Assignment Limitations and strengths of the study variables

Assignment Limitations and strengths of the study variables

Assignment Limitations and strengths of the study variables

1. Evaluate the discussion section of the article attached and identify if the following was addressed. (Note, you need to show evidence, do not just say yes or no. Post what the researcher indicated that supports that these elements were addressed in the discussion section. Add the page number where you found them)

a) limitations and strengths of the study variable(s)

b)hypothesis(es)/research questions

c) theoretical framework

d) design

e) sample

f) data collection procedures

g) data analysis



j)recommendations for future research

2. After reviewing and evaluating the “Discussion” section of the article, discuss the strength of the evidence supports a change in current practice (If you think it does, support your answer with evidence based literature. You describe what the article indicated and find another source to support why the strength of evidence support a change in current practice).

3. What is your cosmic question? (This should be based on chapter of the week. Pose a research question on discussion section of a research)

Attached you will see the article

Assignment: limitations and strengths of the study variable(s)

Effectiveness of a Role-Modeling Intervention on Student Nurse Simulation Competency


Debriefing is the most commonly used simulation teach- ingelearning intervention used in nursing education. In a recent survey by the National Council of State Boards of Nursing, 80% of the 1,060 responding prelicensure registered nurse programs reported debriefing students after participation in medium- or high-fidelity simulations (Hayden, Assignment Limitations and strengths of the study variables 2010). Despite the known effectiveness and wide- spread use of debriefing in nursing education, this teach- ingelearning strategy has one major disadvantage. Debriefing is time intensive for faculty.

Waxman (2010) suggests that debriefing sessions should be 2 to 3 times longer than the simulation scenario itself. This corresponds to 60 to 90 minutes of faculty time for every 30-minute scenario (i.e., 60 hours for 40 student groups). Faculty may have difficulty sustaining this recommendation given the resource, time, laboratory space, and budget constraints faced by nursing programs today. There is an urgent need to develop more cost-effective interventions to promote improved performance with simulation with novice nurses. Assignment Limitations and strengths of the study variables

* Corresponding author: (B. Aronson).

A national call for reform in nursing education (Benner, Sutphen, Leonard, & Day, Assignment Limitations and strengths of the study variables 2010) has recom- mended that the National Council of State Boards of Nursing require perfor- mance assessments for li- censure. According to Benner et al. (2010), stu- dents should be assessed on their skills of clinical reason- ing, including the ability to solve clinical problems by setting patient care priorities or responding to a change in patient condition. Novice nurses are often inade- quately prepared to respond to complex patient care situ- ations in which patients’ conditions deteriorate.

Two large-scale studies (Ns of 760 and 10,988) with novice nurses responding to video- taped   scenarios   depicting a change in patient condition found that 70% to 76% of new graduates did not meet expectations in the Performance Based Development System assessment (del Bueno, 2001). In another study examining critical thinking and the ability to respond to a critical patient situation (Fero et al., Assignment Limitations and strengths of the study variables 2010), the majority of nursing students (75%) did not meet overall performance expectations after viewing vignettes or partici- pating in high-fidelity human simulations. Students had the most difficulty related to problem recognition and reporting findings to physicians.

A previous study by the authors (Aronson, Glynn, & Squires, 2011a) found similar results. Student nurses (N 144) performed poorly during a simula- tion scenario designed to mimic a response-to-rescue event, achieving a mean score of only 49% on the rating tool used to assess student nurse performance. The raters noted that stu- dents were not organized in completing an assessment in a timely fashion, did not recognize or cluster data and come to an appropriate conclusion regarding the patient’s changing condition, and did not report significant data to the physician when the patient deteriorated. Additionally, students did not consistently follow national patient safety standards. Assignment Limitations and strengths of the study variables

By watching and role-modeling the behavior of experi- enced nurses, novice nurses learn, after they graduate, to detect and document changes in patients’ conditions and present a firm, convincing case to the physician (Benner, 1984). According to Clarke and Aiken (Assignment Limitations and strengths of the study variables 2003), surveillance and taking action when life-threatening complications occur are two important nursing activities that can prevent failure-to-rescue events.

These activities include assessing patients frequently, attending to cues and recognizing complications, and taking action when life-threatening complications occur. Taking action involves quickly insti- tuting appropriate measures and activating a team response, communicating clearly, and conveying the urgency with which team members are needed at the bedside. Exposure, before participation in a simulation, to a videotaped inter- vention that models and reinforces expected behavior by an expert nurse may improve novice practitioners’ compe- tency in a more time- and resource-efficient manner with- out compromising the integrity of performance measures. Assignment Limitations and strengths of the study variables

Pilot studies are used in intervention research to establish the content strength and timing of an intervention and to finalize outcome measures. They are also used to develop the protocol for large multisite studies, including the intervention implementation process and effect size (Whitemore & Grey,  Assignment Limitations and strengths of the study variables 2002). Therefore, the primary purpose of this feasibilityepilot study was to assess the preliminary effectiveness of a theory-based role-modeling intervention on student nurse competency in responding to a simulated response-to-rescue event. The secondary purpose was to determine whether there was a relationship between student competency scores and days elapsed since the intervention.

Assignment Limitations and strengths of the study variables Literature Review

There is conflicting evidence as to whether videotaped guided interventions improve student or novice health practitioners’ performance. In a pilot study with undergrad- uate and nurse anesthesia students, participants in the videotape-debriefing group were more likely than the control group to demonstrate desirable behaviors concerning patient identification, team communication, and vital signs (Grant, Moss, Epps, & Watts, Assignment Limitations and strengths of the study variables 2010). Byrne et al. (2002) examined the performance of 34 anesthetists in managing five crisis sit- uations. Trainees exposed to videotaped feedback had a shorter median ‘‘time to solve’’ and a smaller decrease in chart error compared with those not exposed to video feed- back; the differences were not significant.

A third study compared the performance of 42 anesthesia residents who received debriefing with video-assisted oral feedback, oral feedback alone, or no debriefing. Participants’ skills did not improve in the control group; however, the oral feedback group (with or without videotape review) performed signifi- cantly better (Savoldelli et al., Assignment Limitations and strengths of the study variables 2006). Results may have been influenced by small sample sizes and deficiencies in perfor- mance measures. In these studies, after participating in a sce- nario, participants viewed their own performance during a debriefing session. Observing the actions of experts in a vid- eotaped intervention first may assist novice practitioners in then performing expected behaviors in a scenario.

Assignment Limitations and strengths of the study variables Theoretical Framework

Social learning theory (Bandura, 1977) proposes that human behavior is learned through observing others. During exposure, observers acquire mainly symbolic representations of the modeled activities, which serve as a guide for ap- propriate behavior in the future. According to Bandura (1977), observational learning is governed by four compo- nent processes: attention, retention, motor reproduction, and motivation.

Humans cannot learn by observation unless they are able to attend to and perceive accurately the significant features of modeled behavior. Assignment Limitations and strengths of the study variables They also must be able to retain modeled behavior in their memories in symbolic form and convert these symbolic forms into appropriate actions. Humans are more likely to adopt modeled behavior if it results in outcomes they value.

The Role-Modeling Intervention© used in this study was developed to affect some of the factors that are thought to influence these processes (Table 1).

Assignment Limitations and strengths of the study variables Role-Modeling Intervention

The Role-Modeling Intervention© consists of a 40-minute expert practice video, combined with verbal reinforcement of expected behaviors and tailored feedback. The expert practice video, which was developed and produced by the re- searchers, depicts an expert nurse responding competently to a simulated patient care scenario in which the patient’s con- dition rapidly deteriorates. It was designed to be used as a teachingelearning intervention before students participate in simulated response-to-rescue scenarios.Assignment Limitations and strengths of the study variables

While students watched the video, expected behavior was reinforced verbally by one of the researchers as the nurse actor modeled the corresponding behaviors. The research team wrote the script for the video, and the simulation scenario was re- hearsed multiple times until the researchers were confident that the expert nurseeactor demonstrated all the expected competencies. The final videotape was viewed by the three of us, and we rated the performance of the expert nurse inde- pendently (r 1.00). The role-modeling intervention was shown to participants in a group setting (see Figure 1).


Student performance during the study was assessed with an 85-item instrument titled the Heart Failure Simulation Competency Evaluation Tool© (HFSCET), which we had developed previously. The process of instrument develop- ment, revision, and psychometric testing is described in Aronson, Glynn, and Squires, 2011a. The HFSCET was used to assess the student nurses’ ability to competently respond, in a deteriorating heart failure patient scenario, in the domains of patient safety, assessment, communica- tion, interventions, and documentation. Assignment Limitations and strengths of the study variables

The HFSCET incorporates national patient standards, practice guidelines, national safety initiatives, hospital accreditation standards, and descriptions of best practices related to the care of a patient with heart failure. The instrument evaluates student nurse competency in complet- ing an initial assessment of a newly admitted heart failure patient, recognizing the signs and symptoms of a sudden deterioration in the patient, mounting a rescue response by implementing appropriate nursing interventions, reporting significant findings to the physician, and then carrying out the ordered treatments. If students complete these behav- iors, the patient recovers. Assignment Limitations and strengths of the study variables

Content validity for the HFSCET was previously established by an extensive literature review and content expert recommendations. Interrater reliability improved from r .73, .76, and .78 to .84 after extensive item revi- sion and testing with 144 student nurses (Aronson, Glynn, & Squires, Assignment Limitations and strengths of the study variables 2011a). A second study with 60 undergraduate students assessed the relationship between observed and videotaped ratings with the HFSCET (Aronson, Glynn, &

Assignment Limitations and strengths of the study variables References

  1. Aronson, B., Glynn, B., & Squires, T. (2011a). Competency assessment in simulated response to rescue events. Clinical Simulation in Nursing. doi: 10.1016/j.ecns.2010.11.006. Advance online publication.
  2. Aronson, B., Glynn, B., & Squires, T. (2011b). [Differences between observed and video-taped ratings] Unpublished data.
  3. Bandura, A. (1977). Social learning theory. Upper Saddle River, NJ: Prentice Hall.
  4. Benner, P. (1984). From novice to expert. Menlo Park, CA: Addison- Wesley.
  5. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
  6. Byrne, A., Sellen, A., Jones, J., Aitkenhead, A., Hussain, S., Gilder, F., et al. (2002). Effect of videotape feedback on anaesthetists’ performance while managing simulated anaesthetic crisis: A multicentre study. Anaesthesia, 57, 169-182.
  7. Clarke, S., & Aiken, L. (2003). Failure to rescue. American Journal of Nursing, 103(1), 42-47.
  8. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159.
  9. del Bueno, D. (2001). Buyer beware: The cost of competence. Nursing Economic$, 19(6), 150-157.
  10. Fero, L., O’Donnell, J., Zullo, T., Dabbs, A., Kitutu, J., Samosky, J., et al. (2010). Critical thinking skills in nursing students: Comparison of simulation-based performance with metrics. Journal of Advanced Nurs- ing, 66(10), 2182-2193.
  11. Grant, J., Moss, J., Epps, C., & Watts, P. (2010). Using video-facilitated feedback to improve student performance following high-fidelity simulation. Clinical Simulation in Nursing, 6, e177-e184. doi: 10.1016/j.ecns.2009.09.001.
  12. Hayden, J. (2010). Use of simulation in nursing education: National survey results. Journal of Nursing Regulation, 1(3), 52-57.
  13. Savoldelli, G., Naik, V., Park, J., Joo, H., Chow, R., & Hamstra, S. (2006). Value of debriefing during simulated crisis management. Oral versus video-assisted oral feedback. Anesthesiology, 105, 279-285.
  14. Waxman, K. (2010). The development of evidence-based clinical simula- tion scenarios.: Guidelines for nurse educators. Journal of Nursing Education, 49(1), 29-35.
  15. Whitemore, R., & Grey, M. (2002). The systematic development of nursing interventions. Journal of Nursing Scholarship, 34(2), 115-120.

Assignment Limitations and strengths of the study variables

mersin escmersin esc