Papers by MARY ANN SHINNICK
Journal of Cardiovascular Nursing, May 1, 2008
Despite advances in healthcare, heart failure patients continue to experience complications that ... more Despite advances in healthcare, heart failure patients continue to experience complications that could have been prevented or treated. This occurs because the only way that a therapeutic or preventive regimen can be effective, assuming that the patient's condition has been accurately diagnosed and appropriately treated, is if the patient implements self-care behaviors and adheres to the treatment regimen. However, it is widely accepted that this does not occur in many or even most instances. This article provides an overview of the current evidence related to adherence and self-care behaviors among heart failure patients and describes the state of the science on interventions developed and tested to enhance self-care maintenance in this population. Our review of literature shows that effective interventions integrate strategies that motivate, empower, and encourage patients to make informed decisions and assume responsibility for self-care. Gaps in current evidence support the need for additional research on ways to improve adherence and self-care for patients who are at an increased risk of poor adherence, including those with cognitive and functional impairments and low health literacy.
Background: There is a lack of objective and valid measures for assessing nursing clinical compet... more Background: There is a lack of objective and valid measures for assessing nursing clinical competence which could adversely impact patient safety. Therefore, we evaluated an objective assessment of clinical competence, Time to Task (ability to perform specific, critical nursing care activities within 5 min), and compared it to two subjective measures, (Lasater Clinical Judgement Rubric [LCJR] and common "pass/fail" assessment). Design/Methods: Using a prospective, "Known Groups" (Expert vs. Novice nurses) comparative design, Expert nurses (ICU nurses with > 5 years of ICU experience) and Novice nurses (senior prelicensure nursing students) participated individually in a simulation of a patient in decompensated heart failure. Fourteen nursing instructors or preceptors, blinded to group assignment, reviewed 28 simulation videos (15 Expert and 13 Novice) and scored them using the LCJR and pass/fail assessments. Time to Task assessment was scored based on time thresholds for specific nursing actions prospectively set by an expert clinical panel. Statistical analysis consisted of Medians Test and sensitivity and specificity analyses. Results: The LCJR total score was significantly different between Experts and Novices (p < 0.01) and revealed adequate sensitivity (ability to correctly identify "Expert" nurses; 0.72) but had a low specificity (ability to correctly identify "Novice" nurses; 0.40). For the subjective measure 'pass/fail', sensitivity was high (0.90) but specificity was low (0.47). The Time to Task measure had statistical significance between Expert and Novice groups (p < 0.01) and sensitivity (0.80) and specificity (0.85) were good. Conclusion: Commonly used subjective measures of clinical nursing competence have difficulties with achieving acceptable specificity. However, an objective measure, Time to Task, had good sensitivity and specificity in differentiating between groups. While more than one assessment instrument should be used to determine nurse competency, an objective measure, such as Time to Task, warrants further study.
Clinical Simulation in Nursing, Nov 1, 2011
Clinical Simulation in Nursing, Oct 1, 2016
Background: Standardized, objective measures of performance in a simulated experience are lacking... more Background: Standardized, objective measures of performance in a simulated experience are lacking. As eye tracking glasses (ETG) provide video, audio, and data capture of a simulation event and quantitative data of participant actions, this technology is well suited for assessment. Therefore, this study sought to begin validating ETG as an adjunct, objective performance assessment tool in simulation. Method: This was a prospective, validation study with a two-group, convenience sample of novice and expert nurses who participated in a heart failure (HF) simulation scenario to validate ETG using a known-groups approach. A HF scenario designed to elicit seven basic nursing tasks was followed by a knowledge test and demographic questionnaire. Results: The groups were equivalent in basic HF knowledge as related to the care of a dyspneic patient. Of the seven tasks, all novices completed only one, while in the expert group, all participants completed four of the seven. Significance was found between groups for time to task in five of seven tasks and eye fixation times in key areas. Conclusions: This pilot study begins the validation process of ETG technology as an objective assessment method as significant differences were elicited between known groups. ETG technology also provides meaningful data and visual images that can be used to inform nursing education in simulation. Additional research is needed to further establish the validity and reliability of ETG technology as an assessment tool in clinical simulation.
Circulation, Nov 25, 2014
Introduction: Depression is common in heart failure (HF), and is an independent predictor of mort... more Introduction: Depression is common in heart failure (HF), and is an independent predictor of mortality and morbidity. MRI detected brain injury in many regions, including those associated with depressive symptoms (hippocampus, insular lobes). However, the association between depressive symptoms and documented brain injury has not been reported in HF. Methods: Using a 3.0-Tesla MRI scanner, we assessed brain tissue injury (DTI-based mean diffusivity [MD] procedures [damage indicated by increased diffusion/MD value]) and depressive symptoms (Beck Depression Inventory-II [BDI]; BDI scores >17 indicate depression) in 16 HF (age 55.1 + 7.7 years; 12 males; LVEF 27.8 + 6.8) and 26 controls (age 49.7 + 10.8 years; 17 males). All HF subjects were NYHA Class I-II and were able to lie flat in an MRI scanner. Statistics consisted of Mann-Whitney U and Spearman’s Rho with significance set at p<0.05. Results: No significant differences were found between the groups for age or BMI. A significant difference in depressio...
Summary: The Lasater Clinical Judgement Rubric (LCJR) is frequently used in clinical judgement as... more Summary: The Lasater Clinical Judgement Rubric (LCJR) is frequently used in clinical judgement assessment in education, but there are few clinical studies to illustrate its validity or identify predictors of clinical judgement scores. This study validated the LCJR and found years of nursing experience to be predictive of higher LCJR scores. Content Outline: Introduction A. Importance of Clinical Judgement in Nursing B. Measurements of Clinical Judgement C. Impact questions of stress in a simulation D. Purpose of the study
American Journal of Critical Care, 1999
European Journal of Heart Failure, 2014
Compromised Blood Brain Barrier Function in Patients with Heart Failure Heart failure (HF) patien... more Compromised Blood Brain Barrier Function in Patients with Heart Failure Heart failure (HF) patients show brain injury, but the underlying cause for this neural damage is unknown. A potential cause for this brain injury is alteration in the blood brain barrier (BBB) function, but BBB changes have not been reported in HF. Therefore, the specific aim of this pilot study was to examine the BBB function in HF compared to healthy controls. METHODS: We assessed global brain arterial transit time (ATT) and water exchange rates across the BBB values [indicator of BBB status (Kw = Psw/Vc; Psw = capillary permeability surface area product of water, Vc = distribution volume of water tracer in capillary space)] in HF compared to control subjects, using diffusion-weighted pCASL procedures developed by Co-Investigator Dr. Wang and his colleagues. 28,29,42 We collected diffusion-weighted pCASL data from 3 HF subjects (age, 52±19 years), and 6 control subjects (age, 53±3 years), using a 3.0 Tesla MR...
Critical care nurse, 1992
Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association, 1994
Nurse Educator, 2020
BACKGROUND Time goals have not been tested as a component of nursing competence. METHODS Using a ... more BACKGROUND Time goals have not been tested as a component of nursing competence. METHODS Using a known-groups approach, a multisite study was performed on prelicensure nursing students (novices) and experienced nurses (experts) who participated in 2 simulations of patient deterioration with time goals. Video capture was achieved with an eye tracker. RESULTS While all novices did not achieve the time goals in both simulations, there was a significant improvement between the 2 simulations (P = .04). Experts were more successful in achieving the time-to-task goals in both simulations (44% and 95%, respectively). Statistical significance was found between the novice and expert groups in achieving the time goal for both simulations (P < .01). CONCLUSIONS This study was able to differentiate the expert group as being more proficient in a timed assessment, although the novices showed improvement between 2 simulations. This illustrates an opportunity for skill development among novices in managing patient deterioration amenable to time as an objective assessment.
Clinical Simulation in Nursing, 2022
Clinical Simulation in Nursing, 2020
Background: Six nursing assessments were studied to determine if they could differentiate expert ... more Background: Six nursing assessments were studied to determine if they could differentiate expert (sensitivity) vs. novice (specificity) nurses: Lasater Clinical Judgment Rubric (LCJR), Quint Leveled Clinical Competency Tool (QLCCT), subjective pass/fail (P/F), time to task (TTT), fixation count, and dwell time. Methods: Fourteen reviewers viewed 79 videos of experts and novices in a simulation and scored the LCJR, QLCCT, and subjective P/F assessments. Results: Sensitivity was good for the LCJR and the QLCCT. Specificity was good for subjective P/F and TTT, and excellent for fixation count and dwell time. Conclusion: TTT, fixation count, and dwell time deserve more study.
Nursing Education Perspectives, 2020
This was a pilot study of novice and expert nurses participating in a simulation to determine the... more This was a pilot study of novice and expert nurses participating in a simulation to determine the predictors of clinical judgment. Covariates included age, nursing experience, simulation experience, and six measures of pupil dilation as a measure of stress with scores on the Lasater Clinical Judgment Rubric as the dependent variable. A stepwise linear regression found years of RN experience was the only predictor of better clinical judgment. Despite evidence of stress, only years as a nurse was a statistically significant predictor.
Clinical Simulation in Nursing, 2019
Background: There are no studies identifying specific tasks in a simulation that increase stress ... more Background: There are no studies identifying specific tasks in a simulation that increase stress and cognitive workload. Methods: This was a two-group comparative study of Novice and Expert Nurses participating in simulation using pupillometry to measure stress and cognitive load associated with specific tasks. Results: Significantly higher stress was found in the Novices for four of the six expected tasks, specifically interventional tasks requiring clinical judgment. Conclusions: The Novices had greater stress on interventional type tasks. Simulations with more emphasis on interventional tasks in which the nursing student is the sole decider of interventions may decrease stress and enhance performance.
Nurse education today, 2018
There is a lack of objective and valid measures for assessing nursing clinical competence which c... more There is a lack of objective and valid measures for assessing nursing clinical competence which could adversely impact patient safety. Therefore, we evaluated an objective assessment of clinical competence, Time to Task (ability to perform specific, critical nursing care activities within 5 min), and compared it to two subjective measures, (Lasater Clinical Judgement Rubric [LCJR] and common "pass/fail" assessment). Using a prospective, "Known Groups" (Expert vs. Novice nurses) comparative design, Expert nurses (ICU nurses with >5 years of ICU experience) and Novice nurses (senior prelicensure nursing students) participated individually in a simulation of a patient in decompensated heart failure. Fourteen nursing instructors or preceptors, blinded to group assignment, reviewed 28 simulation videos (15 Expert and 13 Novice) and scored them using the LCJR and pass/fail assessments. Time to Task assessment was scored based on time thresholds for specific nursing ...
Clinical Simulation in Nursing, 2016
Background: Standardized, objective measures of performance in a simulated experience are lacking... more Background: Standardized, objective measures of performance in a simulated experience are lacking. As eye tracking glasses (ETG) provide video, audio, and data capture of a simulation event and quantitative data of participant actions, this technology is well suited for assessment. Therefore, this study sought to begin validating ETG as an adjunct, objective performance assessment tool in simulation. Method: This was a prospective, validation study with a two-group, convenience sample of novice and expert nurses who participated in a heart failure (HF) simulation scenario to validate ETG using a known-groups approach. A HF scenario designed to elicit seven basic nursing tasks was followed by a knowledge test and demographic questionnaire. Results: The groups were equivalent in basic HF knowledge as related to the care of a dyspneic patient. Of the seven tasks, all novices completed only one, while in the expert group, all participants completed four of the seven. Significance was found between groups for time to task in five of seven tasks and eye fixation times in key areas. Conclusions: This pilot study begins the validation process of ETG technology as an objective assessment method as significant differences were elicited between known groups. ETG technology also provides meaningful data and visual images that can be used to inform nursing education in simulation. Additional research is needed to further establish the validity and reliability of ETG technology as an assessment tool in clinical simulation.
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2013
ABSTRACT Introduction/Background: Gains in knowledge using human patient simulation (HPS) in the ... more ABSTRACT Introduction/Background: Gains in knowledge using human patient simulation (HPS) in the education of pre-licensure nursing students are well established.1-5 While many surmise the gains to be temporary, the impact of successive, duplicate HPS events over time is not known. Therefore, the aim of this study was to explore knowledge scores after a baseline heart failure (HF) HPS event and again after a second HPS following a clinical internship (three months). Methods: Using a one group repeated measures design, we examined knowledge of HF care using a six item HF Knowledge Questionnaire in prelicensure nursing students (age 25 +/- 4.2; gender =73% female) at baseline (pretest), after an initial HF HPS (post-test 1) and after a three month clinical internship and a second HF HPS training session (post-test 2). Statistical analysis consisted of Kruskal-Wallis with post-hoc Mann-Whitney U tests as the data were non-parametric. Results: Thirty seven age and gender matched subjects completed the study. Statistically significant increases in knowledge scores were seen between the pretest (3.62 +/- 1.21) and post-test 1 (4.49 +/- 0.80; P = &lt; 0.01). Post-test 2 scores (after three months of a clinical internship on a Medical-Surgical Unit and a second HPS; 4.24 +/- 0.83; p &lt; 0.01) continued to be significantly higher than the pretest. While there was a decline from Post-test 2 from the Post-test 1, this was not statistically significant (P = 0.25). Conclusion: These findings indicate a maximum knowledge impact with a single HPS event. This is important information for educators who have been uncertain of the necessary &quot;dose&quot;, or number, of HPS events needed to impact knowledge. However, it is concerning that, despite a second HF HPS session and a three month clinical internship, HF knowledge scores did not continue to increase. It may be that didactic content in the academic setting, augmented by HPS, was not adequately reinforced with teaching on actual patients during their clinical internship. However, the exact reasons why HF knowledge did not continue to increase after clinical internship and a second HPS experience needs to be explored in future studies. In summary, while HPS can be used to augment learning in the academic setting and educators can be assured that a single HPS learning experience provides a higher level of HF knowledge over baseline which is not significantly impacted by clinical internship or a second HPS dose. References: 1. Brannan J, White A, Bezanson J. Simulator effects on cognitive skills and confidence levels. Journal of Nursing Education 2008;47:495-500. 2. Hoffmann RL, O&#39;Donnell JM, Kim Y. The effects of human patient simulators on basic knowledge in critical care nursing with undergraduate senior baccalaureate nursing students. Simul Healthc 2007;2:110-4. 3. Howard V. A comparison of educational strategies for the acquisition of medical-surgical nursing knowledge and critical thinking skills: human patient simulator vs. the interactive case study approach. In. Pittsburgh: University of Pittsburgh; 2007. 4. Jeffries P, Rizzolo M. Designing and implementing models for the models for the innovative use of simulation to teach nursing care of ill adults and children: A national, multi-site, multi-method study: National League for Nursing; 2006. 5. Shinnick M, Woo M, Horwich T, Steadman R. Debriefing: The most important component in simulation? Clinical Simulation in Nursing 2011;7:e105-e11. Disclosures: None.
IMPACT OF HUMAN PATIENT SIMULATION ON NURSING CLINICAL KNOWLEDGE INTRODUCTION: Currently, there i... more IMPACT OF HUMAN PATIENT SIMULATION ON NURSING CLINICAL KNOWLEDGE INTRODUCTION: Currently, there is a widespread shortage of clinical rotation sites for nursing students to practice clinical skills and many schools and acute care facilities have turned to Human Patient Simulation (HPS) as an educational tool. Use of HPS is common, yet its effectiveness is unclear. Therefore, the specific aims of this study were to: 1) to determine if HPS improves clinical knowledge and 2) to determine if HPS improves self-efficacy in clinical behavior in undergraduate nursing students. METHODS: Using a one group, quasi-experimental pre/post-test design, we examined 57 Master's Entry-level Clinical Nurse (MECN) program students, who were studied in groups of 10. All students completed pre-tests (Self-Efficacy for Nursing Skills Questionnaire and Clinical Knowledge Test), participated in four medical-surgical simulations (SimMan, Laerdal), attended debriefing, then completed post-tests (same as pre...
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Papers by MARY ANN SHINNICK