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Nursing student experiences of clinical practice
Factors influencing safety in patient care
Effectiveness of simulation training
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Recommended: Nursing student experiences of clinical practice
It is essential for nursing students to have high-quality educational experiences that prepare them for the skills, critical thinking, and deductive reasoning needed to provide competent patient care. Traditional clinical experiences involve direct patient care in a health care facility. However, many programs are facing clinical challenges such as increased outpatient services, high acuity inpatients, instructor to student ratios unconducive to direct instruction, competition for limited sites, short staffing, quality initiatives, and patient safety initiatives (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).
Clinical simulation enables students to experience the challenges and complexities of caring for patients in a safe learning
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The simulation would be very similar to what I did as a nurse with the mock codes referring to a very common infection that we see in the pediatric population, which is respiratory syncytial virus (RSV). Often times, the patient with RSV can deteriorate rapidly into acute respiratory failure.
For the scenario that I would run with students, they would be admitting an 18-month-old boy with RSV. Upon assessment of the child, you note that he appears to be in distress. His oxygen saturation is 84% on room air, using accessory muscles to breath, respiratory rate 34, and cyanosis around the lips is noted. What would be your first nursing actions that you would take for this patient?
• At this time, I would want students to recognize the signs and symptoms of respiratory distress. Some interventions that I would expect them to take are administering oxygen via facemask, contacting the physician, attaching the child to a heart, respiratory, and sat monitor, calming the family by educating them regarding the situation, and delegating tasks to other team members. Depending on the facility that they are educated in, this would warrant calling a rapid response code as
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(2009). Outcomes of clinical simulation for novice nursing students: communication, confidence, clinical judgement. Nursing Education Research, 30(2), 79-82.
Bastable, S. B. (2014). Nurse as educator: Principles of teaching and learning for nursing practice. (4 th ed.). Burlington, MA: Jones & Bartlett Learning.
Hassinger, A. B., Breuer, R. K., Nutty, K., Ma, C. X., & Al Ilbrahim, O. S. (2017). Negative-pressure ventilation in pediatric acute respiratory failure. Respiratory Care, 62(12), 1540-1549. doi: 10.4187/respcare.05531
Hayden, J.K., Smiley, R.A., Alexander, M., Kardong-Edgren, S., & Jeffries, P.R. (2014). The NCSBN national simulation study: a longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S1-S64. Retrieved from https://www.ncsbn.org/JNR_Simulation_Supplement.pdf
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children. (7th ed.). St.Louis: Elsevier.
Padilha, J. M., Machado, P. P., Ribeiro, A. L., & Ramos, J. L. (2018, February). Clinical virtual simulation in nursing education. Clinical Simulation in Nursing, 15, 13-18.
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Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety ro...
Across the nation many nursing programs are facing clinical site shortages for their students. The hardest hit population is the license vocational nursing (LVN) students. Many hospitals are trending toward achieving “Magnet Status” for their institutions. Therefore, LVN students are no longer allowed to complete their clinical training in several hospitals. This action forces many nursing programs to seek alternative methods of clinical instruction. In years past simulation training was used as an aid to facilitate learning. Today, for many nursing programs scenario based simulation is the only option for learning patient care.
Respiratory distress is related to respiratory impairment which is a life threatening problem. Life threatening problems are high priority and need immediate care.
Conflict often arises between new graduate nurses and experienced staff over the ideal patient care. The realities of practice often turn out to be contrary to what graduates were taught in university (Phillips, Kenny, Esterman, & Smith, 2014). These discrepancies in practices have been shown to create distress and reality shock for new RNs (Gardiner & Sheen, 2016). Reality shock is experienced when the considerate effort is put into preparing for a specific employment and new employee finds the candidate not prepared at all (Harwood, 2011). This often stems as a result of the gap between a theoretical and practical component of an education (Whitehead, 2011). Ortiz discussed that university education does not prepare graduate nurses to deal with the irritated physicians and family members (2016). All these experiences presented together to the newly qualified nurse 's results in reality
... simulations, which range from computer run screen simulations to physical simulations, are helping the medical trainees acquire high edge experiences from repetitive exercises of complex medical procedures. The skills and understanding derived from this kind of training is hopefully expected to improve the actual medical service delivery once the students graduate.
On the other hand, I learned new concepts and terms. Simulation repeats some essential aspects of patient situation so that the situation may be understood and managed when it occurs in real clinical practice. Students in the school of nursing use the simulation learning center to learn and get experience in the field. The simulation is an educational process that requires the learner to demonstrate procedural techniques, decision making, and critical thinking. I learned that a simulation experience allows students to critically analyze their own actions and reflect on their own skill set. As a nursing student, I learned you have to complete clinical hours and practice in the simulation learning center. To become a certified nurse there are many training courses, exams to pass, and in the field experience to complete. Health professionals such as a nurse,
Realistically, most students are not privy to the winding journey of a nursing career. Students learn how to bathe, medicate, feed, assess, and some psychosocial concepts. However, there is no class that teaches or can teach students how to stand back and watch your patients struggle to help themselves, how to face your own mortal...
Nursing students at State University need better clinical experiences and better clinical sites. Clinical sites that have nothing to do or preceptors who don’t want to educate should be cut out and replaced with better sites. Ideally each clinical should allow nursing students to gain experience in critical skills and patient ca...
Tuoriniemi, P. & Scott-Baer, D. (2008) Implementing a high-fidelity simulation program in a community college setting. Nursing Education Perspectives, 29(2), 105-109.
Rozmus, C. L., Jones, D., Meyers, S., Hercules, P., & Schumann, R. (2014). Pacesetter curriculum: An experimental design evaluation of a clinical immersion model for nursing education. Journal of Nursing Education and Practice, 4(6), p60.
It prepares a novice to be able to perform basic skills throughout their career. Learning is related in the classroom by simulation labs and clinical instructors. Educators consider nursing education to be serious. Their role in preparing nursing students is to convey safe practice for patients. They focus on educating students to learn the knowledge of essential care for different patients. New graduates who learn the sufficient knowledge and skills will be able to understand aspects to protect and design for the nurse and patient. Students are taught to recognize safety threats and will understand the significance of reporting errors for future prevention.
Education for registered nurses provides significant benefits to the nursing career and therefore, it is imperative. As a registered nurse, education has influenced my practice at the hospital considerably. One of the major areas influenced by education is caring for patients. As a nurse, caring for patients is one of their primary responsibilities. Education for nurses emphasizes the need to show care and empathize with the patient besides providing competencies and knowledge for the nurse clinician (American Associations of Colleges of Nursing, 2014). While care is something intrinsic, educators strategize on learning situations and teaching designs
Additionally, the clinical staff has shown very low level of confidence in the RR documentation on observation chart. Lack of time, laziness, lack of training and knowledge and unawareness of the importance of the respiratory assessment are main reasons to neglect this important aspect of nursing as stated in this study (Philip, Richardson, & Cohen,
VandenBranden, S. L. (Dec 2010). ‘The role of the nurse practitioner in the case of children with chronic respiratory disorders’. Pediatric Annals, 39 (12), 800-803.
I believe placing student nurses in the clinical setting is vital in becoming competent nurses. Every experience the student experiences during their placement has an educative nature therefore, it is important for the students to take some time to reflect on these experiences. A specific situation that stood out to me from my clinical experience was that; I didn’t realize I had ignored the patient’s pain until I was later asked by the nurse if the patient was in any pain.