Medicine and Health Sciences Commons^™

Using An Educational Module And Simulation Learning Experience To Improve Medication Safety, Barbara Lynn Durham

Doctor of Nursing Practice (DNP) Projects

The purpose of this evidence-based change in practice project was to provide nurses with an experiential learning opportunity, using simulation, to identify and report near miss events during the medication administration process related to patient-controlled analgesia (PCA) usage. Despite extensive in-service training on a Medical/Surgical (Med/Surg) floor in an acute care hospital, inconsistent, inaccurate and incomplete documentation with use of the new PCA pumps continued to be problematic. A conceptual framework of just culture was used with the quality improvement method of the Plan-Do-Study-Act (PDSA) cycle for testing change. Medication safety education was a valid andragogical strategy to decrease rates …

Specimen Labeling Improvement Project: Slip, Traci Hoiting

Doctor of Nursing Practice (DNP) Projects

Blood specimens are labeled at the time of acquisition in order to identify and match the specimen, label, and order to the patient. While the labeling process is not new, it is frequently laden with errors (Brown, Smith, & Sherfy, 2011). Wrong blood in tube (WBIT) poses significant risk. Multiple factors contribute to mislabeling errors, including lax policies, limited technological solutions, decentralized labeling processes, multi-tasking, distraction from the clinician, and insufficient education and training of staff. To reduce blood specimen labeling errors, a large academic medical center implemented an innovative technological solution for specimen labeling that integrates patient identification, physician …

Using Video Simulation To Enhance Rn-Pca Communication, Boris Chang

Master's Projects and Capstones

The purpose of this project was to develop a video simulation exercise to enhance communication between Registered Nurses (RNs) and Patient Care Assistants (PCAs). From a general microsystem assessment initially performed on an urban hospital medical-surgical unit, 75% of respondents noted that the most pertinent issue to address was improving communication between RNs and PCAs. Literature review of evidence-based practices found several studies that support the use of human clinical simulation to promote teamwork and interdisciplinary communication. RNs (n = 24) and PCAs (n = 9) were then individually interviewed with surveys and responses scored based on the …

Preparing Nurse Educators: Designing Hps Simulations Using Cerner Aes., Rachel Ramsey, Katrina Kessler, Robert Snow

Katrina J Eby

No abstract provided.

Preparing Nurse Educators: Designing Hps Simulations Using Cerner Aes., Rachel Ramsey, Katrina Kessler, Robert Snow

Rachel A. Ramsey

No abstract provided.

A Universal Appointment Rule With Patient Classification For Service Times, No-Shows And Walk-Ins, Cayirli Tugba, Kum Khiong Yang

Research Collection Lee Kong Chian School Of Business

This study evaluates patient classification for scheduling and sequencing appointments for patients differentiated by their mean and standard deviation of service times, no-show, and walk-in probabilities. Alternative appointment systems are tested through simulation using a universal Dome rule and some of the best traditional appointment rules in the literature. Our findings show that the universal Dome rule performs better in terms of reducing the total cost of patient’s waiting time, doctor’s idle time, and overtime, and its performance improves further with the right sequencing of patient groups. Although it is a challenge to find the best sequence, we propose a …

High-Stakes Evaluation: Five Years Later, Tonya Rutherford-Hemming, Suzan Kardong-Edgren, Teresa Gore, Patricia K. Ravert, Mary Anne Rizzolo

Faculty Publications

This article compares the International Nursing Association of Clinical Simulation and Learning (INACSL) memberships' thoughts and discussions about the use of simulation for high- stakes evaluation in nursing education to a similar town hall discussion, five years ago. Data on the topic of high-stakes testing were collected through a survey before the INACSL conference in June 2014. During a town hall meeting at the conference, the survey data was presented, attendees shared their thoughts and reacted to prepared comments by selected simulation leaders. Half of the town hall attendees favored high stakes testing before the survey findings and discussion. This …

Surgical Suturing Training With Virtual Reality Simulation Versus Dry Lab Practice: An Evaluation Of Performance Improvement, Content, And Face Validity, Michael J. Amirian, Samuel M. Lindner, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

The purpose of this study is to evaluate the effectiveness of virtual reality (VR) simulation versus dry lab suturing practice at improving suturing performance in robotic surgery. Nineteen novice participants with no prior robotic suturing experience were randomized to two groups, VR simulation and dry lab, which consisted of inanimate training on a da Vinci Si surgical system. Each group underwent baseline suturing evaluation, then trained on the Simbionix™ Suturing Module (SSM) or undertook suturing practice using the da Vinci Surgical System in a dry lab. Final suturing performance was evaluated using the objective suture scoring method. Participants in the …

Proactive Policy Planning For Unexpected Student Distress During Simulation, Janet Willhaus, Mitzi Averette, Michael Gates, Janet Jackson, Susan Windnagel

Janet Willhaus

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.

A Safety Mnemonic For Pediatric Oncology Patients: Knowledge, Confidence And Skills Accuracy During Simulation, Luanne Linnard-Palmer, Barbara Ganley

Luanne Linnard-Palmer

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1]. Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2]. This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of …

Best Practices In High Fidelity Patient Simulation To Enhance Higher Order Thinking Skills, Kathryn S. Mock

Theses and Dissertations

Undergraduate nursing education has begun to use very expensive and time intensive high fidelity simulation activities without making full use of the ability to build higher order thinking skills in students. Current research in high fidelity patient simulation has tended to be subjective and focus on critical thinking. However, reflective thinking habits of mind must be in place before full use can be made of critical thinking skills. A comprehensive search of all reflective thinking literature used in conjunction with simulated patient experiences by healthcare students was undertaken. A guideline

was created for nurse faculty to use that outlined current …

Constructing Representative Social Networks For Disease Simulation, Tao Yang, Mario Ventresca

The Summer Undergraduate Research Fellowship (SURF) Symposium

Diseases spread mechanisms have been questioned and studied for many years. The ability to make predictions about an epidemic could enable scientists to evaluate inoculation/ isolation plans, control the mortality rate, and prevent the future course of an outbreak. Accurate predictions, however, are extremely hard to make and requires interdisciplinary solutions from epidemiology, sociology, statistics, graph theory, and Computer Science. For making the prediction, currently few network analysis platforms written in C++ are designed and optimized. The research is aimed to address this gap by exploring methods of constructing social contact network, simulating disease spreading, and proposing mitigation strategies for …

Gate Monte Carlo Simulations In A Cloud Computing Environment, Blake Austin Rowedder

UNLV Theses, Dissertations, Professional Papers, and Capstones

The GEANT4-based GATE is a unique and powerful Monte Carlo (MC) platform, which provides a single code library allowing the simulation of specific medical physics applications, e.g. PET, SPECT, CT, radiotherapy, and hadron therapy. However, this rigorous yet flexible platform is used only sparingly in the clinic due to its lengthy calculation time. By accessing the powerful computational resources of a cloud computing environment, GATE's runtime can be significantly reduced to clinically feasible levels without the sizable investment of a local high performance cluster. This study investigated a reliable and efficient execution of GATE MC simulations using a commercial cloud …

The Effect Of Curricular Sequencing Of Human Patient Simulation Learning Experiences On Students’ Self-Perceptions Of Clinical Reasoning Abilities, Rebecca Jensen

Rebecca S Jensen

It is unknown whether timing of human patient simulation (HPS) in a semester, demographic (age, gender, and ethnicity), and situational (type of program and previous baccalaureate degree and experience in healthcare) variables affects students‘ perceptions of their clinical reasoning abilities. Nursing students were divided into two groups, mid and end of semester HPS experiences. Students‘ perceptions of clinical reasoning abilities were measured at Baseline (beginning of semester) and Time 2 (end of semester), along with demographic and situational variables. Dependent variable was Difference scores where Baseline scores were subtracted from Time 2 scores to reveal changes in students‘ perceptions of …

Nursing Student's Clinical Reasoning During Simulation, Rebecca S. Jensen

Rebecca S Jensen

Statement of problem While debriefing is considered essential for student understanding of the concepts embedded in a simulation, the measurement of clinical reasoning before and after debriefing has been minimally published. Students typically rate their performance as better than ratings by faculty, and the largest disparity is between self and faculty ratings for poorer performing students (Davis et al., 2006). Debriefing may be a method of attenuating students’ self-assessment by explicating their actions and reasoning during the simulation (Dreifuerst, 2012).

Hypotheses

1. There will be no difference in student self-ratings and lab personnel ratings of student performance during simulation using the …

Clinical Reasoning During Simulation: Comparison Of Student And Faculty Ratings, Rebecca Jensen

Rebecca S Jensen

A recently developed tool, the Lasater Clinical Judgment Rubric (LCJR) was used to evaluate nursing students' clinical reasoning during simulated pateint care scenarios. For two semesters, students and nursing faculty completed the clinical reasoning tool after participating in and observing students' reactions to simulated emergent patient simulations. Sores were compared between nursing students and faculty and between programs, associate (AS) and baccalaureate of science (BS). Students' scores differed statistically based on program, BS means greater than AS, but student and faculty ratings were rarely significantly different. Additional research across multiple programs for a larger sample size and additional testing of …

Student Evaluations Of Interprofessional Simulation, Rebecca Jensen, Deborah Poling

Rebecca S Jensen

Statement of problem While the 2010 report “The Future of Nursing: Leading Change, Advancing Health” proposes that nurses work collaboratively with other health care professionals, relatively little has been published on the use of simulation to achieve this goal in nursing and other disciplines. Student ratings of and interprofessional simulation and its effect on collaboration with other disciplines will provide valuable information on ways to improve interprofessional simulations.

Hypotheses

1. Students’ self-ratings of confidence for patient care will improve from beginning to end of the simulation.
2. Students’ self-rating of collaborative learning will improve from beginning to end of the simulation.
3. Students …

Electronic Medical Record In The Simulation Hospital: Does It Improve Accuracy In Charting Vital Signs, Intake, And Output?, Carel M. Mountain

Doctoral Projects

The introduction of electronic health records has created a shift in the way nursing care is delivered (McBride, Delaney, & Tietze, 2012; Furukawa, Raghu, & Shao, 2010). A factor which heavily influences a nurse’s ability to navigate and utilize EMR is adequate education in the use of computerized documentation (McBride, et al., 2012). There is an increased risk for error at the bedside without the correct knowledge and skills regarding EMR documentation (Kelly, Brandon, & Docherty, 2011). This skill should be introduced during the pre-licensure education of the nurse.

Two groups of associate degree nursing students attending a small community …

Reducing "Failure To Rescue" Occurrences: A Pilot Project Incorporating High-Fidelity Simulation During Mock Codes, To Enhance Pediatric Nurses' Clinical Knowledge And Skills, Denise Dawkins

Doctoral Projects

Thanks to advances in technology, the survival rate of infants and children with critical illnesses has improved. One consequence has been an increase in the acuity levels of hospitalized pediatric patients, which may heighten the risk of in-hospital cardiopulmonary arrest. Patient safety can be compromised by nurses who do not detect subtle clinical changes in a patient's condition, do not perform accurate interventions, or do not apply critical thinking (failure to rescue). The Institute of Medicine (10M) in 1999 estimated that approximately 100,000 people died each year as the result of poor care.

Patients and families place great trust in …

Validation Of A Novel Methodology For Evaluating Surgical Tissue Plane Identification, Syed T. Ali

Electronic Thesis and Dissertation Repository

Introduction: The ability to identify tissues planes is a fundamental surgical skill. This study attempts to validate a previously developed test for assessing this ability.

Methods: 48 video captured images from laparoscopic right hemicolectomies were presented on an iPad to 18 surgeons who were grouped based on experience (Consultants (C), Senior trainees (S), and the Junior trainees (J)). Subjects were asked to draw a line indicating the tissue plane of dissection. Lines were compared by a modified Hausdorff measure. Within group variability represented group precision and trainee accuracy was determined from comparison to Consultants.

Results: Within group comparisons demonstrated Consultants …

Simulation In Dietetic Education In Australia, Peter Williams, Eleanor Beck

Peter Williams

In 2011 the Dietitians Association of Australia conducted a survey of simulated learning experiences in all universities offering dietetic course in Australia. A total of 35 SLEs currently used were identified: 14 paper-based, 15 physical-based and 6 computer or video based.

A Safety Mnemonic For Pediatric Oncology Patients: Knowledge, Confidence And Skills Accuracy During Simulation, Luanne Linnard-Palmer, Barbara Ganley

Collected Faculty and Staff Scholarship

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1]. Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2]. This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of …

Nursing Students' Perceptions Of Mental Health Patients And Mental Health Nursing, Susan Furr

Nursing Theses and Capstone Projects

This Capstone project evaluated the impact of a simulation-based learning experience on nursing students' anxiety levels, preparedness for psychiatric practicum, and stereotypical views towards individuals with mental illness. A sample of 15 bachelor level nursing students was utilized. The experimental group (n=8) was exposed to a four-hour simulation-based learning experience prior to the beginning of their clinical experience. The control group (n=7) began their clinical rotation without any simulation exposure. A pretest, posttest design utilizing the Mental Health Nursing Survey Part 1 (MHN-1) and the Mental Health Nursing Survey Part 2 (MHN-2) was used to measure the students' stereotypical views, …

Best Practices: A Network Approach Of The Mandatory Influenza Vaccination Among Healthcare Workers, Greg Attenweiler, Angie Thomure

Master of Public Health Program Student Publications

A network simulation was applied to hospital social networks improve the influenza vaccination rate of healthcare workers in a healthcare system. Social network methods can be used to develop an understanding of structures of social relations. Over 200,000 U.S. patients are hospitalized annually for influenza, which attributes to 36,000 deaths and is the sixth leading cause of death in adults. The best way to prevent influenza each year is by receiving the influenza vaccination. The typical influenza vaccination rate among healthcare workers is 40- 50%. A Healthy People 2020 objective is to increase the percentage of healthcare workers who are …

The Innovation Of Simulation Laboratories And The Novice Nurses In The Clinical Setting, Brenda Washington Moore

Walden Dissertations and Doctoral Studies

The push to generate professional nurses has raised questions about the competency level of the novice nurses that are entering the workforce. Utilization of simulation laboratories is being viewed as an option for bridging the gap for the shortage of nurses, nurse educators, and clinical sites. The theory of goal attainment was used to guide this project, which aimed to develop and validate an ER simulation scenario that mimics a clinical setting as a tool for measuring nursing skills. An additional purpose, to be accomplished after graduation, will be to implement a pilot project to determine the impact of the …

Engineering Collaborations In Medical Modeling And Simulation, Frederic D. Mckenzie, Salim Chemlal, Tom Hubbard, Robert E. Kelly, Roderick C. Borgie, David A. Besachio, Michel Audette

Computational Modeling & Simulation Engineering Faculty Publications

Fifty years ago computer science was just beginning to see common acceptance as a growing discipline and very few universities had a computer science department although other departments were utilizing computers and software to enhance their methodologies. We believe modeling and simulation (M&S) is on a similar path. Many other disciplines utilize M&S to enhance their methodologies but we also believe that M&S fundamentals can be essential in making better decisions by utilizing the appropriate model for the problem at hand, expanding the solution space through simulation, and understanding it through visualization and proper analyses. After our students learn these …

Effectiveness Of A Structured Curriculum Focused On Recognition And Response To Acute Patient Deterioration In An Undergraduate Bsn Program, Patricia L. Hart, Jane D. Brannan, Janice M. Long, Mary Beth R. Maguire, Lois R. Robley

Faculty and Research Publications

The study purpose was to evaluate the effectiveness of a structured education curriculum with simulation training in educating undergraduate Baccalaureate of Science in Nursing (BSN) students to recognize and respond to patients experiencing acute deterioration as first responders. Researchers have demonstrated a lack of adequate clinical reasoning skills in new graduate nurses is a factor in critical patient incidents. A mixed methods design using a quasi-experimental, repeated measures and a descriptive, qualitative approach was used. A convenience sample of 48 BSN students was recruited. Statistically significant increases were shown in knowledge, self-confidence, and perceptions of teamwork. Six categories emerged from …

Does The Sequence Of Instruction Matter During Simulation?, Jill E. Stefaniak, Carman L. Turkelson

STEMPS Faculty Publications

Introduction: Instructional strategies must be balanced when subjecting students to full-immersion simulation so as not to discourage learning and increase cognitive overload. The purpose of this study was to determine if participating in a simulation exercise before lecture yielded better performance outcomes among novice learners.

Methods: Twenty-nine participants were divided into 2 groups as follows: group 1 participated in simulation exercises followed by a didactic lecture and group 2 participated in the same learning activities presented in the opposite order. Participants were administered a multiple-choice cognitive assessment upon completion of a workshop.

Results: Learners who participated in the simulated exercises …

Utilizing Early Simulation To Increase Clinical Confidence In Novice Nursing Students, Dana R. Martin

Nursing Theses and Capstone Projects

The purpose of this project was to determine if early simulation would increase the clinical confidence of novice nursing students. A convenience sample of 20 junior nursing students in their first semester of a baccalaureate nursing program within a small, rural university participated in the project prior to their first clinical experience. The students were administered the Confidence Scale as a pre-test prior to the early simulation experience which consisted of a scenario comparable to what the students would experience in the clinical setting. After the simulation, the primary investigator facilitated a debriefing exercise and then administered the Confidence Scale …

A Retrospective Analysis Of Paramedic Student Performance Under Simulated Stress, Nicholas Franklin Miller

Online Theses and Dissertations

The paramedic profession is an inherently difficult, dangerous and stressful profession. The paramedic is constantly barraged with acute stressors during the performance of his duties. These stressors have predictable, documented, negative effects on performance. The acute and chronic exposure to stress can negatively impact the safety and the well being of the paramedic. These stressors, if not successfully managed, can also result in negative effects to patients. Despite the overwhelming presence of stress in the paramedic environment, most paramedics receive little or no training to successfully perform under stress. One exception was a program called Trauma Lanes that was held …