Wednesday, 23 March 2016

Protected mealtimes - worth the effort?

Roger Watson, Editor-in-Chief

Protected mealtimes became very 'trendy' a few years ago due to the idea that patients, especially those who have difficulty eating, eat less and their nutrition becomes compromised when they are disturbed, for example, by consultant rounds or medicine administration. I know that one small study I was involved in showed that they were ineffective but that was carried out on the basis of audit and not a rigorously designed research study.

Two studies from Australia and published in JAN investigate protected mealtimes.The first by Young et al. (2016) titled: 'Assisted or Protected Mealtimes? Exploring the impact of hospital mealtime practices on meal intake' aimed to: 'evaluate the impact of mealtime practices (meal time preparation, assistance and interruptions) on meal intake of inpatients in acute hospital wards.' A survey design was used. Counterintuitively: 'There was no difference in meal intake between patients who were interrupted, compared with those who were not interrupted.' Various aspects of positioning and assisting were shown to be effective in helping patients to eat and the authors conclude: 'clinicians and managers should consider adopting an ‘assisted mealtimes’ focus to improve meal intake, rather than only focusing on Protected Mealtimes.'

The second study by Porter et al. (2016) titled: 'Implementation of protected mealtimes in the subacute setting: stepped wedge cluster trial protocol' aims 'to determine if protected mealtimes implementation closes the energy deficit of 1900 kJ between estimated requirements and actual energy intake of hospitalized adults in the subacute setting.' Given the outcome of the previous study, it will be interesting to see what the outcome of this study is. It is good that the evidence-base is building in this important area of patient care and that JAN is contributing to it.


You can listen to this as a podcast.


References

PORTER J., HAINES T. & TRUBY H. (2016) Implementation of protected mealtimes in the subacute setting: stepped wedge cluster trial protocol. Journal of 1 Advanced Nursing doi: 10.1111/jan.12930


YOUNG A. , ALLIA A. , JOLLIFFE L . , DE JERSEY S . , MUDGE A. , MCRAE P. & BANKS M. (2016) Assisted or Protected Mealtimes? Exploring the impact of hospital mealtime practices on meal intake. Journal of Advanced Nursing doi: 10.1111/jan.12940

Tuesday, 15 March 2016

Justifying smoking in pregnancy

Roger Watson, Editor-in-Chief


Smoking during pregnancy is known to be harmful to unborn babies, so why do some women persist? Smoking is also damaging to the smoker and to others in the vicinity, but surely - and especially - no mother wants to take the risk of harming her baby. So you would think!

The aim of the study reported in an article from Poland and published in JAN by Goszcyńska et al. (2016) was to study: 'lay justifications expressed by smoking pregnant women to explain why they use cigarettes during pregnancy and to determine a typology for these justifications' The article is titled: 'How do pregnant women justify smoking? A qualitative study with implications for nurses’ and midwives’ anti-tobacco interventions'.

An online forum was used and responses were analysed to see what the justifications were. One woman obviously thought 'so far so good' as she said: 'I’ve been smoking for the first trimester and nothing has happened to the baby, so still there’s no risk.' Another woman thought it was a matter of degree as she claimed: 'Nobody’ll dare to say out loud: ‘smoking while pregnant doesn’t harm’. But a teratogenic effect only happens if you smoke a packet a day. A cig won’t do harm.'

For some it seemed pointless to stop now; as one woman said: 'I’m 25 weeks pregnant. . ..It won’t make much difference if I quit now. There are already toxins in my body and it would take some time to get rid of them, about half a year.' Alternatively, everything causes cancer - so what's the point? 'Even fruits bought in stores contain so many chemicals and other rubbish. Should we give it all up during pregnancy? Smoking is said to cause cancer. What doesn’t cause cancer? Everything does!'

And, of course, people who justify the risk are always able to generalise from the particular.,.,.and miss the point: 'A friend smoked during pregnancy and gave birth to healthy twins. What’s important is that they’re loved and taken care of. Even a horrible stench won’t bother a child if it’s loved.'

Clearly some women are going to be difficult to convince about the benefits of not smoking during pregnancy. The authors conclude: 'The essence of the change required in current practice involves altering it into a dialogue with patients that aims to recognize and work on their specific justifications, which will augment their personal motivation to alter their behaviour.'


You can listen to this as a podcast.



Reference

GOSZCZYŃSKA E., KNOL-MICHAŁOWSKA K. & PETRYKOWSKA A. (2016) How do pregnant women justify smoking? A qualitative study with implications for nurses’ and midwives’ anti-tobacco interventions. Journal of Advanced Nursing doi: 10.1111/jan.12949

Are doctors as good as nurses?

Roger Watson, Editor-in-Chief

Can doctors be substituted by nurses?  This alluring possibility has caught the imagination of health services in several countries mainly, it has to be said, because it is likely to be cheaper.  This study from The Netherlands by van der Biezen et al. (2016) titled: 'Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study' and published in JAN reports on a study of the substitution of general practitioners (GPs) by nurse practitioners (NPs).

The aim of the study was to: 'provide insight into the impact of substituting general practitioners with
nurse practitioners in out-of-hours services' and the number of patients and their characteristics were studied as outcomes using data from over 12,000 patient records.  The results showed that: 'General
practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners’ caseload.'

The outcome of this study suggests that, in the circumstances of this study, nurses can be substituted for doctors and this could be useful where there is a shortage of doctors.  Specifically, the authors conclude: 'a GP can be substituted by an NP in a team with other GPs, just like in daytime primary care. The team with an NP provides care to the same number and type of patients. Consistent with what they learned in their master’s training programme, NPs saw a broad range of common complaints. Differences between the patients seen by NPs and GPs were mainly due to complaints that do not fit the predefined scope of NP care.'

You can listed to this as a podcast.

Reference

VAN DER BIEZEN M., SCHOONHOVEN L., WI JERS N., VAN DER BURGT R., WENSING M. & LAURANT M. (2016) Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental studyJournal of Advanced Nursing doi: 10.1111/jan.12954

Monday, 14 March 2016

JAN editor Rita Pickler named in STTI 2016 Researcher Hall of Fame

The Honor Society of Nursing, Sigma Theta Tau International Announces
2016 Nurse Researcher Hall of Fame Inductees

Honorees will be inducted during the
27th International Nursing Research Congress in Cape Town, South Africa

INDIANAPOLIS — The Honor Society of Nursing, Sigma Theta Tau International (STTI) will induct 19 nurse researchers into the International Nurse Researcher Hall of Fame at STTI’s 27th International Nursing Research Congress in Cape Town, South Africa, 21-25 July 2016. On Saturday, 23 July 2016, these 19 individuals —representing the countries of Canada, England, Lebanon, South Africa, Taiwan, and the United States — will be presented with the International Nurse Researcher Hall of Fame award and participate in a conversation with STTI President Cathy Catrambone, PhD, RN, FAAN.
Created in 2010, the International Nurse Researcher Hall of Fame recognizes nurse researchers who have achieved significant and sustained national or international recognition and whose research has improved the profession and the people it serves. The honorees’ research projects will be shared through STTI’s Virginia Henderson Global Nursing e-Repository, enabling nurses everywhere to benefit from their discoveries and insights. The award presentation is sponsored by Wiley.
“These cumulative research achievements of these 19 honorees has been nothing short of life changing,” said STTI President Cathy Catrambone, PhD, RN, FAAN. “We celebrate their achievements in advancing world health, and I offer my personal congratulations. I look forward to learning and sharing more about their contributions.”
“Wiley proudly recognizes the efforts of this year's recipients of the STTI’s International Nurse Researcher Hall of Fame awards. We congratulate each individual recipient for their significant contributions towards outstanding research, leadership, and efforts in advancing health around the world. As in years past, we enthusiastically support nursing researchers for their high impact on the nursing profession and their contributions to improving patient outcomes” said Wiley Publishing Manager for Nursing Kassie Stovell.
STTI’s annual international nursing research congress attracts nearly 1,000 nurse researchers, students, clinicians, and leaders, who learn from evidence-based research presentations. The theme for the 27th congress is Leading Global Research: Advancing Practice, Advocacy and Policy. To view details or register for the event, visit http://congress.nursingsociety.org.

2016 International Nurse Researcher Hall of Fame Honorees
Deborah Bruner, PhD, RN, FAAN
Robert W. Woodruff Professor of Nursing
Emory University Nell Hodgson Woodruff School of Nursing
Alpha Epsilon Chapter #027
USA
Janet Carpenter, PhD, RN, FAAN
Associate Dean for Research and Scholarship; Distinguished Professor
Indiana University School of Nursing
Alpha Chapter #001
USA
Eileen Collins, PhD, RN, FAACVPR, FAAN
Professor
University of Illinois at Chicago College of Nursing
Alpha Lambda Chapter #033
USA
Elizabeth Corwin, PhD, RN, FAAN
Associate Dean for Research
Emory University Nell Hodgson Woodruff School of Nursing
Alpha Epsilon Chapter #027
USA
Sonia A. Duffy, PhD, RN, FAAN
Mildred E. Newton Professor of Nursing
The Ohio State University College of Nursing
Rho Chapter #016
USA
Marilyn Hockenberry, PhD, RN, PNP-BC, FAAN
Associate Dean, Research Affairs
Duke University School of Nursing
Beta Epsilon Chapter #051
USA
Huda Abu-Saad Huijer Huda-Abu-Saad Huijer, PhD, RN, FEANS, FAAN
Director School of Nursing
American University of Beirut
Chi Iota Chapter #511
Lebanon
Hester C. Klopper, PhD, MBA, FANSA, FAAN
Chief Executive Officer, FUNDISA; Professor, University of the Western Cape and North-West University Potchefstroom
Tau Lambda-at-Large Chapter #441
South Africa
Terry A. Lennie, PhD, RN
Professor and Associate Dean for Graduate Faculty
University of Kentucky
Delta Psi Chapter #117
USA
Linda McCauley, PhD, RN, FAAN, FAAOHN
Dean and Professor
Emory University Nell Hodgson Woodruff School of Nursing
Alpha Epsilon Chapter #027
USA
Linda McGillis Hall, PhD, FAAN, FCAHS
Kathleen Russell Distinguished Professor
University of Toronto
Lambda Pi-at-Large Chapter #278
Canada
Barbara Medoff-Cooper, PhD, RN, FAAN
Professor of Nursing and the Ruth M. Colket Endowed Chair in Pediatric Nursing
University of Pennsylvania School of Nursing
Xi Chapter #013
USA
Cindy Munro, RN, ANP-BC, PhD, FAAN, FAANP, FAAAS
Associate Dean for Research and Innovation
University of South Florida College of Nursing
Delta Beta-at-Large Chapter #096, Gamma Omega Chapter #094
USA
Anne E. Norris, PhD, RN, FAAN
Professor of Nursing
University of Miami School of Nursing and Health Studies
Beta Tau Chapter #065
USA
Rita H. Pickler, PhD, RN, FAAN
The FloAnn Sours Easton Professor of Child and Adolescent Health; Director, PhD and MS in Nursing Science Programs
The Ohio State University College of Nursing
Epsilon Chapter#004
USA
Anne-Marie Rafferty, CBE, DPhil, MPhil, RN, DN
Professor of Nursing Policy
Florence Nightingale Faculty of Nursing & Midwifery, King's College London
Upsilon Xi-at-Large Chapter #468
England
Ora Strickland, PhD, RN, FAAN
Dean and Professor
Florida International University
Alpha Epsilon Chapter #027
USA
Pei-Shan Tsai, PhD
Distinguished Professor and Associate Dean
College of Nursing, Taipei Medical University, Taiwan
Lambda Beta-at-Large Chapter #264
Taiwan
Judith A. Vessey, PhD, MBA, RN, FAAN
Leila Holden Carroll Professor in Nursing
Boston College
Alpha Chi Chapter #044
USA

Tuesday, 8 March 2016

Antenatal depression in ultra-orthodox communities

Roger Watson, Editor-in-Chief

Some communities are harder to reach than others and few must be harder than the ultra-orthodox Jewish community in Israel as this study from  Israel by Glasser et al. (2016) titled: 'Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra-orthodox community' and published in JAN shows.

The study aimed to: 'investigate the rate of and risk factors for perinatal depression in an Israeli ultra-orthodox Jewish community and assess the contribution of antenatal nursing intervention to reducing symptoms of postpartum depression'. As the authors explain: 'Among Jewish ultra-orthodox women both religion and childbearing play major roles'.  In a study of over 150 women, while rates of perinatal depression were similar to the general population when measured in the study, it was considered that rates of post-natal depression were underreported.

An interesting aspect of the study was that in those families where the husband was 'avrechim' - meaning that he did not work but pursued a life of religious study - the rates of depression were lower.  This was counter-intuitive as in these families the women carry the burden of housework and supporting the family financially.  Rates of depression were higher in families where the husband worked and earned a salary.  This may because of the high value attached to the role that the wives of men who were avrechim had to play and the value and esteem bestowed on them.

In conclusion, the authors say: 'The findings of this study highlight the need, particularly in multi-cultural societies and those with immigrant populations, to understand the norms and sensitivities that affect the responses of different groups to ‘universal’ screening programmes and to open pathways for identifying problems and accessing help when it is needed. This study offered the opportunity to gain insight into the perinatal experiences of a minority sub-population whose norms and lifestyle are different than those of the mainstream culture and to attempt to alleviate symptoms of perinatal depression among them'.

Listen to this as a podcast.

Reference

GLASSER S., HADAD L., BINA R., BOYKO V. & MAGNEZI R. ( 2016) Rate, risk factors and assessment of a counselling intervention for antenatal depression by public health nurses in an Israeli ultra-orthodox community. Journal of Advanced Nursing doi: 10.1111/jan.12938

Monday, 7 March 2016

Response to 'Living dolls and nurses without empathy'

Re: Dean, S., Williams, C., Balnaves, M. (2016). Living dolls and nurses without empathy

Tamara Power
Carolyn Hayes

Having recently published a paper that discussed increasing student engagement with manikins (Power et al. 2016), it was with great interest that we read the editorial by Dean et al. (2016), discussing their impression of a one-off demonstration of a simulation scenario. We welcome this opportunity to provide insight into the use of manikins and the development of empathy in nursing students.

Dean et al. (2016) are correct in stating that manikins are increasingly being used in nursing education. They are incredibly useful for students to practice a wide range of nursing skills (including communication), in an environment that is safe for them and removed from the patient. Unlike humans, manikins can tolerate multiple repetitions of the same clinical procedure with no detrimental or lasting effect. Students can make verbal faux pas, with no risk of offending or upsetting an already vulnerable person. They can learn from making life threatening errors, without endangering an actual patient. Dean et al.s’ (2016, p. 2) statement that “artificial intelligence has found its limits in trying to replicate empathy” does not reflect current investigations. Researchers are actively engaged in developing manikins who have lifelike skin, can emulate facial expressions, move their heads, whose eyes can track faces, read text and have their pupils dilate in response to light (Baldrighi et al. 2014). The primary goal of these researchers is in fact “eliciting a more powerful emotional connection between student and simulator” (Baldrighi et al. 2014, p. 563). Others are experimenting with humanising simulation equipment through retro-projecting expressive human faces onto manikins with translucent face masks (Delaunay, de Greef & Belpaeme 2009). As science fiction rapidly becomes reality, can the future of simulation where manikins are barely distinguishable from humans be that far away?

While we wait for these advances in technology, we agree with Dean et al. (2016) that manikins are currently limited in their emotional range. Those working in simulation have long acknowledged this limitation. It is for this reason that other simulation modalities are employed instead of, or in conjunction with the use of manikins. In our own recently published study, the combination of case study audio-visual vignettes using paid actors, and transferring props from the actors in the vignettes to the manikins, was found to increase student nurses’ empathy in a simulated setting using manikins (Power et al. 2016). Students reported being grateful for an opportunity to witness nurse-patient interactions portrayed in the vignettes. They described repeating phrases that had been used by the nurse actors in the films when practicing skills with the manikins. Despite their current limitations, being able to practice communication with a manikin, while mastering unfamiliar psychomotor skills, has to be preferable to practicing the skill devoid of a patient.

“…Knowing what to say was helpful as we could practice holistic nursing and not just focus on the skills e.g. giving a needle but also focusing on the patients other needs” (Power et al. 2016, p. 129).

Simulation is not limited to manikins. Others academics have successfully used a variety of simulation modalities to develop empathy including paid actors working with students (Ward 2016); providing students with experiential opportunities such as wearing an ostomy bag for 48 hours or engaging in an ageing simulation game (Chen et al. 2015). Cultural empathy has been cultivated through the use of 3D video to simulate the experience of being admitted to hospital in a developing country (Everson et al. 2015).

Additionally, in Australia, it is mandated by accrediting bodies that all undergraduate nursing programs provide a minimum of 800 hours of clinical placements (ANMAC 2012). These placements involve engaging with intra and inter-disciplinary teams and patients who do display non-verbal body language and facial expressions. There are a minimum of 800 hours to engage in ‘embodied practices’. Any simulation experiences offered are in addition to clinical placement. If in the future, as Dean et al. (2016, p. 1) citing Jeffries (2009) reported, clinical learning does move more into the simulated space, it will be in response to “mounting evidence” that the experience is equitable.

Blaming the use of manikins for a decline in empathy, fails to take into account the multiple modern stressors on nursing curricula. As Sheehan et al. (2013, p. 457) highlighted, nurses are operating in an increasingly regulated, policy driven, complex environment. “With nursing faculty attempting to teach the ever expanding list of essential nursing concepts, the time to teach caring, comfort and affective skills is narrowing” (Sheehan et al. 2013, p. 460). These researchers also point to generational factors, highlighting that today’s nursing students are increasingly isolated from human interaction through engagement with personal devices, computers and the internet.

In their own words, “empathy is a multi-determined response that results from the integration of experiences” (Dean et al. 2016, p. 1). However, Dean et al. (2016) have not considered any alternative reasons for a decline in nurse empathy beyond the hypothesised use of manikins. Certainly increasing empathy in nursing students is an admirable goal, and it is heartening that so many recent studies, as referenced here, are pursuing that goal. However, we disagree that any decline in empathy can be laid at manikins’ plastic feet.



Tamara Power | PhD RN
Senior LecturerDirector, Health Simulation
Faculty of Health | University of Technology Sydney

Carolyn Hayes | BHSc RN
Manager, Simulation and Laboratories
Faculty of Health | University of Technology Sydney



References

ANMAC 2012, 'Registered nurse accreditation standards', accessed 1st December, 2014 at http://www.anmac.org.au/sites/default/files/documents/ANMAC_RN_Accreditation_Standards_2012.pdf

Baldrighi, E, Thayer, N, Stevens, M, Ranson Echols, S & Priya, S 2014, 'Design and implementation of the bio-inspired facial expressions for medical mannequin', International Journal of Social Robotics, vol. 6, no. 4, pp. 555-74.

Chen, AMH, Kiersma, ME, Yehle, KS & Plake, KS 2015, 'Impact of the Geriatric Medication Game on nursing student's empathy and attitudes toward older adults', Nurse Education Today, vol. 35, no. 1, pp. 38-43.

Dean, S, Williams, C & Balnaves, M 2016, 'Living dolls and nurses without empathy', Journal of Advanced Nursing, vol. e-publication ahead of print, pp. 1-3.

Delaunay, F, de Greef, J & Belpaeme, T 2009, 'Towards retro-projected faces: An alternative to mechatronic and android faces', paper presented to The 18th IEEE International Symposium on Robot and Human Interactive Communication, Toyama, Japan.

Everson, N, Levett-Jones, T, Lapkin, S, Pitt, V, van der Riet, P, Rossiter, R, Jones, D, Gilligan, C & Courtney-Pratt, H 2015, 'Measuring the impact of a 3D simulation experience on nursing student's cultural empathy using a modified version of the Kiersma-Chen empathy scale', Journal of Clinical Nursing. 24: 2849–2858. doi: 10.1111/jocn.12893

Jeffries, PR 2009, 'Guest editorial: Dreams for the future of clinical simulation', Nursing Education Perspectives, vol. 30, no. 2, pp. 71-.

Power, T, Virdun, C, White, H, Hayes, C, Parker, N, Kelly, M, Disler, R & Cottle, A 2016, 'Plastic with personality: Increasing student engagement with manikins', Nurse Education Today, vol. 38, pp. 126-31.

Sheehan, CA, Perrin, KO, Potter, ML, Kazanowski, MK & Bennett, LA 2013, 'Engendering empathy in baccalaureate nursing students', International Journal of Caring Sciences, vol. 6, no. 3, pp. 456-64.

Ward, J 2016, 'The empathy enigma: Does it still exist? Comparison of empathy using students and standardized actors', Nurse Educator, vol. e-publication ahead of press, pp. 1-5.



Friday, 4 March 2016

Response to 'Living dolls and nurses without empathy'

Re: Dean, S., Williams, C., Balnaves, M. (2016) Living dolls and nurses without empathy

Michelle Kelly


The editorial by Dean et al(2016) in JAN raises several valid points but does not incorporate many others which have been raised or already addressed in the rapidly maturing area of healthcare simulation.

Like other ‘new technologies’ the initial 'wow' factor over time moves to more considered wider application of the initiative and so too with simulation-based education. While Dean et al. (2016) focus on the use of manikins in simulation, other modalities feature strongly in this space – simulation role-plays often with peers or simulated patients (Nestel & Bearman 2015), a hybrid approach (task trainer or mask and person as in MaskEd™(MaskEd™ - KRS Simulation)) and virtual or augmented reality. Such fit-for-purpose approaches, which address the current limitations of manikins, have been cited in the literature for over a decade (Bryans & McIntosh 2000, Hardoff & Schonmann 2001, Kelly & Gallagher 2014, Kneebone & ApSimon 2001, Kneebone et al. 2004). Another exciting area of growth is emotional expressive screen-based simulation such as Baby X (Auckland Bioengineering Institute, 2016) demonstrated at the 2015 SimTecT/SimHealth conference in Adelaide. These types of interactive experiences are a game changing new dimension in simulation for health professions education, and can certainly elicit the affective aspects of learning.  

A strong imperative for using simulation-based education is patient safety - to rehearse clinical procedures or enact commonplace scenarios prior to practice experiences. For undergraduate students these are the main foci of simulation embedded within curricula, and incorporate engaging and communicating with ‘patients’ and ‘relatives’. Unlike in the clinical setting, simulation scenarios can be sped up or slowed down to cater for participants’ expertise or learning needs. As such, cognitive load can be managed and specific skills sets and context can be combined within sequential simulations.

When contemporary simulation ‘appeared on the stage’, the context of scenarios tended to focus on acute medical situations, such as the chest pain vignette described in the editorial. There is now a plethora of literature which features innovative and diverse scenario topics and approaches to simulation-based education to ensure students understand and develop a holistic approach to clinical practice, including empathy (Bearman et al. 2015, Chaffin & Adams 2012, Everson et al. 2015, Orr et al. 2013). Common feedback from nursing students is that simulation ‘glues things together’ – that theoretical aspects make sense as they draw on tacit knowledge and apply it to a realistic unfolding scenario. This does not discount the benefits of other educational strategies to contextualise theory with practice, but simulation scenarios enables students to 'walk in the shoes' of the Registered Nurse, the ‘patient’ (as the voice of the manikin) or the ‘relative’ and appreciate the impact and importance of how interactions amongst the recipients and providers of healthcare impact on patient care and outcomes.

A benefit of this editorial is to remind those who facilitate learning through simulation to engage the wider community in discussions about the contribution of simulation-based education to the health professions. Empathy is certainly an important aspect of professional practice as much as other domains - dexterity in clinical procedures, effective teamwork and communication, and clinical reasoning, judgement and decision making. One reason why simulation appeals to many is that all these components of practice can be incorporated into a well-planned and facilitated scenario to trigger the affective features of learning – to help participants reflect on their values and professional behaviours – inclusive of empathy.


Michelle Kelly  PhD MN BSc RN
Associate Professor
Director: Community of Practice
School of Nursing, Midwifery & Paramedicine | Faculty of Health Sciences

Curtin University
Kent St, Bentley WA 6102 Australia
Michelle.Kelly@curtin.edu.au


References


Auckland Bioengineering Institute. (2016). Laboratory for Animate Technologies. Retrieved 16 February, 2016, from http://www.abi.auckland.ac.nz/en/about/our-research/animate-technologies.html

Bearman, M., Palermo, C., Allen, L. M., & Williams, B. (2015). Learning Empathy Through Simulation: A Systematic Literature Review. Simulation in Healthcare, 10(5), 308-319. doi: 10.1097/sih.0000000000000113

Bryans, A., & McIntosh, J. (2000). The use of simulation and post-simulation interview to examine the knowledge involved in community nursing assessment practice. Journal of Advanced Nursing, 31(5), 1244-1251. doi: doi:10.1046/j.1365-2648.2000.01382.x

Chaffin, A. J., & Adams, C. (2012). Creating Empathy Through Use of a Hearing Voices Simulation. Clinical Simulation in Nursing, 9(8), e293-e304. doi: 10.1016/j.ecns.2012.04.004

Dean, S., Williams, C., Balnaves, M. (2016). Living dolls and nurses without empathy. Journal of Advanced Nursing, 1-3, e-publication ahead of print.

Everson, N., Levett‐Jones, T., Lapkin, S., Pitt, V., Riet, P., Rossiter, R., . . . Courtney‐Pratt, H. (2015). Measuring the impact of a 3D simulation experience on nursing students' cultural empathy using a modified version of the Kiersma‐Chen Empathy Scale. Journal of Clinical Nursing, 24(19-20), 2849-2858.

Hardoff, D., & Schonmann, S. (2001). Training physicians in communication skills with adolescents using teenage actors as simulated patients. Medical Education, 35(3), 206-210. doi: 10.1111/j.1365-2923.2001.00764.x

Kelly, M. A., Hager, P., & Gallagher, R. (2014). What matters most? Students' rankings of simulation components which contribute to clinical judgement. Journal of Nursing Education, 53(2), 97-101. doi: 10.3928/01484834-20140122-08

Kneebone, R., & ApSimon, D. (2001). Surgical skills training: simulation and multimedia combined. Medical Education, 35(9), 909-915. doi: 10.1046/j.1365-2923.2001.00997.x

Kneebone, R., Scott, W., Darzi, A., & Horrocks, M. (2004). Simulation and clinical practice: Strengthening the relationship. Medical Education, 38(10), 1095-1102. doi: 10.1111/j.1365-2929.2004.01959.x

MaskEd™ - KRS Simulation. What is MaskEd™? Retrieved 10 February, 2016, from https://www.cqu.edu.au/about-us/structure/schools/nm/simulation/mask-ed/what-is

Nestel, D., & Bearman, M. (Eds.). (2015). Simulated patient methodology: Theory, evidence and practice. Chichester, UK: Wiley Blackwell.

Orr, F., Kellehear, K., Armari, E., Pearson, A., & Holmers, D. (2013). The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse Education in Practice, 13(6), 529-535. doi: 10.1016/j.nepr.2013.03.023