Enhancing Critical Thinking Disposition and Clinical Judgment Skills in Senior BSN Students via Electronic Interactive Simulation

ProblemThe problem investigated in this study was the lack of empirical evidence available regarding the effectiveness of electronic interactive simulation (EIS) for developing critical thinking disposition and clinical judgment skills in the senior baccalaureate nursing student. AimThe aim of this study was to identify an effective method of experiential learning simulation that may be independently accessed by the learner with a goal of enhancing critical thinking disposition and clinical judgment skills of senior baccalaureate student nurses (BSN). PurposeThe purpose of this experimental study was to compare the effects of EIS to traditional paper case studies on the critical thinking disposition and clinical judgment skills, measured by accuracy and efficiency of situational decision making, of senior nursing students enrolled in baccalaureate nursing programs in the United States. MethodsOne hundred and seventeen senior nursing students completed the randomized control study by using either the EIS or paper case study learning intervention. Repeated measures ANOVA and nonparametric tests were used to test the hypotheses that senior BSN who participate in EIS of real-life clinical scenarios over a period of two weeks will experience significant increases in clinical judgment and critical thinking disposition compared to students who receive traditional paper case study simulation. FindingsResults showed that participants who used EIS over a two-week period increased their scores for critical thinking disposition overall and on three of the subscales. Results also indicated a positive trend, greater than the comparison group, on the remaining subscales. It is noted that many scores for the Case Study group actually decreased, suggesting that this method had a stifling effect on the development of critical thinking disposition. Retention and application of learned information was apparent for both groups, however, there was a trend for a greater change in the EIS group compared to the Case Study group. Additional research is needed to explore the effectiveness of this emerging pedagogy to add to what is known about the effects of experiential learning in the healthcare professions

Patient safety and the practice of anaesthesia: how hybrid networks of cooperation live and breathe

Der vorliegende Beitrag befasst sich mit der Analyse der Kooperation in chirurgischen Operationssälen. Auf der Grundlage von teilnehmender Beobachtung, Videoaufzeichnungen und Interviews wird ein ethnographischer Bericht über die Tätigkeiten in chirurgischen Operationssälen geliefert. Die Studie konzentriert auf die Anästhesie und erforscht die Bedeutung von Praktiken und Routinen in Bezug auf die Patientensicherheit. Darüber hinaus wird ein dreistufiges Modell für die Analyse und die Kategorisierung der sicherheitsrelevanten Kooperation angeboten. Elemente lokaler Kooperationsmuster werden herausgearbeitet und abschließend werden künftige Forschungsperspektiven umrissen. (ICDÜbers)This article is concerned with the analysis of cooperation in operating theatres. Based on participant observation, video recordings, and interviews, it delivers an ethnographic account of activities in surgical operating theatres. The study focuses on anaesthesia, exploring the importance of practices and routines in terms of patient safety, and offers a three-step model for analysing and categorising safety-relevant cooperation. Elements constituting local patterns of cooperation are elaborated, and finally some prospective areas for further research are outlined

A Comparison of the Effects of a Web-Based Education Program about the ICU Environment and a Standard Education Program on Anxiety, Depression, and Acute Stress Experienced Among Family Members of ICU Patients

Family members of ICU patients may experience anxiety, depression, and acute stress disorder symptoms. A need identified by the multi-society task for critical care research was to study the usefulness of interventions to quantify and treat anxiety, depression, and stress symptoms experienced by family members of ICU patients (Deutschman et al., 2012). This task force encouraged investigating using technology to address this need. (Deutschman et al.). The purpose of this prospective, quasi-experimental nonequivalent control group (pretest/posttest) design study was to compare the effect of standard ICU education and a web-based education program about the ICU environment on the level of anxiety, depression, and acute stress disorder symptoms among family members of ICU patients. Participants (n = 127) included 63 enrolled in standard ICU education and 64 in web-based education. This study found family members of ICU patients experienced anxiety, depression, and acute stress disorder symptoms, reinforcing findings of previous studies. This study was unable to conclude if a web-based education program could reduce anxiety F(1, 49) = .60, p = .444 , partial η2 = .01, observed power = .12.; depression F(1, 49) = 1.39, p = .244 , partial η2 = .03, observed power = .21; or acute stress disorder symptoms ASDS F(1, 48) = .65, p = .425 , partial η2 = .01, observed power = .12 IES-R F(1, 48) = .00, p = .988 , partial η2 = .00, observed power = .05 experienced by family members of ICU patients. This study reinforced that family members with lower education levels experienced statistically significantly increased levels of stress compared to family members of ICU patients with higher education levels Λ = .84, F (12, 317.78) = 1.86, p = .039, partial η2 = .06, observed power = .84. Family members of ICU patients who had a prior experience within the past two years were found more likely to experience anxiety, depression, and acute stress symptoms than family members who had not had an ICU experience within the past two years Λ = .92, F [4,122] = 2.70, p = .034, partial η2 = .08, observed power = .74

ANALYZING NURSE-PHYSICIAN DISCURSIVE PRACTICES IN ACUTE PATIENT CARE

This mixed methods study in inter-professional health communication assesses the pedagogical role of writing and visual communication in the education of non-traditional and traditional Nursing students as they interpret and apply the concepts of message framing and message reception in nurse-physician communication. To achieve that goal, this study analyzes the dynamics of terministic screens as message frames that can determine message reception in nurse-physician communication regarding the status of an acute care patient. The study was conducted in two Nursing writing and communication classes during the Spring 2011 semester. Two study groups (combined across classes) included a mixed population of traditional and non-traditional undergraduate Nursing students. During the same week in March 2011, one study group viewed the YouTube video Of Lions and Lambs. Another study group read the transcript of the video. Each group completed pre- and post-intervention Likert-style questionnaires designed to elicit perceptions regarding the efficacy of nurse-physician communication, as reflected in the print or video scenario. Each group also completed three post-intervention qualitative surveys. The qualitative free-writing arm of the study included a focus on situated dialogic learning regarding determinants of effective inter-professional communication. Nonparametric ANOVA analyses were conducted to assess the quantitative Likert data. A discourse analysis was conducted to assess the qualitative free-writing data. Those analyses suggest that the agency of the spoken word to support or confound clinical ethos and patient care is exemplified in the video and script for Of Lions and Lambs. This study suggests a role for combined print and video pedagogies to teach and assess effective versus ineffective nurse-physician communication in acute patient care. More research is needed to confirm how best to combine those pedagogies in traditional and new media contexts. Additional quantitative and qualitative results when complete may help to clarify those issues

Ludic Learning Lab: Serious Games for Nurses. Theatre Training Reimagined

Theatre improvisation supports the development of interpersonal skills, building verbal and physical imagination, whilst enabling compassionate interaction between people to enhance connections. Improvisation is emerging in health care as a pedagogical tool that can enhance human to human connections such as the interaction between a nurse and patient enabling experiential learning. This thesis argues that the ludic nature of improvisation exercises stimulates enhanced interaction skills (Toivanen, 2011). The ancient body-mind practices that improvisation draws on offer valuable skills to the learner, contributing to the andragogy of nurse practice and pre-registration education and training. Nurses require unique cognitive capabilities to multi-task, problem-solve and prioritise urgent needs in a fast-paced hospital environment. Human factors such as communication and situational awareness are essential to maintaining high-level patient care across a challenging environment (Eisenhardt, 2021). The World Health Organisation (WHO, 2019) and The Australian Commission for Quality and Safety in Health Care (Report The State of Patient Safety and Quality in Australian Hospitals, 2019; Fotis, 2010) found that deficiencies in human factor skills in hospital settings are affecting patient safety; fifty per cent of adverse events are preventable. Communicating for safety in training is a number one priority to reduce preventable adverse events. This thesis explores the principles and theories of theatrical improvisation through engaging with the work of Viola Spolin, Rudolph Laban, Augusto Boal, Jacob L Moreno, David Kolb and Howard Gardner. It comprises both a theoretical/critical component and a creative component which is a digital toolkit, the Improv-e-toolkit designed to be used in blended delivery, face-to-face and digital mode. The Improv-e-toolkit is a prototype that aims to unite important clinical nursing skills such as situational awareness, decision making and relationship management. I argue, drawing on the work of Hager (2004) that improvisation training develops team-based trust and effective communication to support positive nurse-patient connections which deliver favourable patient outcomes

Training Effects of Adaptive Emotive Responses From Animated Agents in Simulated Environments

Humans are distinct from machines in their capacity to emote, stimulate, and express emotions. Because emotions play such an important role in human interactions, human-like agents used in pedagogical roles for simulation-based training should properly reflect emotions. Currently, research concerning the development of this type of agent focuses on basic agent interface characteristics, as well as character building qualities. However, human-like agents should provide emotion-like qualities that are clearly expressed, properly synchronized, and that simulate complex, real-time interactions through adaptive emotion systems. The research conducted for this dissertation was a quantitative investigation using 3 (within) x 2 (between) x 3 (within) factorial design. A total of 56 paid participants consented to complete the study. Independent variables included emotion intensity (i.e., low, moderate, and high emotion), levels of expertise (novice participant versus experienced participant), and number of trials. Dependent measures included visual attention, emotional response towards the animated agents, simulation performance score, and learners\u27 perception of the pedagogical agent persona while participants interacted with a pain assessment and management simulation. While no relationships were indicated between the levels of emotion intensity portrayed by the animated agents and the participants\u27 visual attention, emotional response towards the animated agent, and simulation performance score, there were significant relationships between the level of expertise of the participant and the visual attention, emotional responses, and performance outcomes. The results indicated that nursing students had higher visual attention during their interaction with the animated agents. Additionally, nursing students expressed more neutral facial expression whereas experienced nurses expressed more emotional facial expressions towards the animated agents. The results of the simulation performance scores indicated that nursing students obtained higher performance scores in the pain assessment and management task than experienced nurses. Both groups of participants had a positive perception of the animated agents persona

The Effect of Computer Interactive Simulation on Situational Decision-Making and Competency Development of Experienced Staff Nurses

THE EFFECT OF COMPUTER INTERACTIVE SIMULATION ON SITUATIONAL DECISION-MAKING AND COMPETENCY DEVELOPMENT OF EXPERIENCED STAFF NURSES ABSTRACT Simulation and gaming as learning methodologies are increasing in use. Many institutions, including hospitals, are developing simulation programs as an alternative to or in conjunction with the traditional classroom as an instructional method. Many educators believe that learning preferences have changed and that simulation is more effective and motivating to the new generation of learners. The purpose of this study was to test whether computer interactional simulation is more effective as an instructional methodology than the traditional classroom setting in promoting clinical competency in experienced staff nurses. This study was designed to evaluate the effects of simulation on knowledge development and improved situational understanding/critical thinking (decision-making skills) related to the safe management of patients requiring restraints. In this study, nurses with a minimum of one year of experience were randomly selected to participate. Subjects who agreed to participate were randomly assigned to either a control group (traditional classroom, n=11) or the treatment group (simulation, n=21). A literature review was conducted to develop operational definitions and determine the clinical applicability of electronic simulation as an instructional methodology for developing competency in nursing practice. Group differences were analyzed using analysis of covariance (ANCOVA) in a pretest-posttest design that included a demographics instrument. Analysis of the demographics of both groups showed no differences. ANCOVA results showed no significant differences in overall competency development or critical thinking between the two groups. Knowledge scores for the traditional classroom group were significantly higher than the treatment group. Although the literature revealed that simulation and gaming has been used widely in many technical and professional settings to promote situational understanding/critical thinking skills and to increase knowledge, this study raises the question as to whether simulation and gaming is any more effective in competency development in experienced staff nurses than the traditional classroom instruction

Oral Paper SP63. Learner Centred Communication Masterclasses

Background HYMS 3rd and 4th Year MB ChB students frequently encountered communication challenges on clinical placements, despite extensive communication skills teaching in the first two (university based) years of the course. PresentationCompulsory Communication Masterclasses were introduced for 3rd and 4th year students to provide an opportunity for them to address Communication and Professionalism challenges they have encountered on clinical placement. The student-centred Masterclasses are led by Primary /Secondary Care clinicians working with experienced Simulated Patients. They provide an opportunity for students to role play Communication/Professionalism challenges and receive feedback from their peers, Simulated Patient and tutor to help identify strategies for dealing with similar challenges in their future career. Evaluation Students are required to complete an online evaluation which includes descriptive and Likert scale feedback. Students give consistently positive feedback on these sessions, and highlight appreciating the opportunity to reflect and learn from clinician tutors about real-life communication/ professionalism challenges. This student evaluation informs Staff Development Masterclasses for tutors, tutored by faculty and run similarly to the Student Communication Masterclasses. These provide an opportunity to address challenges that tutors have encountered when tutoring Masterclasses and ensure that tutors deliver a consistently high quality student-learning experience

Oral Paper S26 - What are students frightened of?

Background Despite extensive consistent integrated early clinical experience at HYMS, students have often been noted to struggle in making the transition from the largely University-based Phase I (2 years) to immersion in the clinically-based Phase II. Tutors report student difficulties in adopting an appropriate attitude to learning in this environment; some are noted to respond to this by minimising the time spent on the wards with obvious consequences for their experience and education. Presentation A new “Core Clinical Skills and Professional Expectations” course, lasting 2 weeks was introduced in August 2014 for students making this transition. This block aimed to address many areas which students have been noted to struggle with, including professionalism and development of clinical diagnostic reasoning and skills for independent learning. Evaluation Students were asked to identify their own fears and anxieties about moving into the clinical environment. All students completed a brief survey at both the beginning and the end of this two week period which included identification of their own sources of anxiety in approaching immersion in the clinical environment. Results of this survey are presented and discussed with implications for clinical teaching

Roundtable RT06. Clinical Reasoning skills: Something that can be taught or just a matter of seeing lots of patients?

There is considerable literature regarding the complex nature of clinical reasoning for clinicians. Norman (2005) stated “there is no such thing as clinical reasoning - there is no best way through a problem. The more one studies the clinical expert, the more one marvels at the complex and multidimensional components of knowledge and skill that he brings to bear on the problem, and the amazing adaptability he must possess to achieve the goals of effective care”.For novices to become experts they need extensive deliberate practice to facilitate the availability of conceptual knowledge and add to their storehouse of already solved problems (Norman 2005).The authors are aware that previously students learnt how to reason clinically by clerking lots of patients and constructing lists of likely differential diagnoses. Students were repeatedly interrogated by doctors to justify their differential diagnoses. Changes in working time directives and increased shift working mean that students are less likely to have to justify their thinking on several occasions to the same doctor who then helps them develop their reasoning skills.Today’s students face further challenges, as modern medical curricula generally focus on delivering clinical experience in system-specific rotations leaving students unable to organise information effectively when patients present with complex, multisystem illnesses. A limitation of systems based curricula is that it does not encourage the development of clinical reasoning skills.There is now extensive literature regarding the need to explicitly teach clinical reasoning skills to students in addition to them having lots of practice in clerking patients and then constructing lists of the most likely differential diagnoses.Delegates at this round table discussion will be encouraged to debate whether they believe that students can be explicitly taught clinical reasoning skills or whether it is just a case of ‘seeing lots of patients’