Integrating Social Determinants of Health in Health Care Education: Using Simulation Based Learning to Prepare Nurse Practitioner Students

Background/Purpose: Social determinants of Health (SDH) are conditions in which people are born, work, live, and age, and the policies, agendas, norms, and political systems that impact conditions of daily life. SDH should be an integral component of health professional education. Providers need the knowledge, skills, and motivations to address and act on these factors. The study purpose was to test the impact of a simulation intervention on improving Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) and Family Nurse Practitioner (FNP) student knowledge and confidence of enacting SDH in their clinical practices. Methods: A quasi-experimental pretest-posttest design was used. Students participating in Objective Structured Clinical Examinations (OSCE) were assigned to the control or experimental group based on their OSCE itinerary. Before the OSCE, subjects read an article on SDH. At the simulation center, subjects completed a 3-item confidence and a 10-item knowledge pre-test, developed by the research team and assessed for content validity by three experts. The experimental group then received a SDH-centered simulation, while the control group received a non-SDH simulation. Both groups then completed the confidence and knowledge post-tests. Results: Subjects (N = 118: Control n = 57, Experimental n = 61) were predominantly female (87%), age 20-50 (92%), Non-Hispanic/white (74%), and had practiced on average seven years. After the intervention, the control group statistically significantly improved on confidence (p = .03) but not on knowledge, while the experimental group improved on both (p = .02, p = .00),. For both groups, confidence was correlated with overall years in practice (r = .20, p = .05) and practice in a health professions shortage area (r = .21, p = .05). Implications: SDH-centered simulation based learning is an effective way to increase students’ knowledge and confidence in using tenets of SDH in assessing, developing and implementing plans of care for patients. Further testing of the instruments is needed to establish validity and reliability before larger studies are conducted. Future research is needed to examine the sustained use of SDH after graduates enter practice

Cross-national comparison of factors related to stressors, burnout and turnover among nurses in developed and developing countries

To examine factors of a hypothetical model related to stressors, burnout and turnover in nurses from developed and developing countries—Canada, Japan, the United States, Malaysia and Thailand. A cross-sectional questionnaire-based study. Conducted between April 2016 and October 2017, the Maslach Burnout Inventory, Intention to Leave Scale, and Nursing Stress Scale collected data from acute care hospital nurses in Canada (n= 309), Japan (n= 319), Malaysia (n= 242), Thailand (n= 211) and the United States (n= 194). Compared to other countries, burnout “exhaustion” was the highest in Japan and “cynicism” and intention to leave the job were the highest in Malaysia. Thailand had lower burnouts and turnover than other countries and higher professional efficacy than Japan and Malaysia. In all countries, reducing stressors is important for reducing burnout and intention to leave jobs, especially as they relate to “lack of support.

Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students\u27 Access to Electronic Health Records in Clinical Education

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences ( P = .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training