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This paper focuses on changes in the educational preparation of undergraduate nurses in line with contemporary primary and preventative healthcare models. We evaluated a new Australian nursing and community care degree programme using focus groups with 38 students in their first years of study, and quantitative performance data (regarding entry, performance and course attrition). Four main themes were identified related to students’ course experience: ‘I think community health should be an elective’; ‘Focus on relevance to practice’; ‘Teaching by non-nursing academics’ and ‘Access to support during transition to university.’ Overall pass rates were 94% (first year) and 97% (second year) with a low 11% attrition rate. We conclude that based on prior experiences and stereotypical views, students may be ambivalent about the inclusion of primary and preventative care models which nevertheless are essential to enhance practice and to prepare the future nursing workforce
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Clinical practice is fundamental to the learning of undergraduate and entry-level nursing students. It provides the milieu whereby students apply classroom theory and simulated practice to the real world of nursing and become socialised into the profession. In contemporary nursing education, there is often competition among tertiary education providers to locate quality, appropriate placements; substantial costs may be incurred to access suitable placements.
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Aim: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.
Description:
Aim: To examine, in a simulated environment, rural nurses’ ability to assess and manage patient deterioration using measures of knowledge, situation awareness and skill performance. Background: Nurses’ ability to manage deterioration and ‘failure to rescue’ are of significant concern with questions over knowledge and clinical skills. Simulated emergencies may help to identify and develop core skills. Methods: An exploratory quantitative performance review. Thirty five nurses from a single ward completed a knowledge questionnaire and two video recorded simulated scenarios in a rural hospital setting. Patient actors simulated deteriorating patients with an Acute Myocardial Infarction (AMI) and Chronic Obstructive Pulmonary Disease (COPD) as the primary diagnosis. How aware individuals were of the situation (levels of situation awareness) were measured at the end of each scenario. Results: Knowledge of deterioration management varied considerably (range: 27%-91%) with a mean score of 67%. Average situation awareness scores and skill scores across the two scenarios (AMI and COPD) were low (50%) with many important observations and actions missed. Participants did identify that ‘patients’ were deteriorating but as each patient deteriorated staff performance declined with a reduction in all observational records and actions. In many cases, performance decrements appeared to be related to high anxiety levels. Participants tended to focus on single signs and symptoms and failed to use a systematic approach to patient assessment. Conclusion: Knowledge and skills were generally low in this rural hospital sample with notable performance decrements as patients acutely declined. Educational models that incorporate high fidelity simulation and feedback techniques are likely to have a significant positive impact on performance.
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Background: Bibliometrics involves statistical analyses of publication data, particularly citation analysis, to determine popularity/impact of articles and authors. Methods: Citation analysis was conducted on the "top 100'' cited nursing simulation articles in the Scopus database in April 2019. Results: The median number of article citations was 84 (mean = 100.4; range, 53-557). Citations were steadily accumulated after publication; the majority between year four and year seven. Two-thirds of the articles were led by authors from the United States. Conclusions: This report on bibliometric mapping helps to graphically illustrate the evolution of simulation articles in the field of nursing.
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This study explores preregistration nursing students’ views of a Web-based simulation program: FIRST2 ACTWeb (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends-Web). The multimedia program incorporating three videoed scenarios portrayed by a standardized patient (human actor) aims to improve students’ recognition and management of hospital patient deterioration. Participants were 367 final-year nursing students from three universities who completed an online evaluation survey and 19 students from two universities who attended one of five focus groups. Two researchers conducted a thematic analysis of the transcribed narratives. Three core themes identified were as follows: “ease of program use,” “experience of e-Simulation,” and “satisfaction with the learning experience.” The Web-based clinical learning environment was endorsed as functional, feasible, and easy to use and was reported to have high fidelity and realism. Feedback in both focus groups and surveys showed high satisfaction with the learning experience. Overall, evaluation suggested that the Web-based simulation program successfully integrated elements essential for blended learning. Although Web-based educational applications are resource intensive to develop, positive appraisal of program quality, plus program accessibility and repeatability, appears to provide important educational benefits. Further research is needed to determine the transferability of these learning experiences into real-world practice.
Description:
Objectives This paper reports the quantitative findings of the first phase of a larger program of ongoing research: Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACTTM). It specifically aims to identify the characteristics that may predict primary outcome measures of clinical performance, teamwork and situation awareness in the management of deteriorating patients. Design Mixed-method multi-centre study. Setting High fidelity simulated acute clinical environment in three Australian universities. Participants A convenience sample of 97 final year nursing students enrolled in an undergraduate Bachelor of Nursing or combined Bachelor of Nursing degree were included in the study. Method In groups of three, participants proceeded through three phases: (i) pre-briefing and completion of a multi-choice question test, (ii) three video-recorded simulated clinical scenarios where actors substituted real patients with deteriorating conditions, and (iii) post-scenario debriefing. Clinical performance, teamwork and situation awareness were evaluated, using a validated standard checklist (OSCE), Team Emergency Assessment Measure (TEAM) score sheet and Situation Awareness Global Assessment Technique (SAGAT). A Modified Angoff technique was used to establish cut points for clinical performance. Results Student teams engaged in 97 simulation experiences across the three scenarios and achieved a level of clinical performance consistent with the experts' identified pass level point in only 9 (1%) of the simulation experiences. Knowledge was significantly associated with overall teamwork (p = .034), overall situation awareness (p = .05) and clinical performance in two of the three scenarios (p = .032 cardiac and p = .006 shock). Situation awareness scores of scenario team leaders were low overall, with an average total score of 41%. Conclusions Final year undergraduate nursing students may have difficulty recognising and responding appropriately to patient deterioration. Improving pre-requisite knowledge, rehearsal of first response and team management strategies need to be a key component of undergraduate nursing students' education and ought to specifically address clinical performance, teamwork and situation awareness.
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Objective The objective of this article was to review the literature on utilisation and place of Web-based simulation within nursing education. Web-based simulation combines electronic multimedia options with a central video or virtual world to produce interactive learning activities mediated by the learner. Design An integrative review. Data sources A search was conducted of healthcare databases between 2000 and 2014 and of Internet sources for hosted simulation programs in nursing. Eighteen primary programs were identified for inclusion. Review methods A strategy for integrative review was adopted in which studies were identified, filtered, classified, analysed and compared. Results and discussion Of 18 programs, two game-based programs were identified which represented a ‘virtual world’ in which students could simultaneously or individually immerse themselves in a character role-play. However, most programs (n = 10) taught an aspect of procedural patient care using multimedia (e.g. video, audio, graphics, quiz, text, memo). Time-limited sequences, feedback and reflective activities were often incorporated. Other studies (n = 8) taught interpersonal communication skills or technical skills for equipment use. Descriptive study outcomes indicated ease of program use, strong satisfaction with learning and appreciation of program accessibility. Additionally, four studies reported significant improvements in knowledge post-intervention. Conclusion Web-based simulation is highly acceptable to students and appears to provide learning benefits that align with other simulation approaches and it augments face-to-face teaching. Web-based simulation is likely to have a major place in nursing curricula in the next decade, yet further research is necessary to objectively evaluate learner outcomes and to justify its use.
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This work was funded by the Council of Deans of Nursing and Midwifery (Australia and New Zealand) – 2019. The funding body had no role in the design of the study and collection, analysis, and interpretation of data, or in writing the manuscript.
Description:
This work was funded by the Council of Deans of Nursing and Midwifery (Australia and New Zealand) – 2019. The funding body had no role in the design of the study and collection, analysis, and interpretation of data, or in writing the manuscript.
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This paper explores the prevalence of ‘near death experience’ phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients’ reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4–9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.
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Background Simulation-based education is one strategy that may be used to teach nursing students to recognize and manage patient deterioration. Method Final-year preregistration nursing students (n = 97) completed three face-to-face laboratory-based team simulations with a simulated patient (actor) and 330 students individually completed a three-scenario Web-based simulation program: FIRST2ACTWeb™. Results Both groups achieved moderate performance scores (means: face to face, 49%; e-simulation, 69%). Course evaluations were positive, skill gain showing a greater effect size in the face-to-face program than for e-simulation, and higher satisfaction and more positive appraisal. Conclusion Face-to-face simulation and e-simulation are effective educational strategies with e-simulation offering greater feasibility. Either strategy is likely to add value to the learning experience.
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Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
Simulation-based education has become a ubiquitous teaching approach in nursing. However, ensuring the quality of simulation research is critical. We reviewed the methodological quality of 26 quantitative studies published in Clinical Simulation in Nursing, 2017. The Medical Education Research Study Quality Instrument and Simulation Research Evaluation Rubric showed that nearly all studies were of moderate to high quality (rated ≥50%). Correlation coefficients showed that interrater agreement was high overall (≥0.94). In conclusion, this was a valid approach for examining simulation study quality. Although most included studies were of high quality, some elements of study reporting can be improved upon.
Description:
Aims and objectives: To identify how science should be taught to nursing students, and by whom. Background: An understanding of foundational science and its role in supporting safe and effective nursing practice is an important part of student learning. The well documented challenges in teaching this content are compounded by a lack of evidence regarding educational strategies that lead to improved educational outcomes. Design: The study employed a cross-sectional design using online surveys. Methods: Two surveys were conducted in Australia involving (i) academics who teach science in undergraduate nursing programs and (ii) registered nurses (RNs). Participants were asked to respond to a range of questions around how science should be taught to nurses. There were n = 30 and n = 1808 respondents respectively. Results: Findings indicated a need to better integrate science content throughout nursing curricula. Participants were supportive of a discrete science subject in the foundation year and the integration of science content throughout the remainder of the curriculum. Participants across both surveys were ambivalent about whether the depth of science teaching was adequate for nursing practice. Most nurse academics and RNs thought that nurses should teach science, while non-nursing science teachers were less certain. Conclusions: Existing consensus clearly values the delivery of science content as an initial and ongoing priority of learning throughout the undergraduate nursing program. Relevance to practice: Improving the ways in which students learn sciences will impact on nursing practice, with the potential to improve patient care. 2017 Australian College of Nursing Ltd. Published by Elsevier Ltd.