As calls for accountability in our schools increase, teaching quality faces scrutiny and, often, criticism. These realities challenge teacher education programs to find new ways to ensure that their graduates will be effective in highly demanding work settings. In this article the authors draw on literature and practice examples to highlight ways that simulations can strengthen critical aspects of teacher preparation as teacher education programs look for ways to better equip their graduates for future challenges. Experience shows that simulations can support screening for program admission, practice for improving teaching and classroom management skills and development of teaching dispositions. Their potential is increasing as technological advances provide greater realism, distributed access and simulation applications for mobile devices.

Enhancing Teacher Education with Simulations

Simultaneous Multiple Patient Simulation in Undergraduate Nursing Education: A Focused Literature Review

Objective In 2015, the Israeli Ministry of Health issued national guidelines demanding the use of a five-level triage system in pediatric emergency departments (EDs). The present study aimed to evaluate the validity of the Pediatric Canadian Triage Acuity Scale (PedCTAS) in the ED of a tertiary children's hospital in Israel. Methods A retrospective cohort study of all patients admitted between January 2011 and December 2015 was carried out. The proportion of hospitalization was the primary outcome measure. The secondary outcomes were proportion of admissions to the ICU, proportions of patients who left without being seen (LWBS), and length of stay (LOS) in the ED. Results A total of 83 609 patients were included in our analysis. Triage levels 1-5 included 533 (0.6%), 4428 (5.3%), 46 461 (55.6%), 28 510 (34.1%), and 3677 (4.4%) patients, respectively. Hospitalization proportions were 70, 51, 28, 15, and 12% for triage levels 1, 2, 3, 4, and 5, respectively. Admission proportions to ICU were 24.2, 3.05, 0.24, 0.05, and 0.05% for PedCTAS levels 1, 2, 3, 4, and 5, respectively. The proportions of LWBS were 0.001, 0.002, and 0.005% for triage levels 3, 4, and 5, respectively. LOS was shorter as the triage level increased from 2 to 5. Conclusion Triage level was predictive of hospitalization, admission to the ICU, and proportions of LWBS and LOS in the ED. The findings suggest validity of the PedCTAS in this cohort. This is the first report of the performance of a triage tool in an Israeli ED.

Validity of the Pediatric Canadian Triage Acuity Scale in a tertiary children's hospital in Israel.

Aim The purpose of the study was to determine best practices for multiple-patient simulation (MPS) preparation and frequency to improve behavioral performance in nursing students. Background MPS provides a safe environment for novice nurses to practice priority setting, delegation, and multitasking, but evidence for best practices is needed. Method A multisite, blinded, randomized trial was conducted to evaluate the effect of three simulation preparation methods (expert modeling, voice-over PowerPoint, and reading assignments) on students' competence and self-efficacy for providing care to multiple patients in the simulation lab. Participants (n = 73) were enrolled in capstone clinical courses at two schools of nursing. Results Though there was no difference in raw change in competence score among the study groups, there was a statistically significant difference in pretest and posttest scores. The change in self-efficacy did not correlate with the change in competence. Conclusion These findings will help educators understand how novice nurses benefit from repeated MPS activities.

A Randomized Trial of Multiple-Patient Simulation Preparation to Improve Novice Nurses' Competence and Self-Efficacy.

T heuseof themultiple patient simulation (MPS) experience has grown in nursing education as one strategy to help close the education-practice gap and better prepare nursing students for the reality of hospital practice. The evidence demonstrating a need for an educational strategy to bridge this gap is well documented. When evaluating new nursing graduate performance, frontline nurse leaders identified weakness in performance of all 36 competencies deemed essential for safe and effective care, with several causing the most concern: recognition of changes in patient status, taking initiative, tracking multiple responsibilities, the ability to prioritize and anticipate risk, and delegation of tasks. Similarly, Theisen and Sandau identified 6 competencies that were deficient in new graduates: communication, leadership, organization, critical thinking, and stress management. Beroz had comparable results when evaluating students in an MPS experience; students focus on tasks and display poor delegation, prioritization, and communication skills when dealing with multiple patients who have many needs. A later integrative review of the evidence summed up the issues with new graduate performance: a preparationpractice gap exists, the gap is expensive, and it will require changes in education and orientation to practice to improve new graduate performance. One strategy for nursing education is to move beyond the traditional clinical experience of caring for 1 patient to caring formultiple patients aswouldbe required in the clinical setting. Nursing faculty face challenges in providing students with multiple patient assignments that mirror the experienceofthenewRNbecauseof lowfaculty-to-studentratios,

Multiple Patient Simulation: An Exemplar for Designing an Effective Experience.

Multiple-patient simulations may be used to promote the development of leadership skills as well as patient care management. Multiple-patient simulations create opportunities that mimic real interactions encountered in clinical practice. In addition to promoting the development of these essential skills among students, these simulations also meet the needs of new graduate nurses. The purpose of this article is to provide educators with guidelines on how to create and implement a multiple-patient simulation and examples for application.

Sandra Sojka

Papers

Multiple-patient simulations: guidelines and examples.