Previous reviews of simulation relating to critical thinking and efficacy called for more research on the effects of simulation and safety. Safety, as a skill performance outcome of high-fidelity simulation, is reviewed. Data included studies of nursing education that linked safety dimensions with high-fidelity simulation at all student levels. Only primary sources published since 2007 were included. This integrative review evaluates data using scores to assign value to the evidence, analyzes data within categories defined as safety behaviors, and compares evidence using a matrix of factors and outcomes. Definitions of safety and measurement tools are critiqued. Findings reveal that simulation-enhanced clinical experiences may decrease medication errors. Any evidence about perceived improvement in safer communication has not been translated into practice. Knowledge and attitudes of safety may be improved with simulation, depending on the students' educational levels. More comparative studies are needed to support theoretical models of simulation.

Background About 21 million persons have diabetes and account for 11.9% of all emergency department visits for a total cost of $14.1 billion. Non-emergent visits for ambulatory sensitive conditions that could be managed by the primary care provider make up almost one third of the ED visits. African Americans comprise about 30% of South Carolina's population but make up about 50% of the ED visits for diabetes. Methods The research design was a qualitative study using grounded theory with dimensional analysis methods to explore reasons African American patients used the ED for ambulatory sensitive conditions. Research Design The research design for this study is grounded theory with dimensional analysis methods to explore the experiences of 20 African American adults with diabetes with ambulatory sensitive ED use. Following informed consent, interviews were recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes, and consequences provides a key for understanding the themes of the story embedded in the descriptive narratives Results The contested ownership of diabetes was the overarching perspective –“doing what I got to do,” “it's always on mind...wishing not to be a diabetic,” and “it's a constant burden.” And handling diabetes involved taking decisions “into your hands.” The context of perceived urgency of symptoms included all the reasons that precipitated ED visit—personal experience, primary care access and services, and social network support for decisions influenced ownership of these decisions.

Pesticide exposures represent inequities among a vulnerable population of migrant and seasonal farmworkers. A social justice theory synthesized from an environmental health research framework, a middle range theory of critical caring, and literature on pesticide exposure is presented as a situation-specific public health practice theory. Concepts from the physiological, epistemological, vulnerability, and health protection domains are related to concepts of critical caring revealing protective strategies for vulnerable populations exposed to pesticides. The key concepts are risk exposure, community assessment, transpersonal health promotion, community competence, and controllability. Protection from exposure involves raising awareness, critically assessing communities, educating for empowerment, building capacity, and advocating to ensure social justice. Critical caring protection is provided in a mutually respectful relationship that promotes responsibility at the individual and population levels.

Dimensional analysis clarifies the concept of protection, which has a commonly understood definition but is used inconsistently in research literature. Concepts such as protective factors and protective behaviors are often used interchangeably without adequately representing the phenomenon of protection itself. This article critiques a situation-specific theory of protection and presents dimensions of a model with an ecological view of protection. It uses dimensional analysis methods to derive the social construction of protection from its use in a broad range of literature; vigilant management and vigilant communication are salient dimensions of protection. The article compares conceptual literature with research literature to identify inconsistencies in use.

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