Society for Simulation in Healthcare Guidelines for Simulation Training.

BACKGROUND: Simulation has become a staple in the training of healthcare professionals with accumulating evidence on its effectiveness. However, guidelines for optimal methods of simulation training do not currently exist. METHODS: Systematic reviews of the literature on 16 identified key questions were conducted and expert panel consensus recommendations determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. OBJECTIVE: These evidence-based guidelines from the Society for Simulation in Healthcare intend to support healthcare professionals in decisions on the most effective methods for simulation training in healthcare. RESULTS: Twenty recommendations on 16 questions were determined using GRADE. Four expert recommendations were also provided. CONCLUSIONS: The first evidence-based guidelines for simulation training are provided to guide instructors and learners on the most effective use of simulation in healthcare.

A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education: A Systematic Review.

ABSTRACT: With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: ( a ) research study (of any design), ( b ) focused on learners in health professions, and ( c ) compared VR with traditional simulation. Studies were excluded for the following reasons: ( a ) not a research study, ( b ) focused on learners outside health professions, ( c ) used screen-based or computer-based simulation, ( d ) used a task trainer, and ( e ) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.

Factors Associated With Improved Pediatric Resuscitative Care in General Emergency Departments.

OBJECTIVES: To describe the quality of pediatric resuscitative care in general emergency departments (GEDs) and to determine hospital-level factors associated with higher quality. METHODS: Prospective observational study of resuscitative care provided to 3 in situ simulated patients (infant seizure, infant sepsis, and child cardiac arrest) by interprofessional GED teams. A composite quality score (CQS) was measured and the association of this score with modifiable and nonmodifiable hospital-level factors was explored. RESULTS: A median CQS of 62.8 of 100 (interquartile range 50.5-71.1) was noted for 287 resuscitation teams from 175 emergency departments. In the unadjusted analyses, a higher score was associated with the modifiable factor of an affiliation with a pediatric academic medical center (PAMC) and the nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. In the adjusted analyses, a higher CQS was associated with modifiable factors of an affiliation with a PAMC and the designation of both a nurse and physician pediatric emergency care coordinator, and nonmodifiable factors of higher pediatric volume and location in the Northeast and Midwest. A weak correlation was noted between quality and pediatric readiness scores. CONCLUSIONS: A low quality of pediatric resuscitative care, measured using simulation, was noted across a cohort of GEDs. Hospital factors associated with higher quality included: an affiliation with a PAMC, designation of a pediatric emergency care coordinator, higher pediatric volume, and geographic location. A weak correlation was noted between quality and pediatric readiness scores.

Frequently Used Conceptual Frameworks and Design Principles for Extended Reality in Health Professions Education.

Health professions education (HPE) has witnessed a dramatic increase in the use of extended reality (XR), but there is limited evidence that conceptual frameworks are being effectively employed in the design and implementation of XR. This paper introduces commonly utilized conceptual frameworks that can support the integration of XR into the learning process and design principles that can be helpful for the development and evaluation of XR educational applications. Each framework and design principle is summarized briefly, followed by a description of its applicability to XR for HPE and an example of such application.

Interprofessional education faculty development survey: Perspectives on IPE and collaborative practice and COVID-19.

The cancellation of in-person classes in March 2020 due to COVID-19 caused a sudden shift in the educational experiences of health profession students enrolled at the University of Michigan (U-M). With the move to remote learning, educators engaging in interprofessional education (IPE) were faced with the challenge of preparing students for interprofessional collaboration from a distance. A survey was designed to investigate the impact of the pandemic on IPE practices and discover educator development needs. Faculty and staff from 10 health sciences schools within the U-M and Michigan Medicine were invited to complete a survey investigating their use of IPE competencies prior to, during, and after the pandemic; their development needs; and their ideas for future implementation of IPE and collaborative practice. Fifty-six percent of respondents reported their ability to teach IPE competencies was impacted by changes related to COVID. There was a significant (p ≤ 0.001) difference between self-report of incorporating IPE competencies prior to and during pandemic and during and into the future across all five competencies. Technology was reported as a challenge when teaching IPE, and a need for future faculty development. Leveraging virtual and case-based learning and increasing collaboration between schools were identified as ideas for future implementation.

Rural Michigan Farmers' Health Concerns and Experiences: A Focus Group Study.

OBJECTIVES: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents' perceptions of health and experiences interacting with the health care system to identify gaps in care. METHODS: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. CONCLUSION: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most-93% (n = 13)-reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. CONCLUSION: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.

Improving Patient\Population Health: Using 'Why' to Develop a Transformative Research Center.

INTRODUCTION: Novel approaches to address the most vexing problems facing patients and vulnerable populations are needed. The purpose of this project was to establish an innovative research Center based on the principles of transformational organizations. METHODS: A new Center formed included faculty members with expertise in cancer, serious illness, and population health. Applying Sinek's "why, how, and what" framework, members developed and refined a purpose statement and strategic objectives. The Center now includes members representing diverse disciplines. Year 1 accomplishments included a refined mission and vision statement, two funded research proposals, one submitted training grant, one administrative hire, and active recruitment of two-research faculty to support Center activities. CONCLUSIONS: The newly-formed Center for Improving Patient and Population Health has enabled scholars within a research-intensive school of nursing to forge new partnerships to compete successfully for larger, complicated grant proposals on shorter deadlines. Opportunities exist to integrate students and research staff more fully into Center operations.

The Flipped Classroom With Case-Based Learning in Graduate Nurse Anesthesia Education.

A pilot study was conducted to compare student academic performance and course satisfaction with the flipped classroom (a type of blended learning) and casebased learning in a graduate nurse anesthesia program. Quiz, test, and student satisfaction survey scores from a neuroanesthesia principles course were compared between 2 first-year nurse anesthesia student cohorts taught in a flipped classroom with case-based learning (n=17) vs traditional lecture-based classroom (n=19). Mean preclass and postclass quiz scores (SD) improved significantly in both the flipped classroom (8.41 [0.870] vs 8.94 [0.243], P=.03, α =.05) and traditional classroom (8.68 [0.58], P=.03, α .05). Between cohorts, no significant differences were found on mean preclass (8.41 vs 8.68, P=.34, α <.05) and postclass quizzes (8.94 vs 9.0, P=.32, α <.05) or examination scores (29.41 [2.00]; 28.31 [2.14]; P=.12, α <.05). Student satisfaction scores were favorable but not significantly different between cohorts. Based on noninferior outcomes in student academic performance and satisfaction, the flipped classroom with case-based learning may be a suitable alternative to the traditional lecture-based classroom in graduate nurse anesthesia education.

Evaluation of an Interprofessional Training Program to Improve Cancer Drug Therapy Safety.

PURPOSE: Drug therapy for cancer is a high-risk, high-volume clinical intervention that requires interprofessional teams. Given the complexity of anticancer drug therapy and safety concerns, an interdisciplinary team developed a novel training program for oncology registered nurses and pharmacists to improve cancer drug safety. METHODS: Participants completed preworkshop learning assessments and received access to web-based modules on six topics: hazardous drug handling, drug extravasation, hypersensitivity reaction management, sepsis recognition, immune checkpoint inhibitor toxicities, and oral oncolytic adherence. In a 7-hour workshop, participants applied module content in interactive exercises and high-fidelity simulations. Preworkshop and postworkshop questionnaires assessed changes in knowledge and confidence in each topic. Program satisfaction and changes to clinical practice or policies were assessed 3 months after the workshop. RESULTS: Two hundred ninety-two nurses and 82 pharmacists applied to participate, and 103 (35%) and 44 (54%) have participated, respectively. Long-term follow-up data were available on 133 (90%) participants. Change scores in confidence to meet program objectives increased between pre- and postworkshop (range of increase 0.6-0.8, P < .01). Knowledge scores increased significantly between pre- and postworkshop (average improvement of 3.2 points, P < .01). Overall program satisfaction was high (mean 5.0, standard deviation [0.2] on a five-point scale). Seventy-seven (60%) reported that they had made at least one clinical practice or institutional policy change at 3 months. CONCLUSION: An interprofessional education program with online modules, in-person interactive sessions, and simulation activities is a promising strategy to deliver cancer drug safety content to practicing oncology clinicians.

Improving Pediatric Readiness in General Emergency Departments: A Prospective Interventional Study.

OBJECTIVE: To describe the impact of a national interventional collaborative on pediatric readiness within general emergency departments (EDs). STUDY DESIGN: A prospective, multicenter, interventional study measured pediatric readiness in general EDs before and after participation in a pediatric readiness improvement intervention. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS) on a 100-point scale. The study protocol extended over 6 months and involved 3 phases: (1) a baseline on-site assessment of pediatric readiness and simulated quality of care; (2) pediatric readiness interventions; and (3) a follow-up on-site assessment of WPRS. The intervention phase included a benchmarking performance report, resources toolkits, and ongoing interactions between general EDs and academic medical centers. RESULTS: Thirty-six general EDs were enrolled, and 34 (94%) completed the study. Four EDs (11%) were located in Canada, and the rest were in the US. The mean improvement in WPRS was 16.3 (P < .001) from a baseline of 62.4 (SEM = 2.2) to 78.7 (SEM = 2.1), with significant improvement in the domains of administration/coordination of care; policies, protocol, and procedures; and quality improvement. Six EDs (17%) were fully adherent to the protocol timeline. CONCLUSIONS: Implementing a collaborative intervention model including simulation and quality improvement initiatives is associated with improvement in WPRS when disseminated to a diverse group of general EDs partnering with their regional pediatric academic medical centers. This work provides evidence that innovative collaboration facilitated by academic medical centers can serve as an effective strategy to improve pediatric readiness and processes of care.

Virtual and Augmented Realities in Nursing Education: State of the Science.

The use of simulation in nursing education is an integrated part of the curriculum and has demonstrated the benefit for learning in nursing students at all levels. The next stage in simulation-based learning will utilize the wide variety of new technologies that are currently available, including virtual and augmented reality. The use of these new technologies brings with it a need for standard definitions, evaluation of its impact on learning, and new opportunities for research. Efforts are underway to standardized definitions and publish early findings on research using these new technologies. There are many opportunities available for nursing educators to create a new era of simulation-based learning methodologies by incorporating virtual and augmented realities in their curriculum. The state of the science is showing promising outcomes and commercial products are maturing.The utilization of these new technologies should be approached in the same way as other learning methodologies as many new ideas and ways of learning are emerging in this area. It will be critical for nursing educators and faculty to determine the optimal ways to utilize them.

Interactive Anatomy-Augmented Virtual Simulation Training.

BACKGROUND: Traditionally, clinical psychomotor skills are taught through videos and demonstration by faculty which does not allow for the visualization of internal structures and anatomical landmarks that would enhance the learner skill performance. METHODS: Sophomore and junior nursing students attending a large Midwestern Institution (N=69) participated in this mixed methods study. Students demonstrated their ability to place a nasogastric tube (NGT) after being randomly assigned to usual training (Control group) or an iPad anatomy-augmented virtual simulation training module (AR group). The ability of the participants to demonstrate competence in placing the NGT was assessed using a 17-item competency checklist. After the demonstration, students completed a survey to elicit information about students' level of training, prior experience with NGT placement, satisfaction with the AR technology, and perceptions of AR as a potential teaching tool for clinical skills training. RESULTS: The ability to correctly place the NGT through all the checklist items was statistically significant in the AR group compared with the control group (P = 0.011). Eighty-six percent of participants in the AR group rated AR as superior/far superior to other procedural training programs to which they had been exposed, whereas, only 5.9% of participants in the control group rated the control program as superior/far superior (P < 0.001). CONCLUSIONS/IMPLICATIONS: Overall the AR module was better received compared with the control group with regards to realism, identifying landmarks, visualization of internal organs, ease of use, usefulness, and promoting learning and understanding.

Associations among unit leadership and unit climates for implementation in acute care: a cross-sectional study.

BACKGROUND: Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units. METHODS: A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05. RESULTS: Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not. CONCLUSION: Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.

Multidimensional Evaluation of Simulation-Based Course to Enhance Prelicensure Nursing Students' Clinical Skills.

This article describes the development of a new simulation-based course designed to remediate the clinical skills of prelicensure nursing students and the multidimensional method used to evaluate this new course. Evaluation of the course was guided by Kirkpatrick levels of training. The Quint Leveled Clinical Competency Tool was used to evaluate students' clinical competencies. Success of the course was found in 3 levels of evaluation.

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.

The History of Simulation and Its Impact on the Future.

Simulation has had a long and varied history in many different fields, including aviation and the military. A look into the past to briefly touch on some of the major historical aspects of simulation in aviation, military, and health care will give readers a broader understanding of simulation's historical roots and the relationship to patient safety. This review may also help predict what the future may hold for simulation in nursing. Health care, like aviation, is driven by safety, more specifically patient safety. As the link between simulation and patient safety becomes increasingly apparent, simulation will be adopted as the education and training method of choice for such critical behaviors as communication and teamwork skills.

Development of an instrument to measure deliberate practice in professional nurses.

PURPOSE: This paper describes the development of the Deliberate Practice in Nursing Questionnaire (DPNQ) and the reliability and validity characteristics of the instrument. METHODS: A cross-sectional, descriptive study assessed the DPNQ in a sample of critical care registered nurses (RN). It was conducted at one large Midwestern teaching hospital. A medical intensive care unit (ICU), a surgical ICU, and a trauma/burn ICU participated. Instrument construction involved item development based on a literature review, an existing deliberate practice questionnaire and existing parameters of deliberate practice in nursing. Content reliability and validity were established by expert panel review and survey testing. Probit analysis of survey data was used to develop a composite score for the DPNQ. RESULTS: Expert panel review revealed an inter-rater agreement (80% reliability) of .92-.96 and a content validity index of 0.94. The final DPNQ consists of 24 items with six subcategories and a composite score of 96. Cronbach's alpha coefficient for the DPNQ in this study was .660 (standardized, .703). The instrument was further validated with the Nurse Competence Scale. Deliberate practice was significantly, positively correlated with competence (rs=.366, p=001). CONCLUSIONS: Findings from the expert panel provided guidance for development and revision of the DPNQ. Survey testing of the instrument revealed a promising measure of deliberate practice with good reliability and validity characteristics. Identification of a relationship between deliberate practice and competence confirms existing evidence in other domains, providing further validation. Understanding deliberate practice provides a unique way to examine nursing expertise.

INACSL Standards of Best Practice for Simulation: Past, Present, and Future.

AIM: To describe the historical evolution of the International Nursing Association for Clinical Simulation and Learning's (INACSL) Standards of Best Practice: Simulation. BACKGROUND: The establishment of simulation standards began as a concerted effort by the INACSL Board of Directors in 2010 to provide best practices to design, conduct, and evaluate simulation activities in order to advance the science of simulation as a teaching methodology. METHOD: A comprehensive review of the evolution of INACSL Standards of Best Practice: Simulation was conducted using journal publications, the INACSL website, INACSL member survey, and reports from members of the INACSL Standards Committee. RESULTS: The initial seven standards, published in 2011, were reviewed and revised in 2013. Two new standards were published in 2015. The standards will continue to evolve as the science of simulation advances. CONCLUSION: As the use of simulation-based experiences increases, the INACSL Standards of Best Practice: Simulation are foundational to standardizing language, behaviors, and curricular design for facilitators and learners.

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork.

In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.