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Preclinical simulation is an evidence-based method for nurse practitioner (NP) students to improve clinical communication and disease management competency. During simulation, students may receive feedback from multiple sources, including standardized patients (SPs), faculty, peers, and themselves. Although evidence supports simulation with multisource feedback, its impact on clinical knowledge and communication has yet to be evaluated among NP students. We designed, implemented, and evaluated a preclinical simulation program with structured multisource feedback integrated into a disease management course within a Doctor of Nursing Practice curriculum. Differences in communication self-efficacy and disease management knowledge before and after participation, as well as perceptions of learning and importance of varying feedback sources, were evaluated using a single group pre–post mixed-methods design. On average, clinical communication self-efficacy was significantly higher, and disease management knowledge scores were significantly higher after participation. Learners rated feedback sources as important or very important and described varying feedback sources as complementary. Feedback from SPs, peers, learners themselves, and faculty was complementary and important to learning. This preclinical simulation program with purposeful integration of multisource feedback provides an evidence-based foundation for scaffolding multidomain competency development into curriculums to meet updated standards of advanced nursing education. [ABSTRACT FROM AUTHOR]

Background: Escape room simulations are an innovative teaching methodology that may be useful in addressing pediatricspecific content and clinical placement limitations of generalist nursing programs. Problem: This project studied if a pediatric escape room simulation improved students' knowledge and confidence in pediatric nursing to support the development of the pediatric nursing workforce. Approach: A pediatric escape room simulation was developed for a large Midwestern university's prelicensure nursing program. Students completed surveys to assess knowledge and confidence in pediatric nursing. Simulation quality was assessed using the Simulation Learning Effectiveness Inventory. Outcomes: Students' (N = 37) knowledge and confidence in pediatric nursing concepts significantly increased after the simulation. Students responded positively to the simulation and recommended it be included in the undergraduate curriculum. Conclusions: The pediatric escape room simulation offers a promising alternative for students to gain pediatric-specific knowledge and confidence for prelicensure nursing programs in the context of limited pediatric clinical placements. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Transitions to new care environments may have unexpected consequences that threaten patient safety. We undertook a quality improvement project using in situ simulation to learn the new patient care environment and expose latent safety threats before transitioning patients to a newly built adult ICU. DESIGN: Descriptive review of a patient safety initiative. SETTING: A newly built 24-bed neurocritical care unit at a tertiary care academic medical center. SUBJECTS: Care providers working in neurocritical care unit. INTERVENTIONS: We implemented a pragmatic three-stage in situ simulation program to learn a new patient care environment, transitioning patients from an open bay unit to a newly built private room-based ICU. The project tested the safety and efficiency of new workflows created by new patient- and family-centric features of the unit. We used standardized patients and high-fidelity mannequins to simulate patient scenarios, with "test" patients created through all electronic databases. Relevant personnel from clinical and nonclinical services participated in simulations and/or observed scenarios. We held a debriefing after each stage and scenario to identify safety threats and other concerns. Additional feedback was obtained via a written survey sent to all participants. We prospectively surveyed for missed latent safety threats for 2 years following the simulation and fixed issues as they arose. MEASUREMENTS AND MAIN RESULTS: We identified and addressed 70 latent safety threats, including issues concerning physical environment, infection prevention, patient workflow, and informatics before the move into the new unit. We also developed an orientation manual that highlighted new physical and functional features of the ICU and best practices gleaned from the simulations. All participants agreed or strongly agreed that simulations were beneficial. Two-year follow-up revealed only two missed latent safety threats. CONCLUSIONS: In situ simulation effectively identifies latent safety threats surrounding the transition to new ICUs and should be considered before moving into new units. [ABSTRACT FROM AUTHOR]

Background: Developing engaging presimulation learning materials that provide contextualized patient information is needed to best prepare students for nursing simulation. One emerging strategy that can be used by educators to create visual images for storytelling is generative artificial intelligence (AI). Purpose: The purpose of this pilot study was to determine how the use of generative AI--created patient backstories as a presimulation strategy might affect student engagement and learning in nursing simulation. Methods: A qualitative cross-sectional survey with content analysis was completed with undergraduate nursing students following an acute care simulation. Results: Student surveys point to positive pedagogical outcomes of using AI image generation as a strategy to prepare for simulation such as decreased anxiety in simulation, increased preparatory knowledge, and increased emotional connection with the patient's story. Conclusions: Images created with generative AI hold promise for future research and transforming nursing education. [ABSTRACT FROM AUTHOR]

Background: Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear. Purpose: This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students. Methods: This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking. Results: Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students. Conclusions: Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing. [ABSTRACT FROM AUTHOR]

Background: Nursing and midwifery students do not feel adequately prepared during their clinical training to support women who breastfeed, demanding more effective communication skills and knowledge. Aim: The aim was to evaluate changes in students' breastfeeding knowledge. Methods: This was a mixed-methods quasi-experimental design. Forty students voluntarily participated. Using a 1:1 ratio, 2 groups were randomly created and completed the validated questionnaire ECoLaE (pre-post). The educational program consisted of focus groups, a clinical simulation, and a visit to the local breastfeeding association. Findings: The control group's posttest scores ranged from 6 to 20 (mean = 13.1, standard deviation [SD] = 3.0). The intervention group ranged from 12 to 20 (mean = 17.3, SD = 2.3). A Student's t test for independence samples was calculated (P < .005, t = 4.5, median = 4.2). The intervention group had a mean difference of 10 points in improvement (mean =10.53, SD = 2.20, min = 7, max = 14), whereas the control group had a mean of 6 points (mean = 6.80, SD = 3.03, min = 3, max = 13). The multiple linear regression explained the intervention's effect. The regression model had statistical significance (F = 4.87, P = 0.004), with an adjusted R2 = 0.31. The linear regression between the posttest scores and group variables after adjusting by age showed an increment of 4.1 points in the intervention posttest scores (P < .005, 95% confidence interval [CI] = 2.1-6.1). Conclusions: The educational program "Engage in breaking the barriers to breastfeeding" improved nursing students' knowledge. [ABSTRACT FROM AUTHOR]

Background: Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation. Purpose: This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning. Methods: A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed. Results: Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed. Conclusions: Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students. [ABSTRACT FROM AUTHOR]

Background: High-quality transitional care at discharge is essential for improved patient outcomes. Registered nurses (RNs) play integral roles in transitions; however, few receive structured training. Purpose: We sought to create, implement, and evaluate an evidence-informed nursing transitional care coordination curriculum, the Transitions Nurse Training Program (TNTP). Methods: We conceptualized the curriculum using adult learning theory and evaluated with the New World Kirkpatrick Model. Self-reported engagement, satisfaction, acquired knowledge, and confidence were assessed using surveys. Clinical and communication skills were evaluated by standardized patient assessment and behavior sustainment via observation 6 to 9 months posttraining. Results: RNs reported high degrees of engagement, satisfaction, knowledge, and confidence and achieved a mean score of 92% on clinical and communication skills. Posttraining observation revealed skill sustainment (mean score 98%). Conclusions: Results suggest TNTP is effective for creating engagement, satisfaction, acquired and sustained knowledge, and confidence for RNs trained in transitional care. [ABSTRACT FROM AUTHOR]

Background: Senior nursing students are expected to be ready in terms of professional decisions and practices as soon as possible after graduation. Quality and Safety Education for Nurses (QSEN) is a framework to prepare nursing students for practice in the health care system. Purpose: This study aimed to explore the effect of repeated exposure to multipatient simulations on senior nursing students' pregraduation transition views, QSEN knowledge level and self-competency, professional readiness, and postgraduation transition shock. Methods: A randomized controlled trial of intervention and control groups with pretest, posttest, and a follow-up was conducted with 78 senior nursing students at a private, accredited, nursing program in Istanbul, Turkey. Results: There was a statistically significant improvement in the intervention group between the pretest and the posttest for self-confidence (P <.01), QSEN knowledge level (P <.01), and professional readiness (P <.01). The QSEN knowledge level (P <.01) and professional competency (P <.05) of the intervention group were higher than those of the control group. Conclusion: These results suggest that multipatient simulations may be an effective strategy to better prepare students for the health care system's demands. [ABSTRACT FROM AUTHOR]

Introduction: Simulated patients (SPs) are trained to simulate real patient scenarios for health professionals' education and training. The value of including SPs in simulated scenarios, particularly in relation to difficult and complex conversations, has been studied in various contexts, with a focus on learner experiences and outcomes. What has not been as extensively explored is the impact of difficult and complex conversations on the SPs. The aim of this study was to explore the perspectives, motivations, and experiences of SPs, particularly regarding difficult or complex conversations., Methods: A qualitative approach was taken to gather and interpret SP experiences. Open-ended interviews were the primary means of obtaining data. Thematic analysis guided the interpretation of interview data to generate key themes that encapsulated the SP experience., Results: Twelve participants shared their experiences of working as SPs in scenarios that involved difficult or complex conversations. From these data, 4 major themes were determined: Care for Students , Pedagogical Focus , Emotional Regulation , and Organizational Environment . The importance of empathy and safe design and support for simulations was apparent., Conclusions: This study presents insights into the experiences and perspectives of SPs regarding difficult and complex conversations. Participants highlighted the necessity of uniformity in standards of practice in simulation and the need for advocacy for awareness of simulation-based practices., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society for Simulation in Healthcare.)

Summary Statement: This systematic review aimed to identify, appraise, and synthesize evidence for the effectiveness of simulation modalities in promoting nursing students' empathy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was followed with 20 studies included. The Medical Education Research Study Quality Instrument (MERSQI) was used to evaluate the quality of the publications. The mean MERSQI score was 10.95 with an SD of 1.62, which was above the average in the literature.Five simulation modalities were identified: standardized patient, simulated suit, manikin, virtual simulation, and virtual reality simulation. Most of the studies (n = 15) reported significant differences in the measured outcomes after their simulation activities, including all 5 simulation modalities, but the most effective modality was the simulation suit. The simulation suit replicates the lived experiences of others, which enhances perspective taking by "turning the student into the patient" through the physical and sensory effects of simulated suits. However, outcome measures were limited to self-report instruments in the studies., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Society for Simulation in Healthcare.)

Introduction: Medical Spanish programs commonly engage Spanish-speaking standardized patients (SPs) for communication skills assessment, yet no studies address SP recruitment, selection, or training., Methods: We sent questionnaires to medical Spanish faculty at 20 US medical schools to gauge their practices in recruiting and selecting Spanish-language SPs. We invited faculty to distribute a separate questionnaire to Spanish-language SPs to gather SP language abilities, training, and experience. We analyzed data using descriptive statistics and qualitative content analysis. When available, we reviewed SP video encounters to formally assess participating SPs' linguistic performance using the SP Oral Language Observation Matrix, a rating tool adapted from the Physician Oral Language Observation Matrix to assess oral medical Spanish proficiency., Results: Eighty percent of faculty (16/20) responded. Standardized patient recruitment sources included institutional English-language SPs, Hispanic student groups and professional organizations, communities, and language professionals. Faculty-reported strategies to determine language readiness included interviewing SP candidates in Spanish and asking them to self-rate language skills using a validated scale. Fifteen SPs (54%, 15/28) from 5 schools responded to the SP questionnaire, and one third (5/15) reported that their Spanish was not assessed before being selected as an SP. In addition, one third (5/15) did not receive any initial training before performing a medical Spanish case. Raters assessed 11 different SPs using the SP Oral Language Observation Matrix, and 6 were rated as linguistically "ready" for the SP role., Conclusions: Current approaches to recruitment, training, and language assessment of SPs vary. We propose strategies to ensure that medical Spanish encounters authentically reflect Spanish-speaking patients., Competing Interests: P.O., L.C.D., S.E.G., L.K., C.P.-C., and J.G. were supported by a grant from the National Board of Medical Examiners Stemmler Fund. L.C.D. was also supported by Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748). P.O. receives author royalties from Elsevier. L.C.D. receives author royalties from Multilingual Matters. The authors have no other conflicts of interest to report., (Copyright © 2023 Society for Simulation in Healthcare.)

Background: As there is an increasing trend in the number of male-identifying learners in undergraduate nursing education, a need exists to identify the gender differences in learners' perceptions regarding simulation-based learning. Purpose: This study aimed to identify the gender differences in psychological safety, academic safety, cognitive load, and debriefing satisfaction in simulation-based nursing education. Methods: A cross-sectional descriptive survey was implemented with 97 female and 95 male nursing students. Data were analyzed using Mann-Whitney U tests or independent-samples t tests. Results: Female nursing students reported a lower academic safety and higher intrinsic load than male nursing students. Male nursing students perceived a higher germane load than female nursing students. Conclusions: The significance of the present study was the identification of gender differences in participant perception of the simulation learning experience for effective simulation design. [ABSTRACT FROM AUTHOR]

Background: New nurses often struggle with recognizing cues and applying clinical judgment. Nurse educators develop educational simulation scenarios to support students in developing clinical judgment, which includes the foundational step of recognizing cues. Purpose: A scoping review on undergraduate nursing students' cue recognition during simulation was conducted to systematically map the existing research and identify knowledge gaps. Methods: From initial identification of 228 studies published between 2010 and 2020, a total of 17 quantitative or qualitative studies were independently appraised using the Joanna Briggs Institute scoping review process and PRISMA-ScR reporting guidelines. Results: Cues were missed with varying levels of frequency. Participants frequently failed to recognize respiratory rates and physical assessment changes as salient cues to patient deterioration. Verbal cues from simulated patients were often missed or resulted in distancing behaviors. Conclusion: Research is needed to determine the most effective methods for helping learners develop skills in cue recognition and analysis. [ABSTRACT FROM AUTHOR]

Background: Guided reflection during a debriefing after the simulation is a critical component of learning and is essential for clinical judgment development. However, the literature describing student-centered reflection during debriefing is only beginning to emerge. Purpose: This study aimed to explore concordance between student-centered reflection concept characteristics and describe students' experiences related to reflection during an optimal simulation debriefing. Methods: This was a descriptive, mixed-methods study. Results: Quantitative responses (N = 175; 67% response rate) confirmed participants' concordance with student-centered reflection concept analysis attributes, antecedents, and consequences. Analysis of open-ended questions highlighted internal and external factors influencing students' reflections. A recurring theme was the importance of faculty and peers in creating a safe, supportive environment for reflections. Conclusions: Findings support the concordance of student-centered reflection and provide valuable insights into the internal and external factors influencing this reflection. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist device simulation-based mastery learning (SBML) results in better patient and caregiver self-care skills compared with usual training. Objective: The aim of this study was to evaluate the effect of SBML on driveline exit site infections. Methods : We compared the probability of remaining infection free at 3 and 12 months between patients randomized to SBML or usual training. Results : The SBML-training group had no infections at 3 months and 2 infections at 12 months, yielding a Kaplan-Meier estimate of the probability of remaining infection free of 0.857 (95% confidence interval [CI], 0.692-1.00) at 12 months. The usual-training group had 6 infections at 3 months with no additional infections by 12 months. Kaplan-Meier estimates of remaining infection free at 3 and 12 months were 0.878 (95% CI, 0.758-1.00) and 0.748 (95% CI, 0.591-0.946), respectively. Time-to-infection distributions for SBML versus usual training showed a difference in 12-month infection rates of 0.109 (P =.07). Conclusions: Ventricular assist device self-care SBML resulted in fewer 12-month infections. [ABSTRACT FROM AUTHOR]

Background: Fall-related injuries rise with age and are of particular concern for frail populations living in nursing homes. Local Problem: The Perley and Rideau Veterans' Health Centre is a large nursing home in Ontario, Canada. In 2019, we conducted internal audits of our Falls Prevention Program and identified notable variations in staff's response to a resident fall. Interventions: We developed an in situ patient simulation program of a resident fall. Methods: This was a mixed-methods evaluation of participants' perspectives of a simulation-based interprofessional education program for fall prevention. Results: Participants indicated high-level support for simulation-based learning, with more than 80% of the participants expressing that they will apply these skills in the future when caring for a resident who falls. Conclusions: Our findings indicate that simulation-based training is well received by frontline workers in a nursing home setting and can be conducted as part of a typical shift with minimal disruption to resident care. [ABSTRACT FROM AUTHOR]

Background: Diabetic ketoacidosis (DKA) is a common presentation to an emergency department (ED), with the majority presenting to community EDs. Adherence to clinical guidelines in these EDs can reduce morbidity and mortality. Few methods to describe practice gaps for DKA management have been reported., Objectives: We hypothesized that high-fidelity in situ simulation can be used to measure and compare the quality of the care provided to pediatric patients with DKA presenting to community EDs in the state of Indiana., Methods: This observational study examined multiprofessional teams caring for a simulated pediatric patient who presented with DKA to community EDs. The primary outcome was overall adherence to pediatric DKA guidelines as measured by a validated performance checklist. A composite adherence score (CAS) was calculated using the sum of 9 checklist performance parameters. Multivariable logistic regression was used to examine the impact of ED volume and characteristics on the scores., Results: A 49 multiprofessional teams from 13 sites were enrolled. Of the 252 participants, 26 (10.3%) were physicians, 143 (56.7%) registered nurses, 25 (9.9%) respiratory therapists, and 58 (23.0%) were other. The overall CAS for all sites was 55.6% (25th, 75th interquartile range, 44.4%, 66.7%). Excessive intravenous fluid boluses were given by 53.1%, whereas 30.6% and 26.5% incorrectly administered insulin and sodium bicarbonate boluses, respectively. Only 10.2% used an appropriate intravenous fluid rate, and 57.1% performed an hourly glucose. No significant difference in the CAS was found due to pediatric ED volume or presence of an inpatient pediatric service., Conclusions: Using validated in situ simulation; we revealed high variability in adherence to the pediatric DKA management guidelines at a wide range of community EDs. A statewide education initiative focused on decreasing variation and improving adherence to pediatric DKA guidelines is necessary for patient safety., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Six high-fidelity simulations were developed to promote empathetic, evidence-based care devoid of stigma for individuals with opioid use disorder (OUD). Study aim was to validate simulation scenario and content for accuracy and clinical relevance., Method: Simulations were video recorded in August 2022 for content validation. Expert assessment was conducted in September 2022 via focus groups using videoconferencing., Results: A panel of OUD experts that included healthcare providers (n = 10), who were also nurse educators (n = 5) or family members affected by OUD (n = 1), validated simulation content. Thematic analysis identified themes: (a) strategies for enhancing realism, (b) recognition for diverse patients, (c) additional cueing to generate empathetic responses, (d) refining cueing to focus on stigma, (e) recognizing OUD as a chronic illness, (f) novel approach to standardized patients, and (g) limitations of mannequins., Conclusion: Evaluation of simulations provided content validation increasing the potential effectiveness of the simulations to achieve desired learning outcomes., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The birth of a very low birth-weight (VLBW) infant occurs infrequently, especially in the community hospital setting. It is critical that the team managing care of the infant in its first minutes of life follow evidence-based resuscitation guidelines and practices to optimize outcomes for this population.Purpose: To implement a simulation program in a community hospital setting that supports standardized evidence-based delivery room practices of the premature infant born less than 30 weeks' gestation.Methods: Two VLBW emergent delivery scenarios were developed utilizing the neonatal resuscitation program scenario template. Special care nursery interprofessional team members from a community hospital were invited to participate in the simulation program (n = 28). Participants were asked to complete a neonatal version of the Emergency Response Confidence Tool, then view a short presentation related to delivery room management of VLBW infants. Participants attended a simulation program and completed the confidence tool after simulation. The simulation facilitator and unit educator documented team actions during each simulation session.Findings/results: Fifteen opportunities for improvement within 4 simulation sessions were identified and categorized. Fourteen paired pre- and postsurveys were analyzed. Reported confidence increased in 22 of 23 resuscitation-related items.Implications For Practice: Education and simulation programs providing opportunities to experience high-risk, low-frequency VLBW delivery situations can assist in identifying areas for improvement and may improve team member confidence.Implications For Research: Additional research is needed to assess whether results would be similar if this program were provided at all levels of neonatal care throughout the healthcare system. [ABSTRACT FROM AUTHOR]

Background: Understanding and facilitating the seamless and safe transitions of patients across high-acuity hospital settings are important for students to grasp in order to meet patient and family care needs. Problem: Clinical placements do not always give students the opportunity to care for patients in various hospital settings or apply complex knowledge and skills learned in their didactic courses. Furthermore, the global pandemic has limited student clinical experiences in health care settings, underscoring the need for simulated clinical learning opportunities. Approach: A multiscenario simulation using a high-fidelity human patient simulation manikin was incorporated into a senior-level capstone course. Simulated hospital settings included the (1) emergency department, (2) critical care unit, and (3) progressive care unit. Outcome: Student evaluations revealed positive perceptions of learning, enhanced proficiency of clinical skills, and increased confidence regarding transitions of care. Faculty held agreeable opinions of the simulation's ease of facilitation and effectiveness as a teaching tool. Conclusion: Application of complex knowledge and skills, understanding the use of bundles of care, and an appreciation for transitions of care hospitalized patients were successfully achieved. [ABSTRACT FROM AUTHOR]

Introduction: Direct patient contact is essential when training health professionals for future patient-centered interactions. Simulated participants (SPs) play a critical role during training; however, limited information is available about their personal perspectives. This study explored SPs at the College of Medicine and Health Sciences experiences, adaptations, and preferences regarding online and face-to-face encounters., Methods: After ethical approval, a qualitative research study using structured in-depth interviews was conducted online with 16 SPs, applying critical incident narratives and storytelling. Interview data were transcribed and encoded using thematic framework analysis, after which member checking was conducted to increase credibility., Results: All SPs acknowledged the benefits of online delivery models during the pandemic, including the convenience of working from home, continued clinical skills training, and personal protection from COVID infection. Participants preferred face-to-face delivery over online encounters, except for one SP, who saw no difference. Challenges included technical issues, communication problems, and lack of realism., Conclusions: Although these results cannot be generalized, all participants acknowledged the relevance of online portrayals during the pandemic. Most preferred face-to-face delivery models for improving role-playing and enhancing personal communication to achieve better patient outcomes, while one SP had no preference. The use of concurrent online and face-to-face methods may more effectively engage SPs in simulation-based education. Before restructuring programs, further research is needed, including a deeper exploration of students' and educators' perspectives., Competing Interests: The authors declare no conflict of interest. The authors declare no conflict of interest with regards to the exploration, analysis and dissemination of the study. The study did not receive any funds and was not based on financial interests., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society for Simulation in Healthcare.)

Competing Interests: The authors declare no conflicts of interest.

Background: Nursing education is moving toward competency-based education and assessment. Nurse educators will need to adopt strategies to develop and measure competence., Purpose: The purpose of this study was to determine if screen-based virtual patient simulation is an effective strategy to assist learners in developing competencies and subcompetencies required in nursing practice., Methods: Thirteen questions (6 assessment and clinical reasoning focused, 4 clinical judgment focused, 3 attitude and socialization to nursing focused), aligned with the competencies of the American Association of Colleges of Nursing Essentials, were developed for a pre-/posttest design to evaluate student competency development., Results: Senior nursing students (n = 52) participated; 1-tailed paired t test identified 12 of 13 items as statistically significant. Posttest scores were greater than pretest scores., Conclusions: The change in mean scores from pre- to posttest suggests screen-based virtual patient simulation scenarios improve learners' competence in addressing the patient's physical and psychological comfort and decreased caregiver biases., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Empathy is significant in nursing, and showing empathy toward a patient positively impacts a patient's health. Learning empathy through immersive simulations is effective. Immersion is an essential factor in virtual reality. This study aimed to describe nursing students' experiences of empathy in a virtual reality simulation game. Data were collected from nursing students (n = 20) from May 2021 to January 2022. Data collection included individual semistructured interviews; before the interviews, the virtual reality gaming procedure was conducted. Inductive content analysis was used. Nursing students experienced compassion and a feeling of concern in the virtual reality simulation game. Students were willing to help the virtual patient, and they recognized the virtual patient's emotions using methods such as listening and imagining. Students felt the need to improve the patient's condition, and they responded to the virtual patient's emotions with the help of nonverbal and verbal communication and helping methods. Empathy is possible to experience by playing virtual reality simulation games, but it demands technique practicing before entering the virtual reality simulation game., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Background and Importance: There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established., Objective: To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area., Methods: The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance)., Outcome Measures and Analysis: Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis., Results: Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance., Conclusion: In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Most standardized patients (SPs) in Taiwan are middle-aged or older volunteers with a high retention rate and selflessly devote themselves to the service. This study explored the psychological process behind the continued altruistic behaviors of SPs to understand the formation of service motivation, professional identity, and internal transformation., Methods: Sixteen volunteers, aged 50 to 70 years, who served as SPs for 3 to 11 years in a religious hospital were enrolled in this study. Individual semistructured interviews were conducted. Each person was interviewed for approximately 120 minutes. We used a thematic analysis to analyze the interview transcripts., Results: We identified 3 major themes and 8 subthemes. The first theme, SPs' service motivation, included the following 3 subthemes: past medical experiences, acquisition of medical knowledge, and emotional connections. The second theme, SPs' identity formation, included the following 3 subthemes: role recognition, work ethic, and a sense of religious mission. The third theme, SPs' physical and psychological support, included 2 subthemes: internal transformation and personal well-being., Conclusions: The interview results showed doctor-patient or life experiences served as the impetus prompting SPs to engage in such altruistic behavior. In addition, identity formation endowed older SPs with a life purpose and a sense of fulfillment and self-actualization through fostering and training medical students. In addition, a clear recognition of the role of an SP and self-worth helped volunteers mitigate any physical and mental problems caused by negative life experiences. Standardized patients continued to complete their tasks with a positive attitude., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society for Simulation in Healthcare.)

Introduction: Virtual patient (VP) simulations have been widely used for healthcare training, education, and assessment. However, few VP systems have integrated emotion sensing and analyzed how a user's emotions may influence the overall training experience. This article presents a VP that can recognize and respond to 5 human emotions (anger, disgust, fear, joy, and sadness), as well as 2 facial expressions (smiling and eye contact)., Methods: The VP was developed by combining the capabilities of a facial recognition system, a tone analyzer, a cloud-based artificial intelligence chatbot, and interactive 3-dimensional avatars created in a high-fidelity game engine (Unity). The system was tested with healthcare professionals at Changzhou Traditional Chinese Medicine Hospital., Results: A total of 65 participants (38 females and 27 males) aged between 23 and 57 years (mean = 38.35, SD = 11.48) completed the survey, and 19 participants were interviewed. Most participants perceived that the VP was useful in improving their communication skills, particularly their nonverbal communication skills. They also reported that adding users' affective states as an additional interaction increased engagement of the VP and helped them build connections with the VP., Conclusions: The emotionally responsive VP seemed to be functionally complete and usable. However, some technical limitations need to be addressed before the system's official implementation in real-world clinical practice. Future development will include improving the accuracy of the speech recognition system, using more sophisticated emotion sensing software, and developing a natural user interface., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Introduction: Empathy is essential for effective patient care. Yet, research shows suboptimal empathy in patient-practitioner interactions. Intelligent virtual patient simulations may offer an effective educational tool for empathy training. This observational study explored the quality of speech pathology of students' empathy responses in virtual patient simulations., Methods: Using the 7-point Empathic Communication Coding System (ECCS), we examined 72 students' empathic communication during a 12-week virtual patient interview series as part of their standard curriculum across 4 cohorts (a total of 388 empathic responses). The ECCS data were tallied and graphically displayed. We compared year groups (cohorts from 2015 to 2018), changes over semester, and differences between virtual patients., Results: Median ECCS scores were 4 of a maximum of 6 (interquartile range, 3) across all interviews. Most students (89%) scored between a level 2 (implicit recognition) and level 5 (confirmation) with only a few responses scoring at the lowest 2 levels of empathy (0: denial, 0.5%; 1: automatic recognition, 2%) or the highest level of empathy (6: shared feeling or experience, 9%). Students consistently acknowledged patients' feelings and often offered an action, solution, or reassurance. However, shared feelings or experiences were infrequent., Conclusions: Although virtual patient simulations do not replace experiential learning such as simulation, standardized patients, and clinical practicum, they offer a safe environment to practice skills. This article provides support for designing larger controlled clinical trials and provides insights for educators on how to design virtual patient empathic opportunities of varying complexity for students., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Objectives: Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate.Methods: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions.Results: After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses.Conclusions: Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula. [ABSTRACT FROM AUTHOR]

Background: Delivering high-quality cardiopulmonary resuscitation (CPR) requires teams to administer highly choreographed care. The American Heart Association recommends audiovisual feedback for real-time optimization of CPR performance. In our Emergency Department (ED) resuscitation bays, ZOLL cardiac resuscitation device visibility was limited. Objective: To optimize the physical layout of our resuscitation rooms to improve cardiac resuscitation device visibility for real-time CPR feedback. Methods: A simulated case of cardiac arrest with iterative ergonomic modifications was performed four times. Variables included the locations of the cardiac resuscitation device and of team members. Participants completed individual surveys and provided qualitative comments in a group debriefing. The primary outcome of interest was participants' perception of cardiac resuscitation device visibility. Results: The highest scoring layout placed the cardiac resuscitation device directly across from the compressor and mirrored the device screen to a television mounted at the head of the bed. Comparing this configuration to our standard configuration on a five-point Likert scale, cardiac resuscitation device visibility increased 46.7% for all team members, 150% for the team leader, and 179% for team members performing chest compressions. Conclusion: An iterative, multidisciplinary, simulation-based approach can improve team satisfaction with important clinical care factors when caring for patients suffering cardiac arrest in the ED. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Background: The National Organization of Nurse Practitioner Faculties supports the incorporation of telehealth in nurse practitioner (NP) education. Purpose: The purpose of this article is to describe the implementation of a no-cost telehealth simulation and its impact on students in their first NP clinical course. Methods: Twenty-eight NP students participated in the telehealth objective structured clinical examination (OSCE). Students completed an online survey about the impact of telehealth OSCE simulation both before and after the simulation. Results: The students' general understanding of the field of telehealth was significantly greater after the telehealth OSCE experience. Directed content analysis revealed 3 themes: usefulness of telehealth, benefit in role preparation, and technology. Conclusion: The use of telehealth simulation can be an effective strategy to assess clinical competency, provide individualized feedback, and ensure students are using evidence-based practice. [ABSTRACT FROM AUTHOR]

Hospitals are experiencing an influx of patients in active behavioral crises, leading to restraints as a behavior management strategy. Over 100 staff participated in simulation training designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants managing escalating patient behavior. Results suggest simulation can be an effective strategy to train medical staff to manage challenging behavior and reduce restraint use., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflicts of interest.

Background: Over the past decade, the implementation of simulation education in health care has increased exponentially. Simulation-based education allows learners to practice patient care in a controlled, psychologically safe environment without the risk of harming a patient. Facilitators may identify medical errors during instruction, aiding in developing targeted education programs leading to improved patient safety. However, medical errors that occur during simulated health care may not be reported broadly in the simulation literature., Objective: The aim of the study is to identify and categorize the type and frequency of reported medical errors in healthcare simulation., Methods: Systematic review using search engines, PubMed/MEDLINE, CINAHL, and SCOPUS from 2000 to 2020, using the terms "healthcare simulation" AND "medical error." Inclusion was based on reported primary research of medical errors occurring during simulated health care. Reported errors were classified as errors of commission, omission, systems related, or communication related., Results: Of the 1105 articles screened, only 20 articles met inclusion criteria. Errors of commission were the most reported (17/20), followed by systems-related errors (13/20), and errors of omission (12/20). Only 7 articles reported errors attributed to communication. Authors in 16 articles reported more than one type of error., Conclusions: Simulationists and patient safety advocates must continually identify systems-related errors and training deficits that can lead to inaction, improper action, and poor communication. Recent dialogs in the simulation community have also underscored the potential benefits of developing a registry of errors across simulation centers, with a goal of aggregating, analyzing, and disseminating insights from various simulation exercises., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Patients who undergo ventricular assist device (VAD) implantation and their caregivers must rapidly learn a significant amount of self-care skills and knowledge. Objective: The aim of this study was to explore patient, caregiver, VAD coordinator, and physician perspectives and perceptions of existing VAD self-care training to inform development of a simulation-based mastery learning (SBML) curriculum to teach patients and caregivers VAD self-care skills and knowledge. Methods: We conducted semistructured, in-person interviews with patients with a VAD, their caregivers, VAD coordinators, and physicians (cardiac surgeons, an infectious disease physician, and advanced heart failure cardiologists). We used a 2-cycle team-based iterative inductive approach to coding and analysis. Results: We interviewed 16 patients, 12 caregivers, 7 VAD coordinators, and 11 physicians. Seven major themes were derived from the interviews including (1) identification of critical curricular content, (2) need for standardization and assessment, (3) training modalities, (4) benefits of repetition, (5) piercing it all together, (6) need for refresher training, and (7) provision of training before implant. Conclusions: Findings from this study suggest that SBML is a natural fit for the high-risk tasks needed to save VAD self-care. The 7 unique training-related themes derived from the qualitative data informed the design and development of a VAD SBML self-care curriculum. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no conflict of interest.

Objectives: The aim of this systematic review was to synthesize research completed between 2011 and 2021 to report the current state of the science on the use of standardized patients (SPs) to teach communication skills. The research question that guided this study was, "Among health care professionals, does the use of SP methodology as a means of teaching communication skills result in improved learner knowledge, skills, attitudes, and/or patient outcomes when compared with other simulation methodologies?", Design: This review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Data SourcesFour databases (CINAHL, Ovid Embase, Ovid Medline, and Scopus) were searched using a combination of medical subject headings, or Mesh terms, as well as keywords to retrieve nonindexed citations.Review MethodsThe inclusion criteria were broad to complete a comprehensive search of the literature. To be eligible for inclusion, a study had to be original research that compared simulation using an SP to another simulation methodology. The study had to evaluate communication knowledge, skill, attitude, and/or patient outcome with an academic or practicing health care professional., Results: The initial database search strategy yielded 8058 citations. These results were narrowed down to 18 studies through an in-depth analysis of each article using identified inclusion criteria. The SPs were superior to role play in 1 (33%, n = 3) study where knowledge was evaluated, 6 (75%, n = 8) studies where skills were evaluated, and 1 (20%, n = 5) study where attitude was evaluated. The SPs were compared with a manikin in 5 studies. The SPs were superior to a manikin in 3 (60%, n = 5) studies where knowledge was measured and in 1 (100%, n = 1) study where attitude was measured. No study measured the outcome knowledge of an SP to a manikin. Finally, SPs were compared with a virtual SP in 3 studies. When knowledge was evaluated, SPs were superior to a virtual SP in 1 study (100%, n = 1). When skills were evaluated, SPs were superior to a virtual SP in 1 study (50%, n = 2), and when attitude was evaluated, SPs were superior to a virtual SP in no study (0%, n = 2). No study evaluated patient outcomes in the comparison of an SP to another simulation methodology., Conclusions: Studies show a weak indication that SP-based education is superior to other simulation methodologies in most contexts. However more rigorous studies with larger sample sizes, validated instruments, and effects on patient outcomes are needed to definitively determine the optimal method/modality for teaching communication to health care professionals., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Abstract: Understanding what interventions and approaches are currently being used to improve the knowledge, skills, and effectiveness of instructors in simulation-based education is an integral step for carving out the future of simulation. The current study is a scoping review on the topic, to uncover what is known about faculty development for simulation-based education.We screened 3259 abstracts and included 35 studies in this scoping review. Our findings reveal a clear image that the landscape of faculty development in simulation is widely diverse, revealing an array of foundations, terrains, and peaks even within the same zone of focus. As the field of faculty development in simulation continues to mature, we would hope that greater continuity and cohesiveness across the literature would continue to grow as well. Recommendations provided here may help provide the pathway toward that aim., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Society for Simulation in Healthcare.)

Summary Statement: Use of the term "confederate" is often used in research literature to describe an individual allied with the research team. Confederate is used in simulation research to describe participants allied with the simulation facilitator. Confederate can also refer to the Confederate States of America and has connotations of racial injustice and slavery. Use of this term in simulation may adversely affect psychological safety of learners. Use of the term within the literature is a potential driver of use during simulation sessions. We completed a rapid review of the health care simulation literature to determine the frequency of the term confederate. From 2000 to 2021, 2635 uses of confederate were identified in 765 articles. There seems to be an increased trend in use of this word. We argue that alternative terms exist and should be used to maximize psychological safety of learners., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Society for Simulation in Healthcare.)

Two different sequences of blocks of simulated and clinical practicum learning experiences compared the clinical competency development of nursing students using a randomized crossover design. Competency was measured 3 times: after each block of simulated and clinical experiences and after a final simulated experience. No significant differences in competency scores between the 2 groups across the 3 time points were found. Using alternative models of clinical and simulation learning may help address barriers to the delivery of clinical education faced by schools of nursing. [ABSTRACT FROM AUTHOR]

This article describes the development, implementation, and evaluation of a simulation exercise designed to teach spiritual care to prelicensure nursing students. Participation in a spiritual care simulation resulted in improved knowledge and attitudes relating to spirituality and spiritual care. The results from this study demonstrate the value of using simulation and spiritual assessment to teach students how to recognize and respond therapeutically to spiritual needs. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no conflicts of interest.

Background: The assignment to be an observer in simulation is common. Despite evidence that learning outcomes are similar for participants and observers, there is uncertainty among simulation facilitators about how to create a valuable learning experience for learners in observer roles., Problem: The prebriefing practices of establishing a fiction contract and orienting learners to their role are frequently centered on learners in participant roles., Approach: Tailoring a fiction contract to the opportunities and challenges that observers experience as well as the use of feedforward to provide specific objectives to learners in observer roles is discussed., Conclusions: Including specific strategies in the prebriefing for learners in observer roles sets observers up for success in simulation learning experiences., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

Summary Statement: Standardized patients (SPs) play a pivotal role in medical education. They are proxies for real patients, preparing students to meet the challenges of excellent patient care. Human simulation, with SPs, is used for teaching and assessing communication and clinical skills in medical education around the world. Standardized patients work individually with other faculty, students, or in conjunction with medical faculty to facilitate learning with feedback. In most simulation centers, SPs receive extensive training in communication and clinical skills, yet they inhabit territory often unrecognized as professional in medical education. The manner in which SPs are seen and treated by faculty and students may be a reflection of how real patients are seen and treated-not always heard, not always respected-and this tension detracts from both simulated and real patient encounters. Exploring how SPs, as proxies for real patients, are treated in medical education is a key to what we might learn and how we might close gaps in cultural respect and, ultimately, in patient care., Competing Interests: The author declares no conflict of interest., (Copyright © 2022 Society for Simulation in Healthcare.)

Introduction: This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes., Method: After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method. Performance markers included automated VSP grading and, for SP cases, faculty-graded observational checklists and patient notes. Performance was compared between modalities using t tests and analysis of variance and then correlated with US Medical Licensing Examination performance., Results: Sixty-six students participated (VSP first: n = 37; SP-first: n = 29). Attitudes toward CCC significantly improved after training (Cohen d = 0.35, P = 0.043), regardless of modality. Simulation order did not impact learner performance for SP encounters. Learners randomized to VSP first performed significantly better within VSP cases for interview (Cohen d = 0.55, P = 0.001) and treatment (Cohen d = 0.50, P = 0.043). The HVC component of learner performance on the SP simulations significantly correlated with US Medical Licensing Examination step 1 ( r = 0.26, P = 0.038) and step 2 clinical knowledge ( r = 0.33, P = 0.031)., Conclusions: High value care didactics combined with either VSPs or SPs positively influenced attitudes toward CCC. The ability to detect an impact of VSPs on learner SP performance was limited by content specificity and sample size., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Society for Simulation in Healthcare.)

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)