Ms. Amanda M Dexter

Nursing students must gain experience collaborating with other members of the health-care team. Simulation can provide intra- and interprofessional collaboration experience; however, there can be barriers such as scheduling difficulties. We evaluated multi-patient, standardized patient simulations using telehealth as a strategy to provide baccalaureate nursing students with opportunities to learn and practice intra- and interprofessional collaboration. Forty-four final-semester nursing students participated. Student groups rotated to the simulation laboratory over 12 weeks to participate in two simulations that used telehealth to enable them to communicate patient concerns to other clinicians: a nurse practitioner, respiratory therapists, and social workers. Self-reported collaborative competencies and amount of collaboration in the clinical setting were measured at the start and end of the semester. Satisfaction and self-confidence were measured immediately after each simulation. For collaborative competencies, there was a statistically significant improvement in all item, subscale, and overall scale mean scores. Amount of clinical collaboration significantly improved, with the amount who indicated they never reported a patient concern to another professional decreasing from 39.5% to 6.8%. Findings also revealed a high level of student satisfaction and self-confidence following the simulations. Using telehealth to collaborate during simulations is a promising strategy to prepare nursing students for practice by improving collaborative competencies and encouraging more collaboration in the clinical setting.

Nurse faculty must utilize teaching strategies that promote student achievement of essential competencies, and simulation can provide experiential learning to help prepare students for professional practice.
The purpose of this phenomenological qualitative study was to explore baccalaureate nursing students' experiences with multi-patient, standardized patient simulations that used telehealth to provide opportunities to learn and practice intra- and interprofessional collaboration. Student perceptions of their ability to utilize lessons from the simulations in clinical practice were also examined.
Focus group interviews were conducted with 27 final-semester baccalaureate nursing students after they had participated in two telehealth-enhanced simulations.
Analysis revealed five themes: Anxiety due to lack of experience, Improved clinical reasoning, Real world practice, How to communicate effectively, and Application to clinical practice.
The use of telehealth helped overcome barriers to implementing collaborative simulations and provided students with experiential learning that addressed essential competencies for safe and effective professional nursing practice.
•Simulating the multiple demands of clinical practice can improve confidence.•Simulation is a safe environment to practice communication and collaboration.•Telehealth-enhanced simulations provide exposure to the informatics competency.•Students applied lessons from the simulations to improve their clinical practice.

Ventilator graphic monitoring is common in ICUs. The graphic information provides clinicians with immediate clues regarding patient-ventilator interaction and ventilator function. These display tools are aimed at reducing complications associated with mechanical ventilation, such as patient-ventilator asynchrony. It is also useful to assess respiratory mechanics in mechanically ventilated patients using both scalar and plot displays on the ventilator. Additional information can be gained by observing secondary ventilator measures including stress index, inflection points, and work of breathing. Ventilator graphics impact mechanical ventilation management through optimizing effectiveness of patient care and enhancing promptness of clinician response. Despite being a valuable asset in providing high-quality patient care, many bedside clinicians do not have a thorough understanding of ventilator graphics. Mastery of ventilator graphics interpretation is key in managing patients who are receiving ventilatory support.

Airway management techniques are aimed at reducing complications associated with artificial airways and mechanical ventilation, such as retained secretions. The impact of airway management techniques on ventilator-associated events (VAEs) varies considerably by modality. Closed-suction techniques are generally recommended but have limited, if any, impact on VAEs. Normal saline instillation during suctioning is not recommended. Devices designed specifically to remove biofilm from the inside of endotracheal tubes appear to be safe, but their role in VAE prevention is uncertain. Subglottic secretion clearance by artificial cough maneuvers is promising, but more research is needed to assess its clinical feasibility. Continuous cuff-pressure management appears to be effective in reducing microaspiration of subglottic secretions.

Objective: This study sought to validate pediatric models with normal and altered pulmonary mechanics.
Methods: PubMed and CINAHL databases were searched for studies directly measuring pulmonary mechanics of healthy infants and children, infants with severe bronchopulmonary dysplasia and neuromuscular disease. The ASL 5000 was used to construct models using tidal volume (V-T), inspiratory time (T-I), respiratory rate, resistance, compliance, and esophageal pressure gleaned from literature. Data were collected for a 1-minute period and repeated three times for each model. t tests compared modeled data with data abstracted from the literature. Repeated measures analyses evaluated model performance over multiple iterations. Statistical significance was established at a P value of less than 0.05.
Results: Maximumdifferences of means (experimental iterationmean - clinical standard mean) for T-I and V-T are the following: term infant without lung disease (T-I = 0.09 s, V-T = 0.29 mL), severe bronchopulmonary dysplasia (T-I= 0.08 s, V-T = 0.17 mL), child without lung disease (T-I = 0.10 s, V-T = 0.17 mL), and child with neuromuscular disease (T-I= 0.09s, V-T = 0.57 mL). One-sample testing demonstrated statistically significant differences between clinical controls and V-T and T-I values produced by the ASL 5000 for each iteration and model (P < 0.01). The greatest magnitude of differences was negligible (V-T < 1.6%, T-I = 18%) and not clinically relevant.
Conclusions: Inconsistencies occurred with the models constructed on the ASL 5000. It was deemed accurate for the study purposes. It is therefore essential to test models and evaluate magnitude of differences before use.