Lessons Learned: Utilizing the NEWS Tool in High-Fidelity Simulation.

ABSTRACT: Nurse educators can enhance students' clinical judgment by providing cues to guide decision-making during simulation. The purpose of this experimental feasibility study was to evaluate the effectiveness of using the National Early Warning Score as a set of cues during high-fidelity simulation to guide students in the development of clinical judgment, resulting in early detection of patient deterioration. Differences in clinical judgment scores and speed of detection of patient deterioration between groups of junior-level nursing students trained in the use of National Early Warning Score versus those who were not were evaluated. No significant differences were detected between the groups; however, valuable lessons were learned.

Graduate Student Outcomes Following Critical Care Simulation: An Italian Pilot Study.

ABSTRACT: High-fidelity simulation provides nursing students with the opportunity to learn and achieve competence in a safe context. The aim of the study was to assess learning outcomes following multiple exposures to high-fidelity simulation sessions. The sample consisted of 18 graduate students enrolled in a critical care nursing course. A four-hour high-fidelity simulation experience was conducted, with a four-hour retraining one month after. Group performance, self-efficacy, self-confidence, and satisfaction improved after multiple exposures to high-fidelity simulation. High-fidelity simulation is a valid adjunct to nursing education in the short term and may improve learning when offered at multiple time points.

Evaluating the Interchangeability of Forehead, Tympanic, and Axillary Thermometers in Italian Paediatric Clinical Settings: Results of a Multicentre Observational Study.

PURPOSE: This study was conducted to investigate the interchangeability of infrared forehead, digital axillary, and infrared tympanic thermometers while identifying the most reliable non-invasive body temperature measurement method in paediatric settings. DESIGN AND METHODS: A multicentre observational study was conducted enrolling all children less than or equal to 14 years of age requiring a temperature measurement and after obtaining their parent's informed consent. Socio-demographic characteristics and temperature values in Celsius (°C) were simultaneously collected using forehead, axillary, and tympanic thermometers. RESULTS: A total of 433 children were enrolled, 57.5% were male and the mean age was 5.3 ± 3.9 years. The average value of tympanic temperature (37.05 °C) was higher than forehead (36.87 °C) and axillary (36.8 °C). The mean difference between axillary and forehead temperatures (-0.06 °C) was not statistically significant (p = 0.158). Comparing the measurements of each type of thermometer with the overall average of the three measurements recorded as the virtual gold standard, Bland Altman analysis highlighted tympanic with narrower 95% limits of agreement (+0.96 °C to -0.68 °C). The tympanic thermometer also had the highest percentage (81.6%) of differences falling within the maximum clinically acceptable difference (±0.5 °C). CONCLUSIONS: Differences between paired measurements of the three investigated devices demonstrated the devices are not interchangeable. Measurements using the tympanic thermometer more closely resembled the reference temperature indicating its preferential use in paediatric clinical practice. PRACTICE IMPLICATIONS: To safely and consistently measure body temperature, nurses should not assume peripheral thermometers are interchangeable. It is essential to clinically validate all temperature values with clinical observations.

Usefulness of a Simulated Helicopter Transport Experience for Medical Resident Training.

OBJECTIVE: This study evaluated the usefulness of a medical transport simulation to increase residents' understanding of medical transport. METHODS: Twenty-four medical residents participated in an intensive half-day medical transport simulation experience. Two questionnaires were administered, a pre/postsimulation questionnaire containing 11 questions that assessed the impact of the simulation training and a questionnaire that assessed realism of the flight simulator. RESULTS: There were statistically significant differences between the pre/postsimulation questions assessing perceived level of knowledge, experience, and training of transferring a patient in a helicopter with a mean change of 25 points on a 0 to 100 scale (P ≤ .001) and awareness of obstacles to treating patients during air transport exhibiting a mean change of 28 (P ≤ .001). The mean stress level for all participants increased from 32 (0-100 scale) before the start of the simulation to 47 during the simulation and decreased to 31 after the simulation (F2,46 = 20.67, P ≤ .001). CONCLUSION: The findings from this study provide evidence that the air medical simulation experience increases residents' perceived awareness of the context and difficulties of transferring a patient by helicopter and that the experience would influence their medical decision making in their future practice related to patient transfers.

Simulating the Role of the Parent: Promoting Family-Centered Nursing Care.

Parents of hospitalized children need support to diminish their own fear and anxiety and provide safe and loving care for the child. Baccalaureate nursing students, who are rarely parents themselves, often find it difficult to understand the needs of parents. An innovative simulation strategy was created to enhance students' understanding of the parent's role and its effect on family-centered care. This article describes the development of pediatric simulation experiences that actively incorporate the role of a parent. Portraying the parent during the simulation increases students' ability to be empathetic while providing safe family-centered care.

A Systematic Review of the Use of Standardized Patients as a Simulation Modality in Nursing Education.

AIM: The objective of the study was to search, extract, appraise, and synthesize studies using standardized patients (SPs) in nursing academia to determine how this modality of simulation is being used. BACKGROUND: SPs are a common simulation modality used in nursing education. METHOD: This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Five databases were searched as well as keywords to retrieve nonindexed citations for the period January 2011 to September 2016. The inclusion criteria included nurses, a simulated experience with SPs, and original research published in English. RESULTS: Sixty-five studies were identified and analyzed. CONCLUSION: More randomized controlled trials and studies with power analyses and validated measurement instruments are needed. Studies that compare SPs to high-fidelity simulators are also desired to determine optimal student learning outcomes and standardize best practices in simulation.

Promoting Interprofessional Collaborative Practice Through Simulation.

A 12-week program was developed to educate nursing, medicine, and physician assistant faculty on the principles and best practices of simulation. The goal was to facilitate team building and collaborative practice through the implementation of an interprofessional (IP) simulation experience for students. Workshops focused on IP communication involving seminar-based instruction, discussion, and the progressive development of an IP simulation based on a National League for Nursing Advancing Care Excellence for Seniors scenario. During the final session, students participated in the simulation while faculty evaluated and revised the scenario to best meet the needs of students from the three disciplines.

Promoting Simulation Globally: Networking with Nursing Colleagues Across Five Continents.

Simulation education is gaining momentum internationally and may provide the opportunity to enhance clinical education while disseminating evidence-based practice standards for clinical simulation and learning. There is a need to develop a cohesive leadership group that fosters support, networking, and sharing of simulation resources globally. The Frances Payne Bolton School of Nursing at Case Western Reserve University has had the unique opportunity to establish academic exchange programs with schools of nursing across five continents. Although the joint and mutual simulation activities have been extensive, each international collaboration has also provided insight into the innovations developed by global partners.

Flying Lessons for Clinicians: Developing System 2 Practice.

There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education.

Response of Flight Nurses in a Simulated Helicopter Environment.

OBJECTIVE: The purpose of this study was to determine if a helicopter flight simulator could provide a useful educational platform by creating experiences similar to those encountered by actual flight nurses. METHODS: Flight nurse (FN) and non-FN participants completed a simulated emergency scenario in a flight simulator. Physiologic and psychological stress during the simulation was measured using heart rate and perceived stress scores. A questionnaire was then administered to assess the realism of the flight simulator. RESULTS: Subjects reported that the overall experience in the flight simulator was comparable with a real helicopter. Sounds, communications, vibrations, and movements in the simulator most approximated those of a real-life helicopter environment. Perceived stress levels of all participants increased significantly from 27 (on a 0-100 scale) before simulation to 51 at the peak of the simulation and declined thereafter to 28 (P < .001). Perceived stress levels of FNs increased significantly from 25 before simulation to 54 at the peak of the simulation and declined thereafter to 30 (P < .001). Perceived stress levels of non-FNs increased significantly from 31 before simulation to 49 at the peak of the simulation and declined thereafter to 25 (P < .001). There were no significant differences in perceived stress levels between FNs and non-FNs before (P = .58), during (P = .63), or after (P = .55) simulation. FNs' heart rates increased significantly from 77 before simulation to 100 at the peak of the simulation and declined thereafter to 72 (P < .001). CONCLUSION: The results of this study suggest that simulation of a critical care scenario in a high-fidelity helicopter flight simulator can provide a realistic helicopter transport experience and create physiologic and psychological stress for participants.

Interprofessional Flight Camp.

The Dorothy Ebersbach Academic Center for Flight Nursing in Cleveland, OH, holds an annual flight camp designed for master's degree nursing students in the acute care nurse practitioner program, subspecializing in flight nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University. The weeklong interprofessional training is also open to any health care provider working in an acute care setting and focuses on critical care updates, trauma, and emergency care within the critical care transport environment. This year, 29 graduate nursing students enrolled in a master's degree program from Puerto Rico attended. Although the emergency department in Puerto Rico sees and cares for trauma patients, there is no formal trauma training program. Furthermore, the country only has 1 rotor wing air medical transport service located at the Puerto Rico Medical Center in San Juan. Flight faculty and graduate teaching assistants spent approximately 9 months planning for their participation in our 13th annual flight camp. Students from Puerto Rico were extremely pleased with the learning experiences at camp and expressed particular interest in having more training time within the helicopter flight simulator.

Challenges and Resources for New Critical Care Transport Crewmembers: A Descriptive Exploratory Study.

OBJECTIVE: The purpose of this study was to identify the challenges new crewmembers experience in the critical care transport (CCT) environment and to determine the most valuable resources when acclimating to the transport environment. To date, no study has focused on the unique challenges nor the resources most effective in CCT training. METHODS: This descriptive exploratory study was conducted with a convenience survey sent to the 3 largest professional CCT organizations: the Association of Air Medical Services, the Air and Surface Transport Nurses Association, and the Association of Critical Care Transport. RESULTS: The study survey responses revealed that more education and training are needed. Novice crewmembers identified areas in safety, communication, environment, and crew resource management as particularly challenging. Responses also validate the need for more simulation training, especially for CCT of low-volume/high-risk patient populations. CONCLUSION: Results of this survey provide valuable insight for improving training effectiveness of health care professionals transitioning to the CCT environment. More information regarding best practice on the frequency and timing of CCT simulation training should be collected, particularly for simulations completed in the transport environment.

Standardized Patient Versus Role-Play Strategies: A Comparative Study Measuring Patient-Centered Care and Safety in Psychiatric Mental Health Nursing.

Nursing faculty traditionally use role-play to demonstrate mental health behaviors. However, until students interact with a mental health patient, they may not know what to expect. Standardized patient (SP) interactions can be used to overcome this challenge. This study compared pre-licensure nursing students' knowledge, attitudes, and self-efficacy following a sequence of psychiatric mental health role-play and SP experiences. Results suggest that the order of teaching strategies (role-play first versus SP interaction first) does not significantly impact student knowledge, attitude, or self-efficacy. However, student scores improved in all categories after the second experience.

Critical Care Transport Training: New Strides in Simulating the Austere Environment.

The air medical transport arena requires the practitioner to develop clinical and diagnostic reasoning abilities to manage the dynamic needs of the patient in unstructured, uncertain, and often unforgiving environments. High-fidelity simulation can be instrumental in training interprofessional flight teams to improve competency through quality and safe patient care during medical transport that may otherwise take years to learn because of the inconsistency in real-world experiences. Because of the suboptimal circumstantial conditions inherent to critical care transport, a helicopter simulator designed to discretely replicate the phases of flight and train teams in air medical transport scenarios has been developed at the Dorothy Ebersbach Academic Center for Flight Nursing at the Frances Payne Bolton School of Nursing in Cleveland, OH. The goal is to prepare interdisciplinary critical care transport flight teams in collaborative practice, research, and leadership through measurable and highly structured learning activities.

The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis.

OBJECTIVES: This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students. DESIGN: Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results. DATA SOURCES: Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies. REVIEW METHODS: The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias. RESULTS: Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported. CONCLUSIONS: The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.

Incorporating climate change into Doctor of Nursing Practice curricula.

Climate change is a global crisis with major impacts on planetary health and quality of life. Nurses are well positioned to recognize the major health consequences of climate change on health. Therefore, highlighting nurses' active engagement in mitigating climate change impact and resilience efforts is essential. However, there is little evidence of climate change content in nursing curricula. Climate change/planetary health content could be integrated into existing Doctor of Nursing Practice programs so that graduates, as influential leaders, are equipped to meet the challenges ahead. The domains, competencies and sub-competencies outlined in the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN), 2021) are proposed as a curricular scaffold to integrate climate change content in DNP curricula. Climate change content matched to the AACN domains and competencies could be included in many existing DNP courses. Climate change would become a consistent concept throughout all DNP curricular programs rather than a specified course addressing climate change. The curricular structure presented would provide a foundation for enhancing DNP students' knowledge, attitudes and skills related to climate change. These students and future graduates would be well prepared to introduce changes in practices and policies at the local, national, and global levels.

Evaluating the use of simulation with beginning nursing students.

The purpose of this quasi-experimental study was to evaluate and compare the effectiveness of simulation versus a traditional skills laboratory method in promoting self-confidence and satisfaction with learning among beginning nursing students. A single convenience sample of 63 first-semester baccalaureate nursing students learning effective comfort care measures were recruited to compare the two teaching methods. Students participating in the simulation experience were statistically more confident than students participating in the traditional group. There was a slight, nonsignificant difference in satisfaction with learning between the two groups. Bivariate analysis revealed a significant positive relationship between self-confidence and satisfaction. Students in both groups reported higher levels of self-confidence following the learning experiences. Findings may influence the development of simulation experiences for beginning nursing students and encourage the implementation of simulation as a strand from beginning to end in nursing curricula.

Effects of high-fidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis.

OBJECTIVE: The purpose was to analyse the effectiveness of high-fidelity patient simulation (HFPS) based on life-threatening clinical condition scenarios on undergraduate and postgraduate nursing students' learning outcomes. DESIGN: A systematic review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. DATA SOURCES: PubMed, Scopus, CINAHL with Full Text, Wiley Online Library and Web of Science were searched until July 2017. Author contact, reference and citation lists were checked to obtain additional references. STUDY SELECTION: To be included, available full-texts had to be published in English, French, Spanish or Italian and (a) involved undergraduate or postgraduate nursing students performing HFPS based on life-threatening clinical condition scenarios, (b) contained control groups not tested on the HFPS before the intervention, (c) contained data measuring learning outcomes such as performance, knowledge, self-confidence, self-efficacy or satisfaction measured just after the simulation session and (d) reported data for meta-analytic synthesis. REVIEW METHOD: Three independent raters screened the retrieved studies using a coding protocol to extract data in accordance with inclusion criteria. SYNTHESIS METHOD: For each study, outcome data were synthesised using meta-analytic procedures based on random-effect model and computing effect sizes by Cohen's d with a 95% CI. RESULTS: Thirty-three studies were included. HFPS sessions showed significantly larger effects sizes for knowledge (d=0.49, 95% CI [0.17 to 0.81]) and performance (d=0.50, 95% CI [0.19 to 0.81]) when compared with any other teaching method. Significant heterogeneity among studies was detected. CONCLUSIONS: Compared with other teaching methods, HFPS revealed higher effects sizes on nursing students' knowledge and performance. Further studies are required to explore its effectiveness in improving nursing students' competence and patient outcomes.