Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation.

Nurses serve a valuable role in the healthcare industry. Nurses are trained with the skills and knowledge to thrive in a fast-paced, evolving environment. In order to meet the complex and diverse needs of patients, nurses must be able to assess and prioritize care to produce safe and high-quality outcomes. Simulation is an established method of educating nursing students and preparing nurses to respond appropriately to situations they are likely to encounter in practice. Traditional nursing simulation devices are prohibitively expensive for many nursing education institutions. The development of augmented, mixed, and virtual reality simulation delivery offers a new platform for simulation, known as immersive simulation. Immersive simulation can virtually place nursing students in situations that are difficult to arrange in actual clinical practicums or that occur rarely but for which nurses need to be prepared. Additionally, the hardware required to deliver immersive simulation is much cheaper than that of traditional nursing simulation devices. This chapter describes the virtual standardized patient application delivered via mixed reality immersive simulation. This chapter also discusses the research initiative currently underway to assess student perceptions to this modality of health training simulation.

Hypertension and related lifestyle factors among persons living in rural Nicaragua.

BACKGROUND: Globally about 40% of adults are diagnosed with hypertension, with high-income countries having a lower prevalence than low-income countries. However, there are limited data about adult hypertension prevalence in Nicaragua. The purpose of this study was to determine the prevalence of hypertension in rural coffee farm workers. METHODS: A convenience sample of 229 adult coffee farm workers was used. Blood pressure was measured using an established protocol and the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) guidelines. RESULTS: Nearly 60% of the sample reported at least one prior blood pressure measurement. Hypertension was detected in 16.7% of males and 26.3% of females (20.7% of the total). Prehypertension was detected in 59.3% of males and 27.7% of females (46.2% of the total). Of the men, 51.4% reported smoking at least some days and just over one third of the sample reported adding extra salt to their food. DISCUSSION: While the prevalence of hypertension in this sample is lower than global estimates, almost half of the sample had prehypertension, demonstrating an area where health promotion efforts could be focused. Given the limited funding and resources often available in these areas, increasing disease prevention efforts (including health promotion and wellness programs) and establishing settings that provide outreach and education, may improve chronic disease management and prevent comorbidities from occurring.

Using simulation pedagogy to enhance teamwork and communication in the care of older adults: the ELDER project.

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings.

The ELDER Project: educational model and three-year outcomes of a community-based geriatric education initiative.

The purpose of the ELDER (Expanded Learning and Dedication to Elders in the Region) Project was to address the needs of underserved older adults by providing worksite education to individuals who provide nursing care to older adults in community health centers, home health agencies, and long-term care facilities. Four agencies located in a Health Professional Shortage and Medically Underserved Area participated. Project staff conducted separate focus groups with administrators and staff at each agency to determine educational needs and preferences. Curricula from the Hartford Institute, End-of-Life Nursing Education Consortium, and Geriatric Education Centers were adapted to design unique curricula for each agency and level of personnel (licensed nurse or unlicensed caregiver). Activities included focus group meetings to tailor content to the needs of each agency, on-site educational sessions, and identification of an agency champion to sustain the program after the funding ended. A case-based simulation-learning approach was used in the final year to validate application of knowledge and to facilitate teamwork and interprofessional communication. Over 100 nurses and nursing assistants and eight administrators and allied health professionals participated over the three-year period of the project. Retention over this period, independent evaluations, and simulations demonstrated participants' ability to integrate best practices into typical clinical scenarios and revealed improved communication among care providers. Tailored on-site education incorporating simulation was an effective model for translating gerontological knowledge into practice and improving the care of older adults in these multiple settings.

Building coalitions: A statewide nursing organization's role in changing nursing education regulation during the COVID-19 pandemic.

The California Association of Colleges of Nursing (CACN), representing California's baccalaureate and higher degree nursing education programs, has raised concerns for over two-years about the number, relevance, and legitimacy of nursing education regulations. Formal CACN letters to state regulators did not affect change. While California nursing education regulations require 75% direct patient contact for all clinical courses, meeting this requirement became impossible as clinical agencies closed to nursing students during the beginning of the COVID-19 pandemic. Nursing regulatory change was urgently needed to provide greater flexibility in meeting clinical course objectives using simulation and other online learning modalities. At stake was the graduation of over 14,971 RN students from public and private nursing programs. While state regulators opposed a legislative approach, CACN collaborated with stakeholders to support legislation that led to a reduction in direct patient care hours, allowing nursing students to progress and graduate. This longstanding advocacy work was accelerated by the pandemic and required leadership and knowledge about the legislative process for nurse educators to succeed. The ultimate goal for CACN is to forge a more respectful relationship and greater collaboration between educators and regulators to enhance quality, reduce costs, and redundancies in nursing education in this state.

Statewide political activism for California academic nursing leaders.

The California Association of Colleges of Nursing (CACN) is a not-for-profit, non-partisan nursing organization whose members are the universities' Schools of Nursing that offer baccalaureate and graduate degree programs in California. The nursing deans and directors are the individuals who attend scheduled statewide meetings and actualize the mission, vision, and governance of this organization. Starting in 2011, CACN began a journey toward greater political activism that was initiated by strategic planning. During the Spring 2017 meeting, forty-four California nursing deans/directors advanced their advocacy by attending prescheduled visits with California legislators. The goals for meetings with California policy makers included: 1. Inform them about CACN as an organization and its sphere of influence and 2. Educate them about CACN's perspective on current bills in the California legislature. This manuscript details a process to assist other state organizations to move toward political activism in support of the nursing profession from the academic nursing leadership perspective.

Does race affect readmission to hospital after critical illness?

OBJECTIVE: To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients. METHODS: Racial status is a risk factor for early (within 7 days) hospital readmission after initial recovery from critical illness and respiratory failure. This was a retrospective cohort study that took place in a 350-bed community hospital. Adult patients who received mechanical ventilation during their intensive care unit stay were included. Study subjects were categorized as white, black (non-Hispanic), Hispanic, and Asian/other. The main outcome measure was readmission to the hospital within 7 days of discharge. Secondary outcomes were hospital mortality and durations of hospital and intensive care unit stay. Comparisons were made across racial groups. RESULTS: Of 772 patients, 172 (22.3%) died, and 96 of the 591 discharged patients (16.2%) were readmitted within 7 days. Race was not a determinant of rapid readmission: 11.6% of blacks (P = .2), 20.6% of Hispanics (P = .3) and 16.5% of whites were readmitted within 7 days. Readmitted patients were more likely to have been discharged to a rehabilitation or extended care facility rather than to home (22.1% vs 2.2%, P < .0001). Readmitted patients tended to have had prolonged duration of mechanical ventilation > or = 30 days (41% vs 15.1%, P = .004), to be aged > or = 80 years (24.4% vs 13.9%, P = .005), and to be female (19.5% vs 13.7%, P = .04). Multivariate logistic regression analyses demonstrated that discharge to a place other than home (odds ratio 10.1, 95% confidence interval 3.6-28.3) and prolonged duration of mechanical ventilation (odds ratio 2.8, 95% confidence interval 1.1-6.9) were independently associated with readmission. Race did not significantly influence in-hospital mortality. Overall, the deceased were older and more likely to be female, and had longer durations of mechanical ventilation and medical and surgical intensive care unit stays. CONCLUSION: Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.