Insights Into Learning Among Physical Therapy, Medical, and Nursing Students Following a Simulation-Based, Interprofessional Patient Safety Course.

As the need for a strong interdisciplinary approach in the delivery of healthcare services becomes increasingly vital, interprofessional education (IPE) is essential to equip healthcare professionals of the future to deliver better care. IPE encounters using simulation-based education can be a powerful tool in inculcating pre-professional students with foundational tools for successful interprofessional work. This qualitative study explores the learning that occurs during IPE encounters that include nursing, physical therapy, and medical students. The results of this work highlight how important IPE encounters are in uncovering and changing cross-disciplinary notions about knowledge, skills, role, and team contributions. Specifically, our analysis demonstrated that there are common misunderstandings about contemporary roles, knowledge, and skills of physical therapists among both nursing and medical students that can be corrected in IPE encounters. Results also demonstrated that careful planning can bolster opinions of the value of activities embedded as part of a larger course. Moreover, planning and attention to the specific educational needs of all students may prevent any group feeling that their educational needs were not fully met across all disciplines. The findings support the consideration that IPE can be an important method to instill foundational interprofessional knowledge, skills, and attitudes to promote a foundation from which to establish strong career-long interprofessional collaborations. It is important to lay foundational interprofessional skills and appreciation of the 'other' in pre-licensure curricula, but these efforts should not be limited to only pre-licensure programs and need also to be included as part of on-going professional development education, especially as healthcare education, roles, and responsibilities evolve.

A comparison of learning outcomes from two poverty simulation experiences.

OBJECTIVES: Five nationally representative U.S. federal data sources consistently showed the link between poverty and poor health outcomes. To determine the modality effective in teaching students about poverty and health, this study compared the attitudes toward poverty of students participating in the Community Action Poverty Simulation (CAPS) and the poverty table-top simulation (Dwell™). METHODS: In this quasi-experimental study, undergraduate and graduate nursing students and physical therapy students participated in either CAPS or a table-top simulation (TTS) depending on their semester of enrollment in the relevant course. The Undergraduate Perception of Poverty Tracking Survey (UPPTS) was administered before and after each simulation. RESULTS: The analysis included 118 matched pairs. Using MANOVA tests, the authors found no group difference in the overall change of attitude after the simulations (p = .232). However, by the subscale analyses, TTS significantly increased students' willingness to help (p = .008, η2  = 0.058) and their empathy toward those living in poverty (p = .039, η2  = 0.039). CONCLUSION: TTS participants had more elements of improvement, but both modalities were found to change participants' attitudes.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Participation in a System-Thinking Simulation Experience Changes Adverse Event Reporting.

INTRODUCTION: System failures are contributing factors in the thousands of adverse events occurring in US healthcare institutions yearly. This study explored the premise that exposure to a simulation experience designed to improve system thinking (ST) would impact adverse event reporting patterns. METHODS: An intervention-control study was used to explore impacts of participation in a simulation designed to improve ST on adverse event reporting. Each summer Bachelor in Nursing Science students along with medical students participate in a week-long simulation-based interprofessional patient safety course. During the 2017 course, Friday Night in the ER, a table-top simulation designed to develop ST was included. As part of the school nursing's simulation program, students are asked to report adverse events observed or committed during simulation encounters into a simulated adverse event reporting system outside the simulation-based interprofessional patient safety course. Adverse event reporting system data were used to examine patterns of adverse event reporting in control and intervention groups studied. RESULTS: Findings demonstrated differences in proportions of reported adverse events. The proportion of reported adverse events by students with the second and terminal semesters of course work combined and the 2016 and 2018 control groups combined demonstrated statistically significant differences, P < 0.001. Additional analysis revealed that the intervention group reported more medication-related events, whereas the control group reported more failure to rescue and airway-related events. CONCLUSIONS: Exposure to a simulation designed to develop ST seems to impact adverse event reporting. These findings support the idea that ST may change safety monitoring behaviors.

Human Simulation in Nursing Education.

Although, human simulation methodology has its origins in medical education, nursing education has increased its use of simulated patient (SP) methodology to improve the education of nursing students across the curricula. This chapter will review the history of human simulation, introduce the human simulation continuum, and review different applications of SP methodology in undergraduate and graduate nursing education.

Adaptive Quizzing Improves End-of-Program Exit Examination Scores.

BACKGROUND: A third of nursing schools use a standardized, end-of-program exit examination requiring minimum passing scores for student progression. Student failures on high-stakes tests have negative implications for students and schools of nursing. Adaptive quizzing has increased grades, graduation rates, and NCLEX-RN passing rates and reduced test anxiety in nursing students. PURPOSE: To diminish the negative effects of high-stakes testing and increase standardized exit examination scores, an undergraduate nursing program incorporated customized adaptive quizzing for nursing students in their final nursing course before graduation. METHODS: End-of-program exit examination scores were compared in a preintervention cohort of students and postintervention cohort assigned individualized adaptive quizzing. RESULTS: Statistically significant increases in end-of-program exit examination scores were evident in groups of students completing the customized adaptive quizzing assignments. CONCLUSION: The use of tailored adaptive quizzing increased exit examination scores, supporting the implementation of customized assignments for remediation.

Adverse event reporting following simulation encounters in accelerated and traditional bachelor nursing students.

OBJECTIVE: This study was to investigate the differences in the types, frequency, and perspectives of self-reported adverse events reported following simulation encounters between students enrolled in two Bachelor of Science in Nursing (BSN) programs: accelerated option (AO-BSN) or traditional (T-BSN) and by role (participant or observer) during simulation. METHODS: This study analyzed 6994 adverse event reports entered by students through the simulated adverse event reporting system. RESULTS: The AO-BSN students reported a higher percentage of adverse events coded as errors. In contrast the T-BSN students reported more near misses and sentinel events. Further, the T-BSN students significantly reported more fall related errors, while AO-BSN students reported more confidentiality breach errors. Participants reported more medication errors, whereas observers reported more airway and fall categorized errors. CONCLUSION: The vantage from which adverse events are viewed and educational track appear to alter slightly the perceptions of the precipitating factors leading to committed or observed adverse events.

Establishing a convention for acting in healthcare simulation: merging art and science.

SUMMARY STATEMENT: Among the most powerful tools available to simulation instructors is a confederate. Although technical and logical realism is dictated by the simulation platform and setting, the quality of role playing by confederates strongly determines psychological or emotional fidelity of simulation. The highest level of realism, however, is achieved when the confederates are properly trained. Theater and acting methodology can provide simulation educators a framework from which to establish an acting convention specific to the discipline of healthcare simulation. This report attempts to examine simulation through the lens of theater arts and represents an opinion on acting in healthcare simulation for both simulation educators and confederates. It aims to refine the practice of simulation by embracing the lessons of the theater community. Although the application of these approaches in healthcare education has been described in the literature, a systematic way of organizing, publicizing, or documenting the acting within healthcare simulation has never been completed. Therefore, we attempt, for the first time, to take on this challenge and create a resource, which infuses theater arts into the practice of healthcare simulation.

Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby.

BACKGROUND: Reports regarding hand hygiene compliance (HHC) among hospital visitors are limited. Although there is an implicit assumption that the availability of alcohol-based hand sanitizer (AHS) promotes visitor HHC, the degree of AHS use by visitors remains unclear. To assess AHS use, we observed visitor HHC and how it is affected by visual cues in a private university hospital. METHODS: Using an observational controlled study, we tested 3 interventions: a desk sign mandating all visitors to use AHS, a free-standing AHS dispenser directly in front of a security desk, and a combination of a freestanding AHS dispenser and a sign. RESULTS: HHC was 0.52% at baseline and did not improve significantly when the desk sign was provided as a cue 0.67% (P = .753). However, HHC did improve significantly with use of the freestanding AHS dispenser (9.33%) and the sign and dispenser combination (11.67%) (P < .001 for all comparisons of dispenser alone and sign and dispenser with baseline and sign alone). The degree of improvement with the sign and dispenser combination over the dispenser was not statistically significant. CONCLUSIONS: Hospital visitors represent an important factor in infection prevention. A coordinated effort is needed to increase visitor HHC, including an evaluation of the AHS placement, education of visitors on the importance of HHC, and evaluation of corresponding changes in hand hygiene behavior.

Factors impacting hand hygiene compliance among new interns: findings from a mandatory patient safety course.

BACKGROUND: Residency is a critical transition during which individuals acquire lifelong behaviors important for professionalism and optimal patient care. One behavior is proper hand hygiene (HH), yet poor compliance with accepted HH practices remains a critical issue in many settings. This study explored the factors affecting hand hygiene compliance (HHC) in a diverse group of interns at the beginning of graduate training. METHODS: During a required patient safety course, we observed HH behaviors using a standardized patient encounter. Interns were instructed to perform a focused exam in a simulated inpatient environment with HH products available and clearly visible. Participants were blinded to the HH component of the study. An auditory alert was triggered if participants failed to perform prepatient encounter HH. Compliance rates and the number of alerts were recorded. All encounters were videotaped. RESULTS: The HHC among the 169 participants was 37.9% pre-encounter and was higher among female interns than males, although this difference was not statistically significant (41.6% versus 31.5%, P  =  .176). International medical graduates had significantly lower HHC compared with US graduates (23.2% versus 45.1%, P  =  .006). Most initially noncompliant participants performed HH after 1 alert (87.6%). DISCUSSION: The initial low rate of HHC in our sample is comparable to other studies. Using direct video surveillance and auditory alarms, we improved our success rates for prepatient encounter HHC. Our study identified medical school origin as an important factor for HHC, and the significantly lower compliance for international medical graduates compared with US graduates has not been previously reported. These findings should be considered in designing interventions such as intern orientation and clinical education programs to improve HH behaviors.

Creating a common patient safety denominator: the interns' course.

AIM: After finishing medical school, interns are in many ways unprepared for handling patient care challenges independently. Recognizing that interns may benefit from a patient safety orientation, we developed an innovative curriculum to impart competencies related to their role in preventing medical errors. In the course, which runs during the first week of the intern year, we specifically address 1) calling for help; 2) teamwork and communication; 3) hand hygiene compliance; and, 4) preventing medication and other system errors. METHODS: The course consists of a lecture, interactive workshop, and a Web-based didactic component. Small-group simulation sessions allow instructors to assess interns' baseline competence in hand hygiene and patient hand-offs. In an individual exercise, interns performed a directed physical exam on a standardized patient and their hand hygiene adherence was recorded. In a group exercise, team performance was evaluated in accepting a hand-off from another provider and managing a deteriorating patient. RESULTS: Of the 131 interns, 35% (41) did not wash their hands before and 95% (121) did not wash their hands after patient examination. In the team exercise, scores for 23 teams ranged from 8 to 18 out of 30. None of the participants asked for additional information prior to accepting responsibility for the patient, despite a clearly inadequate hand-off. Post-course surveys indicate that interns consider the course worthwhile: 95% (121) found it beneficial, acquired new teamwork skills, had more appreciation for patient safety, and felt better prepared for clinical duties. DISCUSSION: We observed serious gaps in hand-hygiene compliance and in communication during hand-offs, both significant impediments to quality patient care. Nevertheless, positive responses to the course from both the interns and the institution reflect an important step in fostering a culture of patient safety.

Aspiration assessment and prevention in critically ill enterally fed patients: evidence-based recommendations for practice.

Providing nutrition to patients is a vitally important aspect of care. Enterally feeding even critically ill patients remains the method of choice for most prescribers; however, the decision to provide nutrition via the enteral route comes with the added concern of bronchopulmonary aspiration as a complication. The majority of the literature and research on enteral feeding is out of date and focuses primarily on ways to identify aspiration, rather then preventing it. Although much of this research and literature is not current, many valid and useful recommendations have been made that can be applied to current practice. These recommendations are synthesized in this article in an effort to improve the quality and safety of administration of enteral nutrition to critically ill patients. However, this compiled information is limited to the current resources. More research should be done to decrease the risk of aspiration in this delicate population.