Educational Characteristics of Virtual Simulation in Nursing: An Integrative Review

Rising to the Challenge: The Delivery of Simulation and Clinical Skills during COVID-19

The declaration of a global pandemic in March 2020 resulted in all higher education institutions having to quickly transform traditional didactic teaching and learning to online delivery. This involved delivering lectures and seminars virtually, and student contact time in University ceased immediately. Although many Universities had existing resources such as Blackboard® and Microsoft Teams® in place to assist with this delivery, the facilitation of clinical skills and simulation would prove to be more of a challenge. This paper explores how one University adapted and utilized innovative ways to provide students with virtual learning experiences, specifically in relation to the facilitation of clinical skills and simulation.

Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review

OBJECTIVES

To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses.

DESIGN

A scoping review of published and unpublished research from 2009 to 2019.

DATA SOURCES

Nine electronic databases and hand-searching of reference lists.

REVIEW METHODS

Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis.

RESULTS

The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement.

CONCLUSION

Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.

Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis

BACKGROUND

Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time.

METHODS

We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment.

RESULTS

A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI -0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI -0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI -0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=-0.55, 95% CI -2.04 to 0.94, P=.47, I2=97%).

CONCLUSIONS

The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results.

Maintaining Clinical Continuity Through Virtual Simulation During the COVID-19 Pandemic

BACKGROUND

Amidst the COVID-19 pandemic, university instruction was transitioned online, including an undergraduate nursing clinical course. Charged with developing and executing virtual simulations, an online clinical course was conceived.

METHOD

Simulated clinical experiences were crafted using a combination of student preassignments and video-conferencing facilitated by faculty. Each experience included the collective review of a case study and student-developed care plans before viewing and debriefing a series of videos. Students summarized their experience in a weekly written reflection.

RESULTS

Student feedback was examined through their reflections and verbal responses. The videos served as catalysts for robust discussion. Feedback was overwhelmingly positive related to an interactive experience, a heightened sense of teamwork, and enhanced comprehension by sharing differing perspectives of common experiences.

CONCLUSION

This educational innovation was successful in creating an engaging environment that facilitated student learning and a sense of togetherness during a global pandemic. The use of technology enabled the continuity of a productive teaching-learning experience. [J Nurs Educ. 2020;59(9):522-525.].

What should be included in web-based simulation for new nurses?

PURPOSE

The purpose of this study was to investigate newly graduated nurses' educational needs for web-based simulation (WBS) education.

METHODS

A cross-sectional descriptive study was conducted with 132 registered nurses, regardless of their career length, working at a hospital in Korea. Data accrued through a self-reported questionnaire asking nurses about their educational needs. Data were analyzed using descriptive statistics, independent t-test ANOVA, and Scheffe test.

RESULTS

Almost all (96.2%) participants said that new nurses need simulation training, and 90.2% of participants said WBS is necessary. The highest ranked category was fundamental nursing knowledge, followed by fundamental nursing technique. Among 81 items of nursing education needs, top ranked items were cardiopulmonary resuscitation, care of artificial airways, oxygen therapy, and mechanical ventilation, which were mostly in the fundamental-nursing-techniques category. Educational needs significantly differed depending on participants' clinical experience (F = 5.37; p = .006), hospital types (t = -3.48; p = .001), and past experiences as a preceptor (t = 2.71; p = .008). Participants with 4 to 6 years of clinical experience, working in a hospital with more than 300 beds, and with experience as a preceptor, answered that new nurses have high educational needs WBS.

CONCLUSIONS

WBS for new nurses should include fundamental nursing knowledge and techniques that can apply to clinical practice immediately after learning. Also, emergency nursing care should be included to prioritize adequately and cope with emergency situations. The use of WBS will help new nurses learn and adapt to the clinical setting, which can assist nurses in providing optimal care to patients with confidence.

Evaluation of two simulation methods for teaching a disaster skill

Introduction

With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed.

Methods

A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self- Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination.

Results

A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination.

Conclusions

Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.