• Simulation to Improve Confidence among Newly Licensed Nurses in the Pediatric Intensive Care Setting

      Hamilton, Hannah; Franquiz, Renee (2020-05)
      Introduction: Communication and critical thinking are essential practice competencies for every registered nurse. However, newly licensed registered nurses (NLRN) often lack these skills on entry into practice contributing to low levels of clinical confidence. Aims: The purpose of this Quality Improvement (QI) project was to implement and evaluate the effectiveness of simulation on clinical confidence among NLRNs. Methods: This QI project was guided by the MAP-IT model and involves NLRNs in a Pediatric Intensive Care Unit within an urban academic teaching hospital. NLRNs participated in three clinical simulations reflecting common PICU clinical practice, utilizing the Simulation Module for Assessment of Resident’s Targeted Event Responses (SMARTER) and the Behavior Assessment Tool (BAT). NLRN confidence data were collected immediately pre-simulation and post-simulation, as well as one-month post-simulation using the self-report C-Scale Instrument of Clinical Confidence. Qualitative data was collected via observation by the NLRN preceptor using the C-Scale Instrument of Clinical Confidence. Paired sample t-tests were used to determine a significant change in confidence, and content analysis was performed by two evaluators on the qualitative data derived from the C-Scale observations to identify confidence themes and patterns. Results: Paired sample t-tests revealed a significant increase in clinical confidence between baseline and sustained one-month post simulation. Qualitative data collection of preceptor observations revealed improved clinical confidence and communication abilities. Conclusions and Implications: Data indicates that simulation is an effective strategy to increase clinical confidence as perceived by the NLRNs. Incorporation of simulation into transition-to-practice programs such as Nurse Residency or facility orientation is an evidence-based recommendation to improve development of clinical confidence and communication abilities in this population.
    • Using Simulation to Train Nurse Residents on Bedside Legal Ethical Dilemmas

      Salas, Elisa C. (2017)
      Problem: Nurse residents at a medium-size urban medical center reported a gap in knowledge on how to handle legal-ethical issues at the bedside. Objective: To develop a sustainable approach to integrate legal-ethical simulations into a nurse residency curriculum. Methods: In this quality improvement project, classroom content on ethics was replaced by a ten-minute presentation followed by two simulations depicting legal-ethical dilemmas at the bedside. The project leader designed the two legal-ethical simulations using a format consistent with the NLN/Jeffries simulation design. The topics of the simulations were cancer and pneumonia. The simulations for the first nurse resident cohort (N=9) were directed by the project leader; after training, the nursing residency coordinator directed the second cohort (N=19). Targeted training for nurse educators was also developed. Prior to and after the simulation, students completed a ten-item test to measure legal-ethical knowledge. Immediately after the simulation, students also completed the Student Satisfaction and Self-Confidence in Learning questionnaire, a 13 item Likert scale, 1= strongly disagree to 5 =strongly agree. Results: Comparison of pre and post legal-ethical knowledge scores showed a statistically significant increase in scores (Wilcoxon Signed-Rank Test p < .001, effect size medium to strong, r = .48). Scores for the Student Satisfaction and Self-Confidence in Learning showed consistency. There were no significant differences in scores between cohorts (Mann-Whitney U =256, z= 1.39, p= .1, two tailed) or between simulations (Mann-Whitney U= 371, z= 0.11, p= .9 two tailed). Implications: Providing nurse residents with a ten-minute presentation and two simulations appears sufficient to refresh knowledge of basic legal-ethical concepts. Satisfaction and self-confidence scores were high after each of the two simulations, suggesting that their implementation in the residency program could assist in filling the reported knowledge gap.