The design and development of a programme for simulation best practices in South African nursing education institutions

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements of the degree of Doctor of Philosophy Johannesburg, 2017.Although simulation has been part of health care education for the last 40 years, there appears to be some resistance to embedding the education methodology in both nursing and medical curricula. Possible reasons for this lack of integration could be the educators’ fear of technology, organizational barriers, such as time for integration, and a lack of support for educators wanting to introduce simulation. In South Africa at present, simulation is only being used in pockets at universities and nursing colleges, with no formal contextually relevant training programme in place, specifically for nursing education, despite evidence that simulation improves student’s outcomes and critical thinking. Nurse educators have expressed anxiety and bewilderment and seem uncertain about the use of simulation. The purpose of this study was to develop a best practice simulation programme for nurse educators wanting to use simulation in their undergraduate nursing curricula. A multi-method design within a pragmatic paradigm was used for this study. The process was divided into four phases. Phase one involved data collection, using the National Council of State Board of Nursing (NCSBN) survey: Use of Simulation in Nursing Education (Hayden, 2010), to describe the prevalence and use of simulation in both university and college undergraduate curricula. Phase two consisted of two parts, conducted consecutively: a scoping literature review to determine simulation best practices in nursing and medical education, followed by a Delphi Study to elicit the perceptions of educators in South Africa regarding simulation and best practice. In the scoping literature review the question asked was: What does the literature identify as simulation best practices in nursing and medical education? Four best practices emerged from the literature, namely the importance of debriefing, identifying learner objectives, the integration of simulation into the curriculum and the inclusion of deliberate practice. A Delphi Study was then conducted to elicit the judgement and perceptions of simulation educators, working in the South African context, of the identified best practices. Phase three was the design of a conceptual framework and the development of a constructivist blended learning programme, using the Assessment, Design, Development, Implementation and Evaluation (ADDIE) instructional design method. The goal of the programme was: Participants will be able to apply simulation knowledge and skills to meet the learning needs of their undergraduate nursing students. The four best practices and the National League of Nurses/Jeffries Simulation Framework guided the programme. The resultant programme was developed in seven Modules building towards the completion of a simulation scenario, including planning for the scenario and post simulation debriefing. Phase four was an expert review of the programme, from an e-learning specialist, nurse educators and a simulation expert. Both an expert review guideline for a written report and interviews were used for evaluation and refinement of the programme, prior to the programme being rolled out to nurse educators. Results: Simulation in South African nurse education institutions is predominantly at a task training level and has been developed into complex patient scenarios using higher fidelity simulations. The programme was well received by the experts as relevant to simulation education in South African undergraduate nursing curricula, either in a university or nursing college educational environment. Limitations: The limitations to the study include the small sample sizes in the data collection phases, due to simulation in South Africa being relatively new in nursing education. Universities were predominantly represented in the data collection findings, despite the researcher reaching out to nursing colleges for their perspectives and inputs. There is a dearth of South African simulation literature and none on best education simulation practices in South African Nursing Education Institutions (NEIs), and therefore the researcher relied on international literature in the scoping review. Conclusion: The blended education simulation programme is based on the needs of nurse educators wanting to include simulation in their education environment, based on their resources, and allows them to work through the programme in their own work space and time.MT201

Integration of Simulation into the Nursing Curriculum What Does It Actually Mean

Session presented on Saturday, July 23, 2016 and Sunday, July 24, 2016: All authors of this study are Part of the National League for Nurses Simulation Leadership Program 2015, this poster is part of an ongoing project in this programme. Purpose: The purpose of this study is to determine why there still appears to be resistance from educators to integrating simulation into their curricula. As part of the National League of Nursing Simulation leadership programme we questioned why there was this lack of curricular integration and developed a step wise approach for simulation integration. Methods: Ethics approval was obtained from the participating Nursing Education Institutions prior to the study commencing. A web based survey was created based on what the literature indicates as possible reasons for limited integration of simulation. The survey was piloted, the aim was to establish educator's views of curricular placement of simulation, including their current uses of simulation, and their thoughts on what common concepts could be included in simulation. Their perceived barriers to curricular integration were also explored using either focus groups or semi structured interviews and open ended questions. Results: The total sample of respondents was 126 (N=126), 39% of the participants who responded to the survey were novice simulation educators. The barriers to simulation integration were identified as a lack of training and support for the educators. The reason for wanting to develop simulation in their teaching methods was too improve the learners nursing skills (35%) and the competition for clinical places (33%). Of the total responders 41% stated that they would like to work with a simulation team and (58%) a simulation coordinator to assist them with integration of simulation into their curriculum. The common themes that were identified by the respondents and could be embedded in all simulation scenarios were the following: Communication skills, patient safety, the nurses scope of practice, understanding diverse cultures, and translating evidence into practice. Conclusion: Initially this group identified commonalities between seven different nursing education programs reviewed. While this collaboration was the first to create an international comparison table it reinforced the global aspects to educating nursing students. However the question remained of how best to integrate simulation in to the curriculum. Based on the survey results we identified a step-wise method that begins developing a simulation integration plan where a simulation team would be identified through their interest in using simulation, a course would be selected that would be used to develop their knowledge and simulation skills, as well as scenario development. On-going support and review and evaluation would be essential for the success of this approach for curricula integration

Prevalence and Use of Simulation in Undergraduate Nursing Education Institutions in South Africa

Session presented on Sunday, July 24, 2016: Purpose: The purpose of this presentation is to assess the prevalence, uses and practices of simulation as a teaching methodology in undergraduate nursing curricula in South Africa. Methods: A survey of the prevalence and practices of simulation in South Africa was carried out as part of a situational analysis for the development of a simulation programme. The validated 2010 Simulation in Nursing Education Survey (Hayden, 2010) was used with permission from the original authors. The researcher received ethics approval from the relevant university's Human Ethics Research Committee to conduct the study, prior to contacting potential participants. The population selected to participate in this study were educators situated at either a University or Nursing College that offers an undergraduate four-year degree or diploma. The survey consisted of 28 questions, with both mixed Likert scale and open-ended questions being used. A total of 138 surveys were emailed to educators. Data was collected from December 2013 to December 2014, using SurveyMonkey. Results: Fifty one participants responded, reflecting a 36.95% response rate. Completed surveys were returned from 8 of the 9 provinces in South Africa, University = 34; College= 17. Low response rates could be due to the necessity for internet access, adequate computer literacy of respondents. In resource restricted areas in South Africa these issues may have made a significant contribution to coverage bias in this study. Alternative measures were put in place in an attempt to negate these anticipated difficulties. The measures included: All selected Nursing Colleges and Universities were sent a letter via email by the researcher informing them of the study, and a copy of the survey. The researcher was present at as many nursing functions and conferences as possible, in order to promote the study, and to ask interested nurse educators for their current email addresses as well of those of any potential contacts who might be interested in participating in the study. All contacts were sent follow-up emails and a copy of the survey. Where possible, emails were sent to both work and home email addresses. Prevalence measures: Non-manikin simulation - role playing was used by 90.91% of respondents followed by 54.55% who use standardised patients in their teaching. Computer-based simulation tools such as CD-ROMs and internet-based virtual programmes were only used by 43.18% and 20.45% of educators respectively. High fidelity and medium fidelity simulators are most commonly used in midwifery (36.11% and 50.00% respectively) Debriefing is not routinely performed after simulation experiences in South African Nursing Education Institutions. Of the participants who replied to the question, 43.59% debrief students while 56.41% do not accommodate debriefing. Simulation is most commonly not graded (61.90%) and when it is graded, 26.32% of educators give an objective graded score and 28.95% give a pass/fail grade. 95.23% of respondents stated that they should be using more simulation with only 4.77% stating that they were using just the right amount of simulation in their programme, The percentage of simulation hours substituted for clinical hours ranged from 1% to 30% with the average being 15.2%. The biggest barrier to not using simulation was a lack of training in both simulation techniques and debriefing (75.00%) Conclusion: It is not surprising that the midwifery curriculum has the highest use of simulation, as exposure to clinical emergencies may be infrequent. Therefore simulation-based learning has an essential role to play in the curriculum, to help a nurse gain the necessary confidence and knowledge needed to respond to a given emergency. But the overall results of this study indicate that South African Nursing education Institutions are not using simulation in undergraduate nursing courses optimally, this may be due to limited access to high-fidelity simulator by educators as they are often expensive to buy and maintain but also, high-fidelity simulation is a relatively new technology in nursing education and nurse educators might not have been sufficiently trained in the methodology to feel comfortable using the technology, thus reinforcing the need to expand context specific, hands-on simulation training programmes to both universities and colleges wanting to use simulation

Oilseed rape seeds with ablated defence cells of the glucosinolate–myrosinase system. Production and characteristics of double haploid MINELESS plants of Brassica napus L.

Oilseed rape and other crop plants of the family Brassicaceae contain a unique defence system known as the glucosinolate–myrosinase system or the ‘mustard oil bomb’. The ‘mustard oil bomb’ which includes myrosinase and glucosinolates is triggered by abiotic and biotic stress, resulting in the formation of toxic products such as nitriles and isothiocyanates. Myrosinase is present in specialist cells known as ‘myrosin cells’ and can also be known as toxic mines. The myrosin cell idioblasts of Brassica napus were genetically reprogrammed to undergo controlled cell death (ablation) during seed development. These myrosin cell-free plants have been named MINELESS as they lack toxic mines. This has led to the production of oilseed rape with a significant reduction both in myrosinase levels and in the hydrolysis of glucosinolates. Even though the myrosinase activity in MINELESS was very low compared with the wild type, variation was observed. This variability was overcome by producing homozygous seeds. A microspore culture technique involving non-fertile haploid MINELESS plants was developed and these plants were treated with colchicine to produce double haploid MINELESS plants with full fertility. Double haploid MINELESS plants had significantly reduced myrosinase levels and glucosinolate hydrolysis products. Wild-type and MINELESS plants exhibited significant differences in growth parameters such as plant height, leaf traits, matter accumulation, and yield parameters. The growth and developmental pattern of MINELESS plants was relatively slow compared with the wild type. The characteristics of the pure double haploid MINELESS plant are described and its importance for future biochemical, agricultural, dietary, functional genomics, and plant defence studies is discussed

A Herbivorous Mite Down-Regulates Plant Defence and Produces Web to Exclude Competitors

Herbivores may interact with each other through resource competition, but also through their impact on plant defence. We recently found that the spider mite Tetranychus evansi down-regulates plant defences in tomato plants, resulting in higher rates of oviposition and population growth on previously attacked than on unattacked leaves. The danger of such down-regulation is that attacked plants could become a more profitable resource for heterospecific competitors, such as the two-spotted spider mite Tetranychus urticae. Indeed, T. urticae had an almost 2-fold higher rate of oviposition on leaf discs on which T. evansi had fed previously. In contrast, induction of direct plant defences by T. urticae resulted in decreased oviposition by T. evansi. Hence, both herbivores affect each other through induced plant responses. However, when populations of T. evansi and T. urticae competed on the same plants, populations of the latter invariably went extinct, whereas T. evansi was not significantly affected by the presence of its competitor. This suggests that T. evansi can somehow prevent its competitor from benefiting from the down-regulated plant defence, perhaps by covering it with a profuse web. Indeed, we found that T. urticae had difficulties reaching the leaf surface to feed when the leaf was covered with web produced by T. evansi. Furthermore, T. evansi produced more web when exposed to damage or other cues associated with T. urticae. We suggest that the silken web produced by T. evansi serves to prevent competitors from profiting from down-regulated plant defences

Improving UAV Handling Qualities Using Time Delay Compensation

This research investigated control loop time delay and its effect on UAV handling qualities. Compensation techniques to improve handling qualities in the presence of varying amounts of time delay were developed and analyzed. One technique was selected and successfully flight-tested on a UAV. Flight-testing occurred at a constant flight condition with varying levels of additional time delay introduced into the control loop. Research pilots performed a pitch tracking task and gave Cooper-Harper ratings and comments. Tracking errors were used as a quantitative measure of Pilot/Display/UAV system performance. Predictive pitch compensation was found to significantly reduce pilot workload and improve Cooper-Harper ratings. Using the predictive display doubled the amount of system time delay that research pilots could tolerate while tracking the task bars. Overall system tracking performance, however, was not improved. Parameter variations of ∓20% in the aerodynamic model used to generate the predictive display produced statistically significant, although not operationally significant, changes in both pilot opinion and performance. Analysis of flight test data and follow-on simulations resulted in predictor improvements that increased predictor accuracy to the point of restoring system tracking performance to equal that of the system with no additional time delay