After reviewing the literature, nurses at the bedside seeking answers to clinical questions may find their inquiries remain unanswered. This article describes the yearlong Research Fellows Program in which candidates, funded for 12 hours per month of research release time, answered formal research questions in a curriculum designed to provide the skills to complete their study. Five have completed their studies; 1 has received a grant to continue. Two are in process of submitting manuscripts to journals.
Thi s article provides an overview of a curriculum effort to exchange 25% of nursing student clinical time in a hospital for carefully planned simulation experiences in a laboratory setting. Students enrolled in a pediatric clinical class in a prelicensure nursing program practiced frequently used and emergency scenarios in the skills laboratory to maximize the instructional effect of their interactions with patients and families in the inpatient setting.Caring for children and their families requires a unique set of skills and knowledge. Assessment of the neonate differs widely from that of the infant, toddler, preschooler, child, and teen. Developmental physiology places children at unique disease risk as the maturation of systems continues through the teen years. Administering small doses of medication based on weight per kilogram requires careful mathematical calculations. Precision in providing intravenous fluids demands that nurses remember differences in fluid needs based on surface area and total body water. Handling smallgauge equipment requires considerable psychomotor skill. Neurocognitive differences, elaborated so well by Piaget, 1 requires an understanding of the communication needs of children, as preverbal and concrete thinkers need age-appropriate explanations to reduce fear. Pediatric nurses must also be aware of the importance of collaborating with parents, who hold legal and ethical responsibility for medical decisions of their children. The education of student nurses within this discipline requires that they learn precision, patience, and diplomacy.In the past decade, the shift in healthcare for Americans is clear and well documented; improved same-day surgical care, expanded outpatient services and home health care have resulted in shorter in-hospital patient stays. Many children are cared for in-clinic settings where the personnel consists primarily of medical assistants and physician assistants, leaving few mentors for student nurses. Although a great benefit to children and families, an unintended consequence has been the difficulty in securing adequate clinical experiences for student nurses, whose education rests on the scaffolding of learning experiences from simple to complex. In many hospital settings, pediatric patients are simply too complex to be safely cared for as students learn their craft; clinical sites have become increasingly invested in ensuring the highest degree of patient safety. 2,3 As student experiences have become more observational and less "hands-on," nurses are graduating less practiced. In turn, hospitals have had to establish lengthy and in-depth "new graduate" programs, an unexpected and costly burden. The new graduate programs take precedence over student assignments, exacerbating the competition for patient experiences. One of the ways in which academia might respond to this problem, is to employ clinical simulation as a means of preparing student nurses in this unique discipline.
This article describes a novel approach that allows students to actively participate in a root cause analysis, whether the error was committed in the clinical setting or in the simulation setting. This process can develop student awareness of the responsibility and professional duty to participate in creating a safer patient environment.
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