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Effective clinical nursing instructors are essential for maximizing nursing students' educational experience. Due to a shortage of clinical placement sites and advancements in technology, nursing students are increasingly learning clinical judgment and decision making in the simulated clinical experience (SCE) with human patient simulators. In this environment, SCE instructors help students acquire knowledge and skills in decision making in a controlled, risk-free, hospital-like clinical environment. Using informal student interviews, this study examined nursing student perceptions of the characteristics of an effective instructor in the simulated clinical experience. To capture information about the characteristics of effective SCE instructors, interviews were conducted with students (N = 8) from two universities in Northern California. All participants had experience working with human patient simulators in the simulation laboratory. Students identified six themes for SCE instructors: Personality, Teaching Ability, Evaluation, Nursing Competence, Interpersonal Relationships, and Realism. Further research on the similarities and differences of this new educational environment is recommended.

A patient with a spinal cord injury presented to our clinic with signs and symptoms that our staff did not recognize. It was later determined to be autonomic dysreflexia. What is important to know about autonomic dysreflexia?-GE, GA Julianne Mercado, RN; Amanda Ruiz, RN; and Bridget Parsh, EdD, RN, CNS respond-Autonomic dysreflexia (AD), also known as autonomic hyperreflexia, is a potentially life-threatening acute syndrome that occurs in 20% to 70% of patients with spinal cord injury (SCI) at or above the level of T6. 1,2 Unfortunately, knowledge of AD is low among healthcare professionals. 3 Uninhibited or exaggerated sympathetic responses to noxious stimuli below the level of the SCI result in diffuse vasoconstriction and hypertension. A compensatory parasympathetic response causes bradycardia and vasodilation above the level of the SCI, but it is insufficient to decrease the BP.In most cases, urologic issues such as urinary tract infection, distended bladder, or a blocked indwelling urinary catheter can be the trigger for AD. 1 Other stimuli that can cause AD include constipation, fecal impaction, gastric ulcers, hemorrhoids, pressure injuries, ingrown toenails, and burn injuries. 1,4 Additional triggers include tight clothing, sexual activity, menstrual cramps, ovarian cysts, or bone fractures. 5 Wrinkled sheets can also trigger a patient who lays on them. Patients with AD may be unaware of these stimuli due to either absent or reduced sensation below the level of injury. 5

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