Demonstration of caring and motivational interviewing in online simulation: A cross-sectional observational study

AimThe purpose of this paper is to describe an innovative educational approach for pre-licensure nursing students to learn and practice motivational interviewing skills in a telehealth simulation with standardized patients portraying pregnant women with substance use disorder.BackgroundGiven the ongoing need for online delivery of both nursing education and clinical practice, providers must continue to find approaches to facilitate the provision of empathetic and personalized care to achieve optimal patient outcomes. Motivational interviewing integrates a person-centered approach with specific communication strategies to encourage and support patients' commitment to change. Motivational interviewing skills can be implemented across a wide variety of patient situations, including mental health and primary nursing care.DesignThe study followed a pre-/post-test cross-sectional observational design.MethodsAfter completing an online training course to learn motivational interviewing skills, students participated in an online simulation with a standardized patient portraying a woman with substance use disorder during pregnancy. Prior to the simulation, students completed the Caring Behaviors Inventory-24 and the Opening Minds Scale for Health Care Providers. After the simulation, students and standardized patients completed the Simulated Clinical Interview Rating Scale and a 5-item version of the Caring Behaviors Inventory-6.ResultsOf the 252 students in the course, 85 (34%) participated in the study. Twenty-six student participants completed both pre- and post-simulation questionnaires; 40 completed only pre-simulation questionnaires; and 19 completed only post-simulation questionnaires. Prior to the simulated patient encounter, students rated themselves most favorably on ability to demonstrate assurance behaviors. After the training and simulation, students and standardized patients reported successful student demonstration of motivational interviewing skills and caring behaviors consistent with fundamental therapeutic communication and motivational interviewing knowledge. There was no statistically significant difference between self-reported student performance and the standardized patients’ observations.ConclusionsStudents attained and applied motivational skills and demonstrated caring behaviors in a virtual setting with standardized patients.     

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.     

Effects of weight bias training on student nurse empathy: A quasiexperimental study

AimThis study aimed to identify the efficacy of weight bias training on the empathy skills of student nurses when working with a person with obesity.BackgroundWeight bias with nurses harboring negative attitudes towards patients with obesity results in inferior care and patients' reluctance to seek medical care. Empathy is a communication skill used in nursing to build trust and rapport with patients to provide optimal patient-centered care.MethodsThis study used a quasi-experimental design with 121 undergraduate nursing students in their first semester of the nursing program. The students completed learning activities on weight bias, including reading an article on weight bias, watching a video showing an individual with obesity's experiences in the healthcare setting and participating in a group discussion and reflection on the article and video. In addition, students completed the Jefferson Scale of Empathy-Health Professions Students’ version before and after the learning activities. Following the learning activities, students participated in a simulation activity with a standardized patient wearing an obesity suit. The standardized patient completed the Jefferson Scale of Patient Perceptions of Nurse Empathy to rate the patient's perception of the nursing student's level of empathy based on their interactions in the simulation scenario.ResultsA comparison of the scores on the Jefferson Scale of Empathy-HPS showed there was not a significant difference in the scores before learning activities (M = 15.45, SD = 12.7) and post-learning activities (M = 15.94, SD = 11.5); t(120) = 0.476, p = .635. Data analysis identified significant changes in empathy scores on the Jefferson Scale of Empathy-HPS in the accelerated second-degree cohort with differences in scores before learning activities (M = 113.7, SD = 10.5) and post-learning activities (M = 116.5, SD = 13.4); t(50) = 2.02, p = .049. The traditional cohort did not have a significant change in empathy scores. Empathy scores and the patient's perception of empathy scores showed no relationship. Most (79 %) of the patient's perception of empathy scores was moderate. Student comments in this study support the findings that some nursing students harbor weight bias towards individuals with obesity.ConclusionThere is a need to identify learning activities that eliminate weight bias in the nursing student population and result in the student's ability to demonstrate appropriate communication skills and nursing behaviors in a nondiscriminatory manner to the patient with obesity. To improve empathy behaviors, students should practice communication skills throughout the nursing curriculum.     

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.     

Initiation into qualitative data analysis

Qualitative data analysis may be daunting to nursing graduate students and other novice qualitative researchers. This article describes a qualitative research project required in a graduate nursing research course that was desired to guide students through their first qualitative data analysis. Common pitfalls novice researchers may encounter, such as data shuffling, premature closure, and overly delayed closure, also are discussed. The project reported in this article not only decreased students' anxiety concerning qualitative data analysis but also helped students gain respect for the amount of time, effort, and creativity this process entails.     

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.     

Usability testing of the sexual orientation and gender identity nursing education eLearning toolkit and virtual simulation games

BackgroundIndividuals of the LGBTQITS community face significant disparities when accessing healthcare, including stigma, oppression, and discrimination contributing to health inequities. Integrating cultural humility practice in nursing education is needed to navigate barriers.MethodA mixed methods usability study evaluated a bilingual online educational toolkit including curated instructional videos, personal bias quiz, and virtual simulation games VSGs. A convenience sample of nursing faculty and students were invited to participate.ResultsParticipants (N = 11) were observed playing the games, overall average time was 14 mins per game. Largely usability testers agreed or strongly agreed VSGs were easy and fun and helped them understand personal assumptions. Presimulation preparation was mostly viewed as relevant and engaging.ConclusionsResults support the feasibility of educating nurses and students about cultural humility, sexual orientation, and gender identity (SOGI) using VSGs. The SOGI-Nursing toolkit was found to be functional and a valuable and engaging teaching and learning strategy.     

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.     

实习护生情绪智力、临床实习环境与病人安全感知能力的中介效应

目的:了解实习护生情绪智力、临床实习环境与病人安全感知能力现状并探讨三者关系。方法:采用情绪智力量表、临床实习环境量表和卫生职业教育病人安全感知量表对492名实习护生进行调查。结果:实习护生情绪智力总分为(123.81±18.69)分,临床实习环境总分为(119.48±22.16)分,病人安全感知能力总分为(67.16±12.06)分,情绪智力、临床实习环境与病人安全感知能力呈正相关(r值分别为0.723和0.720,P<0.01);情绪智力在临床实习环境和病人安全感知能力间起部分中介效应,中介效应估计值为0.286(28.6%)。结论:学校要举办人文课程活动以培养情绪智力;医院应制订计划增加学习机会,选拔给予护生充分支持的带教老师,改善临床实习环境。     

FIRST-YEAR nursing students’ experiences of simulation involving care of older patients. A descriptive and exploratory study

Mastering geriatric nursing skills takes time and its acquisition should start early in undergraduate nursing training. The purpose of this study is to synthesise and evaluate the learning experiences that first-year nursing students had following geriatric patient simulation and practice of clinical patient handover. Qualitative content analysis of survey comments from first-year students (n = 216) at a large university in Norway were performed. Simulation training included systematic patient observation of scenarios based on genuine geriatric cases in nursing homes and practice of clinical patient handover. Content analyses identified four generic categories: (1) ‘embodying theoretical knowledge’; (2) ‘increased awareness about one's self’; (3) ‘understanding that collaboration is needed’; (4) ‘preparing for future work life’. These themes provide evidence for students integrating geriatric theoretical knowledge with clinical skills as a result of simulation. Analysis of learning experiences shows that geriatric scenario simulation and practice of clinical patient handover are valuable instruments before entering clinical training with geriatric patients, even for novice students. The use of genuine simulation cases and instruction on the use of clinical handover instruments are effective in producing conceptual changes that prepare students for their first encounter with complex, real-world geriatric scenarios.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.     

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.     

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.