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Adults with all levels of hearing loss have faced financial and accessibility constraints in obtaining prescription hearing aids. To increase access to hearing aids, the Food and Drug Administration (FDA) has created a new designation of over-the-counter (OTC) hearing aids for adults with perceived mild to moderate hearing loss. The goal of this article is to describe the incorporation of OTC hearing aid users into established audiology services. A proposed workflow was created by otolaryngologists and audiologists at Johns Hopkins University School of Medicine and is being implemented at outpatient audiology offices. We used published criteria for appropriate OTC hearing aid usage and disqualifying criteria hearing specialists should be aware of. The proposed workflow describes the multiple entry points for OTC hearing aid users seeking access to care and appropriate objectives for these visits. The new FDA ruling has increased the accessibility of hearing assistance devices; however, the varying degrees of retailer support systems could lead to improper fitting and other technical problems for some patients trialing new hearing aids. Our proposed workflow aims to describe the incorporation of established hearing assistance services with the new OTC hearing aid market.

Computer-based virtual simulation in nursing is a rapidly developing field. A summary of current research could benefit nursing faculty who are incorporating this pedagogy into online teaching due to social distancing requirements. This umbrella review aimed to explore the use and effectiveness of virtual simulations in prelicensure nursing education. Our umbrella review approach was informed by The Johanna Briggs Institute guidelines. The 18 included reviews captured the experiences of over 7600 nursing students who engaged with five different virtual (screen-based) simulation modalities. Results indicated that virtual simulations can be effective in developing nursing students' knowledge and psychomotor and psychosocial skills, for example, in medication administration and communication. There was no study that showed a conclusive benefit of virtual simulations for developing clinical reasoning. Students enjoyed virtual simulations, claiming they were accessible, fun, and engaging ways to learn. Many benefits of virtual simulations and some technological challenges were identified in a mapped model. In the future, more rigorous and experimental studies are needed to confirm effects on learning outcomes. Nursing curriculum designers need to define the place and purposes of the pedagogy to ensure that knowledge and skills learned during virtual simulations can be applied to real-world, patient-centered care.

Refereed/Peer-reviewed

Virtual simulation is an interactive teaching and learning strategy used in undergraduate nursing student education, especially since the onset of the COVID-19 pandemic. Few published studies have reviewed the impact of virtual simulation as a strategy for teaching nursing students the elements of evidence-based practice.To describe types of virtual simulation that are relevant to nursing student education and examine how these modalities are applied to teach elements of evidence-based practice.A rapid review of literature was conducted to discern the use and impact of virtual simulation. Thirty-seven studies published between 2017 and May 2021 that addressed nursing students' educational outcomes were reviewed and summarized as a narrative analysis.Virtual simulation and virtual reality simulation engage learners in role-plays via a computer screen or hand-held phone. Various levels of realism and immersion were apparent across different modalities and with the utilization of educational games. Most studies related to the teaching of best practice evidence-based clinical nursing topics. Twenty primary studies reported objective measures of students' improvement such as knowledge, performance, better documentation, or communication accuracy. Sixteen studies that measured knowledge identified significant knowledge gains. All studies endorsed virtual simulation as a teaching method.Virtual simulation approaches offer an innovative and feasible option for teaching nursing students. Such approaches should be included in undergraduate nursing curricula. While it is apparent that evidence-based practice guidelines inform the design of the virtual simulation scenarios, the effectiveness of the modality for teaching specific elements of evidence-based practice to nursing students is not yet confirmed. Nursing curricula need to include ways of teaching nursing students to search for and critically appraise trustworthy sources of knowledge for clinical practice.

Clinical nurse educators within Queensland, Australia, tend to be selected for the job based on their clinical expertise and consequently may lack knowledge of educational theories and practices. Within the Nursing School in which this project was based, there is interest in developing expertise in Transformative Learning theory. To share this knowledge with clinical educators, a workshop was designed using short films produced by the research team that focused on potentially transformative moments in clinical placement settings that the literature and the researchers' experience had shown to be important. As the project developed iteratively through various stages, action research was chosen as the most suitable methodology to research and document the evaluation of this training workshop, which brought together 20 nursing clinical nurse educators. Interpretive data analysis approaches were employed to understand participants' learning experiences resulting from the workshop, which led to four key themes: 1) first encounters with students need to be engaging and energising; 2) teach students how to bracket personal needs so they can provide professional empathic actions; 3) teach students to value both procedural- and person-centred care; 4) a transformative learning pedagogy is useful for clinical nurse educators to frame and enhance their teaching practice. Learning experiences produced using an action research methodology can stimulate clinical nurse educators to engage with and use relevant educational theory in ways that enable some of the more nuanced and affective dimensions of clinical training Refereed/Peer-reviewed

Introduction School-aged children between the ages of 5 and 12 years face new environments and experiences as they transition through grade school. They are still developing and learning as they engage within their home and carry these experiences into their school environment. This study is an assessment of the association between family relations and school outcomes in children 5 to 12 years of age as measured by the field-tested SA-LIBRE5-12 (School-Aged Life Impact Burn Recovery Evaluation), a new parent-reported outcome measure. Methods Within the social and family functioning domain of the SA-LIBRE5-12, 10 family relations and 13 school items were scored on a scale from 0 (Never) to 4 (Always). Scores were re-coded so that higher scores denote better functioning. An exploratory factor analysis (EFA) was conducted to confirm model fit. A regression model assessed the relationship between the school and family factors, controlling for demographic and clinical characteristics (child sex, race, ethnicity, age at survey completion, burn size, burns to critical areas, and pain severity). Results A total of 356 parents completed these items from the SA-LIBRE5-12. EFA resulted in four sub domains of family engagement, family stress impact, school success, and school difficulties. A univariate analysis of the demographic characteristics showed that the child being female (p=0.008) and non-white (p=0.0216) had a better mean score in school success (3.33 vs. 3.19 + 0.78 (SD) and 3.38 vs. 3.21 + 0.75 (SD), respectively). In addition, children with a burn size < 1% had better school difficulties score (3.76 vs 3.61 + 0.38, p=0.0018). Regression analysis showed positive correlations between family engagement and school difficulties (r=0.26, p< .0001), family engagement and school success (r = 0.56, p< .0001), family stress impact and school success (r=0.21, p< .0001) and family stress impact and school difficulties (r=0.49, p< .0001). Conclusions This study indicates that a cohesive family relationship and home life may promote productive school outcomes in children between the ages of 5 and 12 based on parent reported outcomes. Applicability of Research to Practice This research will provide burn care providers, parents, and teachers with greater insight into the relationship between a child’s current family relations and their success in school. Results will guide caregivers in fostering a productive and healthy family environment.

Background: Choirs are an important source of wellbeing for people experiencing palliative and end-of-life care. Threshold choirs are an innovation that could be more widely introduced, as hospital and palliative care settings have become more open to community input. Aims: Before such choirs are recommended and encouraged, evidence for their effectiveness and implementation barriers need to be known. Methods: A literature review was undertaken in 2019 and 2020 using CINAHL, PUBMED, Medline, ProQuest, Google Scholar and an internet manual search. Findings: The review identified a total of 26 research and discussion papers relevant to the topic of choir in palliative care settings. Conclusion: Following the review, guidelines were developed that may be useful to assist choirs and service providers to effectively introduce this valuable initiative. Choirs may be a creative, and uplifting arts-based activity to augment and enrich the culture of person-centred care during palliative care processes.

Introduction Hypermetabolism following a burn injury causes perturbations of key cardiopulmonary and cellular functions which often persist long-term. Patients are advised to increase caloric intake to address this hypermetabolic state. However, potential weight change implications from such blunt strategies are not well studied. We aimed to 1) determine factors associated with weight change from discharge and 2) understand their relationship to other physical and psychosocial measures over time. By doing so, more tailored approaches to healthy weight management could be devised. Methods Adult participants that were enrolled in the Burn Model System (BMS) National Database after 2015 were included in the analysis. Weight was collected and BMI calculated during admission and at 0.5, 1, 2, and 5 year follow-ups. Mixed models included repeated measures controlling for correlated error of the outcomes and were used to assess the association of weight change with demographic, injury factors and psychosocial measures over time. Results A total of 698 individuals were included in the analysis. Median age was 48 years (IQR 33, 59), 218 participants were female (31.2%), median TBSA injured was 10% (IQR 3, 25), and 388 sustained flame injury (55.6%). Median BMI was 26.75 kg/m2 (IQR 23.67, 31.05). During follow-up, 446 participants (64%) had a median weight gain from admission to last follow-up of 2kg (IQR -2, 6.3). There were significant differences in weight trajectory between BMS centers (p=0.0003), which was included in subsequent models. Sex, marital status, and race were not associated with weight change. Increases in burn size (p< 0.0001) and number of months working after injury (p=0.03) were associated with greater weight, while older age at time of injury (p< 0.0001) was associated weight loss. Greater weight gain was associated with higher PROMIS-29 Physical Function (p=0.002) and Neuro-QOL (p=0.03) scores (meaning better) after one year. PROMIS-29 Sleep Disturbance score was associated with weight change only between years 2-5 of follow-up (p=0.029), with higher sleep disturbance score associated with lower BMI. Conclusions Most people living with burn injury experienced a modest weight gain after injury. Weight trajectory was impacted by several demographic factors including age, burn size, and amount time spent working, as well as physical and psychosocial measures (PROMIS-29 Physical Function, Neuro-QOL). Applicability of Research to Practice These factors can be used to inform anticipatory guidance, diet recommendations, and exercise programs for people with burn injury. The impact of tracking weight and health goals with patients in the outpatient settings should be more closely examined.

Introduction Children ages 5 to 12 are in pivotal stages of psychological development as they become more self-aware. Body image can be a formation of both internal experiences and influences from the surrounding environment. This perceived image adapts during this age group and can be negatively impacted by the changes in physical appearance due to the burn injury. Previous research indicates older age and the presence of larger, visible burns can impact body image and self-esteem in the present and long-term. This study assessed the association between burn characteristics and the child’s ability to maintain positive body image in this age group using a new parent-reported instrument for assessment of child outcomes after burn injury. Methods Preliminary data was obtained from the School-Aged Life Impact Burn Recovery Evaluation (LIBRE)5-12 study, which is currently in stages of field-testing. Classic test theory methods were used to assess body image items (n = 13) from the Psychological domain. Each item was scored on a 5-point Likert scale ranging from 0 (never) to 4 (always). Data was recoded for selected items such that higher scores denote better functioning. Multivariate linear regression analyses measured the association between burn injury characteristics and body image (controlling for sex, race and ethnicity, burn injury to critical areas, total body surface area burned (TBSA), and age at survey completion). Mean body image score was calculated. Results Data was obtained from 356 surveys with completed body image items from parents of children with burns. The mean age at survey completion was 8.6 + 2.4 years and mean total body surface area burned (TBSA) was 9.2 + 13.9 with 55% male and 66% white. Items from body image subdomain were identified as a unidimensional scale (α = 0.91, item-total correlations >0.4, ratio of the 1st and 2nd eigenvalues = 4.98). The mean body image score was 3.5 + 0.6. The presence of a foot burn (p = 0.0099), genitalia burn (p = 0.0449) and TBSA >1% (p = 0.0013) resulted in a lower body image score (3.3 + 0.6, 3.1 + 0.8, and 3.4 + 0.7, respectively). In the regression model, age at survey completion was also associated with decreased body image score (β = 0.074, p < 0.0001). Conclusions Parents reported older school-aged burn survivors often had difficulty with body image. Presence of larger burn size and injury to critical areas also worsened body image. Applicability of Research to Practice Burn-care providers and family members can utilize body image score to understand the burn survivor’s current body image satisfaction and assist in fostering positive body image after burn injury through assessment and early intervention.

Introduction Following burn survivors in the community is critical to understand their problems and needs. Physical activities automatically recorded by smartphones have shown to be a convenient and burdenless method for post-discharge assessment. However, it is unclear if physical activities are associated with burn survivors’ physical and psychosocial outcomes. This study aims to examine the relationship between smartphone-tracked physical activities and scale-based outcomes. Methods Adult burn survivors living in the community were included in this study. A mobile application was downloaded to participants’ smartphones and automatically recorded daily number of steps, travel miles and activity minutes. Participants received weekly surveys assessing pain (Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Interference), depression (Patient Health Questionnaire (PHQ-8)), anxiety (PROMIS Anxiety) and social participation (Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities). Correlation coefficients between physical activities and survey results were examined and interpreted as “very weak” (|r|≤0.19), “weak” (0.20≤|r|≤0.39), “moderate” (0.40≤|r|≤0.59), “strong” (0.60≤|r|≤0.79), and “very strong” (0.80≤|r|≤1.00). Results There were 24 burn survivors with an average of 24 years after injury included in this study. The 180-week data collected between November 2021 and August 2022 was analyzed. Daily number of steps, travel miles and activity minutes separately showed relationships with PROMIS Pain Intensity (r=-0.312, p< 0.001; r=-0.247, p=0.001; r=-0.239, p=0.001), PROMIS Pain Interference (r=-0.375, p< 0.001; r=-0.318, p< 0.001; r=-0.291, p< 0.001), PHQ-8 (r=-0.403, p< 0.001; r=-0.357, p< 0.001; r=-0.311, p< 0.001), PROMIS Anxiety (r=-0.310, p< 0.001; r=-0.209, p=0.007; r=-0.150, p=0.054), LIBRE Social Interactions (r=0.272, p< 0.001; r=0.291, p< 0.001; r=0.328, p< 0.001) and LIBRE Social Activities (r=0.381, p< 0.001; r=0.414, p< 0.001; r=0.404, p< 0.001). Conclusions Daily number of steps demonstrated a moderate correlation with depression while both daily travel miles and activity minutes showed moderate correlations with social participation. The results support that smartphone-tracked physical activities are related to burn survivors’ psychosocial outcomes. Applicability of Research to Practice This study may inform future use of smartphone-tracked physical activities to understand and track burn recovery and ultimately improve care.

Introduction Rehabilitation services improve the functional recovery of people who have experienced burn injury. Therapy services are often initiated during patients’ hospitalization and continue for months to years after discharge. However, numerous factors contribute to a patient’s overall complexity and functional impairments following discharge and need for Inpatient Rehabilitation (IR). Characteristics associated with longer IR stays have not been well explored. This study aimed to examine patient and clinical factors associated with length of IR stay. We hypothesized that burn severity, including size and location, as well as insurance payor will be associated with length of rehabilitation time. Methods Adult participants in Burn Model System National Database (1994-2022) who were discharged to IR following their hospital stay were included. A negative binomial regression analysis examined the association between IR days and demographic and injury characteristics including age, gender, burns to critical areas (head and neck, perineum, hand), payor, etiology, circumstance of injury, and range of motion deficits. A p-value less than 0.05 was considered significant. Results The study included 585 participants who were 72% male with mean age 46.1 (SD 16.8), and mean burn size 34.6% (20.5) total body surface area (TBSA). Average IR days were 22.8 (19.3). For every 1% increase in TBSA burned there was a 1% increase in IR days. Similarly, each additional 1 ventilator day was associated with an 1% increase in IR days. Electrical injuries were associated with 44% more IR days than flame injuries. Self-inflicted injuries were associated with 55% more IR days, while hand burns were associated with 18% decrease in IR days. Self-pay, philanthropy or other insurance coverage was associated with 37% fewer IR days. Of note, range of motion deficits were not significantly associated with IR days. Conclusions Longer IR stays were associated with greater burn severity, etiology (electrical), and circumstance (self-inflicted), all of which are markers of overall case complexity. Shorter IR stays were associated with specific injury location (hand), though reasoning for this needs further investigation. Payor type was also associated with shorter IR stay, which highlights risk of inequity in rehabilitation service delivery. Applicability of Research to Practice These findings can help clinicians set expectations regarding IP for patients and families, and advocate for strategies to deliver rehabilitation services more equitably.

Introduction Care discontinuity, or the care that is provided by disparate healthcare professionals when patients are readmitted to a hospital different than their original admission (non-index hospital), has been associated with worse outcomes among surgical patients. However, little is known about its effect on burn patients. Our aim was to determine the impact of care discontinuity on long-term outcomes in a national sample of burn patients. Methods The longitudinal Burn Model System National Database was queried from 1996 to 2021. All adult burn patients from participating sites were included. Care discontinuity was defined by having therapy or burn-related surgeries at non-index hospitals. The main outcomes were the physical (PCS) and mental (MCS) health component summary scores of the Veterans RAND 12 (VR-12) score at 6 and 12 months after injury. Multivariable regression was used to examine the association between care discontinuity and long-term outcomes, adjusting for patient characteristics and burn injury severity. Results A total of 1,866 burn patients were included. Mean age was 43.36 (SD 15.85) years, 73% were male and 76% were white. Mean PCS scores were 43.56 (SD 10.95) and 45.17 (SD 11.18); and mean MCS scores were 48.00 (SD 12.60) and 48.25 (SD 12.55) at 6 and 12 months, respectively. Care discontinuity was reported in 423 (22.6%) burn patients, who reported having therapy or burn-related surgeries at a non-index hospital. In adjusted analyses, care discontinuity was associated with worse PCS at both 6 months (Coefficient -2.18, 95% Confidence Interval [CI] -3.44 – -0.91, p=0.001), and 12 months (Coefficient -2.16, 95% CI -3.50 – -0.82, p=0.002), compared to patients having therapy/surgery at index hospitals. Care discontinuity was not associated with MCS scores at 6 (Coefficient 0.54, 95% CI -0.04 – 2.03, p=0.473) and 12 months (Coefficient -0.90, 95% CI -2.49 – -0.67, p=0.262). Conclusions Care discontinuity was significantly associated with lower physical health component scores at long-term follow up, but not with mental health component scores. Future studies should focus on developing strategies to ensure continuity of care and/or identifying out of system patients to provide targeted resources. Applicability of Research to Practice Understanding the implications of care fragmentation on longitudinal outcomes may help clinicians develop strategies to ensure care continuity and consequently better outcomes.

Introduction Social rehabilitation is a critical step in the recovery process post burn injury, yet there is limited published data on the topic. The LIBRE Profile was developed as a burn specific instrument to examine social participation outcomes across six domains. The objective of this study is to use the LIBRE Profile to measure social participation and explore the trajectories of recovery in each domain. Methods Data from the LIBRE Journey Study was analyzed, utilizing both the LIBRE Profile Computer Adaptive Test and fixed short forms. Demographic and clinical characteristics included age, gender, race, ethnicity, education, marital status, burn size and time since injury. LIBRE Profile scores collected at five time-points from baseline to two years, approximately 6 months apart, calculated score trajectories for each of the LIBRE Profile domains (Family and Friends (FF), Social Activities (SA), Romantic Relationships (RR), Sexual Activity (SX), Social Interactions (SI), and Work and Employment (WE)). Linear mixed models with the log of time since burn injury were applied to each domain, adjusting for demographic and clinical variables. Models were fit using the score trajectories with 95% confidence intervals to demonstrate change over time and significant impact of the covariates. Results Analyses included 454 participants with a mean age of 45.4 (SD 15.4) and mean burn size of 38.7% (SD 24.6). Time since burn injury ranged from 13 days to 71 years. All participants were included in analyses of the FF, SA, and SI, with 265, 292, and 288 participants included in the WE, RR, and SX domains based on screening questions for relevance, respectively. Multiple predictors were found to significantly effect LIBRE domain scores (Table 1), with all domain scores increasing with time since burn injury (p < 0.0001) and decreasing with an increase in burn size (p < 0.04), except for FF and RR. Conclusions Analyses showed significant improvement of social recovery post burn injury for both the short- and long-term in four of the six domains. Analysis of LIBRE Journey data demonstrates the social participation trajectories with findings that can establish future applications in clinical practice. Applicability of Research to Practice The LIBRE Profile is a tool used to monitor social participation after burn injury. Understanding the trajectories of social recovery after injury will inform and optimize both clinical care and resource allocation by providing the ability to benchmark an individual’s recovery with one’s peers.

Introduction Measuring physical, psychological, and social outcomes following childhood burn injury is important to understand the impact of the burn. Condition-specific outcomes are highly relevant in assessments for purposes of gauging early growth and development through parent-reported outcome measures (PROMs). Item content in existing PROMs for preschool children is limited and often covers only one construct. Computer adaptive tests (CATs) with advanced psychometric artificial intelligence technologies minimizes respondent burden and enables the creation of a comprehensive condition-specific instrument. This project developed a parent-reported CAT (Preschool1-5 Life Impact Burn Recovery Evaluation (PS-LIBRE1-5) Profile) to measure relevant outcomes after burn injuries in children aged one to under six years. Methods Responses to the field-tested PS-LIBRE1-5 Profile (188 items) were measured on a scale of frequency or ability levels. Scores were coded from 0 to 4 where higher scores reflected better functioning. Factor analysis and Partial Credit Models identified the items retained in the final item bank of each scale. Differential item functioning (DIF) determined if subgroups of burn survivors at the same ability level demonstrated different probabilities of responses. CAT simulations were conducted to estimate the mean score of each scale. The simulated CAT score and full item bank scores were compared based upon the score range, ceiling and floor effects, and marginal reliabilities. Results The child mean age was 3.0 + 1.5 years (n = 498), with primarily mothers (83%) responding. Average burn size and time since burn injury were 4.2% TBSA and 1.1 years, respectively. Analysis resulted in eight scales: Physical (27 items), Communication and language (20 items), Emotional wellbeing (16 items), Mood (11 items), Anxiety (13 items), Peer acceptance (7 items), Play (8 items), and Peer relations (9 items). Severe DIF by ‘age at survey completion’ was shown in 13 items. Ceiling effects were acceptable at < 14%. A CAT was created with the exception of four of the scales (Peer acceptance, Play, Mood, and Anxiety) due to limited item content in these scales’ full item bank. Marginal reliabilities were credible (0.83 to 0.90). CAT simulations revealed that administering the CAT would save the respondent about 14 minutes compared to administering the full item bank. Conclusions Final scales of the PS-LIBRE1-5 Profile contain 111 items and is a comprehensive measure that captures physical, communication and language, psychological, and social functioning of preschool burn survivors in the community. Applicability of Research to Practice This work lays the groundwork for developing a set of age-based CATs, adding to prior adult LIBRE project. The CAT aims to detect the progress of a child during burn recovery for use in clinical practice.

Introduction People with burn injury often experience long-term social participation challenges. A previous study explored demographic and injury variables predicting social participation outcomes after burn injury. This study aims to further examine post-traumatic growth, and physical and psychological symptoms as predictors of social participation. Methods This is a multi-center Burn Model System (BMS) study with a prospective cohort design. Adult BMS Database participants from July 2018 to April 2022 were included. Predictors were measured at 12- and 24-month after injury including Post-Traumatic Growth Inventory Short Form (PTGI-SF), Post-Traumatic Stress Disorder Checklist Civilian Version (PCL-C), Patient-Reported Outcomes Measurement Information System (PROMIS-29) Depression, Anxiety, Fatigue, Sleep Disturbance, Pain Interference and Heat Intolerance. Social participation outcomes were measured with Life Impact Burn Recovery Evaluation (LIBRE) Social Interactions and Social Activities at 24-month after injury. Multivariable regression analyses were conducted to assess the association between predictors and outcomes. Results A total of 158 burn survivors were included with an average age of 47 years and a mean burn size of 19.5% total body surface area. Significant predictors included PCL-C and PROMIS-29 Depression for LIBRE Social Interactions, and Heat Intolerance, PROMIS-29 Pain Interference and Depression, and PCL-C for LIBRE Social Activities. See Table 1 for details of regression results. Conclusions Overall, self-reported post-traumatic stress and depression are associated with limited social interactions while heat intolerance, pain interference, depression, and post-traumatic stress are related to fewer social activities. Applicability of Research to Practice This study improves our understanding of the multiple and modifiable factors which influence social participation after burn injury.

Background Clinical facilitators have an essential role in the development of safe and committed nurses worldwide, but the approach to provision of professional development to help clinical facilitators reach potential is informal, inconsistent and not always relevant to their learning needs. It is important to examine the reported role tensions to generate solutions to the problems and include these teachings in professional development opportunities for clinical facilitators. Method An integrative literature review was undertaken intending to understand and collate the tensions, constraints, as well as supports, and best practice in the role. Results The review identified 40 relevant studies. Conclusion The identified studies highlighted challenges such as lack of role clarity and lack of evaluation of professional development approaches, which hamper best practice; as well as exemplary practices, such as peer-to-peer learning; which has potential to advance the sub-specialty of clinical facilitation.

Background The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia. Methods An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1263 nursing students, across all year levels at six Australian Universities and one further education college in 2019–20, to confirm validity, reliability and feasibility. Results The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r = .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 min) and students’ comments, the tool was deemed applicable and feasible. Conclusions The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.

A multicampus nursing school supported faculty simulation usage by creating a digital repository of simulation resources targeted to faculty needs. This qualitative exploratory study on faculty first impressions and repository usage identified five themes: (a) a welcomed resource;(b) easy to access and use; (c) facilitates multi-campus consistency; (d) supports novice simulation educators; (e) grows simulation pedagogy usage. A digital repository of simulation resources is an innovative tool for supporting simulation usage amongst nursing faculty

Clinical learning experiences are known to exacerbate nursing student anxiety, causing them to present to clinical placement in distressed, meaning anxious, states. Students already living with anxiety are also more likely to suffer setbacks at this time. Supervising Registered Nurses (RNs), in the clinical settings, struggle to support this student cohort. A professional development activity was designed to introduce RNs to higher education and nursing students' known mental health concerns (such as anxiety) and to arm them with strategies for working with distressed students. A research approach that enabled researchers to collaborate with participants was employed to design the intervention. A study evaluated the impact of the educational intervention with 45 Australian RN supervisors. Two tailed T-tests were chosen to explore the statistical difference between pre- and post-test mean results across the survey items. A 95% confidence interval was used. Statistical significance was set at0.05. The evaluation indicated the activity could be useful for improving supervising RNs' mental health literacy, thus enhancing their understanding of how to work with distressed students. Participants recommended the activity be offered to any staff supporting student clinical learning. Collaboration between nursing researchers and nursing clinical staff produced a meaningful professional development activity and motivated the participants to increase their mental health literacy and understanding of strategies to support distressed students. Future projects should adopt similar approaches that would support both RNs' ability to support students' during clinical learning and students in distress would also benefit.

Refereed/Peer-reviewed This article describes an interdisciplinary creative collaboration between a group of academic researchers from the creative arts and nursing education, along with professional actors, who co-created a series of short film scenarios for pedagogic impact. The scenarios were intended to improve the experiences of nursing students on placement by supporting nurse educators to experiment with a transformative learning praxis in their pre-and post-placement interactions with students. This work addresses the process of collaborative content creation, which was undertaken through a method comprising character and story development drawn from screenwriting, improvisation and (Creative) Participatory Action Research. Beyond influencing nursing pedagogy, we suggest this approach has useful implications for creative practice disciplines more broadly, and the application of story development scenarios across a range of academic contexts for pedagogic impact.

Health Related Quality of Life (HRQoL) surveys such as PROMIS-29 may facilitate shared decision-making regarding surgery after burn injury. We aimed to examine whether scar revision and contracture release surgery after index hospitalization was associated with differences in HRQoL.Patient and PROMIS-29 Profile v2.0 data were extracted from the Burn Model System (BMS) at 6-, 12-, and 24-months after burn. PROMIS-29 measures 7 health-related domains. Linear regression was performed to identify associations between independent burn patient variables (e.g. scar-related surgery) and PROMIS-29 scores. Socio-demographic and injury variables were analyzed using logistic regression to determine the likelihood of undergoing burn-related surgery.Of 727 participants, 201 (27.6%) underwent ≥ 1 scar/contracture operation within 24 months of injury. Number of operations at index hospital admission and range of motion (ROM) deficit at discharge were correlated with an increased likelihood of undergoing subsequent scar/contracture surgery (p 0.05). Participants undergoing scar/contracture surgery and those that were Medicaid insured reported significantly worse HRQoL for PROMIS domains: anxiety, depression, and fatigue (p 0.05).After adjusting for burn severity and available confounders, participants who underwent scar-related burn reconstructive surgery after index hospitalization reported overall worse Health-Related Quality of Life (HRQoL) in multiple domains.

Edited byMichelle Cleary, PhD, RNSchool of Nursing, Midwifery & Social Sciences, CQUniversity, Sydney, AustraliaMental health nurses who uphold the principles of cultural safety have awareness of t...

Objectives Simulation debriefing skills are inadequate. Barriers to effective debriefing include a lack of understanding of the meaning of debriefing and time to learn necessary skills. In nursing, students have reported simulation debriefs are used for assessment purposes, with little opportunity or time for reflection, affecting their learning. This study reports on an intervention to support nursing simulation facilitators to develop and learn self-reflective learning skills to use when facilitating simulation debriefs. Design The authors designed and developed a six-hour workshop. The published simulation literature and Open Dialogue techniques informed the skill set included in the workshop. Open Dialogue is a therapeutic approach used in mental health care. Participants Twelve (N = 16, n = 12) female nurses who regularly facilitate simulations for nursing students were purposively recruited to the study. Methods This evaluation study utilised a modified version of a previously validated self-reported reflective learning questionnaire for participants to rate their experiences of the workshop. The modified questionnaire comprised 17 items across four subsets and utilised a five point Likert scale. Open-ended questions were also included. Results Eight questionnaires were returned. High scores indicated the participant's positive evaluation of the workshop in developing a skill set to promote self-reflective learning, together with analysing emotions in everyday professional situations and in communication skills. Conclusions Participants reported the intervention was beneficial to their professional development and in helping them to develop their own self-reflective learning skills. The skill set included in the workshop was helpful to nursing simulation facilitators and could be one way to enhance nursing simulation facilitators debriefing skill set.

Background Australian nursing students have said they learn more from their clinical facilitator than from any other educator or learning experience. Thus, there is need for more studies that focus on the actions of clinical facilitators so that expertise within this subspecialty can be developed and shared. Method In 2017, a qualitative study was undertaken using Interpretive Description. Eleven clinical facilitators working in diverse locations across Australia participated in individual semi-structured telephone interviews. Aim The study aimed to explore the lived experience of Australian clinical facilitators' interactions with nursing students. Findings Four themes revealing participants' different mindsets, actions and skills from their daily work were produced from the study and provide insights into the complexity of the role. These four themes included preparing to work with students; facilitating successful clinical experiences; facing unique challenges; and encountering rewards along the way. Discussion Clinical facilitators are a legitimate sub specialisation within nursing and as such require regular professional development, particularly in relation to the four aspects of work identified in this study. Conclusion Professional development for clinical facilitators should be developed on these four aspects of work and its impact evaluated and reported.

Bibliometrics is an emerging science in nursing. Quantitative methods were used to conduct a bibliometric analysis of highly cited virtual simulation nursing education articles to describe rank order, breadth of topics and authorship patterns.A desktop analysis of publication performance was conducted using the Scopus database as the source of article citation data.The top 100 cited articles clustered over 14-years, 2008 to 2021. Citations per paper ranged from 88 to a low of 3 (median 18, mean 22.1) and in the top 10 studies, from 88 to 41. The citation trajectory was moderately correlated with article maturity (r = -.384, p ≤0.001). Article citations in subsequent publications commenced the first year after publication and three-year-old papers reached the mean citation rate of 22. Nurse Education Today was the most cited journal. There was no significant impact of article type (72% primary research, 17% literature reviews, 11% descriptive papers) (p = 0.755). International representation was strong, as first authors in 21 countries were cited - many (43%) from USA. One highly cited author (M. Verkuyl) from Canada led six papers, with six other authors each leading two studies. Virtual simulation modalities included virtual simulation, virtual reality simulation, 3D virtual reality simulation, virtual games and virtual worlds. The top 10 articles offer a diverse resource for faculty and educators who wish to consider using virtual simulation.Virtual simulation studies in nursing education cover an emerging field of research that has relatively low citation rates. Nursing researchers and faculty need to understand the usefulness and limitations of bibliometric analysis as this methodology can make a unique contribution to research, policy, and funding decisions, and enable productivity assessments of faculty staff and departments.

Introduction Clinical placements are a mandatory component of nursing students’ education internationally. Despite clinical education being a key to nursing students’ achievement of nursing competencies, few studies have reviewed students’ narratives to describe their experiences of learning during clinical placement. Such studies may be important in offering a deeper insight into clinical learning experiences than quantitative surveys. Methods A systematic thematic synthesis of qualitative studies between 2010 and June 2020 was conducted. English language studies that offered a thematic analysis of undergraduate nursing students’ experiences of learning during placement were sought. A search was made of five databases PubMed, Ovid Medline, CinahlPlus, SCOPUS, and Google Scholar. The study was guided by the ENTREQ statement for enhancing transparency in reporting the synthesis of qualitative research. Results Twenty-seven qualitative studies were included in the review. A thematic synthesis showed over 100 themes and subthemes across the studies. A cluster analysis revealed positive elements and others that were seen in the studies as a barrier (hindrance) to clinical learning. Positive elements included supportive instructors, close supervision, and belonging (in the team). Unsupportive instructors, a lack of supervision and not being included were seen as a hindrance. Three key overarching themes that could describe a successful placement were revealed as “Preparation,” “Welcomed and wanted” and “Supervision experiences”. A conceptual model of clinical placement elements conducive to nursing students’ learning was developed to enhance understanding of the complexities associated with supervision. The findings and model are presented and discussed. Conclusion The conceptual model presents positive elements that influence students’ clinical placement experiences of learning. This model may provide a framework to guide professional development programs and strategies to support students and supervisors alike, an important step forward in moving beyond the current clinical placement rhetoric.

Objectives To review undergraduate nursing students' perceptions of the quality of their clinical placement experiences by means of surveys conducted using the Clinical Learning Environment Supervision and Nurse Teacher questionnaire. Design Systematic review of English language studies published between 2014 and 2020, in any clinical setting, utilising data collected in the decade 2010 to 2020. Data sources Structured searches were conducted in CinahlPlus, Ovid Medline, Scopus, PubMed and Google Scholar. Review methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framed the review. Results A total of 111 records were screened, after which 21 studies met criteria for inclusion. Studies were centred on students in Sweden and in 15 other countries. Students' ratings of ‘Experience’ were positive across five scale subdimensions with means 3.0–3.95 of a possible 5 (overall mean 75.4%). ‘Satisfaction’ across seven studies was rated highly (mean 4.16 of 5) 83.2% agreement. The highest rated subdimension was Supervisory relationship, with the Role of the Nurse Teacher rated lower and inconsistently. The underlying elements are discussed. Conclusion Although students' Experience and Satisfaction were rated highly averaging over 75%, there is still room for improvement. Further research is needed to examine how students perceive various components of ‘satisfaction’ within clinical learning environments because this can be seen as the primary measure of program quality. Research using experimental and observational study designs is needed to compare ways of preparing clinical teachers and reporting measurable learning outcomes for models of supervision that are applicable in varied clinical learning environments.

Background: A career in nursing academia offers clinicians a new challenge. Academic nursing and clinical nursing are two separate worlds with different social and cultural borders, foci and ways of working. It is possible to imagine this space as a kind of borderland, a new frontier that is simultaneously exciting and perilous. Aim: A concept analysis explored the borders as a site of meaning for professional development. Method: This study employed a four step concept analysis. Results: The analysis revealed four attributes of borders that are useful for clinical teachers to understand; liminality, border crossing, border work, and inhabiting a new world. Conclusion: As a liminal space, clinical teaching can be a site where uncertainty and ambiguity arises. This can create anxiety but also opportunities to think about both worlds differently, so that clinical teachers may discover new insights and applications for their work.

Background: The quality of nursing clinical placements has been found to vary. Placement evaluation tools for nursing students are available but lack contemporary reviews of clinical settings. Therefore, the aim of this study was to develop a feasible, valid and reliable clinical placement evaluation tool applicable to nursing student placements in Australia.Methods: An exploratory mixed methods co-design project. Phase 1 included a literature review; expert rating of potential question items and Nominal Group Technique meetings with a range of stakeholders for item development. Phase 2 included on-line pilot testing of the Placement Evaluation Tool (PET) with 1,263 nursing students, across all year levels at six Australian Universities and one further education college in 2019-20, to confirm validity, reliability and feasibility. Results: The PET included 19-items (rated on a 5-point agreement scale) and one global satisfaction rating (a 10-point scale). Placements were generally positively rated. The total scale score (19 items) revealed a median student rating of 81 points from a maximum of 95 and a median global satisfaction rating of 9/10. Criterion validity was confirmed by item correlation: Intra-class Correlation Co-efficient ICC = .709; scale total to global score r = .722; and items to total score ranging from .609 to .832. Strong concurrent validity was demonstrated with the Clinical Learning Environment and Supervision Scale (r= .834). Internal reliability was identified and confirmed in two subscale factors: Clinical Environment (Cronbach’s alpha = .94) and Learning Support (alpha = .96). Based on the short time taken to complete the survey (median 3.5 minutes) and students’ comments, the tool was deemed applicable and feasible. Conclusions: The PET was found to be valid, reliable and feasible. Use of the tool as a quality assurance measure is likely to improve education and practice in clinical environments. Further international evaluation of the instrument is required to fully determine its psychometric properties.