Nursing Education Leaders Decision-Making During a Pandemic Crisis.

ABSTRACT: Academic nursing leaders faced unprecedented decision-making during the recent global pandemic. Although some universities had emergency response plans, many did not, and those that did have plans did not address the specific needs of nursing education programs. This descriptive survey study sought to describe the decision-making and response of nursing education leaders during the pandemic and provide recommendations for the future. Themes identified in the study include preparedness, emergency response, uncertainty, leadership and policy, and communication. Results of the study provide nursing program administrators with insights for preparing to lead in future emergencies.

Development of a Scale to Measure Synergy: A Tool to Evaluate Team-Based Learning in Nursing.

AIM: The purpose of this study was to develop and pilot an instrument to assess group synergy and team-based learning among nursing students. BACKGROUND: Little is known on how to evaluate soft nursing skills such as synergy. METHOD: Nurse faculty were recruited through purposive and snowball sampling to serve on an expert panel. Using the DeVillis framework, three rounds of data were collected using semistructured online surveys. The resulting scale of 34 items was piloted with teams of undergraduate nursing students taking part in a simulation experience. RESULTS: Item-content validity index ranged from .8 to 1.0 for each item. Scale-content validity index average was .93; scale-content validity index universal was .62. Exploratory factor analysis identified three factors. CONCLUSION: This study suggests that synergy is multifactorial and can be assessed by faculty. However, further testing of the scale is needed.

Anxiety and Stress in Live Disaster Exercises.

INTRODUCTION: Nurses play critical roles in disaster response, often preparing through simulated exercises. According to The NLN Jeffries Simulation Theory, simulations can lead to anxiety in participants that affects learning. The objective of this research was to measure and describe anxiety and stress levels of participants in a live disaster-training exercise. METHODS: A quasiexperimental/descriptive design using quantitative methods (amylase, cortisol levels) and qualitative methods (survey, focus groups) was used with a convenience sample of senior nursing students taking part in a disaster exercise. Participants completed self-reports of anxiety before and after the exercise using the State-Trait Anxiety Inventory (pre/post). Following the training, participants provided saliva samples for analysis of cortisol and amylase levels to measure physiological stress levels. Participants were also invited to take part in a focus group after exercise participation. RESULTS: A total of 22 participants were recruited. Significant elevation of self-reported anxiety levels was found on the State-Anxiety Inventory comparing pre- with post-training, but no Trait-Anxiety changes were noted. Amylase and cortisol levels were within normal ranges. Themes emerging from qualitative analysis include preparation, uncertainty, teamwork, realism, and decision making. DISCUSSION: Disaster training may be anxiety provoking and stressful. ED nurses should consider how to include best practice approaches for simulation in design of exercises to prepare for the increasing number of multicasualty events.

The Student Experience With Varying Immersion Levels of Virtual Reality Simulation.

With increasing use of virtual reality simulation (VRS) in nursing education and given the vast array of technologies available, a variety of levels of immersion and experiences can be provided to students. This study explored two different levels of immersive VRS capability. Study participants included baccalaureate nursing students from three universities across four campuses. Students were trained in the skill of decontamination using traditional methods or with VRS options of mouse and keyboard or head-mounted display technology. Results of focus group interviews reflect the student experience and satisfaction with two different immersive levels of VRS.

Effectiveness of Two Varying Levels of Virtual Reality Simulation.

AIM: The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination. BACKGROUND: Little is known about the use of VRS in providing disaster education, including retention. METHOD: Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months. RESULTS: Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive. CONCLUSION: VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

Learning and Retention Using Virtual Reality in a Decontamination Simulation.

AIM: The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention. BACKGROUND: Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy. METHOD: A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination. RESULTS: Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills. CONCLUSION: VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.

An innovative approach to preparing nursing students for care of the elderly in the home.

Nurse educators must prepare future nurses for the increasing number of elderly requiring care in community-based settings. This quasi-experimental study examined the outcomes of a geriatric home care simulation experience for senior community health nursing students (n = 56). The experience included a home care visit to an elderly diabetic client using a high-fidelity human patient simulator as well as a geriatric home safety assessment exercise. Results indicated students were satisfied with the experience and that it had a positive impact on confidence, but no differences were found between groups in terms of learning. Additional analysis using Spearman's rho found outcomes of satisfaction and self-confidence were significantly correlated (rs=.378-.605) with simulation design, especially the provision of student support and a challenging problem to solve. Results provide nurse educators with evidence for developing geriatric simulation education experiences for preparing new graduates to care for the increasing number of elderly who desire to age in place.

The impact of covid-19 on the regulation of nursing practice and education.

To adapt to the environment resulting from a worldwide pandemic, states across the country enacted regulation changes impacting nursing education, entry into practice, and licensure. In this manuscript, the authors collected state board of nursing data from sources including websites and letters from the State Boards to deans, directors, and chairs. Information obtained reflected changes to regulation of practice and regulation of education. As the pandemic continues, associate degree educators will need to continue to stay abreast of nursing regulation changes made to meet healthcare workforce needs while also ensuring public safety.

Evaluation of two simulation methods for teaching a disaster skill.

Introduction: With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed. Methods: A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self- Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination. Results: A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination. Conclusions: Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.

High-fidelity simulation: factors correlated with nursing student satisfaction and self-confidence.

While available research suggests positive outcomes when using high-fidelity simulation in nursing education, little is known about factors associated with these outcomes. This descriptive, correlational study examined the effects of a simulation experience on two outcomes (student satisfaction and self-confidence) as well as factors correlating with these outcomes. This was accomplished by both descriptive statistical analysis (mean and standard deviation) in addition to correlational statistical analysis using bivariate statistics (Spearman's rho) and multiple linear regression. Results indicate that design characteristics, especially clear objectives and an appropriately challenging problem to solve, were significantly correlated with student satisfaction and self-confidence.

National Disaster Health Consortium: Competency-Based Training and a Report on the American Nurses Credentialing Center Disaster Certification Development.

As the largest profession of health care providers, nurses are an integral component of disaster response. Having clearly delineated competencies and developing training to acquire those competencies are needed to ensure nurses are ready when disasters occur. This article provides a review of nursing and interprofessional disaster competencies and development of a new interprofessional disaster certification. An overview of a standardized disaster training program, the National Disaster Health Consortium, is provided as an exemplar of a competency-based interprofessional disaster education program.

Learning Outcome Measurement in Nurse Participants After Disaster Training.

OBJECTIVE: The National Disaster Health Consortium is an interprofessional disaster training program. Using the Hierarchical Learning Framework of Competency Sets in Disaster Medicine and Public Health, this program educates nurses and other professionals to provide competent care and leadership within the interprofessional team. This study examined outcomes of this training. METHODS: Training consisted of a combination of online and on-site training. Learning outcomes were measured by using the Emergency Preparedness Information Questionnaire (EPIQ) pre/post training and participant performance during live functional exercises with the use of rubrics based on Homeland Security Exercise and Evaluation principles. RESULTS: A total of 64 participants completed the EPIQ before and after training. The mean EPIQ pre-training score of 154 and mean post-training score of 81 (reverse-scored) was found to be statistically significant by paired t-test (P<0.001). Performance was evaluated in the areas of triage, re-triage, surge response, and sheltering. Greater than 90% of the exercise criteria were either met or partially met. Participants successfully achieved overall objectives in all scenarios. CONCLUSIONS: Disaster response requires nurses and other providers to function in interprofessional teams. Educational projects, like the National Disaster Health Consortium program, offer the potential to address the need for a standardized, interprofessional disaster training curriculum to promote positive outcomes. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

Preparing Nursing Students for Leadership Using a Disaster-Related Simulation.

Increasing numbers and severity of disasters across the globe require nurses to be prepared to provide leadership in disaster situations. To address this need, a combination of didactic and simulation exercises was used to provide a daylong experience emphasizing application of nursing leadership skills in disasters to senior baccalaureate students. Evaluation of learning outcomes demonstrated significant improvement in student self-efficacy related to leadership in disasters.

Development of an assessment instrument to evaluate performance of the skill of decontamination.

BACKGROUND AND PURPOSE: Nurses must competently demonstrate psychomotor skills. Few reliable and valid instruments are available for psychomotor evaluation for disaster skills, including the skill of decontamination. OBJECTIVES: The purpose of this study was to develop and refine an instrument to measure the skill of decontamination. DESIGN: A seven step instrument development design was implemented that included content validity and reliability as well as inter-rater reliability analysis. SETTING AND PARTICIPANTS: A convenience sample of approximately 140 participants was drawn from two colleges of nursing at two large academic universities. The sample included senior nursing students in either their community or final practicum nursing course. METHODS: Based on a sample of 140 students who participated in a decontamination training experience using virtual reality simulation, a seven step established process for assessment of reliability and validity was implemented to develop a checklist for the skill of decontamination. RESULTS: The final instrument statistics: Content Validity Index for the overall instrument score was 0.94, Internal consistency coefficient=0.607(KR-20) and Inter-rater reliability=0.9114. CONCLUSIONS: This instrument provides a reliable and valid assessment of nurses' competency in performing the skill of decontamination offering a template for educators to develop similar tools.

Decontamination training: with and without virtual reality simulation.

Nurses must be prepared to care for patients following a disaster, including patients exposed to hazardous contaminants. The purpose of this study was to examine the use of virtual reality simulation (VRS) to teach the disaster-specific skill of decontamination. A quasi-experimental design was used to assign nursing students from 2 baccalaureate nursing programs to 1 of 2 groups to learn the disaster skill of decontamination-printed written directions or VRS. Performance, knowledge, and self-efficacy were outcome measures. Although students in the treatment group had significantly lower performance scores than the control group (p = 0.004), students taking part in VRS completed the skill in a significantly shorter amount of time (p = 0.008). No significant group differences were found for self-efficacy (p = 0.172) or knowledge (p = 0.631). However, students in the VRS treatment group reported high levels of satisfaction with VRS as a training method. The disaster-specific skill of decontamination is a low-volume, high-risk skill that must be performed with accuracy to protect both exposed patients and providers performing decontamination. As frontline providers for casualties following a disaster event, emergency nurses must be prepared to perform this skill when needed. Preparation requires cost-effective, timely, and evidence-based educational opportunities that promote positive outcomes. Further investigation is needed to determine the benefits and long-term effects of VRS for disaster education.

The use of high-fidelity simulation to teach home care nursing.

The use of high-fidelity human patient simulation (HPS) is increasing in nursing education, yet little is known about its use in community health. This study examined an HPS home care experience to determine effects on three outcomes (student satisfaction, self-confidence, and learning). In addition, design characteristics of the simulation and demographic characteristics of students were examined for correlation with these outcomes. Senior baccalaureate students took part in the experience. Results indicated that students were very satisfied with the experience and felt it increased their confidence in providing care in the home, although learning outcomes were not high. Although no demographic characteristics were found to be correlated with outcomes, five design characteristics of a simulation were moderately correlated with the outcomes of satisfaction and self-confidence, especially support. It is recommended that nurse educators design HPS home care simulation experiences that provide student support prior to their first home care visit.

Assessing performance outcomes of new graduates utilizing simulation in a military transition program.

This multi-site, quasi-experimental study examined the performance outcomes of nurses (n = 152) in a military nurse transition program. A modified-performance instrument was used to assess participants in two high-fidelity simulation scenarios. Although results indicated a significant increase in scores posttraining, only moderate interrater reliability results were found for the new instrument. These findings have implications for nurse educators assessing performance-based outcomes of new nurses completing transition programs.