SU Nursing Research Methods DQ

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SU Nursing Research Methods DQ

SU Nursing Research Methods DQ

1. Evaluate the discussion section of the article attached and identify if the following was addressed. (Note, you need to show evidence, do not just say yes or no. Post what the researcher indicated that supports that these elements were addressed in the discussion section. Add the page number where you found them)

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a) limitations and strengths of the study variable(s)

b)hypothesis(es)/research questions

c) theoretical framework

d) design

e) sample

f) data collection procedures

g) data analysis

h)generalizations

i)conclusions

j)recommendations for future research

2. After reviewing and evaluating the “Discussion” section of the article, discuss the strength of the evidence supports a change in current practice (If you think it does, support your answer with evidence based literature. You describe what the article indicated and find another source to support why the strength of evidence support a change in current practice).

3. What is your cosmic question? (This should be based on chapter of the week. Pose a research question on discussion section of a research)

 

Clinical Simulation in Nursing (2013) 9, e121-e126 www.elsevier.com/locate/ecsn Featured Article Effectiveness of a Role-Modeling Intervention on Student Nurse Simulation Competency Barbara Aronson, PhD, RN, CNEa,*, Barbara Glynn, DNP, RN-BCb, Timothy Squires, MS, RN-BCc a Department of Nursing, Southern Connecticut State University, New Haven, CT 06515, USA School of Nursing, Quinnipiac University, North Haven, CT c Department of Education, MidState Medical Center, Meriden, CT b KEYWORDS Abstract: Novice nurses are often inadequately prepared to respond to complex, patient care situations where patients’ conditions deteriorate. Exposure to a video-taped intervention that role-models and reinforces expected behavior of an expert nurse before participation in a simulation may improve student nurse performance in a cost-effective manner. The primary purpose of this quasi-experimental pre-test, post-test study was to assess the preliminary effectiveness of a theory based role-modeling intervention on enhancing student nurse competency in responding to a simulated response to rescue event. Performance was measured by a previously validated Heart Failure Simulation Competency Evaluation Tool Ó (HFSCET). Total mean scores on the HFSCET for the pre-test (59.08) and post-test (87.08) were significantly different (p = .000); students performed better on the post-test after exposure to the role-modeling intervention. A power analysis indicated a large effect size (effect size = .926; alpha = 0.50; power = 0.991). Students who had a greater number of days between the intervention and the post-test had a lower score. This innovative intervention based on established learning theory may change the way educators prepare novice students to achieve expected clinical competencies in graded simulation performance assessments. intervention; nursing students; performance assessment; simulation Cite this article: Aronson, B., Glynn, B., & Squires, T. (2013, April). Effectiveness of a role-modeling intervention on student nurse simulation competency. Clinical Simulation in Nursing, 9(4), e121-e126. doi:10.1016/ j.ecns.2011.11.005. Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved. Introduction Debriefing is the most commonly used simulation teachingelearning intervention used in nursing education. In a recent survey by the National Council of State Boards of Nursing, 80% of the 1,060 responding prelicensure registered nurse programs reported debriefing students after *SU Nursing Research Methods DQ

Corresponding author: aronsonb1@southernct.edu (B. Aronson). participation in medium- or high-fidelity simulations (Hayden, 2010). Despite the known effectiveness and widespread use of debriefing in nursing education, this teachingelearning strategy has one major disadvantage. Debriefing is time intensive for faculty. Waxman (2010) suggests that debriefing sessions should be 2 to 3 times longer than the simulation scenario itself. This corresponds to 60 to 90 minutes of faculty time for every 30-minute scenario (i.e., 60 hours for 40 student groups). Faculty 1876-1399/$ – see front matter Ó 2013 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ecns.2011.11.005 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Effectiveness of a Role-Modeling Intervention e122 may have difficulty sustaining this recommendation given the resource, time, laboratory space, and budget constraints faced by nursing programs today. There is an urgent need to develop more cost-effective interventions to promote improved performance with simulation with novice nurses. A national call for reform in nursing education Key Points (Benner, Sutphen, Leonard, Novice nurses are not & Day, 2010) has recomadequately prepared to mended that the National perform successfully Council of State Boards of in complex simulation Nursing require perforscenarios designed to mance assessments for limimic response-tocensure. According to rescue events. Benner et al. (2010), stu Student nurse ratings dents should be assessed on improved by 46% their skills of clinical reasonafter exposure to ing, including the ability to a role-modeling intersolve clinical problems by vention in this pilot setting patient care priorities study. or responding to a change in Each student dyad patient condition. Novice score improved after nurses are often inadeexposure to the role quately prepared to respond modeling intervento complex patient care sitution, although the ations in which patients’ longer the interval beconditions deteriorate. SU Nursing Research Methods DQ

Two tween exposure and large-scale studies (Ns of post-testing, the lower 760 and 10,988) with novice the score. nurses responding to videotaped scenarios depicting a change in patient condition found that 70% to 76% of new graduates did not meet expectations in the Performance Based Development System assessment (del Bueno, 2001). In another study examining critical thinking and the ability to respond to a critical patient situation (Fero et al., 2010), the majority of nursing students (75%) did not meet overall performance expectations after viewing vignettes or participating in high-fidelity human simulations. Students had the most difficulty related to problem recognition and reporting findings to physicians. A previous study by the authors (Aronson, Glynn, & Squires, 2011a) found similar results. Student nurses (N ¼ 144) performed poorly during a simulation scenario designed to mimic a response-to-rescue event, achieving a mean score of only 49% on the rating tool used to assess student nurse performance. The raters noted that students were not organized in completing an assessment in a timely fashion, did not recognize or cluster data and come to an appropriate conclusion regarding the patient’s changing condition, and did not report significant data to the physician when the patient deteriorated. Additionally, students did not consistently follow national patient safety standards. By watching and role-modeling the behavior of experienced nurses, novice nurses learn, after they graduate, to detect and document changes in patients’ conditions and present a firm, convincing case to the physician (Benner, 1984). According to Clarke and Aiken (2003), surveillance and taking action when life-threatening complications occur are two important nursing activities that can prevent failure-to-rescue events. These activities include assessing patients frequently, attending to cues and recognizing complications, and taking action when life-threatening complications occur. Taking action involves quickly instituting appropriate measures and activating a team response, communicating clearly, and conveying the urgency with which team members are needed at the bedside. Exposure, before participation in a simulation, to a videotaped intervention that models and reinforces expected behavior by an expert nurse may improve novice practitioners’ competency in a more time- and resource-efficient manner without compromising the integrity of performance measures. Pilot studies are used in intervention research to establish the content strength and timing of an intervention and to finalize outcome measures. They are also used to develop the protocol for large multisite studies, including the intervention implementation process and effect size (Whitemore & Grey, 2002). Therefore, the primary purpose of this feasibilityepilot study was to assess the preliminary effectiveness of a theory-based role-modeling intervention on student nurse competency in responding to a simulated response-to-rescue event. The secondary purpose was to determine whether there was a relationship between student competency scores and days elapsed since the intervention. Literature Review There is conflicting evidence as to whether videotaped guided interventions improve student or novice health practitioners’ performance. In a pilot study with undergraduate and nurse anesthesia students, participants in the videotape-debriefing group were more likely than the control group to demonstrate desirable behaviors concerning patient identification, team communication, and vital signs (Grant, Moss, Epps, & Watts, 2010). SU Nursing Research Methods DQ

Byrne et al. (2002) examined the performance of 34 anesthetists in managing five crisis situations. Trainees exposed to videotaped feedback had a shorter median ‘‘time to solve’’ and a smaller decrease in chart error compared with those not exposed to video feedback; the differences were not significant. A third study compared the performance of 42 anesthesia residents who received debriefing with video-assisted oral feedback, oral feedback alone, or no debriefing. Participants’ skills did not improve in the control group; however, the oral feedback group (with or without videotape review) performed significantly better (Savoldelli et al., 2006). Results may have been influenced by small sample sizes and deficiencies in performance measures. In these studies, after participating in a scenario, participants viewed their own performance during a debriefing session. Observing the actions of experts in a videotaped intervention first may assist novice practitioners in then performing expected behaviors in a scenario. pp e121-e126 Clinical Simulation in Nursing Volume 9 Issue 4 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Effectiveness of a Role-Modeling Intervention e123 Theoretical Framework Social learning theory (Bandura, 1977) proposes that human behavior is learned through observing others. During exposure, observers acquire mainly symbolic representations of the modeled activities, which serve as a guide for appropriate behavior in the future. According to Bandura (1977), observational learning is governed by four component processes: attention, retention, motor reproduction, and motivation. Humans cannot learn by observation unless they are able to attend to and perceive accurately the significant features of modeled behavior. They also must be able to retain modeled behavior in their memories in symbolic form and convert these symbolic forms into appropriate actions. Humans are more likely to adopt modeled behavior if it results in outcomes they value. The Role-Modeling InterventionÓ used in this study was developed to affect some of the factors that are thought to influence these processes (Table 1). Role-Modeling Intervention The Role-Modeling InterventionÓ consists of a 40-minute expert practice video, combined with verbal reinforcement of expected behaviors and tailored feedback. The expert practice video, which was developed and produced by the researchers, depicts an expert nurse responding competently to a simulated patient care scenario in which the patient’s condition rapidly deteriorates. It was designed to be used as a teachingelearning intervention before students participate in simulated response-to-rescue scenarios. While students watched the video, expected behavior was reinforced verbally by one of the researchers as the nurse actor modeled the corresponding behaviors. The research team wrote the script for the video, and the simulation scenario was rehearsed multiple times until the researchers were confident that the expert nurseeactor demonstrated all the expected Table 1 competencies.SU Nursing Research Methods DQ

The final videotape was viewed by the three of us, and we rated the performance of the expert nurse independently (r ¼ 1.00). The role-modeling intervention was shown to participants in a group setting (see Figure 1). Instrument Student performance during the study was assessed with an 85-item instrument titled the Heart Failure Simulation Competency Evaluation ToolÓ (HFSCET), which we had developed previously. The process of instrument development, revision, and psychometric testing is described in Aronson, Glynn, and Squires, 2011a. The HFSCET was used to assess the student nurses’ ability to competently respond, in a deteriorating heart failure patient scenario, in the domains of patient safety, assessment, communication, interventions, and documentation. The HFSCET incorporates national patient standards, practice guidelines, national safety initiatives, hospital accreditation standards, and descriptions of best practices related to the care of a patient with heart failure. The instrument evaluates student nurse competency in completing an initial assessment of a newly admitted heart failure patient, recognizing the signs and symptoms of a sudden deterioration in the patient, mounting a rescue response by implementing appropriate nursing interventions, reporting significant findings to the physician, and then carrying out the ordered treatments. If students complete these behaviors, the patient recovers. Content validity for the HFSCET was previously established by an extensive literature review and content expert recommendations. Interrater reliability improved from r ¼ .73, .76, and .78 to .84 after extensive item revision and testing with 144 student nurses (Aronson, Glynn, & Squires, 2011a). A second study with 60 undergraduate students assessed the relationship between observed and videotaped ratings with the HFSCET (Aronson, Glynn, & Component Processes of Social Learning Theory Integrated into Role-Modeling Intervention Motor Reproduction Processes Attentional Processes Retention Processes Nurse actor perceived by participants as expert nurse promotes attention to modeled behaviors. Visual performance of expected behavior by expert nurse enhances images of modeled behaviors. ‘‘Practicing Out Loud’’ by participants promotes verbal coding of modeled behaviors. Verbal reinforcement of expected behavior by faculty researchers promotes verbal coding of modeled behaviors. SU Nursing Research Methods DQ

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