Evaluation of students' perceived clinical competence and learning needs following an online virtual simulation education programme with debriefing during the COVID-19 pandemic

The hotspots and trends of nursing master's education in China: a bibliometric analysis from 2000 to 2022

BACKGROUND

Graduate nursing education is the main way to train high-quality nursing personnel. Globally, the nursing education system has been gradually improved, forming a multi-level, multi-channel, and multi-specification education system including secondary, specialized, undergraduate, and postgraduate.

OBJECTIVE

To analyze the research hotspots and trends of nursing postgraduate education in China by using bibliometric methods, and to provide reference for scholars at home and abroad to understand the current status of this field.

METHODS

Literature related to graduate nursing education was searched in the Chinese full-text journal database (CNKI) from January 2000 to May 2022 and analyzed using CiteSpace software.

RESULTS

A total of 998 kinds of literature were included, with a growing trend in the number of articles issued. The research hotspots and trends of nursing graduate education in China are clinical practice, cultivation mode, and core competence.

CONCLUSION

Chinese nursing graduate education is improving. Foreign experience should be drawn upon, combined with the hotspots and trends summarized in this study, to promote the development of nursing graduate education in China.

Subjective learning gain from a simulation-based health management course: a mixed methods study

Objectives

Simulations are increasingly being offered as part of the educational experience of healthcare students. We used a Health Management Scenario Simulation system to create a course. This study aimed to evaluate learning gains before and after the course.

Methods

Based on the learning strategies of framing, simulation, and debriefing, the Health Management Scenario Simulation course lasted 4 weeks and was conducted online. Learning gain was assessed using a comparative self-assessment questionnaire administered electronically at the beginning and end of the course. We organized focus group interviews and collected quantitative data after students completed the simulations and the questionnaire. These data were subjected to descriptive statistical analysis and thematic grouping using frequency counting.

Results

There were 195 health management students enrolled in the course. In total, 265 anonymously completed questionnaires were received, 141 (72.31%) on the pre-simulation and 124 (63.59%) on the post-simulation. All questionnaire item gain values were positive, except the item "I can identify common health risk factors," which showed no change. The skills domain showed the highest learning gain, ranging from 16 to 22%. Six students participated in the focus-group study. The main themes that emerged from students' reflections were learner-centeredness, competencies, and career development.

Conclusion

Students acquired health management skills through the simulation, which contributed to the development of basic attitudes and skills in their professional careers. Students' comments highlighted the value of practicing health management skills in a simulated environment.

Application of virtual reality in nursing communication education: A systematic review

BACKGROUND

Communication skills are very important for nursing students. As a developing teaching technology, virtual reality is used in nursing communication education. However, the teaching effect and the effective teaching elements are not clear.

OBJECTIVE

This systematic review was designed to summarize the characteristics of interventions and teaching design of nursing communication education based on virtual reality and to extract the common positive features to provide a reference for further nursing communication education.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched eight databases in December 2021, and an updated search was performed in June 2023. The Mixed Methods Appraisal Tool was used for study appraisal.

RESULTS

A total of thirteen studies were included in the systematic review. Although differences were observed in the designs, evaluations and communication results of these studies, we extracted some elements that can be used to promote positive communication results, such as a combination of an intervention design based on theory with communication strategies, positive feedback and reporting.

CONCLUSIONS

Virtual reality-based education shows mixed teaching effect in improving nursing students' communication cognition and skills. Further studies are necessary to verify the practical influence of intervention design combined with teaching methods on improving nursing students' communication and clinical communication coping ability.

Impact of Simulation Training on Core Skill Competency of Undergraduate Medical Students

INTRODUCTION

Simulation based medical training (SBMT) is gaining traction for undergraduate learning and development. We designed, implemented, and independently assessed the impact of an SBMT programme on competency in surgical history taking and clinical examination for senior clinical students.

METHODS

With institutional ethical approval and initial pilot study of student volunteers that ensured format appropriateness, we implemented an SBMT programme weekly for ten weeks during the core surgery module of our Medicine degree programme. Groups of 5 students collaboratively undertook an observed focused history and physical examination while simultaneously directing care on a simulated surgical patient (actor) with acute abdominal pain. This was conducted in a nonclinical, standardised, tutor-supervised environment and followed by a group debriefing led by both the simulated patient and tutor discussing student interaction and competency. All students undertook Southampton Medical Assessment Tool (SMAT) on a surgical inpatient prior to (baseline) and within 2 weeks after SBMT. Students without simulation training functioned as a control group and randomized cluster sampling was utilised for group selection. Second assessments were by independent surgical academics blinded to student group. Feedback was collected via anonymous questionnaire from those who undertook SBMT.

RESULTS

One hundred students took part, fifty of whom undertook SBMT. Global mean SMAT scores were similar between the control and intervention group at baseline (p > 0.05). Scores on the second assessment were significantly higher (p = 0.0006) for those who had undertaken SBMT vs. controls; 94% of students taking SBMT reported benefit via questionnaire with 85% stating increased confidence in history-taking and 78% reporting improved abdominal examination.

CONCLUSIONS

Undergraduate simulation training at scale is feasible and positively impacts undergraduate student core task competency.

The design, implementation, and evaluation of a blended (in-person and virtual) Clinical Competency Examination for final-year nursing students

INTRODUCTION

Studies have reported different results of evaluation methods of clinical competency tests. Therefore, this study aimed to design, implement, and evaluate a blended (in-person and virtual) Competency Examination for final-year Nursing Students.

METHODS

This interventional study was conducted in two semesters of 2020-2021 using an educational action research method in the nursing and midwifery faculty. Thirteen faculty members and 84 final-year nursing students were included in the study using a census method. Eight programs and related activities were designed and conducted during the examination process. Students completed the Spielberger Anxiety Inventory before the examination, and both faculty members and students completed the Acceptance and Satisfaction questionnaire.

FINDINGS

The results of the analysis of focused group discussions and reflections indicated that the virtual CCE was not capable of adequately assessing clinical skills. Therefore, it was decided that the CCE for final-year nursing students would be conducted using a blended method. The activities required for performing the examination were designed and implemented based on action plans. Anxiety and satisfaction were also evaluated as outcomes of the study. There was no statistically significant difference in overt, covert, and overall anxiety scores between the in-person and virtual sections of the examination (p > 0.05). The mean (SD) acceptance and satisfaction scores for students in virtual, in-person, and blended sections were 25.49 (4.73), 27.60 (4.70), and 25.57 (4.97), respectively, out of 30 points, in which there was a significant increase in the in-person section compared to the other sections. (p = 0.008). The mean acceptance and satisfaction scores for faculty members were 30.31 (4.47) in the virtual, 29.86 (3.94) in the in-person, and 30.00 (4.16) out of 33 in the blended, and there was no significant difference between the three sections (p = 0.864).

CONCLUSION

Evaluating nursing students' clinical competency using a blended method was implemented and solved the problem of students' graduation. Therefore, it is suggested that the blended method be used instead of traditional in-person or entirely virtual exams in epidemics or based on conditions, facilities, and human resources. Also, the use of patient simulation, virtual reality, and the development of necessary virtual and in-person training infrastructure for students is recommended for future research. Furthermore, considering that the acceptance of traditional in-person exams among students is higher, it is necessary to develop virtual teaching strategies.

How Are Alternative Clinical Placements Performed Compared to Traditional Clinical Placements During the COVID-19 Pandemic? Sought Through a Systematic Review and Meta-Analysis

Clinical placement is the essential method of learning in health professions education, but it has been the most disrupted by the COVID-19 pandemic. Institutions of higher education resorted to alternative learning such as telehealth, simulations, and blended-learning for clinical placement to ensure that educational activities continue without delay. However, this raises questions about student competency and necessitates making up for missed in-person hours. A thorough investigation of the effectiveness of alternative clinical placement learning is required. A systematic searching was conducted on ten electronic databases, and the quality of the included articles was assessed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis was conducted by pooling studies with examination mark outcomes. Twenty-four articles were included in the systematic review and nine were included in the meta-analysis. The average MERSQI score for included studies is 11.15. Outcomes on student performance favor alternative placement, whereas perceived-based outcomes have mixed results and are slightly prone to traditional clinical placement. Meta-analysis indicates that alternative learning is either more effective than traditional clinical placement or at least on par with it. There is a discrepancy between perceived outcome and performance assessment regarding the utility of alternative learning to conventional clinical placement. Nonetheless, objective measurement outcomes and the meta-analysis support alternative learning as a reliable learning strategy for clinical education. Alternative learning for clinical placement experience can be improved further by adding more synchronous sessions, and implementing various learning methods, learning activities based on strong instructional design, and at least a short real-setting attachment.

Analysis of Knowledge and Satisfaction in Virtual Clinical Simulation among Nursing Students: A Mixed Study

Virtual simulation offers a powerful educational tool with considerable, albeit underexplored potential. This technology immerses students in lifelike digital scenarios, fostering the acquisition of knowledge and skills necessary for their future careers. This study aimed to assess knowledge acquisition and satisfaction outcomes among students using a virtual simulation teaching approach. The specific objectives were (1) to compare pre-and posttest knowledge acquisition, (2) to investigate the influence of prior professional experience on knowledge, and (3) to explore satisfaction levels with virtual simulation. One hundred and fifty-nine nursing students participated in a virtual simulation-based clinical intervention, entailing the resolution of a virtual adult patient hospitalized with respiratory pathology. Sociodemographic data and prior professional experience were collected, and knowledge was evaluated through pre-to-post tests. Satisfaction levels were assessed using open-ended questions. Quantitative data were analyzed using descriptive statistics, Wilcoxon, Mann-Whitney U, and Cohen's tests, while qualitative data underwent keyword-in-context analysis. Significant differences were noted between pre- and posttest knowledge levels, with prior experience showing no significant impact on knowledge acquisition. Participants reported high levels of satisfaction. Lexicometric analysis identified four clusters of words related to the key terms "simulation", "learn", "activity", and "knowledge". Virtual clinical simulation effectively enhances knowledge acquisition and fosters satisfaction, with students recognizing the positive impact of this approach on their learning. Consequently, virtual simulation contributes to the training of competent health professionals.

Relationship between learning styles and clinical competency in nursing students

BACKGROUND

The acquisition of clinical competence is considered the ultimate goal of nursing education programs. This study explored the relationship between learning styles and clinical competency in undergraduate nursing students.

METHODS

A descriptive-correlational study was conducted in 2023 with 276 nursing students from the second to sixth semesters at Abhar School of Nursing, Zanjan University of Medical Sciences, Iran. Data were collected using demographic questionnaires, Kolb's learning styles, and Meretoja's clinical competence assessments completed online by participants. Data were analyzed using SPSS version 16, employing descriptive statistics and inferential tests (independent T-test, ANOVA, Pearson correlation) at a significance level 0.05.

RESULTS

The predominant learning styles among nursing students were divergent (31.2%), and the least common was convergent (18.4%). The overall clinical competency score was 77.25 ± 12.65. Also, there was a significant relationship between learning styles and clinical competency, so the clinical competency of students with accommodative and converging learning styles was higher. (P < 0.05).

CONCLUSION

The results of this study showed the association between learning styles and clinical competence in nursing students. It is recommended that educational programs identify talented students and provide workshops tailored to strengthen various learning styles associated with enhanced clinical competence.

Changes in rehabilitation students' clinical placement and clinical competence at graduation during the COVID-19 pandemic: A pilot study

BACKGROUND

The COVID-19 pandemic has affected physical and occupational therapist education in various ways.

OBJECTIVE

This study investigated whether the pandemic changed clinical placement, thus influencing the clinical competence of physical and occupational therapists at a hospital in Japan.

METHODS

Eleven therapists (seven physical and four occupational) participated in this study in April 2021. Clinical placement teaching methods were surveyed using an online questionnaire. The Objective Structured Clinical Examination (OSCE), comprising attitudinal and technical items, was used to examine clinical competence. The results were calculated as the sum of the attitudinal and technical scores, and the ratios of these scores to the full score were compared using a paired-sample Wilcoxon signed-rank test.

RESULTS

During the pandemic, some schools implemented shortened practical clinical placements. The substituted classes included online-only classes and combined online and face-to-face classes. Regarding clinical competence, scores on the OSCE were mostly high. The median proportion of the total attitudinal score to the perfect score was 100% for all three items (range-of-motion test, muscle strength test, Stroke Impairment Assessment Set). The median proportion of the total technical score to the perfect score ranged from 56.7% to 76.7% for the three items. The ratio of the total attitudinal score to the full score was significantly higher than that of the total technical score to the full score (p = 0.001).

CONCLUSIONS

Most clinical placements were canceled or partially administered through online learning during the pandemic. This decrease in clinical placements did not affect newly recruited physical and occupational therapists' clinical competence.

Nursing students' evaluation of clinical learning environment and supervision models before and during the COVID-19 pandemic: a comparative study

BACKGROUND AND AIM

The COVID-19 pandemic has required a rapid reorganization of clinical training and supervision models for nursing education. The aim of this study was to compare students' levels of perception of the quality of the Clinical Learning Environment (CLE) using two different clinical supervision models.

METHODS

A comparative design was implemented. A convenience sample of second and third-year undergraduate nursing students (n=127) in clinical training in the 2018/2019 Academic Year (AY) received the usual nursing staff supervision model, while during the COVID-19 pandemic in the following year, they (n=69) received an individualized supervision model. Data were collected using three instruments: the Clinical Learning Environmental Quality Evaluation Index (CLEQI); the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T); and a socio-demographic tool.

RESULTS

The mean total scores of both scales had increased in the second survey (CLEQI: M=57.88±11.8 vs. M=60.88±9.3, p=0.035; CLES+T: M=148.4±23.3 vs. M=154.5±21.9, p=0.037). The nursing students reported high levels of CLE quality with both supervision models, even though the individualized supervision model was rated significantly higher by the students than the staff supervision model.

CONCLUSIONS

Students supported by a personal supervisor during clinical training had a more positive experience and rated the quality of the tutorial strategies, learning opportunities, safety and nursing care, leadership style of the ward manager and overall CLE more highly.

The status of virtual simulation experiments in medical education in China: based on the national virtual simulation experiment teaching Center (iLAB-X)

BACKGROUND

Virtual simulation experiments have been rapidly applied to medical education curricula in recent years. China constructed a national virtual simulation experimental teaching center (iLAB-X), and this platform covered almost all of the virtual simulation experiment curricula of domestic colleges or universities. We aimed to comprehensively assess the characteristics and usages of virtual simulation experiments in medical education based on iLAB-X.

METHODS

A total of 480 virtual simulation experiment courses had been constructed on iLAB-X (https://www.ilab-x.com/) by December 20, 2022, and the curriculum level, type and design were all searched in this platform. We also conducted an evaluation of curriculum usage and online tests, including the page view, frequency of participation, number of participants, duration of experimental learning and passing rate of the experimental test.

RESULTS

The national and provincial high-quality virtual simulation experiment curricula accounted for 33.5% (161/480) and 35.8% (172/480), respectively. The curricula were mainly set as basic practice experiments (46.5%) and synthetic designing experiments (48.8%). Significantly, forensic medicine (100%), public health and preventive medicine (83%) and basic medical sciences (66%) focused on synthetic design experiments. In terms of usage experiments, the average duration of experimental learning was 25 minutes per course, and the average number of participants was just 1257. The average passing (score ≥60) rate of online tests was 80.6%, but the average rate of score ≥ 85 was only 58.5%. In particular, the average page views, the number of participants, the duration of learning and the test passing rate of clinical medicine were relatively low.

CONCLUSIONS

The curriculum design features, construction level and utilization rate varied in different medical majors. Virtual simulation experiments are particularly underutilized in clinical medicine. There is a long way for virtual simulation experiments to go to become a supplement or alternative for traditional medical education in the future.

Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study

Background

Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries.

Objective

To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units.

Methods

This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups.

Results

The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions.

Conclusion

Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

A scoping review of remote facilitation during simulation-based healthcare education

BACKGROUND

Remote facilitation is a synchronous distance education method where instructors facilitate a lesson, in real-time, in physically separate conditions. In this scoping review, we aimed to describe types of remote facilitation used in a healthcare simulation, the influences on learner outcomes, and related factors.

METHODS

We accessed PubMed, EMBASE, CINAHL, ERIC, and Web of Science using our search strategies. Five reviewers performed the review using the Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping Reviews (PRISMA-ScR) framework, and the Johanna Briggs Institute (JBI) guidelines.

RESULTS

We included a total of 29 articles presenting 28 simulation studies. The most common tool was videoconferencing (n = 26, 89.7%). Knowledge improvement was the most frequently measured outcome. There was no significant difference in learning outcomes between the two teaching modes. There were differences in learners' preferences and satisfaction with remote facilitators before and after COVID-19.

CONCLUSIONS

Our scoping review indicates that remote facilitation has been widely accepted in many healthcare professions using various types of simulation modalities. Remote facilitation can be used to overcome logistical problems of synchronous multi-location education, and to improve learner knowledge, skills, and confidence measured by instructor evaluation or self-assessment.

Changes in Clinical Training for Nursing Students during the COVID-19 Pandemic: A Scoping Review

(1) Background: The COVID-19 pandemic has cost social, economic, cultural, and educational life, distressing nursing training and practice. This study aimed to map the literature on changes in clinical training for nursing students during the COVID-19 pandemic. (2) Methods: A scoping review was conducted according to JBI methodology’s latest guidance. A set of relevant electronic databases and grey literature was searched to report results published in English, Spanish, and Portuguese. (3) Results: A total of 12 studies were included in the study, addressing changes in clinical training in undergraduate nursing students due to COVID-19 pandemic activity, published between 2020 and 2022. (4) Conclusions: Nursing schools made an effort to replace traditional clinical training with several activities, primarily based on simulation or virtual activities. However, contact with others is essential, and simulation programs or scenarios cannot provide it.

Development and Application Evaluation of a Nursing Simulation Teaching Information System Based on Hospital Information Systems

BACKGROUND

The extensive application of hospital information systems in the current information-driven era suggests that nursing education should focus on information education.

METHODS

The newly developed hospital information system was used and evaluated by 544 students to explore the feasibility and necessity of such applications for teaching.

RESULTS

Overall, 97.1% of the students expressed satisfaction, and 96.0% supported simulated information education for nursing. The usability was good, with the system receiving a usability score of 72.625 ± 13.0907. The junior students had a higher score than the sophomores regarding system availability, and the difference was statistically significant.

CONCLUSIONS

Students generally had a high degree of satisfaction with the simulated information nursing education system and highly approved of the teaching method. However, the system needs to be upgraded.

Psychometric Properties of Clinical Learning Environment Comparison Survey Questionnaire in Nursing Students

INTRODUCTION

Continuous evaluations of clinical education and learning in nursing require the use of valid and reliable instruments. The present study aimed to evaluate the validity and reliability of the CLECS questionnaire (a questionnaire for assessing the clinical learning environment) in nursing students.

METHODS

This is a psychometric study conducted on 118 nursing students. Through email correspondence with the corresponding author, permission was obtained from the developer to translate, validate, and use the CLECS. The CLECS was translated into Persian. The psychometric process was performed after the translation and cultural adaptation steps. Cronbach's alpha was used to assess the reliability. The instrument validity was assessed through convergent, discriminant, and confirmatory factor analysis. We used AMOS 18 for confirmatory factor analysis and SPSS-20 for reliability, convergent, and discriminant validity.

RESULTS

A total of 118 nursing students participated in the study. The Cronbach's alpha value of the questionnaire was 0.942. Convergent validity was obtained in all dimensions above 0.4. The confirmatory factor analysis results confirmed the fit of the final model and showed that the present questionnaire was 6-dimensional. Most of the questions in the questionnaire did not have a good differential validity. The highest and lowest means were related to the nursing process and holism dimensions, respectively.

CONCLUSION

Based on the findings of this study, CLECS, except in the discriminant validity, has good validity and reliability, which can be considered to examine the learning environment of undergraduate nursing students.

[Examination in times of Corona: A cross-sectional study on the use of digital media and the implementation of examinations in nursing education]

Examination in times of Corona: A cross-sectional study on the use of digital media and the implementation of examinations in nursing education Abstract. Background: In the pandemic, performance assessments had to be carried out under new conditions during the school closures. The aim of vocational nursing education is to develop competence to act. So far, there are no empirical findings on learning assessments and final examinations under pandemic conditions. Aim: The study aims to record the mode of performance assessments under the changed conditions. Methods: Written online survey of teachers at nursing schools in Germany. The collected data were analysed descriptively and inferentially using Chi-Square tests, and subjected to an integrative content analysis. Results: 884 nursing schools were contacted, 430 questionnaires from 179 responding schools (school-related response rate: 20,2%) could be evaluated. PCs or laptops are mostly used to check learning levels (n = 222). 205 participants do not use digital media for this purpose. Digital media are also used for the oral (n = 108) and written (n = 116) parts of the final examination; various organisational and hygiene measures are taken for face-to-face examinations. The practical part is often conducted in new formats (OSCE, simulation). Conclusions: Based on the results, it remains unclear to what extent competence orientation of vocational nursing education is implemented with digital support in examinations. The practical examination in particular seems to pose a special challenge for all those involved.