Use of simulation for global health pre-departure training

BackgroundOpportunities for students to participate in global health mission trips have expanded. However, lack of pre-departure training is often reported and has been associated with negative outcomes for participants. Simulation is an effective method for providing customized situational learning.ObjectiveTo evaluate the effectiveness of a Pre-Departure Training program incorporating simulation for advanced practice registered nursing (APRN) students prior to a global health mission trip.DesignThis program employed a pre-posttest design with surveys administered at baseline, after a computer-based learning module, and after a simulation-based learning experience.SettingA university in the Southeastern United States.ParticipantsTwenty-two APRN students in their first clinical rotation of the program.MethodsAPRN students with interest in global health missions partake in a pre-departure training program. Pre-departure training includes a computer-based learning module followed by an outdoor simulation replicating a low-income setting. Pre-posttest surveys assessed students' perceptions of confidence, skill, knowledge and comfort regarding global health. A skills checklist was used to evaluate student clinical patient presentation during the simulation.ResultsStudents' preparedness scores increased after the computer-based learning and significantly increased after the simulation. In the simulation, 42% of students successfully completed their patient presentation during their first attempt while 58% required remediation.ConclusionAfter the pre-departure program, students felt more confident in their global health knowledge, and felt significantly more prepared to provide health care in a low-income country. Schools of nursing offering global health mission trips or study abroad programs should consider implementing pre-departure programs using simulation as a teaching method.     

Delivering culturally competent care to the lesbian,gay, bisexual,and transgender (LGBT) population: Education for nursing students

PurposeDespite well-documented healthcare disparities in the lesbian, gay, bisexual, and transgender (LGBT) community, nursing education has lagged other health professions in promoting culturally competent care to members of this minority group.MethodsUsing national guidelines, the author developed an educational program for BSN students to improve competency in providing care for LGBT individuals. One hundred twenty-four students completed online modules and a simulation exercise, which explored LGBT healthcare topics. One hundred eight participants completed surveys pre-, post-, and 1 month after the intervention.ResultsOverall LGB competence scores improved from pre- (M = 4.42) to post-test (M = 5.20) and did not significantly decrease at one-month (M = 5.03, p < .001). Similar findings were observed in the transgender cultural competence scores (pre- (M = 4.02); post- (M = 5.08); one-month (M = 4.92, p < .001)).ConclusionEducational content focused on cultural competency for nurses may lead to improved health outcomes among the LGBT community.     

Using simulation to improve the capability of undergraduate nursing students in mental health care

IntroductionMental health care is an increasing component of acute patient care and yet mental health care education can be limited in undergraduate nursing programs. The aim of this study was to establish if simulation learning can be an effective method of improving undergraduate nurses' capability in mental health care in an acute care environment.InterventionUndergraduate nursing students at an Australian university were exposed to several high-fidelity high-technology simulation activities that incorporated elements of acute emergency nursing practice and acute mental health intervention, scaffolded by theories of learning. This approach provided a safe environment for students to experience clinical practice, and develop their skills for dealing with complex clinical challenges.MethodsUsing a mixed method approach, the primary domains of interest in this study were student confidence, knowledge and ability. These were self-reported and assessed before and after the simulation activities (intervention) using a pre-validated survey, to gauge the self-rated capacity of students to initiate and complete effective care episodes. Focus group interviews were subsequently held with students who attended placement in the emergency department to explore the impact of the intervention on student performance in this clinical setting.ResultsStudents who participated in the simulation activity identified and reported significantly increased confidence, knowledge and ability in mental health care post-intervention. They identified key features of the intervention included the impact of its realism on the quality of learning. There is some evidence to suggest that the intervention had an impact on the performance and reflection of students in the clinical setting.DiscussionThis study provides evidence to support the use of simulation to enhance student nurses' clinical capabilities in providing mental health care in acute care environments. Nursing curriculum development should be based on best-evidence to ensure that future nursing graduates have the skills and capability to provide high-quality, holistic care.     

Nursing presence during death: An end-of-life simulation created by students and faculty

BackgroundNursing curricula often lack end-of-life (EOL) care training, particularly regarding the nursing skill of “being present.” Collaboration between students and faculty in curriculum design is rare, but may effectively help fill the curriculum gaps in EOL care.AimTo describe the creation of a novel EOL care simulation by students and faculty, and its implementation into a pre-licensure Masters of Science in Nursing (MSN) curriculum.MethodsWith support from expert faculty, three students developed an EOL care simulation focused on nursing presence, comfort care, and compassionate communication. Pilot participants submitted pre- and post-test surveys regarding confidence in providing comfort measures for dying patients. The simulation was integrated into the MSN curriculum and simulation evaluations were collected.FindingsPilot data are limited. Once incorporated into the curriculum, 95% of respondents (N = 38; response rate 35%) reported feeling better prepared to respond to changes in patient condition, more confident in their ability to prioritise care and interventions, and better able to communicate with patients. One hundred percent of respondents recommended the simulation for future use.DiscussionA curricular gap in EOL care provided a unique opportunity for nursing students and faculty to develop clinical EOL care training that focused on compassionate nursing presence.ConclusionThis project demonstrated the potential for collaboration between nursing students and faculty to enhance nursing education in EOL care. Pre-licensure exposure to the general principles of EOL care and nursing presence may be beneficial for new nurses entering the workforce.     

Using simulation to prepare neophyte nursing students to deliver intimate patient care

BackgroundPreparing neophyte nursing students to deal with the intimate aspects of patient care including nudity and body excretions is challenging. Traditional simulation approaches that have been used to teach these skills require examination in the context of considering more realistic ways. Mask-Ed™ is a high fidelity modality of simulation that enables the educator to transform into a patient by donning silicone props such as masks and body torsos inclusive of genitalia. The hidden educator is able to coach and direct the learner throughout the simulation.AimThe aim of this study was to identify if Mask-Ed™ simulation enhanced students learning in the context of providing intimate patient care when undertaking the skills of showering and toileting.MethodsFirst year undergraduate nursing students were tasked with showering and toileting a Mask-Ed™ patient in a simulated learning situation within a laboratory context. Following the simulation students were invited to participate in focus groups. Data was recorded, transcribed and analysed using an inductive thematic analysis approach.FindingsFrom class preparation to debrief, participants experienced a safe journey of discovery enabling them to provide intimate care. The realism of the learning environment combined with the confidence students had in their educator, allowed students to overcome their nervousness and anxiety, discover the vulnerable person at the centre of their care, gain confidence and find comrades.DiscussionSimulations that provide neophyte nursing students with an opportunity to face real to life intimate care experiences should be apparent in all undergraduate nursing programs. Nursing students need not only to be prepared to implement skills around safe practice when showering and toileting patients but they also need to feel safe and confident to practice themselves.ConclusionMask-Ed™ is an effective and efficient simulation modality to teach neophyte nursing students about intimate human care.     

Bridging the Gap of Mental Health Inequalities in the Transgender Population: The Role of Nursing Education

The transgender population experience mental health disparities as a result of numerous environmental, sociocultural and personal factors. Health care-related discrimination plays an unfortunate role in these disparities. The institutional and informational erasure of transgender individuals in health care actively contributes to this discrimination. The lack of preparation of health care professionals to care for this population is a significant factor. There is an absence of education on transgender topics in nursing school and a lack of nursing research on this population. An awareness through education of culturally competent transgender terminology is crucial to ensure a transinclusive environment is created. The creation of a transinclusive environment in the mental health care setting will ultimately lead to improved patient outcomes.     

Simulation-based learning for patient safety: The development of the Tag Team Patient Safety Simulation methodology for nursing education

BackgroundSince the ground-breaking report ‘To Err is Human: Building a Safer Health Care System’ was published nearly two decades ago, patient safety has become an international healthcare priority. Universities are charged with the responsibility of preparing the future nursing workforce to practise in accordance with relevant patient safety standards. Consequently, simulation-based learning is increasingly used for developing the technical and non-technical skills graduates require to provide safe patient care.AimTag Team Patient Safety Simulation is a pragmatic group-based approach that enhances nursing students’ knowledge and skills in the provision of safe patient care. The aim of this paper is to describe the Tag Team Patient Safety Simulation methodology and illustrate its key features with reference to a medication safety scenario.MethodsInformed by the National Safety and Quality Health Service Standards and the Patient Safety Competency Framework for Nursing Students, Tag Team Patient Safety Simulation methodology actively engage large numbers of nursing students in critical conversations around every day clinical encounters which can compromise patient safety.ConclusionTag Team Patient Safety Simulation is a novel simulation methodology that enhances nursing students’ skills and knowledge, fosters critical conversations, and has the potential to enhance students’ resilience and capacity to speak up for safe patient care.     

Scenario-based clinical simulation: Bridging the gap between intern-students’ anxiety and provision of holistic nursing care for preterm neonates

AimThis study aimed to determine the effect of Scenario-Based Clinical Simulation (SBCS) on nursing students’ anxiety and skills related to providing holistic nursing care for preterm neonates.BackgroundNursing students who are caring for preterm neonates experience high level of anxiety that might negatively influence their clinical performance. Clinical nurse educators face the challenge of preparing skilful and competent students within the constraints of limited orientation time in the Neonatal Intensive Care Unit (NICU). The application of SBCS provides students with opportunities to practice critical thinking, problem-solving and communication skills, pose questions and remediate their clinical deficiencies in non-threatening learning enviroment.DesignA quasi-experimental, two groups, pre-post test study was carried out in the NICU of Specialized Hospital at Smouha, Alexandria.MethodSixty students completed a baseline skills assessment, as students' clinical skills were scored on a 148-item checklist and participants rated their anxiety. All participants received a didactic lecture and demonstrated nursing procedures. Research team facilitated an interactive SBCS session for the intervention group focused on the holistic care of preterm neonates and the common health problems affecting them. Two weeks later, two independent raters re-assessed the students' skills on the admitted preterms, and participants completed the anxiety questionnaire again.ResultsIt is revealed that all participants in the intervention group (100%) had good skills after two weeks of SBCS compared to 20% of the control group (P < 0.001). Moreover, 43.3% of the nursing students in control group experienced severe anxiety compared to only 6.7% of those in the intervention group who attended the SBCS (P < 0.001).ConclusionThe application of SBCS in NICU provided an interactive learning experience, improved and sustained students' clinical skills. They reflected on their performance and remediated their skills in a conducive environment. So, they encountered less anxiety while providing holistic care for preterm neonates.     

Gaming and anxiety in the nursing simulation lab: A pilot study of an escape room

BackgroundAnxiety accompanying educational simulations is a complex issue impacting nursing students and their learning. Research has provided evidence that some pre-simulation activities can increase student comfort with the simulation environment and may also reduce anxiety. Studies have also provided evidence of promising outcomes for gaming use in nursing education.PurposeThis pilot study explored a medical-surgical escape room game as an introductory simulation experience for nursing students, particularly focused on determining student anxiety levels, and both faculty and student perception of the experience.MethodsA quasi-experimental one group pretest-posttest design was used with a convenience sample to explore student anxiety levels and perceived enjoyment of the game.ResultsStudent anxiety levels significantly decreased (p = .013); however, anxiety levels remained high at posttest. Students reported high enjoyment of the game and provided positive comments.ConclusionEscape rooms can provide an engaging, interactive way to teach nursing concepts in the simulation environment.     

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care.BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards.DesignExplorative qualitative focus group study.MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation.ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity.ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.     

Satisfaction and self-confidence with nursing clinical simulation: Novice learners,medium-fidelity,and community settings

BackgroundSimulation is fast becoming a normative pedagogy for a portion of clinical time in undergraduate nursing programs in the U.S. Studies have shown positive outcomes in increasing self-confidence and satisfaction with simulation. The questions remain as to which fidelity of simulation best matches which learners, how early can simulation begin with novice students, and in which contexts can simulation be best used for these early learners. This study was undertaken to find out if novice students were able to demonstrate increased satisfaction and self-confidence with medium fidelity simulation in community based roles, as these students have no knowledge of acute care skills at this point in their learning.ObjectivesThe purpose of this study was to evaluate the use of medium fidelity simulation by measuring self-confidence and satisfaction among novice learners and to demonstrate the feasibility of using community based scenarios in simulation.MethodA quasi-experimental design using 61 undergraduate nursing students at a Midwestern college. Data was collected using three NLN simulation instruments known as the Educational Practices Questionnaire, Self-Confidence in Learning Questionnaire, and Simulation Design Scale (Jeffries and Rizzolo, 2006) following a five-week pediatric community-based simulation course. Students were concurrently enrolled in pediatric theory courses and their first acute care clinical course and skills lab while completing this community-based simulation course.ResultsThe results revealed that students were satisfied and self-confident following their simulation experience. They also reported high levels of satisfaction with the fidelity of the simulation experience.ConclusionMedium fidelity community based pediatric simulation can be used effectively among novice nursing students. This pedagogy is an effective way to bridge theory instruction with clinical instruction while providing students with necessary community experiences.     

Undergraduate student nurses’ experience of mental health simulation pre‐clinical placement: A pre/post‐test survey

Undertaking a mental health clinical placement can be anxiety‐provoking for nursing students at times. There is a need to adequately prepare undergraduate nursing students for clinical placement in a mental health setting in relation to their skills and confidence. This study aimed to evaluate the effect of a mental health simulation workshop on the skills and confidence of nursing students in providing care to consumers living with a mental illness. The study also evaluated the design of the mental health simulation workshop from an educational perspective. A pre/post‐test survey was administered to a cohort of N = 89 Australian pre‐registration nursing students. Exploratory factor analysis identified three factors: Mental health therapeutic engagement, mental health assessment skills, and mental health placement preparedness. Analyses of pre–post differences indicated that all three factors were significantly different between the initial and follow‐up responses, with follow‐up responses being more favourable. The findings of this study demonstrate that there is value in including mental health simulated patient exercise as part of the learning strategies in the curriculum of pre‐registration nurses. This has implications for the quality of care in the clinical environment and level of preparedness of these students’ nurses for mental health clinical placement where they will be providing care to consumers living with a mental illness under direct supervision.     

Nursing as universal and recognisable: Nursing students'perceptions of learning outcomes from intercultural peer learning webinars: A qualitative study

BackgroundNursing students need to be prepared for the increasingly culturally diverse health care. Therefore, providing students with international perspectives remains the mission of higher education. However, given the logistic and financial constraints, not all students will be able to travel overseas for their international experiences. A feasible alternative to study abroad is internationalisation-at-home where intercultural dimensions are incorporated into curriculum, without students leaving their home universities. This paper presents findings from a collaboration between nursing programmes in Sweden and Hong Kong. The aim of the project was to explore how undergraduate nursing students' perceived achieved learning outcomes after participating in a web-based intercultural peer-learning intervention.     

Evaluating Cultural Competence in Undergraduate Nursing Students using Standardized Patients

BackgroundThe need for culturally competent health-care providers is essential in reducing health disparities and ensuring positive patient outcomes. The purposes of this study were to describe the baseline level of self-reported cultural competence of undergraduate nursing students and compare between groups learning this material with lecture only and those learning with lecture and simulation with culturally diverse standardized patients.MethodA mixed method and design was used for this study.ResultsThere was a statistically significant increase in the level of cultural competence in both groups who participated in the study. Results also present thematically analyzed reactions of participants to the simulation in which several broad themes emerged including participants initially feeling nervous then comfortable during the simulation and finding the simulation extremely valuable.ConclusionThis research suggests that the use of standardized patients is an effective teaching strategy in nursing education particularly as a supplement to traditional lecture.     

HI I CARE: A mnemonic device to frame safe patient encounters and support simulation experiences for novice nursing students

BackgroundRemembering the many safety behaviors and patient care activities expected during a patient encounter can be difficult for novice nursing students. The HI I CARE mnemonic device was created to assist novice nursing students to remember and organize key safety behaviors and patient care activities. Subsequently, the mnemonic device was drafted into a checklist to be used as a performance support tool for students’ first simulation experience.MethodsA survey was designed and administered to beginning nursing students to explore their perception if the HI I CARE mnemonic device helped to (1) reduce anxiety prior to simulation experiences; (2) plan, organize, and deliver care; and (3) integrate classroom learning into the simulated patient encounter.ResultsOverwhelmingly, participants agreed or strongly agreed that the HI I CARE mnemonic helped to achieve these goals.ConclusionThe HI I CARE mnemonic device and correlating checklists are effective performance support tools that can be used to help novice nursing students to recall key safety behaviors and organize patient care activities in the nursing skills laboratory and the simulation setting. This mnemonic device, as a performance support tool, offers associate degree nursing students the opportunity to develop optimal habits that exemplify the safe patient encounter.     

Nurses’ Perspectives on the Care of Adults with Mental Health Problems and Histories of Childhood Sexual Abuse

Despite growing awareness and evidence linking childhood sexual abuse (CSA) to numerous ongoing health problems in adulthood, the integration of this knowledge into nursing practice remains inconsistent. This article reports the results of a study that explored nurses’ perspectives on, and experiences with, providing care for adults with mental health problems who may also have histories of CSA. Nurses’ views underscore the challenges and complexities involved when providing care for this population. The themes of nurses’ knowledge and comfort levels, ethical practice, patient care considerations, and system issues are used to discuss nurses’ understandings, perspectives, and experiences.