Simulation Module for Patients with Hypoglycemia

Simulation Module for Patients with HypoglycemiaDevelopment and valuation of Simulation Module for Patients with HypoglycemiaINTRODUCTIONBackgroundHuman unhurried simulator (HPS) has been used in medical didactics (Alinier, Hunt, Gordon, Harwood, 2006) for al about four decades. Since framework utilize high-fidelity has begun by applying crisis intervention occupying on suck up anesthetist (Fletcher, 1995), over the past 10 years, exemplar has been rapidly spread out in c be for education (Dunn, 2004).Simulation education is not skillful closely obtaining simple knowledge and techniques but rather have been considered as a kind of new education mode that digest train nurse care might by reproducing solid-like clinical federal agency in a safe environment (Hodge, Martin, Tavernier, Perea-Ryan, Alcala-Van Houten, 2008 Steadman et al, 2006). Moreover, pretension education have been speed up by shortening of the forbearings admission period and modified chances of care for scholars participation due to elevated expectations on the medical staff by the patients.Through excuse education, student await out physical examination directly on simulator and immediately separate physiological changes on the monitor. After implementing the proper intervention, they can get feedbacks from results (Bremner,Aduddell,Bennett, VanGeest, 2006). accordingly education utilize seeming is becoming the most eventful defeat in current breast feeding education as a method acting that can break problem solving ability and critical idea of students in clinical situation (Corbridge, McLaughlin, Tiffen, Wade, Templin, Corbridge, 2008 Feingold, Calaluce, Kallen, 2004).Since a simulation pattern method has been introduced to the nursing practice educating in South Korea ten years ago, many a(prenominal) meditate results on the effect of simulation education have been inform in the area of pediatric nursing (Yoo, 2013 Shin, Shim, lee(prenominal), 201 3), maternity nursing practicum (Kim, Ko, Lee, 2012 Kim, Lee, Chae, 2012 Lee Kim, 2011), psychiatric nursing (Choi, 2012), and critical and emergency care unit (Kim, Choi, Kang, 2011 Kim Jang, 2011). original scenario that can be used in simulation education is not still genuine variously in sub-major nursing areas in Korea. and so case is not appropriate to situation so there is a difficulty of having simulation practice. Especially, diabetes mellitus is prevalent disease in middle ages. However, it can be controlled by both concrete assessment for differentiation and anticipatory management. And because patients with diabetes mellitus should always manage blood glucose in their life, nursing education to foreclose hypoglycemia is essential education essences. In nursing student education, simulation practice for critical thinking training to identify symptoms and plan nursing care as precedingity due to hypoglycemia is effective and important nursing problem.In this translate, we tried to test the applicability of the simulation by growing simulating education scenario based on the case of hypoglycemia and evaluating students performance after using it. The study was d hotshot to improve nursing students critical thinking on nursing problems and clinical decision-making ability by developing scenario with high-fidelity SimMan simulator based on clinical real situation. The purpose of this study is to develop a scenario and evaluate students performance and expiation in simulation learning of care for patients with hypoglycemia.METHODDesignThis study used a mixed method design which captured both vicenary and qualitative data to evaluate degree of performance and satisfaction as development and applying simulation module with hypoglycemia. In disciplines such as nursing, the phenomena canvass are often complex and mixed-method approaches can expand the impact and enhance the flexibility of research designs (Sandelowski, 2000)ParticipantsA convenience sample of 55 nursing students participated from a university located in Seoul, South Korea. We have decided that triplet year nursing students who have enough basic knowledge on pathophysiology entrust not have difficulty in applying simulation education on patient with hypoglycemia and developed simulation scenario targeting them. The inclusion criteria to collide with hypoglycemia included (a) junior nursing students, (b) completion of fundamental and internal secretion system nursing course with the same credits and textbook, and (c) no prior participation in a simulation class focused on diabetes mellitus.The participants ages ranged from 21 to 25 years. The majority of students 89% were women.Ethical conside rationsApproval to apportion this study was obtained from the Sahmyook university institutional review board (SYUIRB-2013-074). Written informed have consist of issues of voluntary participation, anonymity, and confidentiality. It explained the purpose o f study, the researchers credentials, and information regarding confidentiality. Collected data will be managed in the researcher office and will be rip up after coding. The IRB proved that there were no factors to this study that would deprive pitying ethical right, and that all contents and processes confirm to proper research ethics. performance of module developmentScenario developmentContents of scenario were developed based on real patients situation which admitted to emergency unit with blast symptom due to hypoglycemia. In addition, we searched more information on nursing care for hypoglycemia from nursing textbook and protocol. Scenario was focused on developing of students ability round assessment and problem naming by critical thinking. For this, the purpose of scenario formulation was to differentiate the origin of profane symptom between hypoglycemia and increasing of intracranial pressure. For testing of validity, v experts consisted of tierce nursing professor s, deuce nurses who have worked in emergency unit over 10 years reviewed contents of scenario. The scenario was pilot tested using flipper students (not included in the present study) to determine feasibility and clarity of instructions. No problems were identified.Development of evaluation checklistThe evaluation checklist focused on the advance of critical thinking ability rather than implementation skill and was divided into three categories assessment, problem identification, and interventions. Finally, 4 percentage points were deleted and 16 items reached by consensus (Table 1). The items were selected, reviewed, and analyzed by a seven expert panel including two nursing professors, five advanced practice nurses.Process of question question questions were also developed focused on critical thinking as three stage process. Description phase What decision did you make when patient complains dyspnea? wherefore did you do? Analysis phase Did you have an enough understandin g about nursing care for patient with hypoglycemia after this simulation practice? and Application phase How can you cope real nursing situation in future through what you learned?. These three phases for questioning are based on clinical judgment model by tan (2006). After taking simulation practice, students had debriefing time for about 2030 minutes per group of four students. The nursing students were encouraged to strike on their critical thinking.Data collection procedureData were serene from May6, 2013 to June 28, 2013. The studys purpose and its procedures were explained to the participants prior to obtaining informed consent. All participants enrolled in this study voluntarily and anonymously, were made aware that there was no injustice to nonparticipation as well as information regarding confidentiality. In addition, the data would be reported as a whole and not individually. The ratio of participation was 98%.Before the simulation, students received an orientation th at included how to lease the simulator, simulation learning objective, the scenario information, and patients health status. Four nursing students have teamed up to have a discussion of the simulation scenario. Students were asked to erosion uniforms and to treat these as actual professional situations. The simulations were scheduled in simulation rooms in which the high-fidelity patient simulators were used. One operator and one instructor observed the simulations from the control room. Each simulation lasted 20 minutes, with the simulation module including debriefing taking about two hours per group. The evaluation checklist was evaluated as a group and was handed to two instructors in a cockeyed envelope. After simulation module, student satisfaction was measured using the cheer of Simulations Experience (SSE).InstrumentsThe evaluation checklist tool using 3-point Likert scale (1 not fulfill, 2 partially fulfill, 3 fulfill) was a researcher-developed tool designed to assess s imulation-based performance. The high the evaluation checklist nock, the better the performance. Content validity was conducted from nurse educators, simulation experts, and clinicians (n=10). The results of the content validity index were above 80% (Waltz and Bausell, 1981). Inter-rater reliability between two independent raters was established using Cohens kappa.Satisfaction which students felt about simulation practice was measured just after finishing the debriefing session using the Satisfaction of Simulations Experience (SSE) scale developed by Levett-Jones and colleagues (2011). This scale consists of 18 items in the area of debrief and reflection (9 items), clinical reasoning (5 items), and clinical learning (4 items). Each item was scored on a 5-point Likert scale. Higher scores indicated higher satisfaction. Cronbachs alpha coefficient in this study was .94.Data analysisThe evaluation checklist and the SSE were analyzed using SPSS 18.0 for Windows to take descriptive st atistics including reputes and standard deviations. Debriefing data were analyzed using the Matrix Method (Garrad, 2007). Four researchers was analyzed all papers cogitate to debriefing. It were photocopied and organized as a review matrix that, once designate appropriately, would serve as a structured abstract of all of the documents. The 3Cs (i.e., codes, categories, and concepts) of analysis was used to capture key characteristics of interest, thereby summarizing a epic amount of textual information into pissedingful themes (Lichtman, 2006).RESULTScenario of simulation-based hypoglycemiaThe patients case was developed based on scenario objectives and performance measures. The phoney patient was a 55-year-old man admitted via the emergency unit complaining of giddiness and sweating. The algorithm proceeded as follows assessment, problem identification, intervention (Fig. 1).Evaluation ChecklistThe evaluation checklist consisted of three categories and 16 items. To identify a statistical measure of inter-rater agreement for items, Cohens kappa was measured. Cohens kappa for the evaluation checklist was 0.61, good strength of agreement, and each category ranged from 0.33 to 0.97.The mean score of each category and item is shown in Table 1. The mean score is average of numbers of two measurers. The total mean score was 2.68 (.129). The mean score of assessment was 2.56 (.199), problem identification was 2.91 (.193), and intervention was 2.71 (.192).DebriefingStudent comments about the simulation birth were grouped 2 categories, 9 subcategories, and 303 significant statements using content analysis (Table 2). The categories were as followed Self-reflection and Improvement of competency. The most frequent subcategories, in order, were nursing intervention, coping ability deficiency, perception of real situation, clinical thinking deficiency, knowledge deficiency and communication.Satisfaction with simulation experienceThe SSE scale was used to assess part icipation in the simulation experience. The total mean score of SSE was 4.15 (.68). The mean score for debrief and reflection was 4.21 (.58), clinical reasoning was 4.09 (.50), and clinical learning was 4.08 (.46). The highest score item in SSE was I received feedback during the debriefing that helped me to learn, and the last-place was The facilitator made me feel comfortable and at ease during the debriefing (Table 3).