Nursing Students' Cue Recognition in Educational Simulation: A Scoping Review

BACKGROUND

New nurses often struggle with recognizing cues and applying clinical judgment. Nurse educators develop educational simulation scenarios to support students in developing clinical judgment, which includes the foundational step of recognizing cues.

PURPOSE

A scoping review on undergraduate nursing students' cue recognition during simulation was conducted to systematically map the existing research and identify knowledge gaps.

METHODS

From initial identification of 228 studies published between 2010 and 2020, a total of 17 quantitative or qualitative studies were independently appraised using the Joanna Briggs Institute scoping review process and PRISMA-ScR reporting guidelines.

RESULTS

Cues were missed with varying levels of frequency. Participants frequently failed to recognize respiratory rates and physical assessment changes as salient cues to patient deterioration. Verbal cues from simulated patients were often missed or resulted in distancing behaviors.

CONCLUSION

Research is needed to determine the most effective methods for helping learners develop skills in cue recognition and analysis.

Honors students in the health professions: An academic-practice partnership for developing interprofessional competencies through simulation

Abundant literature supports the value of interprofessional education (IPE) in health profession programs, but few studies focus on undergraduate honors students. The goals of this academic-practice partnership quality improvement project were to increase awareness of IPE, provide experiential opportunities to learn the principles of interprofessional practice, assess perceptions of readiness for practice, and to explore motivations and learning expectations of undergraduate nursing and pre-medical honors students. Average scores on the Readiness for Interprofessional Learning Scale (RIPLS) increased in several areas after the IPE simulation experiences, with small to medium effect sizes (Cohen's d) on individual items and two subscales (Teamwork & Collaboration and Positive Professional Identity). Themes identified in the narrative data were opportunity, fun, self-awareness, situational awareness, and the value of teamwork. These findings add to literature on honor students' expectations and motivations for learning and can be used in designing interprofessional collaborative learning activities for undergraduate health profession students.

Health care provider use of motivational interviewing to address vaccine hesitancy in college students

BACKGROUND

Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

LOCAL PROBLEM

Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

METHODS

This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

RESULTS

Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

CONCLUSION

MI can be an effective part of a strategy to increase vaccination rates.

The Nature of Nursing Competency in Simulation of Adult Medical-Surgical Nursing: Exploratory Factor Analysis

BACKGROUND AND PURPOSE

Educators, employers, and regulatory agencies face substantive challenges in evaluating nursing competency. Evidence on what competency is and how to measure it can mitigate the challenges.

METHODS

Participants (N = 67) completed three high-fidelity simulation tests. Each video-recorded test was scored by three raters using a 41-item instrument. Exploratory factor analysis was used to define the latent structure of the instrument.

RESULTS

A five-factor solution accounted for 56% of the variance, minimized negative loadings, and minimized the number of cross-loadings. The factors were minimally correlated (each r < .30).

CONCLUSIONS

The factors, Vigilant Action, Role Nuances, Precision, Procedural Skills, and Risk Reduction, represent integrated dimensions of competency that can be linked to specific tasks underlying safe practice.

A National, Qualitative Study of the Motivators and Outcomes of Nurse Educator Certification

AIM

This qualitative study sought to describe motivators and outcomes of academic nurse education certification.

BACKGROUND

Several studies have explored perceptions of the value of nurse educator certification (CNE). However, there is a gap in understanding motivators and outcomes of certification as a nurse educator.

METHOD

As part of a larger, web-based, mixed-method study, a national sample of certified and noncertified nursing educator administrators and faculty responded to nine open-ended questions. The inductive content analysis approach was used to identify constructs and themes.

RESULTS

From an overall sample of 721 participants, three constructs and associated themes emerged.

CONCLUSION

Motivators for pursing CNE align with previously reported intrinsic values. Participants seek extrinsic rewards as well. Educator outcomes include enhanced teaching and expanded roles. Student outcomes were less clear. Further study of outcomes of CNE is recommended to promote recognition of academic nursing education as an advanced nursing specialty.

Measuring the Value of Academic Nurse Educator Certification: Perceptions of Administrators and Educators

BACKGROUND

Certification is one option for validating the professional competence of academic nurse educators. The relative value associated with such certification has not yet been established.

METHOD

Psychometric analysis of a new Perceived Value of Certification Tool for Academic Nurse Educators (PVCT-ANE) was conducted. Certified nurse educators (CNE) and noncertified nurse educators and nursing program administrators responded to an online survey using the PVCT-ANE.

RESULTS

A sample of 718 nurse faculty members and administrators from 48 states in the United States participated. Academic nurse educator certification was valued by nurse educators and administrators as representing specialized knowledge, attainment of a professional standard, educator competence, and professional credibility. Value statements associated with satisfaction and professional accomplishments were rated higher than statements associated with professional recognition and marketing.

CONCLUSION

The PVCT-ANE is useful for assessing how different groups perceive the value associated with academic nurse educator certification. [J Nurs Educ. 2019;58(9):502-509.].

Using Generalizability Theory to Inform Optimal Design for a Nursing Performance Assessment

The promotion of competency of nurses and other health-care professionals is a goal shared by many stakeholders. In nursing, observation-based assessments are often better suited than paper-and-pencil tests for assessing many clinical abilities. Unfortunately, few instruments for simulation-based assessment of competency have been published that have undergone stringent reliability and validity evaluation. Reliability analyses typically involve some measure of rater agreement, but other sources of measurement error that affect reliability should also be considered. The purpose of this study is three-fold. First, using extant data collected from 18 nurses evaluated on 3 Scenarios by 3 Raters, we utilize generalizability (G) theory to examine the psychometric characteristics of the Nursing Performance Profile, a simulation-based instrument for assessing nursing competency. Results corroborated findings of previous studies of simulation-based assessments showing that obtaining desired score reliability requires substantially greater numbers of scenarios and/or raters. Second, we provide an illustrative exemplar of how G theory can be used to understand the relative magnitudes of sources of error variance-such as scenarios, raters, and items-and their interactions. Finally, we offer general recommendations for the design and psychometric study of simulation-based assessments in health-care contexts.

Testing Nursing Competence: Validity and Reliability of the Nursing Performance Profile

Background and Purpose: There is growing evidence that simulation testing is appropriate for assessing nursing competence. We compiled evidence on the validity and reliability of the Nursing Performance Profile (NPP) method for assessing competence. Methods: Participants (N = 67) each completed 3 high-fidelity simulation tests; raters (N = 31) scored the videotaped tests using a 41-item competency rating instrument. Results: The test identified areas of practice breakdown and distinguished among subgroups differing in age, education, and simulation experience. Supervisor assessments were positively correlated, r = .31. Self-assessments were uncorrelated, r = .07. Inter-rater agreement ranged from 93% to 100%. Test–retest reliability ranged from r = .57 to .69. Conclusions: The NPP can be used to assess competence and make decisions supporting public safety.

Integrating your experience and opportunities to prepare for nurse educator certification

Certification is accepted as a universal affirmation of expertise. Nurse educators validate and demonstrate expertise in nursing education by earning the Certified Nurse Educator credential offered through the National League for Nursing's Academic Nurse Educator Certification Program. Educators can prepare to achieve success in certification by reviewing eligibility requirements, creating an individual preparation plan, and using integrated, evidence-based learning strategies.

Computer-based or human patient simulation-based case analysis: which works better for teaching diagnostic reasoning skills?

AIM

The purpose of this study was to determine whether a difference exists in learner performance and the type and frequency of diagnostic reasoning skills used, based on the method of case presentation.

BACKGROUND

Faculty can select from a variety of methods for presenting cases when teaching diagnostic reasoning, but little evidence exists with regard to how students use these skills while interacting with the cases.

METHOD

A total of 54 nursing students participated in two case analyses using human patient and computer-based simulations. Participant performance and diagnostic reasoning skills were analyzed.

RESULTS

Performance was significantly better with the human patient simulation case. All diagnostic reasoning skills were used during both methods of case presentation, with greater performance variation in the computer-based simulation.

CONCLUSION

Both human patient and computer-based simulations are beneficial for practicing diagnostic reasoning skills; however, these findings support the use of human patient simulations for improving student performance in case synthesis.

Measuring competence: collaboration for safety

Few options are available to nursing regulatory boards for the evaluation of nursing competency in registered nurses who are reported for practice breakdown. To address this deficiency, the authors conducted funded research through collaboration between their respective institutions: a state nursing regulatory board, a community college nursing program, and a state university nursing program. Through this collaboration, a competency evaluation process that used high-fidelity simulation was developed and was called the nursing performance profile (NPP). The NPP process consisted of evaluation of videotaped performances of registered nurses providing simulated patient care in three successive situations. Nurses who were experienced in both practice and supervision rated the performances according to scoring guidelines developed by the authors. Findings showed that the NPP process has the potential to (1) provide regulators, educators, and employers with a quantitative picture of nurse performance across nine areas essential to safe practice, and (2) establish a basis for recommending a specific remediation plan or continuing professional development.

Preparing clinical preceptors to support nursing students in evidence-based practice

Staff nurse preceptors contribute importantly to student learning and to academic program outcomes; however, academic-clinical partnerships can offer focused learning opportunities for preceptors as well. This study addressed different interest levels in evidence-based practice across clinical settings by testing the effectiveness of a workshop designed to increase preceptor knowledge and endorsement of evidence-based practice. Nurse preceptor participants (N = 160) recruited from seven hospitals during 2009 to 2011 had an average age of 43.9 (SD = 11.5) and an average of 17.0 (SD = 11.2) years of nursing experience. Participants' scores on the Evidence-Based Practice Beliefs Scale improved significantly from pretest to posttest (M(pre) = 59.0, SD(pre) = 8.4, M(post) = 66.4, SD(post) = 6.8, p < .001), which was confirmed by subgroup analyses. At follow-up (1 to 25 months), 52% of the nurse preceptors reported increased use of evidence-based practice. This study indicates that a short collaborative, content-focused workshop can promote preceptor endorsement of evidence-based practice.