Virtual Interprofessional Education: Team Collaboration in Discharge Planning Simulation.

PURPOSE OF STUDY: This study assessed the effectiveness of a virtual interprofessional education (IPE) discharge planning simulation, focusing on collaborative patient education, and recommendations for hospital discharge. PRIMARY PRACTICE SETTING: An acute care hospital. METHODOLOGY AND SAMPLE: The study utilized a virtual IPE discharge planning simulation for health care students from six different programs. The simulation involved prebriefing, icebreaker, team meeting, patient interaction, and debriefing. Assessment included pre- and post-IPE surveys that included the Interprofessional Education Collaborative (IPEC) Competency Self-Assessment Tool, and video analysis using the Modified McMaster-Ottawa Rating Scale. RESULTS: Student participants from diverse health care programs (n =143) included nursing (n = 20), occupational therapy (n = 21), physical therapy (n = 42), physician assistant (n = 38), respiratory therapy (n = 3), and social work (n = 19). All programs except respiratory therapy showed significant improvement in IPEC Competency scores post-IPE, with positive outcomes for understanding other professions' roles. Students' self-reported perceptions of team performance were rated highly in various categories. Video analysis demonstrated strong interrater reliability for team scores. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Effective hospital discharge planning is vital for cost reduction and patient care improvement. IPE emphasizes collaborative learning among health care students. Previous studies highlight positive outcomes from IPE discharge planning, including virtual formats. This virtual IPE discharge planning simulation significantly improved students' understanding and collaboration competencies, evident in increased IPEC scores across five professions.

Comparing Virtual Simulations to Paper Case Studies in Combination With Manikin-Based Medication Administration Simulations: A Quasi-Experimental Study.

BACKGROUND: Medication errors are among the most common preventable adverse events in health care. METHODS: A quasi-experimental approach with a pre/posttest design was used to explore the effectiveness of an enhanced medication administration simulation bundle that included the use of manikin-based simulation-based experiences (SBEs) in combination with either virtual SBEs (V-SBEs) for deliberate practice (DP) or traditional paper case studies for DP on safe medication administration in undergraduate nursing students. RESULTS: Nursing students (n = 101) participated in multiple medication administration-focused SBEs including DP via V-SBEs or DP via traditional paper case studies. Student performance in the medication administration SBEs improved after the third experience. There was no statistically significant difference between the V-SBE groups compared with the traditional paper case study groups across the 3 medication administration-focused SBEs. CONCLUSION: Findings from this study highlight the importance of DP with medication administration for undergraduate nursing students.

Building Team Leader Competency in Senior Nursing Students.

ABSTRACT: Nursing students have limited opportunities to build team leader skills during their clinical experiences, leaving a practice gap. Senior nursing students participated in a competency-based education unit and a simulation-based learning experience incorporating team leader skills. Presurvey and postsurvey data were collected using the Self-Confidence and Comfort with Utilizing a Standardized Handoff Communication Tool. Participants who completed both surveys were analyzed ( n = 85). Statistically significant improvements were found on 14 of the 19 survey items. Results suggest the effectiveness of using competency-based education and simulation-based learning experience to help nursing students build confidence and comfort in team leader skills.

Using Interprofessional Simulation with Telehealth to Enhance Teamwork and Communication in Home Care.

Interpersonal communication and teamwork are critical to patient safety. There is evidence supporting the effectiveness of formalized team training strategies such as simulation-based learning experiences to permit opportunities for deliberate practice and skill acquisition. However, there is a paucity of evidence examining the best method for delivery of simulation-based interprofessional education activities (Sim-IPE). The purpose of this project was to explore the effectiveness of using a Sim-IPE with a home-based patient assessment and intervention for students in undergraduate nursing, nurse practitioner, and physical therapy programs with the goal of enhancing interprofessional team communication and team performance. A mixed-methods, observational research design was used to evaluate teamwork and communication following virtual/web-based deliberate practice and a subsequent face-to-face Sim-IPE with telehealth. There were two distinct stages: (1) provision of interprofessional education elements of teamwork and communication via a virtual web-based platform to interprofessional student teams; (2) participation of all 29 student teams in a Sim-IPE activity using a standardized patient in a simulated home-based setting. Teams scored very high on an interprofessional communication and teamwork scale, and students strongly agreed that the prebriefing, scenario, and debriefing assisted in their learning. Students also valued exposure to telehealth and the ability to work with students from other health professions.

Maximizing Mobilization of Resources for Unplanned Certified Registered Nurse Anesthetist Staffing Deficiencies in a Large Midwest Multi-Hospital Trauma Center.

Acute staffing deficiencies pose a challenge for hospitals because shortages can negatively impact patient safety. The purpose of this study was to examine the most effective staff recall system (SRS) for Certified Registered Nurse Anesthetists (CRNAs) during times of acute staffing deficiencies, whether from unforeseen emergencies or mass call outs. A preposttest design was used to explore the efficacy of the hospital's current CRNA SRS compared to a newly developed short message system (SMS) Acute Staffing Deficiency Recall Plan. Two 60-minute simulation drills were conducted to test the two systems with a convenience sample of 317 CRNAs. Data were gathered related to CRNAs: contacted, availability, and length of time to contact. Surveys were utilized pre/ post to evaluate knowledge, confidence, and selfefficacy regarding the recall systems. During the first simulation drill, 26% of CRNAs were contacted and 19% confirmed availability within 60 minutes using the standard CRNA SRS. During the second simulation, 86% of the CRNAs were contacted and 38% confirmed availability using the SMS messaging system within 60 minutes (P < .00001 and P < .0001 respectively). The SMS messaging improved CRNA contact by 60% and availability improved by 19% over the standard SRS.

Racism and Professional Competence: Nursing Students in Interracial Evaluations.

BACKGROUND: This pilot study examined the association of internal and external motivation of White nursing students to avoid appearing racist while interacting with standardized patients in a simulation-based learning experience (SP-SBLE). The influence of nursing students' preexisting motivations to avoid racism were examined for their effect on clinical performance in their SP-SBLE. METHOD: White nursing students (N = 50) completed measures of motivations to avoid racism prior to their end of semester practical examination. Students were then randomly assigned to an SBLE with a SP portraying chest pain. RESULTS: White students interacting with White SPs performed better than White students interacting with Black SPs. CONCLUSION: Concern about appearing racist may interfere with White students' ability to perform well in a clinical setting because it may draw cognitive resources away from the clinical task. This is a first step in understanding how nursing students' perceptions may contribute to racial inequities in health. [J Nurs Educ. 2022;61(1):41-45.].

Experiential Learning Through a Dementia Simulation.

Health care providers do not always possess the knowledge and skills necessary to optimally manage behavioral symptoms in patients with Alzheimer's disease (AD). The purpose of the current project was to evaluate the use of a simulated virtual reality AD experience on nursing staff sensitivity, awareness, and perceptions of caring for patients with AD. A quasi-experimental design was used. The Long Tour Survey and Approaches to Dementia Questionnaire were administered pre and post simulation and the Perceptions of Caring surveys were administered 3 to 6 weeks post-intervention. Total scores, although not statistically significant, revealed a slight change in the total score and hope subscale, representing more optimism toward people with dementia. The virtual reality AD simulation was a beneficial experience but unable to demonstrate a real change for the majority of participants. [Journal of Gerontological Nursing, 47(11), 39-47.].

Use of a Structured Approach to Develop Best Practices in Interprofessional Education.

BACKGROUND: Providing interprofessional education (IPE) is mandated by accrediting agencies for health professions education; however, pedagogical, logistical, and financial challenges exist in implementing and sustaining high-quality IPE. After executing several IPE activities, an IPE team developed a structured approach for organizing, sustaining, and ensuring high-quality IPE. This article introduces the Design-Implement-Assess-Modify (DIAM) Model. A portfolio spreadsheet was developed and includes components from each of the DIAM phases. METHOD: The team documented characteristics from five IPE activities conducted annually for 5 years and tracked progress. RESULTS: The DIAM approach has allowed the team to develop a detailed and living portfolio to design, implement, assess, and modify several IPE activities across different professions. CONCLUSION: This approach has led to the intentional planning and development of multiple IPE activities that include the integration of standards of best practice and accreditation, while preparing practitioners for collaborative practice. [J Nurs Educ. 2021;60(6):309-316.].

Increasing awareness, sensitivity, and empathy for Alzheimer's dementia patients using simulation.

BACKGROUND: Alzheimer's Disease (AD), a type of dementia that interferes with memory, thinking, and behavior is the most common type of dementia. As a result, it is a leading contributor to death and disability for those over the age of 65. Therefore, future nurses must have the knowledge and skills to manage patients with AD in any setting spanning the healthcare continuum. OBJECTIVE: The goal of this project was to evaluate perceptions of awareness, knowledge and sensitivity of future nurses concerning AD patients before and after participation in a simulated virtual reality dementia experience. DESIGN/PARTICIPANTS: A quasi-experimental repeated measure pre-post design was used with a convenience sample of 163 undergraduate baccalaureate nursing students from three different courses at large public university in the Midwest. METHODS: Students were placed in teams of four to participate in a 45-minute interactive simulated virtual reality dementia experience. Each session started with a 15-minute team pre-briefing session, followed by a 10-minute individual simulation, which was then followed by a 30-minute team debriefing session facilitated by faculty using the Plus/ Delta debriefing technique. The Dementia Attitudes Scale (DAS), The Knowledge About Memory Loss and Care Test (KAML-C), and the Healthcare Tour Survey were administered pre/post participation. Qualitative data was also collected from student reflections. RESULTS: Statistically significant changes (p < 0.001) were noted in the pre/post DAS survey and the Healthcare Tour Survey. No significant change was noted on the KAML-C, although there was a trend towards improvement. No differences were noted between courses on any of the surveys. CONCLUSION: Using a virtual reality dementia experience proved to be a valuable strategy to increase student perceptions of awareness, knowledge, and sensitivity of AD. Further exploration is warranted to establish how these may be further facilitated to translate into improved care for those with AD.

Report and Prevent: A Quality Improvement Project to Protect Nurses From Violence in the Emergency Department.

INTRODUCTION: Most nurses experience some form of workplace violence resulting in a stressful work environment, employee injury, and turnover. The aims of this project were to develop and evaluate strategies to improve the reporting of workplace violence as well as to empower emergency nurses to prevent assaults and protect themselves. METHODS: This quality improvement project had 2 phases. The phase I educational intervention focused on the importance of reporting workplace violence. Pre- and postintervention surveys measured experiences with workplace violence and reporting. The phase II educational intervention focused on de-escalation and self-protection strategies, training, safety, confidence, and emergency nurses' preparedness to defend themselves. Responses were analyzed using Wilcoxon signed-rank and McNemar tests. RESULTS: Twenty-five emergency nurses participated in phase I, with >90% reporting that they had been assaulted in the past month. Most did not report a workplace assault, which was unchanged after the intervention. Thirty-four emergency nurses participated in phase II, with a postintervention increase reported in the perceived helpfulness of learning self-protection techniques for the emergency nurses' work life (Z = -2.179, P = 0.029). DISCUSSION: This study was consistent with the literature in that emergency nurses often do not report workplace assaults. Most of the emergency nurses surveyed had been assaulted. Although the educational interventions did not achieve the desired outcome, it is clear that additional interventions for individual nurses and institutions need to be developed and refined to increase reporting and prevent workplace assaults.

Checklist design and implementation: critical considerations to improve patient safety for low-frequency, high-risk patient events.

PURPOSE: This pilot project describes the development and implementation of two specialised aviation-style checklist designs for a low-frequency high-risk patient population in a cardiac intensive care unit. The effect of the checklist design as well as the implementation strategies on patient outcomes and adherence to best practice guidelines were also explored. The long-term objective was to improve adherence to accepted processes of care by establishing the checklists as standard practice thereby improving patient safety and outcomes. METHODS: During this project, 10specialised crisis checklists using two specific aviation-style designs were developed. A quasiexperimental prospective pre-post repeated measure design including surveys along with repetitive simulations were used to evaluate self-confidence and self-efficacy over time as well as the perceived utility, ease of use, fit into workflow and benefits of the checklists use to patients. Performance, patient outcomes and manikin outcomes were also used to evaluate the effectiveness of the crisis checklists on provider behaviours and patient outcomes. RESULTS: Overall self-confidence and self-confidence related to skills and knowledge while not significant demonstrated clinically relevant improvements that were sustained over time. Perceptions of the checklists were positive with consistent utilisation sustained over time. More importantly, use of the checklists demonstrated a reduction in errors both in the simulated and clinical setting. CONCLUSION: Recommendations from this study consist of key considerations for development and implementation of checklists including: utilisation of stakeholders in the development phase; implementation in real and simulated environments; and ongoing reinforcement and training to sustain use.

Using Simulation to Evaluate Clinical Performance and Reasoning in Adult-Geriatric Acute Care Nurse Practitioner Students.

BACKGROUND: The use of simulation-based learning experiences (SBLE) with nurse practitioner (NP) students is largely unexplored. The purpose of this pilot project was to develop, implement, and evaluate a simulated patient (SP)-SBLE to improve confidence and evaluate clinical performance and reasoning in Adult-Geriatric Acute Care NP (AG-ACNP) students. METHOD: A mixed-methods design was used to evaluate an SP-SBLE on AG-ACNP student clinical performance and reasoning. RESULTS: Self-confidence scores and themes from reflections indicated that students perceived this as a valuable experience that enhanced learning and confidence. CONCLUSION: Results supported the use of SP-SBLEs to improve confidence in clinical performance and reasoning with AG-ACNP students. [J Nurs Educ. 2019;58(10):599-603.].

Impact of Nursing Education on Phlebotomy Blood Loss and Hospital-Acquired Anemia: A Quality Improvement Project.

BACKGROUND: Phlebotomy blood loss resulting in hospital-acquired anemia remains a significant problem in the critically ill population. A quality improvement project focused on decreasing phlebotomy blood loss and increasing nursing knowledge regarding blood conservation strategies was undertaken in the intensive care unit of a community hospital. METHODS: The project followed a quasi-experimental design. Data were gathered using electronic chart review and surveys before and after educational sessions. Intensive care unit nurses attended educational sessions focused on increasing knowledge regarding phlebotomy blood loss, hospital-acquired anemia, blood conservation strategies, and utilization of blood conservation devices. RESULTS: The study showed a statistically significant increase in nursing knowledge regarding hospital-acquired anemia, phlebotomy blood loss, and blood conservation device use (P < .001) and a statistically significant change in blood conservation device application practice in the posteducation period when compared with the preeducation period (P = .016). CONCLUSION: The findings of this project support the added value of dedicated blood conservation education to nurses to promote increased knowledge, increased blood conservation device utilization, and decreases in phlebotomy blood loss.

Simulated Interprofessional Education Discharge Planning Meeting to Improve Skills Necessary for Effective Interprofessional Practice.

PURPOSE OF STUDY: The purpose of this study was to evaluate the use of a simulation-enhanced interprofessional education (Sim-IPE) discharge planning learning experience using simulated patients (SPs), to explore the ability for students to communicate with each other and to a patient/caregiver, and to use clinical thinking to make a safe and appropriate interprofessional discharge recommendation. PRIMARY PRACTICE SETTING(S): Educational institution; university simulation center. METHODOLOGY AND SAMPLE: A Sim-IPE was performed with students from physical therapy (N = 46), nursing (N = 25), and social work (N = 11). Students were placed into interprofessional teams. Presimulation, each student was expected to complete a survey and review several items including the patient case, a communication strategy, and community resources. The team then interacted with SPs portraying the patient and the family member. Postsimulation, facilitators led a debriefing session and students completed a post-IPE survey. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was completed pre- and postexperience. RESULTS: Most students reported that they strongly or somewhat agreed that the experience improved their clinical thinking skills (67%; n = 55), improved awareness of the patient voice in shared decision-making (72.8%; n = 59), improved ability to prioritize patient's list of impairments (75.3%; n = 61), and improved confidence with discharge planning (69.1%; n = 56). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Discharge planning is inherently an interprofessional process. Utilizing a simulation as a method to practice discharge planning may have a positive impact on future clinical practice. Completing the ICCAS may not be the appropriate assessment when evaluating change before and after an IPE experience based on the high scores noted preexperience. The use of a simulated discharge planning meeting may improve skills necessary for effective interprofessional practice.

Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project.

Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

Full neurologic recovery and return of spontaneous circulation following prolonged cardiac arrest facilitated by percutaneous left ventricular assist device.

Sudden cardiac arrest is associated with high early mortality, which is largely related to postcardiac arrest syndrome characterized by an acute but often transient decrease in left ventricular (LV) function. The stunned LV provides poor cardiac output, which compounds the initial global insult from hypoperfusion. If employed early, an LV assist device (LVAD) may improve survival and neurologic outcome; however, traditional methods of augmenting LV function have significant drawbacks, limiting their usefulness in the periarrest period. Full cardiac support with cardiopulmonary bypass is not always readily available but is increasingly being studied as a tool to intensify resuscitation. There have been no controlled trials studying the early use of percutaneous LVADs (pLVADs) in pericardiac arrest patients or intra-arrest as a bridge to return of spontaneous circulation. This article presents a case study and discussion of a patient who arrested while undergoing an elective coronary angioplasty and suffered prolonged cardiopulmonary resuscitation. During resuscitation, treatment included placement of a pLVAD and initiation of therapeutic hypothermia. The patient made a rapid and full recovery.

Does the sequence of instruction matter during simulation?

INTRODUCTION: Instructional strategies must be balanced when subjecting students to full-immersion simulation so as not to discourage learning and increase cognitive overload. The purpose of this study was to determine if participating in a simulation exercise before lecture yielded better performance outcomes among novice learners. METHODS: Twenty-nine participants were divided into 2 groups as follows: group 1 participated in simulation exercises followed by a didactic lecture and group 2 participated in the same learning activities presented in the opposite order. Participants were administered a multiple-choice cognitive assessment upon completion of a workshop. RESULTS: Learners who participated in the simulated exercises followed by the didactic lecture performed better on postassessments as compared with those who participated in the simulation after the lecture. A repeated-measures or nested analysis of variance generated statistically significant results in terms of model fit F (α=0.05; 4.54)=176.07 with a P<0.0001. Despite their higher levels of increased performance, 76% of those who participated in simulation activities first indicated that they would have preferred to participate in a lecture first. CONCLUSIONS: The findings of this study suggest that differences occur among learners when the sequencing of instructional components is altered. Learners who participated in simulation before lecture demonstrated increased knowledge compared with learners who participated in simulation after a lecture.