Nursing Practicum Project Example NR 621 on New Registered Nurses Feeling Unprepared for Practice

Nursing Practicum Project Example NR 621 on New Registered Nurses Feeling Unprepared for Practice

Nursing Practicum Project Example Nr 621 On New Registered Nurses Feeling Unprepared For Practice
Nursing Practicum Project Example NR 621

This assignment aims to discuss a current educational issue in nursing practice.  We will discuss new registered nurses feeling unprepared for clinical practice.  This issue will be presented in a PICOT format and will include a theoretical framework that will support the issue as well as the intervention proposed to tackle this educational issue.  This assignment will also provide a summary, synthesis of the literature, evaluation plan, and conclusion. 

Educational Issue

The educational issue that I have identified is that new registered nurses do not feel prepared for clinical practice therefore we need more effective teaching methods in educating and training new registered for clinical practice.  As per Halloran et al 2023, there are various reasons that new nurses feel unprepared for clinical practice such as ideals taught in school are not the reality leading to unanticipated expectations, challenges with patient loads, and lack of confidence which is needed to handle some situations. 

Feeling unprepared for clinical practice whether it be from feeling that orientation was too fast or short, the unexpected reality of patient workload, and the nursing practice can leave a nurse unprepared for dealing with an emergency such as hypoglycemia.  This affects their skills, decision-making, and prioritizing which affects patient care and safety, and studies have shown that an educational approach such a simulation exercise can enhance confidence, provide more realistic expectations and provide the skills necessary to effectively handle patient workload and emergencies.

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Implications of the Issue

The issue identified greatly impacts learners and their organization as this issue negatively impacts patient care and safety.  When patient care is not high quality and safe the organization can obtain a bad reputation and no one will seek medical care from them resulting is financial lose ad accreditation issues.  Learners are also impacted negatively as this can cause them to resign, jeopardize their license by making errors and not being able to provide high quality and safe care to patients. 

New nurses are not prepared for the real work environment as studies show that undergraduate nursing courses are insufficient, and factors such as the gap between theory and practice, lack of clinical experience, lack of knowledge, fear of harming patients and lack of confidence can result in stress which are directly related to nursing errors.  Providing new nurses with simulation experiences can reduce the gap between theory and practice, provide them with real expectations, provide clinical practice in a safe environment without fear of harming patients and boost confidence as well as enhance collaboration. 

Project Question

With new registered nurses does simulation learning compared to conventional educational methods such as a classroom lecture strengthen clinical skills and boost confidence helping them feel better prepared for clinical practice within eight weeks.  New registered nurses will participate in a mock patient scenario through a simulation learning exercise and it will be compared to a conventional education method.  The outcome I plan on achieving is for new registered nurses will feel more confident and better prepared to practice.

Theoretical Framework

The theory that I believe best aligns with and supports my project is Benner’s Novice to Expert Theory.  This theory explains that nursing knowledge is acquired through research and clinical experiences.  This theory identifies five stages of nursing development (novice, advanced beginner, competent, proficient and expert) and is able to assess the nurse’s needs during these five stages.  As per Sterner et al 2012, this theory presents that nursing skills and understanding of patient care are developed over time, with proper education and with a multitude of experiences.  Providing simulation exercises can provide the new registered nurse with a multitude of clinical experiences in a safe learning environment. 

Educational Intervention

The educational intervention that I have chosen to help new registered nurses feel better prepared for clinical practice and boost their confidence is to have them participate in a simulation learning exercise.  Simulation learning is a mock scenario of a realworld event or experience.  Simulation learning provides students with scenarios that they will encounter in real-world practice.   This teaching strategy is very beneficial and is utilized for various reason which include developing critical thinking skills, procedural competencies, promote teamwork, communication and improves knowledge retention. 

Another benefit of this learning strategy is that it provides immediate feedback on what was done correctly and what could have been done better.  It can reduce the gap between theory and practice.  According to Koukourikos et al 2021, simulation learning enhances learner’s self-esteem, confidence, promotes critical thinking, provides immediate feedback, reduces the gap between theory and practice, promotes teamwork, communication and provides learners with a more real expectation nursing practice.  It provides learners a safe environment to practice and develop their skills without fear of causing harm to patients. 

Summary

This paper aims to identify an educational issue in nursing practice: the need for better effective teaching methods in educating and training new registered nurses to feel better prepared for clinical practice.    We will discuss new registered nurses feeling unprepared for clinical practice.  The research question is presented in a PICOT format and was developed to evaluate the effectiveness of simulation learning which is the intervention of this project as compared to the effectiveness of a conventional learning strategy which will be a classroom lecture.  The simulation learning will comprise of a mock scenario involving a hypoglycemic patient. 

The objective is to better prepare nurses for clinical practice and boost their confidence.  This paper will also discuss a synthesis of current research that aims to establish that simulation learning is more effective than conventional learning in new nurses being confident and feeling better prepared for nursing practice. 

The theory was selected because it best aligned with the topic of this paper was Benner’s Novice to Expert Theory.  This theory aligns with this paper as according to Nyikuri et al 2020, this theory states that hands on experience, and exposure to various clinical scenarios and various patient conditions contribute to the acquisition of experience, knowledge, critical thinking and technical skills which are imperative for good effective clinical judgement.  Acquisition of the above attributes will better prepare new nurses for practice and instill confidence.  This paper will also discuss an evaluation plan and provide a conclusion. 

Synthesis of the Literature

This section of the paper will discuss what a literature review is and the purpose of a literature review.  We will also discuss how the literature review was conducted and the type of articles that are being used for this paper.  We will discuss a few themes that were identified within the research articles examined for this paper. 

A literature review is a comprehensive analysis of existing literature on a specific topic.  A literature review has various purposes.  The purpose of this literary review it to provide an overview of the research collected on the topic of the practicum project. It also helps the readers understand the background and significance of the literature collected and the connection to topic of the practicum project.  The last purpose of this literary review is to present strong evidence from prior studies that align and support the practicum project topic. 

The literature review was conducted utilizing various databases such as PUBMED, Medline, CINAHL, Web of Science, EMBASS, Science Diet, EBSCO and google scholar as well as Chamberlain University’s library.  Various key words such as registered nurses, simulation learning, conventional educational methods, clinical skills, confidence, clinical practice and preparedness were used and also combined into short phrases such as how simulation learning influences the clinical skills, preparedness of new registered, simulation learning compared to traditional classroom lecture methods, simulation based education vs. traditional education in nursing, alternative teaching strategies/methods, new registered nurse feeling unprepared for practice/clinical practice and registered nurses with lack of confidence, gap between classroom knowledge and clinical practice, impact simulation learning on nursing skills and confidence. 

These are a few of the keyword and phrases that were utilized conducting this literature review.  The search for information for this paper resulted in various peer reviewed, scholarly articles and journals within the past five years being selected as part of this paper.  The themes identified within these journals and articles are effects of Simulation Learning, theory-Practice Gap and how Evidence-Based Effects Training.  Please refer to Appendix A.

Effects of Simulation Learning

The articles used in this assignment state that simulation learning has various advantages and positively impacts learning.  Simulation experiences are a very valuable educational tool.  Using simulation learning positively affects student’s knowledge retention, critical thinking, and judgement which results in high quality, safe patient care and optimal patient outcomes.  “This educational teaching method boosts nurse’s confidence, improves knowledge retention, helps developing critical thinking skills, increase procedural competencies, promote teamwork, and communication. 

As per Williams 2024, studies have proven that using simulation learning not only provides students with a safe environment to practice it also increases confidence, enhances clinical judgment, improves patient safety, optimal patient outcome and has a positive financial effect on the organizations.  As per Sterner et al 2023, simulation learning promotes teamwork, it helps learners develop effective communication skills, prioritizing, helps learners to better understand their roles and gain experience in taking charge and delegating responsibilities in an acute situation.

Theory-Practice Gap

“The biggest challenge facing nursing as an academic field is the theory-practice gap, which is a universal issue in nursing (Saifan et al, 2021).”   This theory is the difference between what is learned in the classroom and the reality of clinical practice.  New registered nurses are usually over whelmed and lost when they enter the real world of clinical practice.  This is due to the different expectations of their role and practice learned in nursing school and the real world of nursing practice. 

This gap is also caused by the limited hands-on learning experiences and lack of dealing with complex situations in nursing school.  Thus, when a new registered begins their practice, they struggle with applying the theorical knowledge to a real-world situation.  Simulation learning provides new registered nurses with a more real expectation of their role and their practice by providing them with a multitude of various scenarios that are close to real-world experiences.

It helps new registered nurses learn how to bridge the gap between theory and practice and correctly apply the learned theory to real-world situations.  The difficult struggle of applying theoretical education into practice which new nurses face when beginning can result in errors, decline in the quality of patient care, decline in patient safety, ineffective practice resulting in unfavorable patient outcomes and have a negative effect financially on the organization. 

As per Kiernan & Olsen, 2021, using simulation technology as an educational learning strategy allows nursing students to effectively apply their knowledge and skills to transfer theory into clinical practice and helps them to smoothly transition into practice.  According to Sterner et al 2023, simulation learning increases learner’s assessment skills and awareness better-preparing nurses to provide acute care.    Simulation learning boosts confidence, ability to provide safe, quality care and helps to shrink the theory practice gap by helping learners transfer their acquired knowledge directly into practice.  As per Ye et al 2022, simulation learning is an important component of education as it enables the development of various skills including collaboration, and can help close the theory-to-practice gap.

How Evidence-Based Effects Training

Using simulation learning as a teaching strategy provides nursing with an effective way to smoothly transition from the education environment of school to clinical practice.  Using evidence-based practices not only prevents unsafe and ineffective practices but also promotes high quality care, improves patient experience, patient outcomes and reduces health care costs. Research has uncovered evidence that simulation learning is an effective learning strategy that improves knowledge retention.  It promotes teamwork and communication.

It enhances nurse’s clinical skills and critical thinking skill in a safe learning environment where feedback is immediately provided.  “The main findings of this work confirm the importance of clinical simulation, not only for training skills and acquiring knowledge but also for enabling students to develop a better self-perceived EBP (Leal-Costa et al, 2024).” Simulation learning provide learners with real-life experiences teaching evidence-based clinical practices and procedures.  According to Takashiki 2023, simulation learning results in improved application of evidence base practices, procedural skills, increased skills and knowledge retention resulting in achieving mastery with adequate support, time, practice and productive feedback.

Summary of the Literature

The research has identified several themes within prior published literature pertaining to the utilization of simulation learning as a teaching method in nursing education and the impact this teaching method would have on new registered nurse’s confidence and preparedness for clinical practice.  The literature examined has also identified another common theme which is the theory practice gap. 

This theory is the difference between what is learned in and the classroom and the reality of clinical practice.  The literature examined has provided evidence of on how evidence-based training impacts a nurse’s skills and confidence.  The theme theorypractice gap relates to the PICOT question as this issue causes new registered nurses to feel unprepared for clinical practice which is the bases of our question.  The theory of the effects of simulations learning is related to the PICOT questions as simulation is the intervention that part of our PICOT question. 

The theory of how evidence-based effects training is related to our PICOT question as we will be providing evidence-based training to newly registered nurses and the literature examined will support the positive effects of this training.  According to Crownover et al 2024, to closing the theory practice gap it is imperative for educators to incorporate learning experiences that immerse learners in complex real-life situation to provide them the opportunity to develop assessment skills, problem and clinical reasoning skills, collaboration in a safe educational environment to properly prepare new nurses for the real world of practice.  As per Kawase, Y. et al 2024, simulation enhances theoretical and practical reasoning, improve clinical judgment and help nurses learn to stay calm in complex situation.

Intervention and Evaluation Plan

In this section of the paper, we will discuss the short term and long-term objectives of the of project, and the practicum site.  This section will also explain who stakeholders are and briefly discuss the stakeholders in connection with this project.  We will discuss the change model that was selected which best aligns with this project, how the project will be implemented and how the effectiveness of the intervention will be evaluated and briefly touch upon the participants of this practicum project.

Objectives

A long-term objective of the practicum project is to reduce the gap between theory and practice and provide the nurses with an expectation that aligns with the reality of the nursing role making them feel better prepared for clinical practice.

A short-term objective of the practicum project is to enhance nurse’s confidence by strengthen their technical skills and critical thinking skills. 

Achieving these objectives positively impacts the nurse’s performance but also impacts patient safety, patient outcomes and overall patient care and over all well-being.  A confident, knowledgeable proficient nurse in turn provides meticulous patient care which improves patient safety, satisfaction and patient outcomes.

Description of the Practicum Site and Stakeholders

The practicum site is a medical facility that provides various inpatient and out-patient healthcare services to the local and neighboring communities and have been providing these services for over a decade.  The facility houses various disciplines that work together to provide the best quality and safest care to achieve optimal patient outcomes.  The facility offers medical care spanning from emergency room services to surgery to rehabilitation and much more.  Besides the facility providing meticulous patient care and service it also focuses on educating new nurses and various other new members of the healthcareprofession. 

 Stake holders are anyone who has an interest in an organization’s operations or its performance or anyone who will be affected by an organization’s operations or its performance.  Stakeholders could be internal or external and include employees, customers, investors, suppliers, governments, and communities.  Some of the stakeholders in relation to this practicum project include administration and leadership who are responsible for procedures being integrated into practice.  Also, the nurse educators, mentors and preceptors who not only provide guidance and support novice nurses through their training but throughout their nursing career and all employees.   

The local and neighboring communities are also stakeholders as they are our patients and they are affected by the operations and performance of the medical facility.  They depend on the facility for quality and safe healthcare and as new registered nurses gain experience and procedures and polices improve so will the medical care and patient outcomes.  Additional stakeholders to this practicum project would be anyone with an interest in the organization or anyone who will be affected by its operations or performance.  The participants of the practicum will be the employees participating in the residency program which consist of new registered nurses from all specialty areas of the medical facility.  The participants will vary in age, race, and culture.  The group will either consist of all females or contain a combination of male and female participants. 

Change Model

The change model that was selected for the practicum project is Kotter’s Eight Step Change Model which was developed by John Kotter in 1995.  This model is a framework for managing change in organizations. Developed by Harvard Business School professor John Kotter, the model consists of eight steps that guide leaders through the process of implementing successful change initiatives. The model has been applied in a variety of contexts, from healthcare to education to business, and is effective in facilitating change. This model offers organizations a systemic approach to successfully and smoothly implement change.  John Kotter indicates that if you complete the steps of his change model in the exact order you will be successful in achieving your desired change. 

First there must be a need and an urgency for change.  A group of influential people are needed to lead the effort to achieve the change, there must be a clear vision of the change and strategy to implement the change.  It is important to communicate the vision to all stakeholders and to support the employees for acceptance of the change and to ensure a smooth transition.  It is important to share and celebrate success no matter how small.  It is also important to build upon the change and to incorporate the change into the organizational culture, policies and procedures. 

Although no change model guarantees success, it has been indicated that Kotter’s eight step change model has been successful in implementing organizational change.  There is an urgency as organizations expect new registered nurses to hit the ground running and in reality, they are unprepared for clinical practice in the real realm of practice.  Change is a process that takes time and patience to successfully implement.  I chose the change model as I feel it provides the best strategy and support to implement change. 

Kotter’s change model best aligns with the practicum project as it states that an urgency for change is needed and organizations want and require new nurses to hit the ground running when they onboard with the organization.  This creates an urgent need for the change.  Employees at any level of the organization can sabotage a change initiative for various reasons.  For any change to be successful you must have a clear vision of the change as well a plan to guide the change process.  This will help in communicating the need and the steps to everyone affected by the change.  This will help those affect to understand the need and the change process. 

It is also important to provide resources and to include all employees to help facilitate the acceptance of change.  When people understand the reason and the process of the change and they are included they will be more willing to accept the change.  This will provide you a group to lead the change effort.  Successful change is not done from the top down, a successful change includes all levels of the organization and is driven at all levels.  This model also mentions short term wins.  This is important because change does not happen overnight and you should celebrate your progress.  When you celebrate progress even small steps you are highlighting achievement when boost confidence and enhances motivation to go further and do more.   To be successful in implementing change it is also important to ensure that the change is embedded into the organization’s structure, systems and culture.  This is done through policies and procedures.  It is also important to embed them into the organization by reinforcing the benefits and rewards of the change. 

Please refer to Appendix B.

Implementation Plan

New registered nurses from the residency program will participate in a simulation learning experience.  The participants will complete a short survey prior to completing the simulation exercise.  After completing the surveys, the participants will proceed into the simulation lab where the they will participate in a simulation learning experience replicating a hypoglycemic event.  After the simulation learning experience is completed, they will participate in a debrief and return to the classroom where the participants will complete a short survey regarding the simulation intervention and their learning experience.  Please refer to Appendix C and Appendix D.

Evaluation Plan

A survey or questionnaire is being created to assess the participants perceptions of the effectiveness of the simulation learning experience.  A survey will be distributed before and after the intervention which is the simulation learning experience.  The surveys will be completed, collected, compared and analyzed.  The pre and post surveys will collect information from the participants on the effects of the interventions and their learning experience.  Please refer to Appendices E (Learner Survey).

Results

This section of the paper will discuss projected quantitative results.  It will discuss sample size as well as demographics.  We will also briefly discus qualitative data.  The completion of this project will show that simulation learning is a more effective teaching strategy than conventional educational methods such as a classroom lecture.  The results will prove that simulation learning experiences help nurses feel better prepared for clinical practice by boosting their confidence and strengthening their clinical skills.  Simulation learning experiences provides nurses with realistic expectation of their role and practice as they are provided with a multitude of real-world experiences that helps them transition smoothly into their roles.  The sample size is estimated to be between ten and twenty participants.  The demographics of the participants are currently unknown as the residency program will not begin for a few weeks.  It is estimated that the majority of the participants will be females varying in age and may contain a few males. 

Quantitative Results

The proposed numeric data from the proposed evaluation tools are described here. Table 1 shows the estimated number of participants, the age range of participants and the    ratio of male nurse to female nurses.

Table 1

Means and Standard Deviations for Response Rates (Course Delivery Method by Evaluation Year)

ParticipantsSample Size                  Ages          Gender
 Male Female

Newly Registered            10-20                         Varied                      1-2                8-10

Qualitative Results

Qualitative analysis will offer a more realistic perspective of the participants experience with simulation learning and their perceptions.  A survey will be conducted to obtain the results on how effective simulation intervention and the participants learning experience which will be compared to conventional educational method such a class room lecture.  The surveys will gauge the participants preference, satisfaction and knowledge retention as well as their feeling of being better prepared for clinical practice utilizing simulation learning.    The qualitative results will be obtained from surveys completed by all participants. Subjective data are described here. This can come from open-ended questions and participant comments.

The simulation learning experience will prove to be a more effective learning strategy to better prepare new registered nurses

for clinical practice.  It will boost their confidence and strengthening their clinical skills.  Simulation learning experiences will also provide them with a realistic expectation of their role and practice as they are provided with a multitude of real-world experiences in a safe learning environment.

Evaluation of the Intervention

The objectives of the project align with the PICOT question which is to determine if simulation learning boosts the confidence of new registered nurses and helps them feel better prepared for clinical practice.  The intervention will prove to improve knowledge retention, boost confidence, strengthen clinical skills, improve communication and collaboration as well as reduce the theory practice gap and help new nurses feel better prepared for clinical practice. 

Project Limitations

Some limitation I anticipate at the moment are sample size as currently it is estimated to be between ten and twenty participants.  Another limitation I may encounter during this project is comprehensive diversity regarding their backgrounds and level of experience.  Time may present to be an issue depending on how many participants commit to participating in the simulation learning experience.  If there are over ten participants providing extra time to have everyone participate in an experience will be an issue.  Size of the simulation lab can also be a limitation depending on how many participants attend.  Equipment as well as technology issues could be limitations to the project.  Another limitation is availability of the simulation lab. 

Discussion

This section of the paper will discuss how this project may affect theory development.  It will also discuss the need for further research.  This paper will discuss how the results of this project may affect nursing education and nursing clinical practice.

Implications for Theory Development

Simulation is used in theory development.  Simulation is used to test and experiment with theories.  Theory dictates when and how to use simulation methods in theory development.

Implications for Further Research

There are implications for further research as simulation learning helps determine effective training methods.  In healthcare it contributes to understanding and improving patient outcomes, reducing medical errors and improving patient care.  Simulation learning offers various opportunities for research and practical applications.  It also can enhance educational practice and teaching methods. Further research can apply the findings to a larger population

Implications for Teaching and Clinical Practice

These positive findings have a direct effect on nursing education and clinical practice.  By having nursing students participate more in simulation learning experiences nurses are better prepared for clinical practice.  Simulation learning is a much more effective learning strategy.  It improves knowledge retention, provides nurses with a more realistic expectation of their role and clinical practice.  Simulation learning will produce nurses that are more confident, competent and better prepared for clinical practice.

Conclusion

The goal of this practicum project was to help newly registered feel better prepared for clinical practice through more effective teaching methods.  With new registered nurses does simulation learning compared to conventional educational methods such as a classroom lecture strengthen clinical skills and boost confidence helping them feel better prepared for clinical practice within eight weeks.  New registered nurses will participate in a mock patient scenario through a simulation learning exercise and it will be compared to a conventional education method.  The outcome I plan on achieving is for new registered nurses will feel more confident and better prepared to practice.

Benner’s Novice to Expert Theory aligns with this paper as a hands-on experience, exposure to various clinical scenarios and various patient conditions contribute to the acquisition of experience, knowledge, critical thinking and technical skills which are imperative for good effective clinical judgement.  These attributes will better prepare new nurses for practice and instill confidence.

The research obtained and examined for this project has identified several themes within prior published literature pertaining to the utilization of simulation learning as a teaching method in nursing education and has supported the positive impact this teaching method boosting confidence and better preparing new nurses for clinical practice. 

The practicum site is a medical facility that provides various inpatient and outpatient healthcare services to the local and neighboring communities.  The stakeholders are anyone who can be or is affected by the organization’s performance or operations.

The change model chosen for this project is Kotter’s eight-step change model.  This model was chosen as it offers organizations a systemic approach to successfully and smoothly implement change. 

This project will be implemented by beginning with participants completing a survey, participating in a simulation experience and completing another survey.  All information gathered for the surveys and the simulation learning experience will be compared and evaluated. 

The quantitative and qualitative results from this project along with the evaluation of the interventions will prove that simulation learning is a more effective teaching strategy that boosts confidence and better prepares new registered nurses for clinical practice.  The limitations anticipated with this project are time constraints, sample size, room to accommodate a large and sample size. 

There are implications for theory development as theory and simulation learning are connected.  Theory dictates when and how to use simulation methods in theory development.  There are implications for future research as simulation learning helps determine effective training methods.  In healthcare it contributes to understanding and improving patient outcomes, reducing medical errors and improving patient care.  Simulation learning is a much more effective learning strategy.  It improves knowledge retention, provides nurses with a more realistic expectation of their role and clinical practice.  Simulation learning will produce nurses that are more confident, competent and better prepared for clinical practice.

References

  • Crownover, J. , Connolly, T. & Beaton, M. (2024). Bridging the Preparation-Practice Gap. Nurse Educator, 49 (2), E101-E102. doi: 10.1097/NNE.0000000000001549.https://oce-ovid-com.chamberlainuniversity.idm.oclc.org/article/00006223-202403000-00024/HTML
  • Kiernan LC, Olsen DM. Improving clinical competency using simulation technology. Nursing. 2020 Jul;50(7):14-19. doi: 10.1097/01.NURSE.0000668448.43535.4f. PMID: 32472824; PMCID: PMC8130000.
  • Kawase, Y., Takahashi, S., Okayasu, M., Hirai, Y., & Matsumoto, I. (2024). Effectiveness of a Simulation-Based Education Program to Improve Novice Nurses’ Clinical Judgment Skills. Curēus (Palo Alto, CA), 16(6), e61685-.https://doi.org/10.7759/cureus.61685
  • Leal-Costa, C., Carrasco-Guirao, J. J., Adánez-Martínez, M. G., Ramos-Morcillo, A. J., Ruzafa-Martínez, M., Suárez-Cortés, M.,
  • Jiménez-Ruiz, I., Molina-Rodríguez, A., & Díaz-Agea, J. L. (2024). Does Clinical Simulation Learning Enhance Evidence-Based Practice? A Quasi-Experimental Study Involving Nursing Students. Clinical Simulation in Nursing, 87, 101494-.https://doi.org/10.1016/j.ecns.2023.101494
  • Saifan, A., Devadas, B., Daradkeh, F. et al. Solutions to bridge the theory-practice gap in nursing education in the UAE: a qualitative study. BMC Med Educ 21, 490 (2021). https://doi.org/10.1186/s12909-021-02919-x
  • Sterner, A., Nilsson, M. S., & Eklund, A. (2023). The value of simulation-based education in developing preparedness for acute care situations: An interview study of new graduate nurses’ perspectives. Nurse Education in Practice, 67, 103549–103549.https://doi.org/10.1016/j.nepr.2023.103549
  • Sterner A, Ramstrand N, Palmér L, Hagiwara MA. A study of factors that predict novice nurses’ perceived ability to provide care in acute situations. Nurs Open. 2021 Jul;8(4):1958-1969. doi: 10.1002/nop2.871. Epub 2021 Apr 2. PMID: 33798279; PMCID: PMC8186698.
  • Takashiki, R., Komatsu, J., Nowicki, M., Moritoki, Y., Okazaki, M., Ohshima, S., Hasegawa, H., Nomura, K., Ouchi, G., Berg, B. W., Shirakawa, H., Nakayama, K., & Takahashi, N. (2023). Improving performance and self efficacy of novice nurses using hybrid simulation based mastery learning. Japan Journal of Nursing Science : JJNS, 20(2), e12519-n/a. https://doi.org/10.1111/jjns.12519
  • Williams, N. (2024). The Effect of Preventable Harm Simulation on Entry-Level Nurses’ Clinical Judgment. Nurse Leader, 22(3), 279–284 https://doi.org/10.1016/j.mnl.2024.03.002
  • Yeh, S., Chiu-Tzu Lin, Li-Hsiang, W., Chun-Chih Lin, Chen-Te, M., & Chin-Yen, H. (2022). The Outcomes of an
  • Interprofessional Simulation Program for New Graduate Nurses. International Journal of Environmental Research and Public Health, 19(21), 13839.    https://doi.org/10.3390/ijerph192113839

Appendix A Research Summary Table

Author (Date)DesignSample/SettingFindingsMeasures (Outcomes)Limitations/Evidence Level
Crownover, J. , Connolly, T. & Beaton, M.  March 2024Literature Review/ Simulation ActivityClassroom Setting/ NGRNsImmersing students in authentic & complex clinical  situations, is an innovative approach in preparing the next generation of nurses for the true realities of practiceStudents revealed a vast improvement in recognizing symptoms & improved skills & attention to detail & students were better able to discern the critical nature of the symptoms and determine the appropriate actions.None discussed in article
Kiernan, L. C., & Olsen, D. M. July 2020QuantitativeJunior and senior year students in a baccalaureate program from rehabilitation centers & different hospitals environments in rural areas.Improvement in patient safety, critical thinking, communication and improved comprehension of patients rights.Noted improvement in various areas of competenceInformation gathered is only from junior & senior students in a BNS program & only 1 university was included in the study.  This study may not be suitable to apply to other programs such as RN to BSN.
Kawase, Y., Takahashi, S., Okayasu, M., Hirai, Y., &Qualitative/ descriptiveNovice nurses on a hospital wardEnhanced clinical judgment.Increased theoretical & practical reasoningOnly one hospital was included and only novice nurses
Matsumoto, I. June  2024     
Leal-Costa, C., Carrasco-Guirao, J. J., AdánezMartínez, M. G., Ramos-Morcillo, A. J., RuzafaMartínez, M., Suárez-Cortés, M., Jiménez-Ruiz, I., Molina-Rodríguez, A., & Díaz-Agea, J. L. Feb 2024Quasi- ExperimentalThird-year undergraduate nursing students  from medical & surgical units of a hospitalIncreases EBP knowledge & skillsIncreased evidence-based practice competency which improves quality of patient care.A local study with no control group
Saifan, Ahmad ; Devadas, Briliya ; Daradkeh, Fares ; Abdel-Fattah, Hadya ; Aljabery, Mohannad ; Michael, Lintu Maria Sept 2021Qualitative studyStudents in a BNS program from FCHSNeed was identified for multifaceted nursing education and an understanding of clinical environment, collaboration & a incorporating evidence-based strategies practices to prepare learners for the reality of the clinical environmentTheory is important as practice is based on theory & they can’t be separatedHomogenous nursing students from one nursing university
Sterner A, Ramstrand N, Palmér L, Hagiwara MA. Feb 2020Exploratory crosssectionalNovice nurses from various parts of Sweden from with somatic care experiencesPCAS scale is a validitySimulation enhances assessment skills in better preparing nurses to provide acute careParticipants were required to submit their answers by pressing a button & If the button was not pressed no answer was submitted
Sterner, A., Nilsson, M. S., & Eklund, A. Feb 2023Qualitative exploratory studyNew graduate nurses with less than four months of work experience in the southwest of SwedenNew graduate nurses expressed a need for interprofessional simulation training which will provide a comprehensive understanding of an acute situation.Scenarios create an opportunity to embody the knowledge that was learned from education and previous situations and work experience.psychometric properties were not subject to testing
Takashiki, R., Komatsu, J., Nowicki, M., Moritoki, Y., Okazaki, M., Ohshima, S., Hasegawa, H., Nomura, K., Williams, N. June 2024Educational intervention, Second year clinical novice nurses from an acute care environment working in a hospital located in Northern JapanUsing simulation learning as an educational strategy for clinical education an ongoing education can assist closing the theory to practice gap which is applying classroom education to clinical practiceSimulation learning improves patient care, patient outcomes, nurses performance,  clinical procedures, reduces errors and lower medical costsSample size is small as partakers were selected from a single group and a single facility
Williams, N. June 2024A pre & post-test study with an LCJR tool.Nurses with less than 12 months of clinical experience, working in acuteSimulation scenarios that are based on a clinical judgment model isClinical judgment outcome measures remarkably increased.  PatientSample size is small as participants are from one facility
  care facility in the Midwest U.S., and participating in the organization’s nurse residency programimperative in facilitating enhanced clinical judgment and clinical behaviorssafety improved patient safety, enhanced application of evidence-based practice, improved patient outcomes, and a positive financial effect on the facility 
Yeh, S., Chiu-Tzu Lin, Li-Hsiang, W., Chun-Chih Lin, Chen-Te, M., & Chin-Yen, H. Oct 2022Qualitative design using a pre-test and post-testHospital /a single group of newly graduated nurses over 20 years oldImproved assessment skills, enhanced critical thinking skills improving patient safety.Simulation learning greatly enhanced nursing ability to integrate healthcare skills, enhanced awareness of humanity issues, and better deal with stressful and complex situationsSmall sample size as only one group of nurses from one hospital were included.  There was no control group without simulation training.  Study conducted over a year.

Appendix B

 Change Model
 Kotter’s 8 Step Change Model
1.Create Urgency:Highlight the need for change and the importance of acting immediately.
1.Form a Powerful Coalition:Assemble a group of influential people to lead the change effort.
2.Create a Vision & Strategy:Develop a clear vision to guide the change process.
3.Communicate the Vision Change:Ensure that everyone understands and accepts the vision and the strategy.
4.Empower Employees for Action:Provide necessary resources to facilitate acceptance of change.
5.Create Short-term Wins:Achieve and celebrate small, early successes to build momentum.
6.Build on the Change:Leverage early successes to drive deeper changes.
7.Anchor the Changes in Corporate Culture:Reinforce the changes by embedding them in organizational culture and practices.

Appendix C Teaching Plan

Making New Registered Feel Better Prepared for Clinical Practice

Target Audience:  New Registered Nurses

Learning Need/Description of Audience: New Registered Nurses in the Residency Program

Lesson Objective(s)Topical Outline (Approximate Time Allotted)Instructional Method with rationale for selectionLearning Resources/MaterialsMethod of Evaluation*
Instructional MethodRationaleStudent AssignmentInstructor Preparationa. Test of knowledge:
b.Survey about the presentation:
At the end of the simulation learning training new nurses will feel better prepared for practice30 minutesSimulation ScenarioThis teaching method is more effective and feedback is providedStudents will perform a   simulation scenario & complete a surveyCreate survey & Mock Scenario       a.   Pre survey
       b.   Post survey
   immediately   
At the end of the simulation learning training new nurses will feel more confident30 minutesSimulation ScenarioThis teaching method is more effective and feedback is provided immediatelyStudents will perform a   simulation  scenario & complete a surveyCreate survey & Mock Scenarioa.pre survey
b.post survey
At the end of the simulation learning training new nurses will be able to identify symptoms of hypoglycemia30 minutesSimulation ScenarioThis teaching method is more effective and feedback is provided immediatelyStudents will perform a simulation scenario & complete a surveyCreate survey & Mock Scenario      a.   Pre survey
b.post survey
At the end of the simulation learning training new nurses will be able to identify signs of hyperglycemia30 minutesSimulation ScenarioThis teaching method is more effective andStudents will perform a simulation scenario & complete a surveyCreate survey & Mock Scenarioa.pre survey
b.post survey
b.
   feedback is provided immediately   

Appendix D

Simulation Scenarios

The simulation scenario will replicate a hypoglycemic event.  The students will need to recognize the signs and symptoms of hypoglycemia.  They will need to know the organizations hypoglycemia protocol and follow it.  They will need to work as a team, collaborate and communicate in order to care for the patient properly.  The simulation experience will prove to be effective in helping nurses feel better prepared for clinical practice and boost their confidence.

Mrs. Merri is a 70 year old female.  Past medical history: former smoker quit 10 years ago; HTN, DM 2,  UTI s/p IV antibiotics, CVA.  She is on metoprolol 25mg daily & lispro sliding scale with 5 units schedule pre-meal lispro & 25 units of lantus at HS.  Mrs. Meri is here for acute rehab following a recent CVA.  Patient in on minced & moist diet with thin liquids. Patient has poor PO intake as she does not like the food and requires assistance to eat. 

At bedside report the patent tells you to shush & leave.  Shortly the therapist comes to you and says Mrs. Merri seems lethargic this morning but is refusing therapy.  You go in and assess the patient she appears to be ok.  She opens her eyes half way, she says get out and shoos you away.  Shortly after you go back you notice that Mrs. Merri is lethargic.  You attempt to wake her up but she is not opening her eyes, just a slight groan.  You notice that the patient does look well.  She responds to a sternal rub.  Her vitals are WNL.  You check her blood sugar and it is 65.  

What do you do?    Correct action is to recheck her blood sugar.  Result is 62.  What do you do next?

According to policy activate the hypoglycemia tree & notify MD. 

Pt is awake enough at this time to safely take po fluids.   Apple juice of 4oz given.   Document.   Patient is rechecked in 15 minutes & result is 72.  Per policy 4oz additional ounces given.  Recheck in 15   results is

85.  Per policy given addition 4oz of juice.  Recheck in 15.   Pt rechecked results 100.

As per policy no further treatment document event correctly.

Appendix E Learner Survey

Pre-Simulation Survey:

  1. What types of learning do you prefer?
  2. What prior knowledge do you have regarding hypoglycemia?
  3. What areas of hypoglycemia do you struggle with the most?
  4. What do you hope to learn from this simulation experience?
  5. Please rate how confident do you feel handling a hypoglycemic event?  

Not          slightly           moderately                             Very confident     confident          confident          confident      confident

1           2                    3                           4                5 

Post Simulation Survey:

  1. Were the simulation roles well explained prior to the simulation learning?
  2. Was the simulation scenario explained well prior to the simulation learning?
  3. Did the simulation learning help you feel better prepared to handle a hypoglycemic event?
  4. Did you receive the support you needed during the simulation Learning?
  5. How satisfied were you with your educator Catherine Francavilla?

Not                   Slightly             Moderately                                            Very

Satisfied          Satisfied              Satisfied                Satisfied                Satisfied

      1                     2                           3                            4                           5

  • How could the quality of this learning experience be improved?
  • How satisfied are you with simulation as a learning experience?

Not                  Slightly                 Moderatley                                             Very

Satisfied          Satisfied                Satisfied                       Satisfied            Satisfied

  1. 2                             3                                   4                       5
  2. How confident do you feel handling a hypoglycemic event after the simulation?

Not               Slightly                  Moderately                                            Very

Confident     Confident               Confident                Confident              Condifent

  1. 2                             3                               4                             5