A Randomized Trial of Multiple-Patient Simulation Preparation to Improve Novice Nurses' Competence and Self-Efficacy.

AIM: The purpose of the study was to determine best practices for multiple-patient simulation (MPS) preparation and frequency to improve behavioral performance in nursing students. BACKGROUND: MPS provides a safe environment for novice nurses to practice priority setting, delegation, and multitasking, but evidence for best practices is needed. METHOD: A multisite, blinded, randomized trial was conducted to evaluate the effect of three simulation preparation methods (expert modeling, voice-over PowerPoint, and reading assignments) on students' competence and self-efficacy for providing care to multiple patients in the simulation lab. Participants (n = 73) were enrolled in capstone clinical courses at two schools of nursing. RESULTS: Though there was no difference in raw change in competence score among the study groups, there was a statistically significant difference in pretest and posttest scores. The change in self-efficacy did not correlate with the change in competence. CONCLUSION: These findings will help educators understand how novice nurses benefit from repeated MPS activities.

Effectiveness of Simulation Preparation on Novice Nurses' Competence and Self-Efficacy in a Multiple-Patient Simulation.

This study examined the influence of three simulation preparation methods (expert modeling/intervention, voice-over PowerPoint/active control, and reading assignments/passive control) on improving novice nurses' competence and self-efficacy for providing care to multiple simulated patients. Both competence and self-efficacy were measured at baseline and following a five-week intervention. Twenty senior pre-licensure nursing students participated in the trial. One-way ANOVAs and parametric/nonparametric correlations were used. Voice-over PowerPoint and expert modeling resulted in greater improvements in self-efficacy compared with traditional reading assignments as simulation preparation. However, there was no relationship between change in competence and self-efficacy over time.

Geriatrics in simulation: role modeling and clinical judgment effect.

Clinical judgment development is critical to preparing students to safely meet the needs of an aging population. Evidence linking manikin-based simulation and clinical judgment is sparse.The purpose of this quasi-experimental international study was to determine the effect of expert role modeling on nursing students' clinical judgment in the care of a simulated geriatric hip fracture client. Students from five diverse schools (n = 275) participated in an unfolding simulation. Students were assigned to treatment or control groups.Treatment groups viewed an expert role model video.Trained observers rated student clinical judgment from selected video recordings using the Lasater Clinical Judgment Rubric (n = 94). Significant group differences (p = .000) were found for the clinical judgment dimensions of noticing, interpreting, and responding. Findings provide support for combining expert role modeling with clinical simulation to improve students' clinical judgment in the care of older adults.

Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: three approaches.

The purpose of this article is to summarize the methods and findings from three different approaches examining the reliability and validity of data from the Lasater Clinical Judgment Rubric (LCJR) using human patient simulation. The first study, by Adamson, assessed the interrater reliability of data produced using the LCJR using intraclass correlation (2,1). Interrater reliability was calculated to be 0.889. The second study, by Gubrud-Howe, used the percent agreement strategy for assessing interrater reliability. Results ranged from 92% to 96%. The third study, by Sideras, used level of agreement for reliability analyses. Results ranged from 57% to 100%. Findings from each of these studies provided evidence supporting the validity of the LCJR for assessing clinical judgment during simulated patient care scenarios. This article provides extensive information about psychometrics and appropriate use of the LCJR and concludes with recommendations for further psychometric assessment and use of the LCJR.

A digital toolkit to implement and manage a multisite study.

Calls for multisite studies are increasing in nursing education. However, the challenge of implementing consistent protocols and maintaining rigorous standards across sites can be daunting. One purpose of a recent multisite, collaborative, simulation study was to evaluate a digital toolkit's effectiveness for managing a multisite study. We describe the digital toolkit composed of Web-based technologies used to manage a study involving five sites including one United Kingdom site. The digital toolkit included a wiki, a project Web site to coordinate the protocols and study materials, software to organize study materials, and a secure location for sharing data. Most of these are familiar tools; however, combined as a toolkit, they became a useful management system. Web-based communication strategies and coordinated technical support served as key adjuncts to foster collaboration. This article also offers practical implications and recommendations for using a digital toolkit in other multisite studies.

Influence of a poverty simulation on nursing student attitudes toward poverty.

This study aimed to determine a poverty simulation's influence on nursing students' attitudes toward poverty. Five cohorts of baccalaureate nursing students participated in the study; two cohorts (experimental group, n = 103) participated in the simulation and three did not (control group, n = 75). The Attitudes Towards Poverty Short Form was administered before the simulation and 6 weeks later; higher scores indicated more positive attitudes toward poverty. Experimental group pretest scores were higher. Higher pretest global scores were negatively correlated with religious affiliation (Spearman's rho = -0.294, p = 0.000) and positively correlated with prior poverty exposure (Spearman's rho = 0.284, p = 0.000) and liberal political views (Spearman's rho = 0.444, p = 0.000). Controlling for pretest differences, posttest mean scores for the experimental group (78.73) were significantly higher (p = 0.007). The poverty simulation is an engaging learning experience providing an opportunity for students to gain sensitivity in working with this population.

A collaborative project to apply and evaluate the clinical judgment model through simulation.

As use of simulations increases in nursing education, nurse educators are challenged to evaluate students' clinical judgment skills. The purpose of this article is to describe faculty development in the use of the Lasater Clinical Judgment Rubric (LCJR); faculty application of LCJR in evaluating students' clinical judgment skills during a simulation scenario; and faculty and students' perception transference from the simulation to the clinical setting.Tanner's Clinical Judgment Model was used in an assigned adult health simulation. Quantitative and qualitative data were collected from faculty and student evaluations and students' reflective statements. Findings support the importance of simulation's contribution to clinical judgment development. However, more work remains to improve the integration of clinical judgment and use of a conceptual framework and evidence-based rubric. For long-term change, both faculty and students need ongoing practice and encouragement in applying the clinical judgment framework to clinical and simulation experiences. For application of the model, a recommendation is to incorporate the clinical judgment language into course syllabi, course assignments, and evaluations.

Spiraling evidence-based practice and outcomes management concepts in an undergraduate curriculum: a systematic approach.

Preparing undergraduate nursing students to practice nursing in the 21st century requires a focus on the development of evidence-based practice and outcomes management knowledge and skills throughout the nursing curriculum. To this end, seven learning activities were created that spiral and increase in complexity while building on previously acquired skills. Working in teams and practicing team-building techniques, students learned how to develop a clinical question, search the literature, synthesize the current knowledge, identify the significance of the issue in an ecological model, decipher existing quality data and compare that data to national benchmarks, investigate a health care quality issue using quality improvement methods, and draft a proposal for implementation of a continuous quality improvement initiative. Work was presented in both written and oral presentation formats, with emphasis on engaging various audiences in a compelling health care issue.

Comparison of expert modeling versus voice-over PowerPoint lecture and presimulation readings on novice nurses' competence of providing care to multiple patients.

Due to today's complex needs of hospitalized patients, nurses' competence and strategies to improve competence are of growing importance. Simulation is commonly used to influence competence, but little evidence exists for comparing how presimulation assignments influence competence. A randomized control trial was used to compare the efficacy of three simulation preparation methods (expert modeling/intervention, voice-over PowerPoint/active control, and reading assignments/passive control) on improving competence for providing care to multiple patients among senior undergraduate novice nurses. Competence was measured at two time points (baseline and following a 5-week intervention) by two blinded raters using the Creighton Simulation Evaluation Instrument. Twenty novice nurses participated in the trial. No significant differences were noted in raw improvements in competence among the three groups, but the expert modeling (Cohen's d=0.413) and voice-over PowerPoint methods (Cohen's d=0.226) resulted in greater improvements in competence, compared with the passive control.