Exploring the Development of Nursing Clinical Judgment Among Students Using Virtual Reality Simulation.

BACKGROUND: Virtual reality simulation (VRS) is an emerging pedagogy in nursing education. PURPOSE: The purpose of this qualitative exploratory study was 2-fold: to determine nursing students' learning experiences when engaged in VRS, and to explore learners' problem-solving/clinical reasoning approach after participation in a VRS clinical scenario. This article reports student descriptions of clinical reasoning/clinical judgment when considering their VRS experience. METHODS: Qualitative description provided a methodological orientation for the study. Widely accepted frameworks for nursing clinical judgment provided a theoretical basis. RESULTS: Focus group participant narratives reveal evidence about nursing clinical judgment when applied to established descriptions and phases. CONCLUSION: Study findings suggest that VRS experiences promote development of nursing clinical judgment among students.

Strategies to Promote the Success of Academically At-risk Accelerated Bachelor of Science in Nursing Students.

BACKGROUND: Accelerated second-degree baccalaureate nursing (ABSN) programs are continuing to increase rapidly as a strategy to address a critical nursing shortage. The ABSN student profile differs from traditional entry-level nursing students, with some studies reporting higher attrition rates for ABSN students. Costs to students and nursing programs associated with program disruption can be high. PURPOSE: The purpose was to identify academic risk factors and develop strategies to promote academic success for timely progression to graduation and licensure. METHODS: Two consecutive descriptive correlational studies were conducted on sequential ABSN cohorts in a nursing program in northern New England. RESULTS: Data revealed modifiable factors that put students at risk of program nonprogression or dismissal. Evidence-based, targeted, individualized academic support interventions were developed and implemented. CONCLUSION: Strategies to promote academic success for ABSN students identified as at-risk have been shown to be effective.

Medication waste reduction in pediatric pharmacy batch processes.

OBJECTIVES: To inform pediatric cart-fill batch scheduling for reductions in pharmaceutical waste using a case study and simulation analysis. METHODS: A pre and post intervention and simulation analysis was conducted during 3 months at a 205-bed children's center. An algorithm was developed to detect wasted medication based on time-stamped computerized provider order entry information. The algorithm was used to quantify pharmaceutical waste and associated costs for both preintervention (1 batch per day) and postintervention (3 batches per day) schedules. Further, simulation was used to systematically test 108 batch schedules outlining general characteristics that have an impact on the likelihood for waste. RESULTS: Switching from a 1-batch-per-day to a 3-batch-per-day schedule resulted in a 31.3% decrease in pharmaceutical waste (28.7% to 19.7%) and annual cost savings of $183,380. Simulation results demonstrate how increasing batch frequency facilitates a more just-in-time process that reduces waste. The most substantial gains are realized by shifting from a schedule of 1 batch per day to at least 2 batches per day. The simulation exhibits how waste reduction is also achievable by avoiding batch preparation during daily time periods where medication administration or medication discontinuations are frequent. Last, the simulation was used to show how reducing batch preparation time per batch provides some, albeit minimal, opportunity to decrease waste. CONCLUSIONS: The case study and simulation analysis demonstrate characteristics of batch scheduling that may support pediatric pharmacy managers in redesign toward minimizing pharmaceutical waste.