Moral distress: Does this impact on intent to stay among adult critical care nurses?

BACKGROUND: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. AIM: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS-R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. STUDY DESIGN: During January to August 2017 a cross-sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. METHODS: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. RESULTS: Two hundred sixty-six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P = .05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = -0.20, P = .02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = -0.28, P < .001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. CONCLUSION: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. RELEVANCE TO CLINICAL PRACTICE: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses.

How do intensive work environments affect nurses' absenteeism and turnover intent?

BACKGROUND: Intensive hospital work environments can affect staff, patient, and organizational outcomes. PURPOSE: (1) To assess quantitatively the relationship between critical care registered nurses' perceptions of their workplace, their absenteeism, and their turnover intent; and (2) to analyze nurses' recommendations for improvements for critical patient care. METHODS: Following STROBE guidelines, a cross-sectional survey sampled registered nurses (n = 302), across the Canadian province of Alberta, in October 2018. We assessed nurses' perceptions of their work environment relative to their absenteeism and turnover intent utilizing regression modelling and the Practice Environment Scale of the Nursing Work Index. FINDINGS: A negative binomial analysis indicated that RNs' positive perceptions about their workplace had significant associations with lower rates of absenteeism. Additionally, participants who scored their work environment higher were found to have decreased intentions of leaving the workplace. RNs ranked their "participation in hospital affairs" lowest when comparing practice environment domains and recommended optimizing staffing as the most important improvement for their work environment and patient care. DISCUSSION: Considering the demands associated with critical care patient settings, stakeholders can consider these findings that significant associations exist between nursing staffs' perceptions of the workplace relative to their absenteeism and their turnover intent. IMPLICATIONS FOR POLICY: Value-based solutions are needed in optimizing these key factors, and staffs' participation in hospital affairs appears vital for organizational success.

Virtual simulation in healthcare education: a multi-professional, pan-Canadian evaluation.

BACKGROUND: As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community. METHODS: Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences. RESULTS: The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential. CONCLUSION: Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice.

High fidelity simulation in critical care: a Canadian perspective.

The use of high fidelity human simulation has exploded into the nursing education context over the last decade. In Ontario, Canada an innovative Critical Care e-learning program was established in 2007 to create accessible critical care education for nurses across Ontario and Canada. The program has a three-pronged approach including online, simulation and practicum components. The purpose of this paper is to present lessons learned during the last five years of development and growth of this program. The paper will focus on the use of simulation to build confidence and prepare registered nurses for critical care nursing practice. In addition, subsequent development of a network of ten simulation partners that deliver critical care simulation will be discussed. High fidelity simulation delivery in the critical care context will be explored and the use of summative or 'high stakes' simulation competency evaluation will be elaborated on.

An educator's toolkit for virtual simulation: A usability study.

BACKGROUND: The rapid change brought on by COVID-19 meant that many educators adopted virtual simulation quickly, often without having a strong background in the pedagogical principles of virtual simulation. To address this resource gap, a team of 21 Ontario virtual simulation-experienced educators created the freely available, online, interprofessional Virtual Simulation Educator's Toolkit. The Toolkit provides the theory, practical strategies and resources needed to teach effectively with virtual simulation. Because the Toolkit would include new content, resources and numerous untested design elements, the team conducted a usability test. DESIGN: A usability study, that followed a three-step process, was conducted. Participants were asked to carefully review the Toolkit, including all interactive components and complete an online survey based on the Technology Acceptance Model, to measure the ease of use and utility of the Toolkit. Lastly, participants were interviewed. PARTICIPANTS: In keeping with sampling principles for usability studies, twenty experienced virtual simulation educators from different disciplines participated in the study. METHODS: A validated survey and one-on-one interviews were used to measure educators' perceptions of the ease of use and utility of the Toolkit and their recommendations to improve it. Quantitative data were analyzed using descriptive statistics and qualitative data were coded and themes developed. CONCLUSION: The score of 90 % on the Toolkit Experience Survey indicated that participants found the Toolkit both easy to use and useful. Results from the interviews indicated that a practical, accessible professional development tool is urgently needed to support education with virtual simulation. Because the Toolkit introduces educators to different ways of implementing virtual simulation, as well as options, process considerations, and tools to enhance their teaching with virtual simulation, different disciplines and educators with different levels of simulation experience may benefit by using it.

The impact of virtual simulation on the recognition and response to the rapidly deteriorating patient among undergraduate nursing students.

A major patient safety challenge is recognition and response to deteriorating patients since early warning signs are often not detected in a timely manner. Nursing students typically learn the skills for early identification through clinical placement, but clinical placements are not guaranteed to provide exposure to deteriorating patients. Nursing students require practice with emergency scenarios to develop their competency and confidence to act in this area. This study aimed to explore the impact of a virtual simulation intervention on the recognition and response to the rapidly deteriorating patient among undergraduate nursing students. A mixed methods study involving a quasi-experimental pre/post design and focus groups. The participants were third or final year undergraduate nursing students from five university sites across four countries (Canada, England, Scotland and Australia, n = 88). Students were randomly assigned to a treatment or control group. The treatment group received a virtual simulation intervention and participated in a focus group. The virtual simulation intervention had a significant effect on improving nursing student knowledge and clinical self-efficacy in the recognition and response to the rapidly deteriorating patient. Students reported that the virtual simulations decreased anxiety, helped them prioritize, filled gaps in their learning, and encouraged autonomous learning within a safe 'low risk' environment. Virtual simulation is an effective strategy for improving knowledge and confidence in recognizing and responding to the rapidly deteriorating patient among undergraduate nursing students.

Work climate in emergency health services during COVID-19 pandemic-An international multicenter study.

Introduction: A good working climate increases the chances of adequate care. The employees of Emergency in Hospitals are particularly exposed to work-related stress. Support from management is very important in order to avoid stressful situations and conflicts that are not conducive to good work organization. The aim of the study was to assess the work climate of Emergency Health Services during COVID-19 Pandemic using the Abridged Version of the Work Climate Scale in Emergency Health Services. Design: A prospective descriptive international study was conducted. Methods: The 24-item Abridged Version of the Work Climate Scale in Emergency Health Services was used for the study. The questionnaire was posted on the internet portal of scientific societies. In the study participated 217 women (74.5%) and 74 men (25.4%). The age of the respondents ranged from 23 to 60 years (SD = 8.62). Among the re-spondents, the largest group were Emergency technicians (85.57%), followed by nurses (9.62%), doctors (2.75%) and Service assistants (2.06%). The study was conducted in 14 countries. Results: The study of the climate at work shows that countries have different priorities at work, but not all of them. By answering the research questions one by one, we can say that the average climate score at work was 33.41 min 27.0 and max 36.0 (SD = 1.52). Conclusion: The working climate depends on many factors such as interpersonal relationships, remuneration or the will to achieve the same selector. In the absence of any of the elements, a proper working climate is not possible.

P Stands for Pivot: Pivoting Face-to-Face Practicum to Virtual Simulation during the Pandemic.

Virtual simulation has been widely used to temporarily replace face-to-face clinical practicum experiences in nursing education in response to the global COVID-19 pandemic. While more traditional clinical settings were prioritized and made available only to senior students, the use of virtual simulation provided an opportunity to safely pivot from the usual placement to a comparable practical learning modality to maintain clinical competence during unprecedented public health restrictions and mitigation strategies. Like many others across the globe, nursing students in a Canadian university continued their nursing education predominantly using virtual simulation for an entire academic year to avoid catastrophic delays in entering the workforce and to ultimately protect the health service delivery needs throughout the oncoming waves of the pandemic. The purpose of the paper is to describe guiding principles established in a School of Nursing as a means to responsibly and ethically adopt a replacement of traditional clinical practicum experiences with virtual simulation. The principles for incorporating virtual simulation included the need to achieve and maintain a high level of quality of learning experiences, a fluid delivery articulated in phases, and a financial commitment by the learning institution. As the global pandemic may see a fourth wave, the use of virtual simulation will continue to present a major change for clinical practicum and establishing principles for the use of virtual simulation has demonstrated to be an integral part of safe pandemic response and post-pandemic recovery.

The relationship between simulation in nursing education and medication safety.

This experimental study examined whether the use of clinical simulation in nursing education could help reduce medication errors. Fifty-four student volunteers were randomly assigned to an experimental (treatment) group (24 students) or a clinical control group (30 students). The treatment replaced some early-term clinical placement hours with a simulated clinical experience. The control group had all normally scheduled clinical hours. Treatment occurred prior to opportunities for medication administration.

Mechanical Ventilation Education and Transition of Critical Care Nurses into Practice.

A foundational skill for critical care nurses caring for mechanically ventilated patients. This paper describes challenges and opportunities in preparing nurses to transition into the intensive care environment. Hospitals invest significant funding in educational programs for new critical care nurses so that they can transition effectively into the critical care environment. Simulation has been shown to impact self-efficacy and performance. This paper describes the integration of mechanical ventilation education into a case-based simulation program and the results of a study measuring self-efficacy and transfer of learning before and after the implementation of a simulation intervention.

Goal orientation and its relationship to academic success in a laptop-based BScN program.

This longitudinal study, conducted within a laptop-based BScN program examines the relationship of goal orientation profiles to comfort with technology and academic success. In phase 1 of this study, 101 first year nursing students completed an on line survey. The measurement tools used were Goal Orientation Assessment, Multiple Intelligences Learning Inventory and a locally developed Technology Comfort survey. Results showed that students were predominantly high in the mastery goal orientation profile. Males had a higher comfort level with technology. Age was inversely related to comfort with technology. An unexpected finding was that grade point average was inversely related to comfort with use of technology. The data did not support the commonly held belief that today's students are uniformly well-skilled and comfortable with new technologies. This study will continue over the next three years and will allow comparison of variables over time. Specific teaching interventions may be developed to accommodate varying learning and motivational styles in relation to comfort with technology.

The use of personal digital assistants at the point of care in an undergraduate nursing program.

This study examined the relationships between the use of personal digital assistants and self-efficacy and the preparation for medication administration among second-year Bachelor of Science in Nursing students in a medical-surgical clinical environment. By using a controlled experimental method, the study attempted to support claims about the educational benefits of personal digital assistants which have generally been reported in more descriptive and anecdotal formats. The sample consisted of 36 students, of which two groups had personal digital assistants and two groups served as a control. The control groups were provided with paper resources equivalent to the software provided by the personal digital assistants. Findings showed a significant increase in self-efficacy in the groups with personal digital assistants.