Disaster 101: A Novel Approach to Disaster Medicine Training for Health Professionals

Background: Despite efforts to improve preparedness training for health professionals, disaster medicine remains a peripheral component of traditional medical education in the United States (US) and is a rarely studied topic in the medical literature. Objectives: Using a pre-/post-test design, we measured the extent to which 4^th-year medical students perceive, rapidly learn, and apply basic concepts of disaster medicine via a novel curriculum. Methods: Via a modified Delphi technique, an expert curriculum panel developed a 90-min didactic training scenario and two 40-min training exercises for medical students: a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins. Medical students were quizzed before and after the didactic training scenario about their perceptions and their disaster medicine knowledge. Results: Students rated their overall knowledge as 3.76/10 pretest compared to 7.64/10 after the didactic program. Students' post-test scores improved by 54% and students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 min. The average overall rating for the experience was 4.85/5. Conclusions: The results of this educational demonstration project reveal that students will value and can rapidly learn some core elements of disaster medicine via a novel addition to a medical school's curriculum. We believe the principle of a highly effective and well-received medical student course that can be easily added to a university curriculum has been demonstrated. Further research is needed to validate core competencies and performance-based education goals for US health professional trainees.     

Effects of high-fidelity simulation on the critical thinking skills of baccalaureate nursing students: A causal-comparative research study

BackgroundCritical thinking has been identified as one of the standards for nursing school accreditation and a long-standing outcome of nursing education and nursing practice. High-fidelity simulation is one method currently used by nursing programs to increase critical thinking in nursing students. Despite these expectations, there is limited empirical evidence which compares the effects of simulation to other teaching strategies.ObjectivesThe purpose of this study was to examine whether statistically significant differences existed in mean critical thinking skill scores within groups (pretest to posttest) and between groups (simulation versus written case studies).DesignA quantitative causal-comparative methodology with a pretest/posttest design.SettingA private university in the midwestern United States which offers a four-year Bachelor of Science Nursing program.ParticipantsBaccalaureate junior nursing students (N = 69) were recruited from a convenience sample and divided into two groups which consisted of a simulation group (n = 36) and a written case studies comparison group (n = 33).MethodsThis research study consisted of a pretest, three weeks of being in either the simulation group or the written case studies group, and a posttest. The Health Science Reasoning Test (HSRT) was the instrument used for the pretest and posttest to measure critical thinking skills of all participants.ResultsA repeated measures mixed analysis of variance (ANOVA) indicated there was no statistically significant difference in participants' mean critical thinking scores within groups (pretest to posttest) or between groups (simulation versus written case studies).ConclusionsThe use of high-fidelity simulation as a teaching strategy versus written case studies to increase critical thinking skills of nursing students was not supported.     

Disaster education for Australian nursing students: An integrative review of published literature to inform curricula

BackgroundGlobally, families and communities are impacted by disasters every day. Nurses are integral to assisting in disasters, in the support and enablement of individuals and communities. However, some studies indicate that nurses feel ill-equipped to assist, partially because disaster content is not thoroughly addressed in the undergraduate curriculum. Therefore, nursing schools need to equip undergraduate nursing students with the knowledge and preparation required to assist effectively during and/or following a disaster.AimTo explore priority disaster topic areas aimed at preparing Australian undergraduate nursing students to assist in caring for survivors in the aftermath of disasters.MethodThis study used an integrative review methodology. Various databases and platforms were searched for literature published between 2000 and 2018 using Medical Subject Heading terms and keywords relating to the undergraduate nursing curriculum. A thematic analysis of the included papers was conducted.ResultsA total of 10 articles were identified that meet the inclusion criteria. The reviewed studies highlighted that the areas of disaster knowledge, assessment and triage, critical thinking, teamwork, technical skills, mental wellbeing, legal and ethical consideration, and socio-cultural contexts, are relevant for the undergraduate curriculum.DiscussionThis review highlights disaster education and training topic areas that could be considered for inclusion in Australian undergraduate nursing curricula. The content relating to disaster assistance must be incorporated into nursing schools’ curriculum.ConclusionThe incorporation of disaster-related content in the undergraduate nursing curriculum may enhance the disaster preparedness of nursing students and the nursing workforce more broadly.     

Tracking the development of professional values in undergraduate nursing students

In the current nursing shortage, nurses are frequently making significant patient care decisions concerning value-laden clinical issues. A program evaluation study was conducted to track professional values over time from entry into a baccalaureate program to graduation. Nursing students completed a survey measuring professional values upon entry into and exit from the program. Comparative analysis of pretest and posttest group means demonstrated statistically significant increases in total scores. The highest pretest value items were also the highest on the posttest, with the addition of patient advocacy. Patient advocacy jumped 16 places from pretest to posttest to become the highest-ranked statement upon exit from the program. All of the values rated as least valued at pretest remained least valued at posttest; however, the means of all but two (participating in nursing research and providing consumer education about products/services) increased significantly. The value statements with mean scores that increased significantly centered on aspects of nursing practice less visible to the lay public and involving interaction with other health care providers.     

Teaching methodologies: knowledge acquisition and retention

In studying the curriculum of a nursing program, knowledge acquisition and retention by nursing students is a primary concern of nursing instructors. The purpose of this study was to determine if a lecture which stimulated several senses would significantly increase knowledge acquisition and retention compared to lectures that stimulate only the auditory sense. Forty-three, junior year, diploma nursing students who had essentially the same clinical experience were the subjects randomly assigned to either Group A or B for this study. Group A (control group) attended a formal lecture on "Spinal Cord Injuries" which stimulated only the auditory sense. Group B (experimental group) attended a lecture on the same subject which stimulated the auditory, visual, and tactile senses. A pretest was given to evaluate the knowledge base prior to the lecture, a posttest was given immediately after the lecture to evaluate initial knowledge acquisition, and a retention test was given three weeks later to evaluate amount of knowledge retained. Students attending the multimodal lecture demonstrated a significantly higher retention test score at the .05 level although they did not demonstrate a significantly higher gain score from pretest to posttest.     

Evaluation of a collaborative project in disaster preparedness

Nurses play an important role in responding to disasters. Preparing nurses to participate in planning for and responding to a disaster is integral to undergraduate nursing education. The authors describe the evaluation of a collaborative learning model that has been used to teach undergraduate nursing students about disaster preparedness.     

Impact of a concept map teaching approach on nursing students’ critical thinking skills

Nurses confront complex problems and decisions that require critical thinking in order to identify patient needs and implement best practices. An active strategy for teaching students the skills to think critically is the concept map. This study explores the development of critical thinking among nursing students in a required pathophysiology and pharmacology course during the first year of a Bachelor of Science in Nursing in response to concept mapping as an interventional strategy, using the Health Education Systems, Incorporated critical thinking test. A two‐group experimental study with a pretest and posttest design was used. Participants were randomly divided into a control group (n = 42) taught by traditional didactic lecturing alone, and an intervention group (n = 41), taught by traditional didactic lecturing with concept mapping. Students in the concept mapping group performed much better on the Health Education Systems, Incorporated than students in the control group. It is recommended that deans, program directors, and nursing faculties evaluate their curricula to integrate concept map teaching strategies in courses in order to develop critical thinking abilities in their students.     

The impact of integrating Quality and Safety Education for Nurses' safety competency in first-year associate degree nursing students

The purpose of this pilot project was to integrate Quality and Safety Education for Nurses (QSEN) safety competency teaching strategies in first-semester associate degree in nursing (ADN) students and evaluate student learning outcomes. A pretest–posttest design measured the students' perception of safety awareness. Results suggest a strong correlation between didactic and clinical instruction of QSEN safety competency teaching strategies to enhance students' awareness of safety, thus fostering quality patient care.     

Using branching path simulations in critical thinking of pain management among nursing students: Experimental study

BackgroundNursing education has to promote nursing students' critical thinking skills especially those who are going to work with people with dementia suffering from pain. Therefore, nursing education needs to incorporate new and effective teaching methods in nursing curricula for critical thinking skills promotion. Branching path simulation is an interactive learning tool which helps students; (1) to make decisions about treatment options for patients and get feedback immediately and (2) to demonstrate and promote their critical thinking skills in a safe and supported environment before dealing with complex and real-life case scenarios.ObjectivesThe present study aimed to examine the effectiveness of branching path simulation in promoting the critical thinking skills of undergraduate nursing students.MethodsThis an equivalent control group pretest-posttest experimental study was done in 2019 on 102 undergraduate nursing students who had registered in both practical and theoretical courses of Advanced Adult Health Nursing. A pretest posttest experimental design with concurrent control group and random assignment to the treatment/nontreatment variable was used and a convenience sample of 102 nursing students was recruited in this study. The students were randomly assigned and divided into two equal intervention and control groups and each group attended different training sessions. The control group was trained by traditional lectures while the intervention group was trained by branching path simulation. The researcher used a demographic questionnaire and the Critical Thinking Self-Assessment Scale (CTSAS) for data collection.ResultsAfter the training sessions, the mean scores of the CTSAS and its subscales domain in the intervention group were significantly higher than the control group.ConclusionsBranching path simulation is an effective teaching method to promote students' critical thinking skills. Future studies are recommended to examine the effect of branching path simulation on other nursing students learning outcomes.     

Clinical experience and cognition of a physical therapy procedure

This investigation was designed to determine if clinical experience influences cognition of a physical therapy procedure. We hypothesized that experience in the application of a physical therapy procedure on patients would increase the student's cognition of that procedure. Twenty-two junior students in a physical therapy baccalaureate program were study subjects. A multiple-choice test pertaining to gait training was administered to all subjects as a pretest and posttest. The pretest was given after classroom instruction and laboratory practice in gait training; posttest was administered eight weeks later. During the interim eight weeks, 11 subjects completed 32 hours of clinical experience and 11 subjects had no clinical experience. Analysis of the results of posttest compared with pretest indicated that for these subjects, clinical experience did not increase cognition of gait training.     

Human patient simulation versus case study: Which teaching strategy is more effective in teaching nursing care for the hypoglycemic patient?

With the ever-increasing safety concerns presented in a health care setting, it is imperative that nursing students are prepared for the demand of utilizing the skill of critical thinking while providing care to patients experiencing hypoglycemia. Nurse educators strive to implement different teaching strategies to promote critical thinking skills. The purpose of the study was to evaluate the effectiveness of two teaching strategies: human patient simulation (HPS) and a single case study during diabetes education. In addition, the study was used to validate the inclusion of HPS in the authors' nursing program curriculum. A quasi-experimental, two-group pretest and posttest design was utilized to evaluate these teaching strategies. Faculty also completed an objective clinical evaluation, which evaluated students' clinical reasoning, and all students completed a postsurvey evaluating the teaching strategies. Study results indicated the pretest average scores for both groups were identical. The posttest results for the case study group were slightly higher than the simulation group results. On the clinical evaluation tool, the simulation group scored much greater than the case study group. Both results were statistically significant. The postlesson survey results were greater overall for the simulation group on all statements. All students agreed or strongly agreed that simulation was effective. According to the student test results and clinical evaluations, both teaching strategies are beneficial in nursing education; moreover, the student surveys and comments validated the addition of simulation as a valuable teaching strategy. As a result of this research, HPS was formally implemented into the nursing curriculum.     

Introducing baccalaureate student nurses to gerontological nursing.

The faculty at the University of Missouri-Columbia Sinclair School of Nursing (MUSSON) developed and implemented a gerontological nursing care course, with support from the Health Resources and Services Administration, the American Association of Colleges of Nursing, and the John A. Hartford Foundation. The course, with both didactic and clinical components, was mandatory for all students in the baccalaureate program. The course drew on two resources unique to the MUSSON: Senior Care, the school's home care agency, and TigerPlace, a retirement community closely linked to the school. Goals of the course were to increase knowledge of gerontology and gerontological nursing and to promote more positive student attitudes toward older adults. Evaluation of six semesters of pretest and posttest data found that knowledge increased although attitudes toward older adults did not become more positive. However, despite the lack of quantifiable improvement in attitudes, some students wrote positive comments on end-of-semester course evaluations about experiences and interactions with older adults during the course.     

Use of an emergency preparedness disaster simulation with undergraduate nursing students

This is a report of an educational strategy to prepare nursing students to respond to disasters. The strategy includes an emergency preparedness disaster simulation (EPDS) implemented in a school of nursing simulation lab using patient simulators, task trainer mannequins, and live actors. The EPDS immerses student groups into a "tornado ravaged assisted-living facility" where the principles of emergency preparedness can be employed. A total of 90 B.S.N. students participated in the EPDS in the final semester of their senior year. Student post-simulation survey responses were overwhelmingly positive, with mean scores of 4.65 (on a 5-point Likert scale) reported for the EPDS "increasing understanding of emergency preparedness" and "well organized." Mean scores were over 4.40 for "scenario believability, increasing knowledge base, increasing confidence in working in teams, ability to handle emergency preparedness situations and to work more effectively in hospital or clinic." The lowest mean score of 4.04 was for "prompting realistic expectations." Owing to the effectiveness of this educational strategy, the EPDS has been incorporated into the undergraduate curriculum.     

Promoting a Mock Disaster Simulation with Leadership from a Nurse Residency Program

Schools of nursing strive to provide students with a broad range of skills required to function optimally as a member of a multidisciplinary team within our ever-changing health care environment. As disasters rise in number and span across the country, disaster preparedness is a priority. The purpose of this article is to describe a mock tornado disaster simulation performed in collaboration between 2 schools of nursing with specific student support through a nurse residency program.     

An obstetric simulation experience in an undergraduate nursing curriculum

Educators face the dilemma of conveying didactic information in concise, creative ways that evoke critical thinking. In addition, high patient acuity, coupled with a growing nursing shortage, requires assimilation of didactic knowledge into sound clinical judgment in a timely manner. Human simulation offers a creative teaching modality that allows transference of textbook knowledge into a real-life situation where nursing students can function in their role without untoward effects to their clients. The author illustrates the use of a human birthing simulator, Noelle, in an undergraduate nursing program as a creative and effective teaching strategy.     

Graduate nursing students' precourse and postcourse perceptions and preferences concerning completely web-based courses

Web-based nursing courses have proliferated rapidly in recent years, but few data are available about course outcomes. A pretest/posttest survey design of student perceptions and preferences was used to evaluate two graduate-level on-line nursing courses (required research and elective aging issues courses; N = 31 and N = 29, respectively) on the basis of Billings' outcomes evaluation framework for nursing Web-based courses. Students in both courses were favorable or at least neutral in their perceptions of outcomes at both pretest and posttest, but favorable shifts in perceptions also occurred from pretest to posttest. Most students remained stable in their preferences for format of instruction (on-line or classroom), and most favored an on-line format. Almost all students indicated they would take the course they took if they had the decision to make over again. Students who took the elective aging issues course had somewhat more favorable perceptions overall at posttest, compared to the required research course, but some differences were accounted for by pretest score differences between the groups. While outcomes were positive for both courses, the results also highlight specific needs for adequate socialization and support of students, particularly for first-year graduate students who are taking Web-based courses.     

The affective outcomes of course work on computer technology in nursing.

At the University of Iowa, nursing students are introduced to computer technology as one unit in a course designed to explore nursing as a profession. A single group, pretest/posttest design was used to evaluate changes in attitudes associated with the course work. Relationships of attitudes scores and eight background variables were studied. Posttest attitudes scores were significantly higher than pretest scores. The attitudes scores were positively related to skills scores at a statistically significant level of .05, with no significant relationship between attitudes scores and knowledge base scores. Four of the eight background factors were related to the attitudes scores at a statistically significant level of .05.     

Effect of electromyographic biofeedback on an isometric strengthening program

An evaluation was carried out of the strength gains after a 19-day training program that consisted of isometric exercise coupled with electromyographic biofeedback to the knee extensor muscles. The subjects were 30 female undergraduate students who were randomly assigned to one of three groups. The experimental group performed isometric exercise and received electromyographic biofeedback, another group performed isometric exercise without receiving biofeedback, and the control group performed no exercises other than the pretest and posttest. The combination of biofeedback and isometric exercise was shown to produce greater gains in peak torque than isometric exercise alone over a 19-day training period. The authors believe that this study may provide a strong rationale for the clinical use of biofeedback.     

Spinal cord injury computer-assisted instruction for medical students

OBJECTIVE: To determine if a computer-assisted instruction program would improve fourth-year medical students' knowledge base related to spinal cord injury, as determined by pretest and posttest scores. DESIGN: A multimedia computer-assisted instruction program was developed and offered on a volunteer basis to an entire class of fourth-year medical students (n = 168). Effectiveness of the instructional content was evaluated with pretests and posttests, and overall user satisfaction with the module was assessed with the courseware evaluation. RESULTS: The responses yielded 83 sets of completed pretest and posttest pairs and 80 sets of fully completed courseware evaluations. Mean posttest score was significantly higher than the mean pretest score (pretest, 6.65 +/- 1.44, vs. posttest, 7.36 +/- 1.38; df = 82, t = -4.74, P < 0.001). Courseware evaluations yielded positive ratings in all areas, including applicability and usability. CONCLUSIONS: The significantly increased posttest scores suggest that the students left the program with an expanded knowledge base in the content areas of spinal cord injury medicine covered in the computer-assisted instruction program.