Medicine and Health Sciences Commons^™

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Rethinking Emergency Response To Mass Casualty Incidents: Disaster Medicine Education And The Role Of Medical Students, Claire Zurlo, Edward Jasper, Md, Mph

Phase 1

Introduction: The threat of a mass casualty incident (MCI) is one that must be taken seriously and for which hospitals must be prepared. In the wake of a disaster, emergency departments are often taxed beyond their ability to handle the demands of incoming traumas. In response to this, Dr. Edward Jasper, an emergency physician at Thomas Jefferson Hospital, designed the Hospital Emergency Response Team (HERT) to alleviate the pressure on the ED during a MCI. The HERT is a team of nursing and medical students who are FEMA trained to respond in the event of a MCI.

Objective: The primary …

The Incorporation Of Evidence-Based Simulated Activities In An Existing Nurse Residency Program, Wendy Partin Thompson

Doctoral Dissertations and Projects

As new graduate nurses are challenged with caring for patients with complex disease processes, nurse residency programs are designed to ease the transition into practice. A community based hospital, in the southern United States has recently implemented such a program. However, the organization continues to have problems with nursing turnover. This problem is especially evident in nurses with less than one year of clinical experience. Research has shown that nurse residency programs without simulative activities eliminate vital critical thinking activities which prepare novice nurses for clinical practice. The purpose of this project was to design evidence-based simulative activities to increase …

Hearing Voices Simulation: Impact On Occupational Therapy Students, Rebecca Ozelie, Paige Panfil, Nicole Swiderski, Elizabeth Walz

The Open Journal of Occupational Therapy

Auditory hallucinations, which are symptoms of schizophrenia, can significantly disrupt individuals’ daily lives. Occupational therapists (OTs) can address both the daily needs of people with schizophrenia and address cultural stigmas against mental illness. To combat stigma and increase empathy for patients with mental illnesses, auditory hallucinations simulations were developed. The purpose of this study was to determine if the Hearing Voices That Are Distressing (HVTAD) Simulation impacts OT students’ attitudes toward patients with auditory hallucinations and to explore the students’ perceptions of the simulation’s effectiveness as a teaching method. The participants completed a pretest Attitudes to Mental Illness Questionnaire (AMIQ) …

Cognitive Load Measurement, Worked-Out Modeling, And Simulation, Jayne Josephsen

Nursing Faculty Publications and Presentations

Using a cognitive load theory framework, this study investigated implementation of a worked-out modeling (WOM) prebriefing intervention on postsimulation knowledge acquisition and cognitive load experienced. A quasi-experimental quantitative design was used with a convenience sample of 61 senior-level nursing students who had previously participated in a simulation. The treatment group received the WOM intervention before simulation participation, and the control group received the usual presimulation interventions. A presimulation and postsimulation knowledge survey and a cognitive load measurement tool were administered after the simulation. Data indicated increased knowledge related to falls and situation, background, assessment, and recommendation in the treatment group …

Evaluating The Use Of High-Fidelity Simulators During Mock Neonatal Resuscitation Scenarios In Trying To Improve Confidence In Residents, Deena Hossino, Christina Hensley, Karen Lewis, Marie Frazier, Renee Domanico, Melissa Burley, Jeffrey Harris, Bobby Miller, Susan L. Flesher

Bobby L. Miller

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents.

Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys.

Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter.

Conclusion: These results revealed that high-fidelity simulation-based …

An Exploration Of Medication Errors Generated By Baccalaureate Nursing Students Using Electronic Medication Administration Record (Emar) Technology In Clinical Simulation, Ryan Chan

Electronic Thesis and Dissertation Repository

Background: Medication errors continue to be a significant issue within both academic and clinical settings, posing substantial threats to the safety and well-being of patients. Through Bandura’s theory of self-efficacy, nursing students’ self-efficacy (confidence) and preparedness related to medication administration were examined to investigate their influence on the generation of medication errors in clinical simulation.

Research Questions: The research questions of this study aimed to examine the generation of medication errors and the differences that may exist based on nursing students’ perceived confidence and preparedness.

Method: An exploratory secondary analysis of previously collected data that examined nursing students’ generation of …

A Malignant Hyperthermia Competency Training For Nurse Anesthesia Trainees: Development, Implementation, And Evaluation, Andrew M. Christ

College of Science and Health Theses and Dissertations

Background: Video simulation is an alternative method of teaching that can play an important role in nurse anesthesia education. Using video simulation for uncommon crisis could prove beneficial.

Objectives: The purpose of this study is to analyze the effects of an educational video simulation regarding malignant hyperthermia (MH) recognition and management on knowledge of nurse anesthesia trainees (NATs).

Methods: A single group pretest-posttest design was used to compare knowledge on recognition and management of malignant hyperthermia. The study included a voluntary convenience sample of junior and senior nurse anesthesia trainees at NorthShore University HealthSystem School of Nurse Anesthesia. Pretest scores …

Evaluating The Use Of High-Fidelity Simulators During Mock Neonatal Resuscitation Scenarios In Trying To Improve Confidence In Residents, Deena Hossino, Christina Hensley, Karen Lewis, Marie Frazier, Renee Domanico, Melissa Burley, Jeffrey Harris, Bobby Miller, Susan L. Flesher

Jeffrey Harris

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents.

Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys.

Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter.

Conclusion: These results revealed that high-fidelity simulation-based …

Evaluating The Use Of High-Fidelity Simulators During Mock Neonatal Resuscitation Scenarios In Trying To Improve Confidence In Residents, Deena Hossino, Christina Hensley, Karen Lewis, Marie Frazier, Renee Domanico, Melissa Burley, Jeffrey Harris, Bobby Miller, Susan L. Flesher

Christina Hensley

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents.

Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys.

Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter.

Conclusion: These results revealed that high-fidelity simulation-based …

Evaluating The Use Of High-Fidelity Simulators During Mock Neonatal Resuscitation Scenarios In Trying To Improve Confidence In Residents, Deena Hossino, Christina Hensley, Karen Lewis, Marie Frazier, Renee Domanico, Melissa Burley, Jeffrey Harris, Bobby Miller, Susan L. Flesher

Marie D. Frazier

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents.

Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys.

Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter.

Conclusion: These results revealed that high-fidelity simulation-based …

Nursing Student Confidence And Self-Efficacy In Simulation: Evidence Synthesis Project, Serena Shirey

Nursing (graduate) Student Scholarship

The use of simulation-based activities is a growing trend in nursing pedagogy and requires evaluation to assess and improve outcomes. This project completed a review of multiple research studies and reviews to evaluate the effects of simulation and simulation methods on students’ sense of self-efficacy and confidence. The findings support the use of simulation and found that simulation does increase students’ perception of confidence and self-efficacy. The data collected included both qualitative and quantitative data. A few studies lacked generalizability due to small sample size and scenario selection. However, multiple methods were noted to improve the simulation experience and they …

Simulation Course Redesign, Hsuan Ho

Master's Projects and Capstones

The purpose of this project is to enhance the clinical nurse leader (CNL) nursing students’ learning experiences through simulation education, ensure that their learning outcomes meet course objectives, and increase students’ recognition of educational best practices in simulation.

This summer semester, the number of students in the obstetric course doubled and the course was changed from four scenarios held over two simulation days for four pre-licensure students each class to five simulation days with eight to ten students in attendance each class period. While the old student-to-instructor ratio was three to four to one, the new ratio is nine to …

Does Ecg And Arrhythmia Simulation Training In Adjunct To Didactics Improve Medical Students’ Clinical Skills Compared To Didactics Alone?, Reed Krause, Amy C. Hayton Md

Amy Hayton, MD

Medical Schools continue to face the challenge of bridging the gap between classroom education and its application in the clinical environment. Several studies have shown utility of incorporating simulation training into a variety of healthcare related topics. We hypothesize that incorporating ECG and arrhythmia simulation training in adjunction to ECG and arrhythmia didactics; it would improve Year-3 medical students’ preparedness for managing arrhythmias in the clinical setting.

Implementing A Caps Simulation To Increase Nursing Education Practice Students’ Self-Awareness Of Attitudes And Beliefs About Poverty, Melissa Ehmke

Dissertations

Problem. The purpose of this project is to determine if college students who are currently in nursing school, will benefit from the addition of a poverty simulation to positively influence their self-awareness and individual-level beliefs and attitudes towards poverty, therefore being able to serve those in poverty fully and guide them to appropriate resources.

Methods. Bachelor of Science in Nursing (BSN) and Doctoral Nursing Practice (DNP) students participated in a three-hour Community Action Poverty Simulation (CAPS). A twenty-one item Attitude Toward Poverty Scale short form (ATPS) survey was completed pre and post-simulation participation.

Results. Significant improvements resulted in three of …

Implementation Of A Scripted Debriefing Tool In Simulation-Based Nursing, Mary Kidd

DNP Scholarly Projects

In nursing education, simulation represents real patient scenarios that are designed to enable students to practice combining theoretical knowledge with clinical skills within a controlled environment (Bland, Topping, & Wood, 2011). Debriefing is a facilitated reflection of the simulation experience and is performed to uncover relationships among the events, actions, thought processes and outcomes with the intention of improving future practice (Cheng et al., 2014; Kolbe, Grande, & Spahn, 2015). Without proper debriefing, erroneous critical thinking, decision-making, and clinical judgement may go uncorrected, potentially negatively impacting patient care. There is an abundance of literature on debriefing methods; yet, empirical evidence …

Decreasing Simulation Anxiety In Nursing Education, Kimberly Byler

Doctor of Nursing Practice Scholarly Project

The purpose of this quantitative research project was to examine the efficacy of pre-simulation progressive muscle relaxation in decreasing the level of anxiety experienced by nursing students during simulation exercises. Simulation is an important teaching strategy in nursing education; it provides an arena in which to practice skills and decision-making without putting real patients in danger of any mistakes. Student anxiety is a challenge of the simulation teaching strategy, because it can make students feel unsuccessful. Decreasing student anxiety will be important as simulation is used more frequently in nursing education. Our study assessed students’ anxiety before simulation and the …

Improving Resident Confidence And Efficiency During Stroke Alerts Through Simulation Training, Megan Margiotta, Md, Danielle Wilhour, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Maria Carissa Pineda, Md, Fred Rincon, Md, Rodney Bell, Md, Diana Tzeng, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Objectives

• Teach incoming neurology residents how to respond efficiently and appropriately to stroke alerts
• Improve the confidence level of residents during stroke alerts

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Examining The Relationship Between The Use Of Simulation In Nursing Education Andsafety With Medication Adminstration In The Clinical Setting, Deborah A. Eremita

Electronic Theses and Dissertations

EXAMINING THE RELATIONSHIP BETWEEN THE USE OF SIMULATION IN

NURSING EDUCATION AND SAFETY WITH

MEDICATION ADMINISTRATION

IN THE CLINICAL SETTING

Deborah A. Eremita

Thesis Advisors: Dr. Ann Sossong and Dr. Patricia Poirier

An Abstract of the Dissertation Presented

in Partial Fulfillment of the Requirements for the

Degree Interdisciplinary Doctor of Philosophy

In Nursing and Education

May 2018

Medication errors represent a significant threat to patient safety. Administration of medications is a primary role of nursing practice and a critical component of nursing education curricula. Safe medication is a challenging process to teach nursing students. Simulation may provide students with a …

Filming Trauma Simulations For Medical Education: A Comparison Of First-Person View Vs. Remotely Shot Video, Christopher Capicotto, Memu-Lye Kamara, John Krutsick, Arthur Sesso

Research Day

With advancements in video technology, first-person view places observers in the vantage point of the camera operator. Lightweight wearable products, such as GoPro cameras, are capable of capturing high-resolution footage. In a 3-phase project, first-person view (FPV) footage was compared to remotely-shot video (RSV) of identical trauma scenarios viewed by medical students and residents at PCOM.

Students responded to a trauma simulation by assessing the patient, obtaining a history and stabilizing the patient. This scenario was run once using RSV and again using FPV to capture the encounter. Both formats were screened for medical students in Phase I and Phase …

Local Anesthetic Systemic Toxicity Management: An Assessment Of Simulation-Based Staff Education, Kevin L. Kanallakan

Doctor of Nursing Practice Projects

When local anesthetics are administered at toxic doses or when certain local anesthetics are directly injected into the patient’s circulation, excessive plasma concentrations of the drug will produce a systemic cascade of events known as local anesthetic systemic toxicity (LAST). LAST is a rare, potentially life-threatening complication, which affects both the central nervous and cardiovascular systems. Anesthesia providers and perioperative healthcare professionals must remain current on best practice LAST management in order to reduce morbidity and mortality.

This quality improvement project utilized high fidelity simulation paired with LAST education to improve stakeholder knowledge and management of a LAST scenario. With …

The Effects Of A Repeating Simulation Experience On Senior Nursing Students, Laura Skoronski

Theses and Dissertations

Nurse educators are challenged with meeting the needs of students and patients. One method of educating students that is used widely across the United States is simulation. The purpose of this dissertation is to determine if participation in a repeating simulation experience has an impact on nursing students’ knowledge and clinical judgment. A conceptual analysis of simulation was undertaken to clarify the definition of simulation and confirm the appropriateness of Kolb’s theory and Tanner’s model as the theoretical framework for the study. A quasi-experimental pre-test/post-test with comparison with norms observational study design guided by Kolb’s Theory of Experiential Learning and …

Nurse Confidence Levels In Malignant Hyperthermia, Paige Wilson

Nursing Theses and Capstone Projects

Malignant hyperthermia is a life threatening medical emergency. When individuals with a certain genetic predisposition are exposed to certain pharmaceutical triggering agents, a malignant hyperthermia crisis can occur. If the crisis is not recognized early and symptoms are not treated, the ending result will be patient death. The ability to recognize and intervene in a malignant hyperthermia crisis demonstrates knowledge and confidence by the nurse. Simulation training is an educational tool that nurses can use to increase confidence levels in recognizing and intervening in this type of medical emergency in a safe environment. The findings from this research indicate a …

Dispensing Medical Countermeasures In Public Health Emergencies Via Home Health Agencies And Points Of Distribution, Anna Hudgeons

Industrial Engineering Undergraduate Honors Theses

A major concern regarding emergency preparedness on the state government level involves the handling and dispensing of the Strategic National Stockpile (SNS) of medicinal supplies. Each state is required to update and maintain a plan of action for dispensing SNS materials that would effectively provide care to the state’s population in times of distress. This research evaluates a state’s ability to dispense an adequate amount of medicine to her population in a timely manner, specifically after it has been received by the state government. Although simulation modeling has previously been utilized to replicate the dispensing process at pre-designated points of …

Using End Of Life Care In A Simulation Scenario In An Effort To Help Increase Student Confidence, Amy P. Davis

Nursing Theses and Capstone Projects

This evidence-based project examined how using the end of life care in a simulation scenario would help in an effort to increase student confidence. A sample size of 28 Practical Nursing Students participated in the simulation scenario. The Confidence Scale (C-scale) developed by Susan Grundy, was administered to the students as a pre-test prior to the simulation and a post-test after the simulation. The C-scale measured student confidence and consisted of five questions asking the students to rate themselves on a scale of one to five in performing a task. The goal was to see if the student’s confidence level …

An Education Intervention To Increase Rounding And Toileting And Reduce Falls In A Hospital Acute Care Of The Elderly (Ace) Unit, Amelia Grayson

Doctoral Projects

Introduction: Falls are the most common accident reported in acute care hospitals and patients who are 65 and older are the most vulnerable. Falls can lead to physical and emotional injury, reduced mobility and functioning, increased length of hospital stay, increased healthcare costs, and admission to long-term care facilities. In 2008, the Center for Medicare & Medicaid Services (CMS) has eliminated reimbursement to hospitals for treatment of injuries resulting from a fall during hospitalization. Research on fall prevention in adult acute care found multifactorial interventions that address multiple risk factors for falls are the most successful at prevention. This …

Try To See It My Way: Patient Perspective Video Capture Debriefing In Simulation, Terri Hendry

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Video capture of simulation provides observation from a wide-angle view. This study introduced a new technique, “patient-perspective” video capture, using a camera mounted into eyeglasses allowing learners to view their nonverbal and verbal communication through the patient’s eyes and to compare this to the wide-angle view. The participants (n = 29) were Nurse Practitioner students. The majority were female (93.2%), with a mean age of 36.8, SD = 12.31. The sample consisted of Millennials (65.6%), Generation Xers (13.8%), and Baby Boomers (20.7%). The average number of years of nursing practice was 9.89. Instruments measured demographics, five domains of patient-centered care …

Ring And Peg Simulation For Minimally Invasive Surgical Robot, Evan Brown

Department of Mechanical and Materials Engineering: Dissertations, Theses, and Student Research

Surgical procedures utilizing minimally invasive laparoscopic techniques have shown less complications, better cosmetic results, and less time in the hospital than conventional surgery. These advantages are partially offset by inherent difficulties of the procedures which include an inverted control scheme, instrument clashing, and loss of triangulation. Surgical robots have been designed to overcome the limitations, the Da Vinci being the most widely used. A dexterous in vivo, two-armed robot, designed to enter an insufflated abdomen with a limited insertion profile and expand to perform a variety of operations, has been created as a less expensive, versatile alternative to the Da …

Hospital-Based Physicians' Intubation Decisions And Associated Mental Models When Managing A Critically And Terminally Ill Older Patient., Shannon Haliko, Julie Downs, Deepika Mohan, Robert Arnold, Amber E Barnato

Articles, Abstracts, and Reports

BACKGROUND: Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences.

OBJECTIVE: We sought to describe physicians' mental models (i.e., thought processes) when encountering a simulated critically and terminally ill older patient, and to compare those models based on whether their treatment plan was patient preference-concordant or preference-discordant.

METHODS: Seventy-three hospital-based physicians from 3 academic medical centers engaged in a simulated patient encounter and completed a mental model interview while watching the video recording of their encounter. We used an "expert" model to code the …