The Evidence in Simulation-Based Learning Experiences in Nursing Education and Practice: An Umbrella Review

Learning outcomes of the observer role in nursing simulation: a scoping review protocol

OBJECTIVE

The purpose of this study is to map the literature investigating learning outcomes that have been measured in the observer role in simulation. A scoping review will be completed to investigate the research question: What learning outcomes have been reported in nurses or nursing students participating in simulation while assigned to the observer role?

INTRODUCTION

Simulation-based learning experiences (SBLE) are being utilized more frequently to support learning with increasing numbers of nurses. Despite SBLE becoming more popular, resources and manikin availability are not meeting the demand placed on simulation programs in nursing schools and health care facilities. Programs are placing more learners in observational roles without knowing what learning can be expected.

INCLUSION CRITERIA

Studies will be considered if they investigated learning outcomes of any nursing population (e.g. pre-licensure nursing student, graduate nursing student, practicing nurse) placed in an observational role in simulation. Any simulation topic related to nursing care will be considered. The observer role may involve observing one's own or expert behavior. The SBLE may occur in a simulation lab, classroom, community, health care facility, or online setting. Studies that include health care professionals other than nurses will be excluded. Experimental, quasi-experimental, observational, and qualitative studies will be considered.

METHODS

The JBI methodology for scoping reviews will be followed. A three-step search strategy will be used to identify potentially relevant articles. Two independent reviewers will screen titles and abstracts, assess full-text studies against the inclusion criteria, and extract data. Results will be presented in a manner that aligns with the objective of the review.

Nurse Educators' Guide to Clinical Judgment: A Review of Conceptualization, Measurement, and Development

AIM

The purpose of this article is to define clinical judgment, examine valid and reliable instruments to measure the construct, review established strategies by which to develop it, and propose key future nursing education research priorities in clinical judgment.

BACKGROUND

A pressing interest in prelicensure nursing students' clinical judgment development has emerged in response to the National Council of State Boards of Nursing project Next Generation NCLEX.

METHOD

Sequential literature reviews uncovered six instruments that measure clinical judgment and 24 studies that demonstrate the effects of high-fidelity simulation on clinical judgment in prelicensure learners.

RESULTS

Six themes emerged: number of simulation-based experience exposures, specific nursing specialty simulations, debriefing and its effect on clinical judgment, assessment, clinical decision-making, and reflection.

CONCLUSION

Based on these results, key future research priorities investigating the effects of interprofessional simulation and simulation in the classroom were identified.

High-fidelity simulation-based education in pre-registration healthcare programmes: a systematic review of reviews to inform collaborative and interprofessional best practice

Simulation-based education (SBE) is recognized as an effective interprofessional teaching and learning method. Whilst there is a large volume of research evidence concerning elements of SBE there is a lack of clarity concerning foundational principles of best practice. This is important for educators wishing to utilize high-quality SBE to deliver interprofessional education. The aim of this review is to synthesize review evidence of SBE best practice in a broad range of pre-registration healthcare programs and contextualize findings in light of relevant educational theory. A systematic search of PubMed, Scopus, Medline/Ovid, British Nursing Index, and the Cochrane Library databases was undertaken in February 2020. Data extraction and quality evaluation were undertaken by two authors. Fifteen reviews were included. In addition to identifying barriers and enablers to implementation, three interdependent themes regarding SBE best practice were found: curriculum level integration and planning (curriculum level integration, the opportunity for deliberate repeated practice, distribution, and sequencing); simulation design and delivery (clearly defined learning outcomes and benchmarks, pre-brief, multiple learning strategies, interactivity and individualized learning, feedback, and debrief); and resources (facilitator competency, controlled environments). These themes broadly align with the social constructivist theory of experiential learning whereby structured opportunities to learn via concrete experience, reflective observation, abstract conceptualization, and active experimentation are provided through effective planning, design, and delivery of SBE. Interdependencies suggest that integration of SBE at curriculum-level enables planning and implementation of best practice principles which are associated with effective learning, which also inform and facilitate the availability of adequate simulation resources.

Development and initial validation of an instrument to measure novice nurses' perceived ability to provide care in acute situations - PCAS

BACKGROUND

Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses' perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations.

METHOD

Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group.Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct.

RESULT

The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach's alfa 0.90 and ordinal alpha 0.92.

CONCLUSIONS

The PCAS scale has proven to have acceptable validity. The factors," confidence in provision of care", "communication" and "patient perspective" are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.

Development of a safe drug administration assessment instrument for nursing students

OBJECTIVE

to determine the content and face validity of a safe drug administration assessment instrument for nursing students.

METHOD

quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice.

RESULTS

nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice.

CONCLUSION

the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Evaluating the “satisfaction” and “self-confidence” in nursing students in undergoing simulated clinical experiences

Abstract Objective: To evaluate the “satisfaction” and “self-confidence” constructs in nursing students who underwent simulated clinical experiences in semiology and semiotechnique disciplines. Method: A descriptive study developed with Nursing students from a federal public university in the interior of Minas Gerais through weekly simulated workshops. The “satisfaction” and “self-confidence” constructs were evaluated by the “Student Satisfaction and Self-Confidence with Learning Scale” and “Simulated Clinical Experiences Satisfaction Scale”. Results: The final sample was 45 students. Most were more satisfied (overall average = 4.18) than self-confident (overall average = 4.12). The Spearman correlation test identified a significant and positive association between the “satisfaction” and “self-confidence” constructs. Conclusion: Students feel self-confident and satisfied with the use of simulation as an active teaching-learning methodology, highlighting that the higher the satisfaction level, the greater the student’s self-confidence.

A Randomized Trial of Multiple-Patient Simulation Preparation to Improve Novice Nurses' Competence and Self-Efficacy

AIM

The purpose of the study was to determine best practices for multiple-patient simulation (MPS) preparation and frequency to improve behavioral performance in nursing students.

BACKGROUND

MPS provides a safe environment for novice nurses to practice priority setting, delegation, and multitasking, but evidence for best practices is needed.

METHOD

A multisite, blinded, randomized trial was conducted to evaluate the effect of three simulation preparation methods (expert modeling, voice-over PowerPoint, and reading assignments) on students' competence and self-efficacy for providing care to multiple patients in the simulation lab. Participants (n = 73) were enrolled in capstone clinical courses at two schools of nursing.

RESULTS

Though there was no difference in raw change in competence score among the study groups, there was a statistically significant difference in pretest and posttest scores. The change in self-efficacy did not correlate with the change in competence.

CONCLUSION

These findings will help educators understand how novice nurses benefit from repeated MPS activities.

On-call simulation for adult gerontology acute care nurse practitioner students: A comparative descriptive study

BACKGROUND

It is now commonplace for acute care nurse practitioners (ACNPs) to work in positions that include an on-call component or management of emergent concerns through telephone. There are no published reports on the inclusion of an on-call component in ACNP clinical preparation of students; novice ACNPs feel unprepared to competently and confidently manage emergent patient situations and on-call responsibilities.

PURPOSE

To examine ACNP student perception of stress, necessary skills, confidence, and benefit of participating in a simulated on-call experience.

METHODS

Using simulated faculty callers as nurses, ACNP students participated in a simulated on-call experience that included receiving two calls, eliciting key information from the nurse, diagnosing and managing the patient, and submitting documentation of the encounter. Students completed preparticipation and postparticipation perception surveys, and they were evaluated by the simulated nurse (faculty) using standardized evaluation tools.

RESULTS

Acute care nurse practitioner students rated the simulated on-call experience as educationally valuable. High levels of anxiety before participation were notably improved after participation. Students identified critical thinking, clear communication, and knowledge with the specific disease as the most important skills needed to manage nurse calls successfully. Students reported marked improvement in their confidence and were receptive to accepting an nurse practitioner position with call/triage responsibilities after their on-call experience.

IMPLICATIONS FOR PRACTICE

Inclusion of a simulated on-call experience in the final semester of an ACNP program is both feasible and relevant to ACNP student development. On-call exposure within the clinical practicum is inconsistent and, therefore, should be added through simulation.

Staff perception of the sustainability of a mature simulation program in nursing and midwifery education: A phenomenological analysis

BACKGROUND

As an established pedagogy for teaching clinical nursing skills, the use of simulation in nursing and midwifery education continues to increase globally. In Australia, government incentives for staff development, capital equipment and scenario provided initial impetus for introducing simulation into nursing programs. However, a mature simulation program requires ongoing investment in staff and resources. Without appropriate commitment from educators and organisations, a likely decline in the quality of simulation activities may have a direct impact on student learning.

PURPOSE

This study sought to explore the views and experiences of nursing and midwifery academics involved in delivering a simulation-based education program in a maturation phase.

METHOD

In this qualitative study, interpretative phenomenological analysis was used to inform data collection and analysis. Data were collected through semi-structured audio-recorded interviews with 10 faculty staff in a tertiary school of nursing and midwifery.

RESULTS

Four main themes related to simulated learning were abstracted from the data: perceptions and reactions, inconsistent customs, pedagogy of simulation-based education, and collateral opportunities. The findings are located within the context of a maturation, rather than introductory, phase of delivering simulation-based education in a tertiary education setting.

CONCLUSIONS

A mature simulation program may be undermined by ageing equipment and scenarios, and facilitators whose skills have not been maintained. Existing simulation activities require ongoing organisational support and investment. The development and introduction of minimum competency levels for facilitators and standardised measures of quality in practice are indicated, to improve simulation practice in the education setting.

The Use of Simulation to Teach Nursing Students and Clinicians Palliative Care and End-of-Life Communication: A Systematic Review

Objectives:

To present the findings of a systematic review on the use of simulation-based learning experiences (SBLEs) to teach communication skills to nursing students and clinicians who provide palliative and end-of-life care to patients and their families.

Background:

Palliative care communication skills are fundamental to providing holistic patient care. Since nurses have the greatest amount of direct exposure to patients, building such communication competencies is essential. However, exposure to patients and families receiving palliative and end-of-life care is often limited, resulting in few opportunities to learn these skills in the clinical setting. Simulation-based learning experiences can be used to supplement didactic teaching and clinical experiences to build the requisite communication skills.

Methods:

Searches of CINAHL, MEDLINE, PsychINFO, ERIC, and Web of Science electronic databases and Grey Literature returned 442 unique records. Thirty articles met the established criteria, including the SBLE must contain a nursing role.

Results:

Simulation-based learning experience are being used to teach palliative and end-of-life communication skills to nursing students and clinicians. Lack of standardization, poor evaluation methods, and limited exposure to the entire interprofessional team makes it difficult to identify and disseminate validated best practices.

Conclusion:

While the need for further research is acknowledged, we recommend this evidence be augmented by training programs that utilize SBLEs through (1) applying standards, (2) clearly specifying goals and objectives, (3) integrating externally validated scenarios, and (4) employing rigorous evaluation methods and measures that link the SBLE to the training objectives and desired clinician practice behaviors and patient outcomes.