Authoring Simulations for High Stakes Student Evaluation

Although simulation methods have primarily been used for teaching in nursing education, there is a growing interest in the use of simulation for student and program evaluation. Developing simulation scenarios for high stakes evaluation differs from traditional teaching/learning scenario authorship in a number of ways. This manuscript describes the process used to write, pilot test, and revise scenarios used in the National League for Nursing High Stakes Testing feasibility study. Observations and reported differences in scenario development and facilitation may provide insight to others regarding the best use of summative simulation scenarios

The Use of Aromatherapy to Reduce Test Anxiety Among Nursing Students

1. Purpose/Aims: The purpose of this study is to examine the effects of aromatherapy on test anxiety in undergraduate nursing students and to compare the efficacy of lavender and orange-peppermint aromas on this population. 2. Rationale/Conceptual Basis/Background: While approximately 17% of the general population suffers from test anxiety, research demonstrates that a greater proportion of nursing students typically fall in this category (Driscoll, Evans, Ramsey, & Wheeler, 2009). Test anxiety can lead to higher cortisol levels in the bloodstream, inducing a full physiological response and negatively affecting performance (Toda & Morimoto, 2011). However, lavender and orange-peppermint are both aromas that have demonstrated an ability to decrease cortisol levels and perception of stress. Lavender has previously been used to reduce anxiety in students at various levels (Kutlu, Yilmaz, & Çeçen, 2008; McCaffrey, Thomas, & Kinzelman, 2009), and other aromas have successfully reduced anxiety in undergraduate nursing students (Johnson, 2014). No research has been done to assess the effects of lavender and orange-peppermint on test anxiety in undergraduate nursing students. 3. Methods: A quantitative experimental design was utilized to evaluate the effects of lavender and orange-peppermint aromas. Undergraduate nursing students are required to pass a high-stakes exam at the beginning of the semester, and participants were randomly assigned to the control group or one of the two intervention groups: lavender or orange-peppermint aromatherapy. The intervention took place directly before the exam. The Visual Analog Scale (VAS) was used before and after the intervention to determine the state anxiety of the student, and the Westside Test Anxiety Scale (WTAS) was used before the intervention and after the test to evaluate general levels of test anxiety. A repeated measures analysis of variance was used to analyze data. 4. Results: Results demonstrated a statistically significant (p=0.045) decrease in VAS scores when comparing the combined treatment against the control group by 1.3 versus 0.7 respectively. However, there was no significant difference between the combined treatment and control groups for change in WTAS scores. Furthermore, when evaluating each treatment group individually, there was also no significant difference against the control group in VAS or WTAS. One factor in the data was the orange-peppermint intervention group had significantly lower WTAS scores initially than the control group and significantly lower VAS scores initially than either the control group or the lavender group. 5. Implications: Aromatherapy has the potential to significantly decrease state anxiety in nursing students immediately before an exam. Additionally, this study demonstrates that reduction in anxiety can occur when students spend time to stop what they are doing and focus on something other than studying before taking a test. Further research should investigate other aromas, as well as utilize a larger sample size. References Driscoll, R., Evans, G., Ramsey, G., & Wheeler, S. (2009). High test anxiety among nursing students. Retrieved from ERIC database. (ED506526) Johnson, C. E. (2014). Effect of aromatherapy on cognitive test anxiety among nursing students. Alternative and Complementary Therapies, 20(2) 84-87. http://dx.doi.org/10.1089/act.2014.20207. Kutlu, A. K., Yilmaz, E., & Çeçen. D. (2008). Effects of aroma inhalation on examination anxiety. Teaching and Learning in Nursing, 3(4) 125-130. http://dx.doi.org/doi:10.1016/j.teln.2008.04.005. McCaffrey, R., Thomas, D. J., & Kinzelman, A. O. (2009). The effects of lavender and rosemary essential oils on test-taking anxiety among graduate nursing students. Holistic Nursing Practice, 23(2) 88-93. http://dx.doi.org/10.1097/HNP.0b013e3181a110aa. Toda, M. & Morimoto, K. (2011). Evaluation of effects of lavender and peppermint aromatherapy using sensitive salivary endocrinological stress markers. Stress and Health, 27(5) 430-435. http://dx.doi.org/10.1002/smi.1402

MEASURES OF PHYSIOLOGICAL AND PSYCHOLOGICAL STRESS IN NOVICE HEALTH PROFESSIONS STUDENTS DURING A SIMULATED PATIENT EMERGENCY

Learning to provide emergency care alone and with others in the clinical environment imposes unexplored stresses on novice caregivers. It is unclear whether this stress inhibits or promotes performance and learning. Many academic health professions programs incorporate simulation as a method for teaching patient care emergencies. This study employed a modified switching replications design to explore the relationships and differences between psychological, physiological, and performance measures in health professions students who participated in acutely stressful health care simulation scenarios. Twenty-seven volunteer participants recruited from nursing, medicine, pharmacy, physical therapy, occupational therapy and speech therapy were assigned to teams in either a simulation treatment or a control group. Teams participated in two simulations scenarios where a fallen patient required assistance. Subjects in the simulation treatment groups received a standardized training module called the First Five Minutes® between simulation experiences. Mean heart rate, maximal mean heart rate, salivary alpha amylase levels, and salivary cortisol levels were compared at intervals before, during, and after each simulation scenario. Psychological stress was evaluated using the Stressor Appraisal Scale (SAS). Team performance during scenarios was scored by independent evaluators using an skills checklist adapted from a standardized commercially available training module, The First Five MinutesTM. Performance scores improved in both groups during the second simulation. Mean performance scores of the simulation intervention teams (M = 14.1, SD = 1.43) were significantly higher (t = 4.54, p < .01) than the performance scores of the control teams (M = 10.6, SD = .96). Psychological and physiological measures did not significantly predict performance. Psychological and physiological indicators were reactive to the simulations across time, but did not differ significantly between the control and simulation intervention groups. This investigation explored the multi-dimensional nature of stress (psychological and physiological) that health professions students experience while learning. Simulation intervention did significantly improve group performance, but did not mitigate individual participant stress. Future research should include study with teams of working professionals to determine whether performance and stress measures differ with experience and expertise

Comparison of Virtual and Live Intravenous Cannulation Success Among Novice Nursing Students

The Laerdal Virtual IV allows students to practice intravenous cannulation in multiple scenarios at multiple practice levels. Research regarding the validity of the device in comparison with other methods of learning is limited as is concurrent validity of the device compared with a live intravenous attempt. A sample of nursing students (N = 12) participated in a non-experimental, comparative investigation of intravenous cannulation attempts on a Virtual IV and on a live subject. Although the findings comparing scored attempts and actual successful cannulation between the Virtua IV and a live attempt were not statistically significant, there were other post hoc findings which provide direction for nursing education and simulation research. Subjects scored poorly on several psychomotor tasks on the live attempt. These tasks are completed with a click of a mouse on the Virtual IV; therefore, these tasks may need different practice modalities. Further nursing research is needed to determine whether simulators are a superior teaching tool or if they are at least as good other methods of instruction for IV placement

Proactive Policy Planning for Unexpected Student Distress During Simulation

Stress reactions resulting from participation in simulation scenarios are seldom reported in the literature but are often informally discussed by simulation faculty seeking guidance to manage the occurrences. Although simulation faculty members often describe events where a single learner’s distress interrupted learning for all involved, no examples of policies to plan for this kind of occurrence are available in the simulation literature. This article offers suggested best practices for identifying and assisting students who exhibit uncontrolled stress in simulation and includes a sample policy for planning

Simulation Use in Entry-Into-Practice Respiratory Care Programs

BACKGROUND: Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care programs to date has not been explored. METHODS: All 412 Commission on Accreditation for Respiratory Care (CoARC)-accredited entry-into-practice respiratory care programs were e-mailed a survey inquiring about simulation use as an educational tool in their programs. RESULTS: Of the initial 412 programs contacted, 124 returned the survey, for a 30% response rate. More than three-quarters of programs reported using simulation including 87% of associate degree programs, 75% of bachelor\u27s degree programs, and 100% of master\u27s degree programs. Simulation modalities differed by course and program as did length of simulation activities and debriefings. Simulation hours may not be substituted for learner\u27s clinical time under CoARC guidelines, and 69% of respondents agreed with this stance; however, 66% of responding programs have mandatory simulation learning activities, and 68% believe the amount of simulation should be increased. The survey also revealed respiratory care faculty have limited training in the use of simulation. CONCLUSIONS: Simulation-based teaching and learning is widespread and varied, but there is a lack of faculty development in its use among respiratory care programs

Implementation of Motivational Interviewing Training in an Undergraduate Nursing Curriculum: Identifying Adolescents at Risk for Substance Use

Motivational interviewing (MI) has been increasingly utilized by health care practitioners for many years. MI has been practiced by social workers, nurses, physicians, psychologists, substance use counselors, and many other health care practitioners. Unfortunately, many health care practitioners do not have adequate training in motivational interviewing, and therefore feel ill equipped to utilize this approach when faced with clients who are in need of assessment and coaching. This paper discusses our experiences with a pilot project to implement MI training within an Adolescent SBIRT (Screening, Brief Intervention, Referral to Treatment) content addition to the undergraduate nursing curriculum. It includes discussion of the evaluation, which measured student attitudes towards substance users with the Substance Use Attitudinal Survey (SAAS), student satisfaction with the newly implemented curriculum, and implications for sustainable inclusion of this content and simulation experiences at the undergraduate level to promote MI use by future health care practitioners. Pre- and post-tests (SAAS) were conducted with 51 nursing students, and 56 students completed the satisfaction survey. Overall, students were very satisfied with the implementation of the curriculum, however, we did not see significant changes in SAAS test scores. This may, however, be a positive indicator of a balanced attitude toward substance users. Continuing evaluation of the curriculum change is needed

An Updated Review of Published Simulation Evaluation Instruments

Interest in simulation as a teaching and evaluation strategy in nursing education continues to grow. Mirroring this growth, we have seen a proliferation of instruments designed to evaluate simulation participant performance. This article describes two frameworks for categorizing simulation evaluation strategies and provides a review of recent simulation evaluation instruments. The review focuses on four instruments that have been used extensively in the literature, objective structured clinical examinations (OSCE\u27s) including four OSCE instruments, and an extensive list of new instruments for simulation evaluation

Simulation Use in Entry-into-Practice Respiratory Care Programs

BACKGROUND: Teaching and learning using simulation-based methods is increasing in health professions education; however, the prevalence of simulation use in respiratory care programs to date has not been explored. METHODS: All 412 Commission on Accreditation for Respiratory Care (CoARC)-accredited entry-into-practice respiratory care programs were e-mailed a survey inquiring about simulation use as an educational tool in their programs. RESULTS: Of the initial 412 programs contacted, 124 returned the survey, for a 30% response rate. More than three-quarters of programs reported using simulation including 87% of associate degree programs, 75% of bachelor’s degree programs, and 100% of master’s degree programs. Simulation modalities differed by course and program as did length of simulation activities and debriefings. Simulation hours may not be substituted for learner’s clinical time under CoARC guidelines, and 69% of respondents agreed with this stance; however, 66% of responding programs have mandatory simulation learning activities, and 68% believe the amount of simulation should be increased. The survey also revealed respiratory care faculty have limited training in the use of simulation. CONCLUSIONS: Simulation-based teaching and learning is widespread and varied, but there is a lack of faculty development in its use among respiratory care programs

Sharing Student Performance Information in Simulation: A Debate

The 2016 INACSL Professional Integrity Standard presented a major change in sharing of performance information. This article presents arguments for and against the sharing of clinical performance information along with audience perspectives from presentations at both the INACSL and SSH conferences