Preparing nurses to recognize the signs and symptoms of a deteriorating patient and to provide appropriate initial interventions is essential. Hospital-based in situ simulation education is an effective evidence-based method that supports adult learning in a safe environment. The purpose of this article is to discuss the development, implementation, and evaluation of an in situ simulation program and the positive impact on nurses’ confidence level in the recognition and initiation of interventions for a deteriorating patient.

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This article builds upon a formal person-situation framework by offering formalisms for its subcomponents, as well as for reality more generally. More specifically, a system of mathematical formalisms is offered relating the following constructs: holarchy, reality, and psychological reality. Psychological reality is offered a portmanteau in the neologism, "psychologicality". Psychologicality denotes mind and behavior, both of which are subcomponents of Sood's [20] person-situation formula. The mathematics offered is woven into a broader, subjective-objective ontology that is required for any truly representative virtual world. The result from above, when synthesized with informatics, is a novel "holarchic informatics" and more specific holarchic psychoinformatics (HPI). Holarchic psychoinformatics is related with Sood's psychoinformatic complexity (PIC) paradigm. The aim of this article is to build upon "third force"-i.e., existential-humanistic (E-H)-psychology. We depart from more traditional approaches in defining E-H psychology as the study of the existence of human minds and behaviors as emergent, interdependent properties of people's interactions with situations. This definition results from the enactive person-situation framework as situated within PIC.

The purpose of this study was to offer the Sun Solutions intervention to operating engineers (N = 232) to decrease sun exposure and skin cancer. The majority (82%) of the engineers worked outside between 10 a.m. and 3 p.m., 4 to 5 hours a day; 81.4% reported more than one sunburn during the past year and 70% sometimes or never used sunscreen compared to 30% who wore sunscreen approximately 50% or more of the time. Most reported that the intervention was helpful (97%), most were satisfied (96%) with the intervention, and 84% expressed a future intention to use sunscreen. Regarding sun protective behaviors, the intervention significantly improved perceived self-efficacy (p < .05) and increased perceived barriers (p < .05). Regarding sunburn and skin cancer, the intervention increased perceived benefits (p < .05), susceptibility (p < .05), and severity (p < .05) for sunburning, but not skin cancer (p > .10). The Sun Solutions intervention showed the potential to increase sunscreen use and decrease the risk of sunburn and skin cancer among operating engineers.