BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/New_York X-LIC-LOCATION:America/New_York BEGIN:DAYLIGHT TZOFFSETFROM:-0500 TZOFFSETTO:-0400 TZNAME:EDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0400 TZOFFSETTO:-0500 TZNAME:EST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20260323T181725Z LOCATION:Morgan DTSTART;TZID=America/New_York:20260324T113700 DTEND;TZID=America/New_York:20260324T120000 UID:HFESHCS_2026 International Symposium on Human Factors and Ergonomics i n Health Care_sess128_LEC173@linklings.com SUMMARY:Using Metric-Based Clinical Simulation to Evaluate Procedural Task s and Clinical Decisions During Ostomy Appliance Change Procedures Perform ed by Nurses with Different Nursing Credentials DESCRIPTION:Hannah Gerlach, Marketa Haughey, Casey Hopkins, David Neyens, and Melinda Harman (Clemson University)\n\nHuman factors and usability eva luations are recognized by the Food and Drug Administration (FDA) as impor tant for medical device safety and effectiveness and are widely used to im prove health care quality and patient safety. Assessment of human factors in medical procedures includes user participation in simulated clinical en vironments, and simulation pedagogy is widely used for teaching and assess ing nursing skills. Simulation allows users to gain hands-on experience an d allows researchers to examine the user interaction with medical devices while performing tasks in realistic yet safe environments. While human fac tors and simulation techniques have been used to assess nursing care, they have not been applied to assess the psychomotor and cognitive tasks essen tial for delivery of high-quality ostomy nursing care. \n\nThis study expl ores factors associated with ostomy appliances that are used by individual s living with a stoma after ostomy surgery. Over 100,000 ostomy surgeries are performed annually in the United States and involve rerouting excreta from internal organs through an abdominal stoma and into an ostomy applian ce. Ostomy appliances require users to perform critical self-care tasks th at include frequent pouch changes and skin care. After ostomy surgery, pat ients rely on instructions provided by nurses to guide their at-home ostom y care, which influences their development of self-care skills. Unfortunat ely, peristomal skin complications (PSCs) are a persistent challenge affec ting approximately one-third of patients within 90 days of ostomy surgery. PSCs are highly influenced by the fit and adhesion of the appliance and a re less common in patients who receive ostomy care education from ostomy n urse specialists. However, there is a shortage of certified ostomy care nu rses (COCN) and a need to extend ostomy nursing care education to non-spec ialty nurses.\n\nClinical competencies (skills and knowledge) in ostomy nu rsing care and their influence on safety (peristomal skin health) and outc omes (patient recovery and health related quality of life) following ostom y surgery are not well understood within a human factors context. Competen ce in performing ostomy skin care is important because it has been shown t hat experts and novices perform work differently. According to Benner’s th eory of clinical competence in nursing practice, expertise develops throug h proper education and experience over time, ultimately enabling holistic assessment to guide clinical decisions. Nurses without ostomy nursing care credentials are often responsible for educating and training patients in self-management of care, and these non-specialty nurses report being uncom fortable managing ostomy problems. Different care environments, such as ac ute-care or home-health settings, can also influence ostomy nursing care d elivery. For these reasons, simulation of ostomy nursing care could enhanc e the understanding of current clinical practices with ostomy appliances a nd support training and skill development of the nursing workforce. \n\nTh e purpose of this study was to explore both clinical practice and decision s made during ostomy appliance change procedures performed by nurses with different nursing credentials using a validated metric-based clinical simu lation procedure. This was accomplished by: 1) documenting discrete tasks and task duration related to product selection, skin care, baseplate sizin g and adhesion, and infection control strategies from video recordings of four nurse groups completing ostomy simulation trials; 2) assessing percei ved usability through the system usability scale (SUS) for each participan t; and 3) describing clinical decision making in ostomy nursing care pract ice using qualitative analysis of debriefing interviews.\n\nThis study was conducted within a School of Nursing located at a healthcare institution in the southeastern United States. The standard testing simulation environ ment included a fully equipped acute-care patient room with an enhanced nu rsing mannequin simulator, which was capable of ejecting simulated stoma e ffluent with physiological fluid properties. The mannequin peristomal skin was covered with a silicone sheet to simulate baseplate adhesion to human skin.\n \nBased on the Benner’s stages of clinical competence, nurses wit h different nursing credentials were recruited as study participants: cert ified ostomy care nurse specialists (COCN+ group), registered nurses worki ng in acute care (RN group), home-health nurses (HH group) and senior prel icensure baccalaureate student nurses (SN group). Each participant was int roduced to the study, reviewed and signed the informed consent, and was gi ven a pre-briefing describing the simulation environment. Each participant was instructed to complete the ostomy appliance change procedure and enga ge with mannequin “Anne” as they would in a clinical setting. Each partici pant completed three trials, and then completed the SUS survey and simulat ion debriefing session with the facilitator.\n\nA validated structured rev iew instrument was used to extract information from video recordings relat ed to: i) clinical practice, more specifically, discrete tasks and the ord er they were performed, ii) task duration such as overall procedure time, stoma and peristomal skin care time, and reapplying appliance time, and ii i) supplies used. Discrete tasks performed, task duration, and supplies us ed were then grouped in the following categories: product selection, stoma and peristomal skin care, baseplate sizing and adhesion, infection contro l strategies, final baseplate opening size, and time duration. The basepla te of the changed ostomy appliance, collected from the mannequin abdomen u pon completion of each trial, was imaged and analyzed for the area and rou ndness of the molded or cut opening size using image analysis software. Re corded participant comments were transcribed verbatim using NVivo Transcri ption software and analyzed using content analysis.\n\nStatistical models were used to evaluate several outcome variables, including: product select ion, stoma and peristomal skin care, baseplate sizing and adhesion, and in fection control tasks considered binomial categorical variable (e.g., “per formed/did not perform” or “used/did not use”) and task duration, final ba seplate opening size, and SUS score considered as continuous response vari ables. Statistical tests were performed to determine if the measured respo nses differed among the nurse groups (COCN+, RN, HH, and SN) and the trial s (1, 2, and 3). Data analysis for the HH group is ongoing. \n\nThere were (n=26) participants in the study, including the COCN+ group (n=6), RN gro up (n=8), SN group (n=10) and HH group (n=2, with data collection ongoing) . To date, approximately 518 min of video recordings and 72 baseplate imag es have been analyzed. Differences between nurse groups include: i) COCN+ group spent significantly longer time on skin care when compared to SN gro up and RN groups; ii) COCN+ group spent significantly longer time reapplyi ng the appliance when compared to SN and RN groups; iii) the final basepla te opening size area was significantly smaller for COCN+ group when compar ed to SN group; and iv) visual differences and variations were observed in final baseplate opening smoothness.\n\nOverall, the results of this study identified variations in clinical decision-making and clinical practice w ithin ostomy care and thus highlights education topics to be emphasized fo r non-specialty nurses such as product selection and use, peristomal clean ing techniques, baseplate sizing strategies and infection prevention strat egies. Significant differences between groups were observed for all four t ask categories for ostomy nursing care (product selection n=14, skin care n=8, baseplate sizing and adhesion n=4, and infection control n=8). There were differences in perceived usability of ostomy appliance change procedu re, with similar SUS scores between COCN+ and RN groups indicating above a verage perceived usability and below average perceived usability for SN gr oup. Participants from all nurse groups made comments related to assessmen t, intervention, and education that reflected differences in decision maki ng and clinical practice that aligned with different stages of competence in clinical ostomy nursing care practice. These study results aligned with Benner's framework of clinical competence in nursing practice.\n\nTrack: Simulation and Education\n\nSession Chair: Jacqueline Hannan (University o f Michigan)\n\n END:VEVENT END:VCALENDAR