Whose Line Is It Anyway? Undergraduate Nursing Simulation for Breaking Bad News.

ABSTRACT: Breaking bad news regarding health care traditionally falls within the scope of practice of the provider. However, now that lab and diagnostic results are uploaded directly to smart devices, patients often receive results before they can be explained. The nurse or nursing student may be the first person the patient sees after reading results and the first to respond to patient questions about bad news. This article describes a simulation where senior baccalaureate students utilize the SPIKES protocol to become better prepared to field questions and break bad news should they find themselves in this situation.

An Online Module to Promote Self-Care and Resiliency in Nursing Students.

ABSTRACT: Because the demands of nursing education can impact the physical and mental health of nursing students, the American Association of Colleges of Nursing's revised Essentials require inclusion of self-care and resilience education in nursing curricula. This article describes the development, implementation, and evaluation of a self-care module in a new online undergraduate course. Using the REST mnemonic (relationships, exercise, soul, and transformative thinking), students developed personalized self-care plans for the semester. End-of-course evaluations revealed an increase in self-care activities. The most used activities were exercise, humor, intentional rest, and healthy eating.

The role of collectivism and moderating effect of IT proficiency on intention to disclose protected health information.

This paper aims to identify and understand factors affecting insiders' intention to disclose patients' medical information and to investigate how these factors affect the intention to disclose. Based on the literature review on deterrence theory and health information security awareness (HISA), we identify relevant factors and develop a research model explaining insiders' intention to disclose patients' health information. We collect data (N = 105) through scenario-based experiments. Results show that two personal factors, collectivism, and IT proficiency, play a significant role in the model. While collectivism affects two components (health information security regulation awareness and punishment severity awareness) of HISA which influences intention to disclose, IT proficiency moderates the relationship between HISA and intention to disclose. In addition, HISA negatively affects reporting assessment and intention to disclose. This paper aims to fill a research gap in understanding factors affecting insiders' intentions to disclose protected health information. We identify and investigate factors (e.g., collectivism, HISA, reporting assessment, and IT proficiency) that may affect insiders' disclosing intentions. We find that collectivism affects two components of HISA which influence reporting assessment and disclosing intention. We also discover that IT proficiency moderates the relationship between HISA and intention to disclose. Our findings suggest that we need to carefully consider personal factors such as collectivistic nature and IT proficiency in managing insiders' security breaches.

Delta Alert: Expanding Gerotrauma Criteria to Improve Patient Outcomes: A 2-Year Study.

BACKGROUND/SIGNIFICANCE: Because of their decreased physical reserve and increased risk of complications, the geriatric trauma patient (GTP) population warrants heightened awareness by clinical staff. PURPOSE: The purpose of this study is to determine whether the institution of a third-tier trauma protocol results in a change in GTP outcomes, complications, and mortality rates. METHODS: Researchers conducted a retrospective review of 2 years of data from the trauma registry, hospital quality improvement audits, and patient charts to examine what, if any, patient outcomes were impacted by the institution of the expanded GTP protocol. RESULTS: Sample homogeneity was determined. Emergency department (ED) length of stay and time to the operating room decreased in the protocol cohort. The rate of complications decreased from 16.4% preprotocol to 1.6% postprotocol. Discharge to home rates in the GTP population improved from 31% preprotocol to nearly 77% postimplementation of the protocol. DISCUSSION: The expanded GTP protocol front loads evaluation and resuscitation to be consistent with ED trauma protocols already in place. By fast-tracking radiology and laboratory testing, patients injuries are identified and the appropriate consultations are initiated. Appropriate inpatient nursing unit placement is identified or treatment and discharge from the ED are expedited. CONCLUSION: The expanded GTP protocol provided early and comprehensive evaluation and interventions for GTPs who fall outside of traditional trauma alert criteria. Patients spend less time in the ED and the hospital. Patients had decreased length of stay in the ED, less complications, and return to home rates showed significant improvement after the protocol was implemented.

Rising from the Rubble: A Capstone Simulation Integrating Leadership and Clinical Skills.

ABSTRACT: This novel simulation approach incorporates assessment, prioritization, patient care, and clinical reasoning with leadership and ethical principles when teaching disaster preparedness content in a prelicensure BSN curriculum. Using a combination of live actors and simulation equipment, 10 patients arrive in the skills lab seeking help for a variety of illnesses and injuries in the aftermath of a severe storm. The patients' ages and conditions represent each of the clinical courses in the nursing curriculum. Students are assigned to assume the role of nurse, triage nurse, or incident commander and plan, prioritize, and provide patient care.

Delta Alerts: Changing Outcomes in Geriatric Trauma.

Geriatric trauma patients (GTPs) suffering minor injuries have suboptimal outcomes compared with younger populations. Patients 65 years or older account for 10% of all traumas but 28% of all trauma deaths. This trauma center established a third tier trauma alert specifically targeting GTPs at risk for poor outcomes. A Delta Alert is activated when GTPs suffer injuries that fall outside traditional trauma alert guidelines. Early identification and treatment of injuries and expedited referral to specialty groups have improved our GTPs' outcomes including decreased mortality and length of stay and increased percentage of GTPs who are discharged home.

Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department.

PROBLEM: Although hand hygiene strategies significantly reduce health care-associated infections, multiple studies have documented that hand hygiene is the most overlooked and poorly performed infection control intervention. METHODS: Emergency nurses and technicians (n = 95) in a 41-bed emergency department in eastern Virginia completed pretests and posttests, an education module, and two experiential learning activities reinforcing hand hygiene and infection control protocols. RESULTS: Posttest scores were significantly higher than pretest scores (t (108) = -6.928, P = .048). Hand hygiene compliance rates improved at the conclusion of the project and 3 months after the study (F (2, 15) = 9.89, P = .002). IMPLICATIONS FOR PRACTICE: Interfaces with staff as they completed the interactive exercise, as well as anecdotal notes collected during the study, identified key times when compliance suffered and offered opportunities to further improve hand hygiene and, ultimately, patient safety.

Use of the Rasch Model for Fit Statistics and Rating Scale Diagnosis for the Student Perception Appraisal-Revised.

Background and Purpose: Nursing student retention is essential to meet workforce demands. Jeffrey's Nursing Student Retention Student Perception Appraisal-Revised (SPA-R1) has been used extensively to understand factors that impact retention. Psychometric testing of the SPA-R1 contributes to greater confidence in the instrument's reliability and validity. Methods: Item response theory and specifically, the single parameter polytomous Rasch model was used as a framework for fit statistic testing and rating scale diagnostics of the SPA-R1. This was a secondary analysis of a convenience sample of undergraduate prelicensure nursing students. The setting for the previous study was virtual, and the study period was 2022. Results: The model item characteristic curves for the 27 items of the SPA-R1 have similar shapes and are clustered in proximity. Overall, there are three clusters of items evident in the Rasch standardized residual contrast. The Rasch scale diagnostics indicated that the scale appropriately monotonically increases. However, there is a greater than 5 logit distance between does not apply and severely restricts, between severely restricts and moderately restricts, and between does not restrict or support and moderately supports. These large threshold distances indicate that additional steps in the scale may be warranted. The items cover the mid-range of the amount of retention perceptions; however, there are no items that represent the highest magnitude of the perceived amount of influence on retention. Conclusions: This study contributes further evidence to support the validity and reliability of the SPA-R1. We recommend adding steps to the scale, removing the does not apply response option, and considering scoring by three domains or clusters.

Creating a Primary Care Track in Prelicensure Nursing Education.

BACKGROUND: RNs practicing in primary care (PC) increase access to health care and contribute to better patient outcomes and cost savings, yet undergraduate nursing education traditionally focuses on disease-oriented care. This article describes a curricular track for infusing PC prelicensure programs. METHOD: PC content is threaded across four semesters with targeted assignments and clinical experiences. Providing clinical immersion experiences with practicing RNs as preceptors in community and PC settings is a key component of this initiative. RESULTS: Student feedback has been favorable. Students stated they gained insight to the role of RNs in PC through class assignments and clinical rotations. Graduating seniors were offered employment in PC settings where they completed their practicum clinical rotations. CONCLUSION: The PC track contributes to building a nursing workforce to meet health care demands and promote health equity. Nurse educators interested in infusing PC content throughout the curriculum can adapt this model for all student populations. [J Nurs Educ. 2023;62(3):171-174.].

Behind the Scenes of an Educational Escape Room.

Educational versions of interactive escape room games can be used to teach and reinforce knowledge and clinical skills. In this article, the authors describe their experience creating, piloting, implementing, and evaluating a safe medication educational escape room for first-year nursing students. They highlight the steps needed to develop an effective learning experience and provide insight into lessons they've learned throughout this process.

Integrative simulation: a novel approach to educating culturally competent nurses.

Nursing education faces many challenges as a result of the population's increased cultural diversification. Of primary importance is the need to prepare culturally competent nurses to provide care in both urban and remote rural areas. This paper presents a HRSA funded program that utilises simulations to provide culturally diverse learning opportunities for both university-based and distance learning students. Cases are developed using focus groups and individual interviews. The information is used with standardised patients to develop vignettes that are loaded into a web-based virtual hospital where students conduct interviews with culturally diverse patients. The information obtained during the interview is then used to provide hands-on care to a high performance simulator (simulated mannequin). The encounters are videotaped for use in debriefing sessions with the students, for educational programs in the classroom, and for video-streaming to web-based distance students. Students in the debriefing sessions and classroom participate in a review of the videotape using the Personal Response System to respond to question. Through the culturally enhanced integrated simulation, students have an opportunity to address clinical situations and the impact of culture in a relatively safe non-threatening environment where the impact of their biases can be explored.

Educational Model to Increase the Number and Diversity of RN to BSN Graduates From a Resource-Limited Rural Community.

Increasing the number of BSN-prepared nurses at the bedside is directly linked to improved health care outcomes. However, employers are challenged to find enough BSN graduates to meet workforce demands. This article presents an educational model that uses evidence-based practices to increase enrollment, retention, and graduation rates of RN students in a BSN program (RN-BSN) in a resource limited rural community. This exemplar may equip nurse educators with strategies to adopt in their own communities.

"Why can't I pass these exams?": providing individualized feedback for nursing students.

The nursing literature on examination remediation and testing feedback strategies focuses primarily on NCLEX-RN success and remediation, rather than on the course examinations taken by students throughout program curricula. Students deemed at risk for NCLEX-RN failure likely have displayed poor performance on examinations long before graduation and licensure testing. Individualized examination feedback that identifies students' specific weaknesses is superior to correct answer feedback. The feedback grid described in this article demonstrates one method of providing structured, individualized feedback using the nursing process, Bloom's taxonomy, and NCLEX-RN blueprints. The feedback grid helped students to identify patterns in knowledge gaps, determine the correct answers to missed examination questions, and improve test scores in a critical care nursing course.

The promise and perils of a weekend nursing program.

In 1996, a weekend nursing program was created as an addition to the traditional weekday schedule to accommodate an increased number of qualified applicants seeking admission to the baccalaureate nursing program. Five years after the inception of the program, a comprehensive evaluation study was conducted to examine the impact of the weekend course schedule on students and faculty. The opportunities and challenges associated with the implementation of an alternative program schedule for entry-level nursing students are presented.

What do I do now?: clinical decision making by new graduates.

Newly graduated nurses (NGNs) are thrust into roles that some purport they are inadequately prepared to handle. This study investigated the experience of NGNs as they made clinical judgments in the critical care setting. Three themes emerged: developing confidence in practice, seeking assistance, and decision making. Nursing professional development educators can use the results to coordinate an education plan that extends beyond formal orientation and provides support for NGNs throughout the first year of practice.

Management of respiratory syncytial virus with lower respiratory tract infection in infants and children.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and children requiring pediatric hospitalizations. Infants with chronic lung, cardiac, or neuromuscular conditions are at increased risk for RSV infection. Early RSV is associated with subsequent diagnosis of reactive airway disease. The management of RSV with lower respiratory track infection in infants and children remains controversial. Bronchodilators may have some short-term benefit, but are not recommended as standard practice for infants and children. Antiviral therapy may be used for high-risk and severely ill patients. Corticosteroids may be effective in cases of moderate to severe RSV with lower respiratory track infection. Monoclonal antibodies have shown some promise in achieving passive immunity for those at greatest risk, including preterm infants younger than 1 year or infants younger than 2 years with chronic lung disease. Emergency management remains primarily supportive, with vigilant monitoring of oxygenation and hydration status. Interventions include supplemental oxygen therapy, ventilation, and fluid and nutrition therapy. Respiratory syncytial virus prophylaxis for high-risk patients includes intramuscular injections of palivizumab (Synagis) each month during RSV season, from November through April. Prevention strategies include washing hands, cleaning environment surfaces, and isolating infants and children with RSV in the emergency care area.