term effects.

Cultivating a Culture of Medication Safety in Prelicensure Nursing Students.

Safety education in nursing has traditionally focused at the level of individual nurse-patient interactions. Students and novice clinicians lack clinical experience to create context and understand the complexity of the health care system and safety science. Using the Quality and Safety Education for Nurses quality and safety competency as a framework, the objective of this education project was to design comprehensive, engaging, learner-centered, online modules that increase knowledge, skills, and attitudes about medication safety.