High Fidelity Patient Silicone Simulation: A qualitative evaluation of nursing students’ experiences

The psychosocial impact of climate change among smallholder farmers: a potential threat to sustainable development

Psychosocial impacts of climate change and implications on sustainable development remain unclear. This problem was addressed focusing on smallholder farmers in resettlement areas of Chirumanzu District, Zimbabwe. An Exploratory Descriptive Qualitative research design was adopted. Purposive sampling techniques were used to select 54 farmers who served as main respondents from four representative wards. Data were collected through semi-structured interviews and analyzed using a grounded theory approach. Code groups and codes were established through inductive approaches considering narratives of farmers. Forty psychosocial impacts were established. They were qualitative, intangible, indirect and difficult to measure quantitatively. Farmers agonized over the threat of climate change on farming operations, felt humiliated, and embarrassed over detestable practices they resorted to due to climate change. Some farmers experienced heightened negative feelings, thoughts, and emotions. It was established that psychosocial impacts of climate change have a bearing on sustainable development of emerging rural communities.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

Learning practical nursing skills in simulation centers - A narrative review

Background

Practical skills are complex procedures integrating communication and caring, as well as technical and manual aspects. Simulation at a simulation/skills center offers a wide range of learning activities and aims to imitate patient situations.

Objectives

To investigate the international research literature on practical skills learning in simulation/skills centers in nursing education. Research questions: 1. What are the range and type of practical skills studied? 2. What learning activities are focused on in the studies included in the review? 3. What are the learning outcomes and how are they assessed?

Design

Narrative review.

Methods

We searched electronically and included studies from Medline Ovid, CINAHL, Eric, Embase, Academic Search Premiere, and Cochrane. Unique indexing terms and search strategies were developed for each database. The criteria for inclusion were bachelor nursing students as the study population and practical nursing skills learning in simulation/skills centers. We used Rayyan QCRIt for the initial screening and the Mixed Method Appraisal Tool for quality assessment. We used a narrative approach to synthesize the diverse range of studies.

Findings

One hundred and twenty-one studies from 26 countries published between January 2013 and March 2022 were included. The amount of quantitative research was overwhelming (n = 108). A total of 50 different practical skills were represented. The studies focused on which learning modalities resulted in the best learning outcomes. Only 8.5% (n = 7) of the included studies concerned students' learning processes. Skill performance (n = 101), knowledge (n = 57), confidence (n = 34), and satisfaction (n = 32) were the main learning outcomes measured.

Discussion

The quality assessment indicated that 10 of the studies achieved 100% on the mixed method appraisal tool criteria. In many of the studies with quasi-experimental and randomized controlled trial designs, the intervention group received some form of educational treatment while the control group received no treatment. The choice of no treatment for the control group in pedagogical research seems to disregard the inherent purpose and effect of teaching and learning.

Conclusion

Heterogeneity in the use of learning modalities and measuring instruments precludes the possibility of building on other research. Technical skills were the preferred choice of skill, while skills that involved a fair measure of communication and collaboration were only sparingly studied. Students' learning processes were barely touched on in the included studies. More focus should be placed on this area in further research, since the choice of learning modalities may affect the students' learning processes in significant ways.

Prebriefing for high-fidelity simulation in nursing education: A meta-analysis

BACKGROUND

Briefing, scenario development, and debriefing of high-fidelity simulation (HFS) have been widely discussed in the past, but less attention is given to prebriefing, and its role in learning outcomes. The prebriefing engages students and equips them with the knowledge and skills they need for a successful simulation.

OBJECTIVES

To identify the effectiveness of prebriefing of HFS in Bachelor of Science in Nursing (BSN) students.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

The Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were for randomized controlled and quasi-experimental studies published in English or Chinese up to June 26, 2022.

REVIEW METHODS

Two authors independently screened the literature, extracted data and evaluated the quality of the included studies. The standardized mean difference with a 95 % confidence interval was used to facilitate direct comparisons between studies. All statistical tests were conducted with Review Manager 5.4 software.

RESULTS

This meta-analysis included 17 randomized controlled studies and 25 quasi-experimental studies involving 4926 BSN students. No significant differences in knowledge (p = 0.58), skill (p = 0.67), satisfaction (p = 0.84), critical thinking (p = 0.56), caring (p = 0.11), learning interest (p = 0.85), and self-confidence (p = 0.21) between HFS with and without prebriefing were found in subgroup analyses. HFS with prebriefing generated larger effect for collaboration (0.82 vs 0.27, p = 0.004).

CONCLUSION

HFS with prebriefing facilitates collaboration of BSN students more effectively, and it has an equivalent effect to HFS without prebriefing on fostering BSN students' knowledge, skills, critical thinking, caring, learning interest, and self-confidence.

Adapting the use of Mask Ed simulation in nursing programmes during the COVID- 19 pandemic

The onset of the COVID-19 pandemic toppled education delivery worldwide. Nursing education was no exception. The pandemic required nurse educators to quickly shift from face-to-face learning environments to remote and more virtual interactions. Educators were compelled to create and employ strategies to support nursing learners as they assimilated critical and complex knowledge, and skills from their homes, instead of classrooms and simulation laboratories. One modality of simulation which maintained engagement and connection with learners in the online environment was Mask-Ed™ Simulation. This paper presents a snapshot of Mask-Ed™ simulation activities across four higher education institutions globally during the COVID-19 pandemic.

Nursing informatics in undergraduate nursing education in Australia before COVID-19: A scoping review

Background

Technology can support transformational outcomes of high quality and evidenced-based care and education. Embedding nursing informatics into the undergraduate nursing curriculum enhances nursing students' digital health literacy, whilst preparing them to use health information systems and technological innovations to support their learning both at university and in the clinical environment.

Aim

This scoping review aimed to provide an overview of the published literature on how nursing informatics was embedded and integrated into the undergraduate nursing curriculum in Australia before coronavirus disease (COVID-19).

Methodology

A scoping review approach guided this study using the Levac, Colquhoun, and O'Brien framework, and the following databases were searched: CINAHL Plus, EMCARE, MEDLINE Ovid, Scopus, ERIC ProQuest, and Web of Science. A total of 26 articles were included: Five quantitative studies, eight qualitative studies and 13 mixed-methods studies.

Findings

Few studies focused on the concept of nursing informatics itself, and only two studies described the process of developing curricula that contain nursing informatics competencies and their implementation: the educational scaffolding and modular development approach and a Community of Inquiry Framework (COI). Most studies centred on nursing informatics tools to facilitate teaching and learning in classrooms and skills laboratories. The reported pedagogical strategies were online learning, blended learning, and technology-enabled simulations. Hindrances to nursing informatics being integrated into undergraduate curricula were disparities of the informatics content, a lack of guidelines and/or frameworks, and poor digital literacy.

Conclusion

This study provided a baseline perspective of how nursing informatics was embedded and integrated into nursing education in Australia before COVID-19. Overwhelmingly, the focus of research to date was found to be mainly on the utilisation of technological tools to support learning and teaching.

Impact of classroom-based MASK-ED™ (KRS simulation) on physiotherapy student clinical performance: a randomized cluster trial

BACKGROUND

In physiotherapy there is a growing body of literature exploring the benefits simulation could have in the university-setting, prior to the commencement of work-integrated learning. MASK-ED™ simulation is one form of simulation that could be beneficial for student learning and improve performance in the clinical setting. MASK-ED™ simulation involves an educator donning a silicone mask and portraying a patient role that has been specifically developed to meet learning objectives.

OBJECTIVE

To evaluate the effectiveness of MASK-ED™ simulation compared to role-play with peers for training pre-clinical physiotherapy students.

METHODS

A single-centre, single-blind, cluster randomized trial with concealed allocation, between group post-measures, and intention-to-treat analysis was conducted at an Australian university between February 2018 - January 2021. Participants were 144 physiotherapy students, cluster randomized by tutorial groups (exp n = 70, con n = 74), undertaking their neurological curricula. The experimental group was exposed to MASK-ED™ simulation in five out of a potential thirty-two tutorials (16%) whilst the control continued with role-play with peers. The primary outcome measure was Assessment of Physiotherapy Practice scores from the students' rehabilitation work-integrated learning clinical placement. These were compared between the experimental and control groups using Mann-Whitney U tests. Secondary outcome measures include practical and written examination scores. These were compared between groups via independent t-tests. Participant satisfaction surveys were also administered to the experimental group.

RESULTS

One hundred thirty-two participants' (exp n = 62, con n = 72) results were analyzed. There were no significant differences between the experimental and control groups for Assessment of Physiotherapy Practice scores (p = 0.699-0.995). There were no significant differences found between the groups, across the secondary outcome measures. Participants found MASK-ED™ simulation was somewhat helpful for preparing them for clinical practice, however felt that a group setting was not as effective as a one-on-one encounter would have been.

CONCLUSIONS

MASK-ED™ simulation was no more effective than role-play with peers in preparing physiotherapy students for work-integrated learning. The influence of the design of simulation on effective learning and the number of classroom-based simulation encounters required to impact clinical performance requires further investigation.

Effects of Manikin Fidelity on Simulation-Based Nursing Education: A Systematic Review and Meta-Analysis

BACKGROUND

Few studies have examined whether higher-fidelity manikins are superior to lower-fidelity manikins in nursing simulation-based education.

METHOD

A database search initially yielded 2,656 studies written in English or Korean. Duplicates and irrelevant studies were excluded. Ancestry searches generated 3 additional studies, and 15 studies met the criteria.

RESULTS

Higher-fidelity manikins were more effective than lower-fidelity manikins in improving skill performance/clinical competence and perception of nursing students and nurses. In terms of learners' knowledge, satisfaction, and self-confidence, both higher- and lower-fidelity manikins were similarly effective for nursing students.

CONCLUSION

This article provides evidence that higher-fidelity manikins do not always ensure a superior educational effect compared with lower-fidelity manikins. [J Nurs Educ. 2022;61(2):67-72.].

Improving Nursing Student Attitudes Toward Older Adults Through the Use of Mask-Ed™ Simulation

Older adults are significant consumers of health care, yet studies find many health care students do not want to work with this population. This negative attitude can impact health outcomes. Increased exposure to older adults is linked to increased positive attitudes toward older adult care. Addressing the need for increased opportunities to interact with older adults will likely enhance these attitudes and thus improve health outcomes. In the current study, four varied Mask-Ed™ simulation activities were used in a course with a specific focus on nursing care of older adults. The Mask-Ed™ character, an older adult woman, works with students and provides opportunities for positive interactions/experiences. Students responded positively to simulation activities. Students described the experiences as helpful in increasing their confidence and comfort level with older adults. This unique experience fostered positive attitudes toward older adults among nursing students by giving them the opportunity to practice engaging with this population. [Journal of Gerontological Nursing, 47(12), 43-47.].

Hybrid medical simulation – a systematic literature review

Health-care education based upon technology enabled mannequins (high-fidelity simulators) is a costly investment for colleges and universities. However, a hybrid model using wearable technology integrated with human actors (standardized patients) may present a cost-effective alternative to high fidelity simulation training scenarios. A systematic literature review of papers published from 1960 to 2019 illustrates that hybrid simulation can be as effective as high fidelity simulators in certain training scenarios while at the same time providing a superior training context to enhance learners patient to care-giver interactions and to better immerse the trainee in the feelings and emotion of the scenario.

"It is much more real when it comes from them": The role of experts by experience in the integration of mental health nursing theory and practice

PURPOSE

To examine nursing students' perceptions of Experts by Experience impact on theoretical and practical learning.

DESIGN AND METHODS

Qualitative exploratory study involving focus groups with undergraduate nursing students from five European countries and Australia. Data were analyzed thematically.

FINDINGS

Participants described positive impacts as: bridging the theory and practice gap through first-hand experience, including sub-themes: bringing theory to life; can't be taught any other way, and innovative teaching methods fueling curiosity.

RELEVANCE TO CLINICAL PRACTICE

Integrating theory and practice is key for quality mental health nursing practice. Experts by experience can potentially contribute to reducing this enduring gap.

Mask-Ed (KRS Simulation) an approach to deliver intimate care for neophyte nursing students: the creator's experience

Nurses deliver intimate care to patients in a variety of ways, especially when attending to showering, bathing, toileting and managing chronic or surgical wounds located in body regions such as the genitalia or breasts. Neophyte undergraduate nursing students can experience fear and anxiety at the thought of carrying out this level of care; hence, there is a need for preparation prior to undertaking clinical placements when students encounter real patients. The preparation should begin in the laboratory context of their tertiary educational settings. Traditionally, task trainers and manikins have been used to demonstrate and practise this care in such environments. However, the realism of experiencing true human responses, by both the patient and student, can be lost through these modalities. In recent years, a simulation approach, Mask-Ed, has enabled intimate care to be taught to students in a university setting in Australia where the laboratory context provides a safety net. Mask-Ed involves the informed educator wearing highly realistic silicone props that include torsos, faces and hands. Having donned the props, the educator then transforms into another person. The newly created person has a backstory designed to enable the educator to become a platform for teaching and to coach students through the clinical experience. The following discussion explains the background to Mask-Ed and the underlying framework that is used to implement the technique to teach intimate care. Mask-Ed is considered one of the most realistic approaches to simulation and is used in healthcare facilities and tertiary educational institutions globally.

Evaluation of the 'Empathic Care of a Vulnerable Older Person' e-simulation

BACKGROUND

Healthcare reports have identified that the nursing care provided to frail older people is sometimes indifferent, unkind, and lacking in empathy. Compelling research indicates that these types of healthcare interactions can result in both emotional and physiological harm. Thus, there is a need for authentic learning experiences that enhance nursing students' empathy towards older people and that they can reflect upon, learn from and transfer to their real-world practice. e-Simulations provide a pragmatic way of addressing this need.

AIM

The aim of this study was to evaluate the impact of an 'Empathic Care of a Vulnerable Older Person' e-simulation on nursing students' empathy levels.

SETTING AND PARTICIPANTS

A convenience sample of first year nursing students from one university in the United Kingdom and two Australian universities was recruited for the study.

DESIGN AND ANALYSIS

A three-group pre-post study was conducted using the Comprehensive State Empathy Scale to evaluate the impact of the effectiveness of the e-simulation. Sample characteristics were summarised using descriptive statistics. Dependent t-tests and analysis of variance (ANOVA) were used to compare the changes in empathy scores pre post and differences between groups.

RESULTS

A total of 684 nursing students participated in the study; their average age was 23 years. Overall, there was a significant increase in empathy scores from pre-test to post-test. Post-hoc comparison of the three groups indicated that the e-simulation had a greater impact on the empathy levels of participants from Universities 2 and 3, compared to those from University 1.

CONCLUSION

e-Simulations using narrative methodologies that cater for learners' emotional memory appear to be an effective approach for enhancing empathy towards older people. However, further studies are needed to explore how this learning activity might inform and influence learners' future clinical practice.

High-fidelity simulation and nursing students' anxiety and self-confidence: A systematic review

BACKGROUND

As a complementary teaching pedagogy, high-fidelity simulation remains as an effective form of simulation modality. Empirical evidence has additionally shown high-fidelity simulation (HFS) to be an effective contributor to students' learning outcomes.

PURPOSE

This paper critically appraised existing scientific articles that covered the influence of utilizing HFS on the effects of nursing students' anxiety and self-confidence during undergraduate nursing education.

METHODS

This was a systematic review of scientific articles conducted from 2007 to 2017 on the topic of the influence of using HFS on students' self-confidence and anxiety. The literature of six electronic databases (Proquest, SCOPUS, MEDLINE, PubMed Central, CINAHL, and PsychINFO) was reviewed.

RESULTS

Following the literature search, 35 articles were selected. This review provides updated evidence on the efficacy of HFS in reducing anxiety and enhancing self-confidence among nursing students when performing nursing duties or managing patients. Moreover, this review highlights the need for more research that examines the impact of HFS on students' anxiety.

CONCLUSION

As this form of simulation is found to be effective in the enhancement of nursing student self-confidence and the reduction of their anxiety when caring for patients and/or employing nursing skills, the inclusion of simulation-based activities in all clinical nursing courses is vital.

Nursing students’ experience in performing intimate clinical procedures via high fidelity Mask-Ed simulation

Background

Didactic clinical skills training employing low fidelity simulation has been the traditional approach to teaching undergraduate nursing students the insertion of an indwelling urinary catheter. This approach, however, does not adequately prepare students for the intricacies and complexity of this procedure in the real world, which is associated with high rates of infection secondary to procedural contamination.

Objectives

To explore students’ confidence levels in developing clinical psychomotor skills associated with the insertion of an indwelling urinary catheter in a high-fidelity simulation using Mask-Ed.

Methods

A mixed methods study was conducted involving final year Bachelor of Nursing students. Preproceduraland postprocedural confidence was rated by students using a 5-point Likert scale. A focus group consisting of eleven students was conducted to further explore student’s experience of engaging with a Mask-Ed character and the procedural experience from a learning perspective.

Results

The findings indicated that students increased their procedure confidence when engaging with the Mask-Ed simulation (P=0.025). The ability to maintain procedural asepsis and ability to accurately identify the correct anatomical structures related to indwelling urinary catheter insertion were found to be related (rs=0.71, P<0.05). Three primary themes were identified: caring of a person, intimate care and communication.

Conclusion

Psychomotor skills related to communication, support and maintaining procedural asepsis were areas that required further clinical development, which are not concurrently integrated into the simulation approach using manikin based simulation. Mask-Ed provided a unique learning opportunity to replicate a clinically and anatomically realistic experience.

An Exploration of Student Midwives’ Lived Experiences Regarding Confidence and Satisfaction in Medium-Fidelity Simulation

Background

Newly qualified midwives are expected to exhibit some level of confidence in practice when they enter the clinical environment.

Objective

To explore the lived experiences of student midwives after exposure to medium-fidelity simulation concerning confidence and satisfaction.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Baccalaureate of Nursing Science student midwives at the University of Fort Hare. In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis approach.

Results

Superordinate theme sense of fulfilment elicited six sub-ordinate themes namely 1) Transferability of skills 2) Knowledgeable 3) Equipment used during simulation 4) Realism of simulation 4) Sense of accomplishment 5) Sure/unsure of performance. The use of a standardised patient during the simulation instead of a mannequin prepared participants for the real clinical environment. After being involved in the simulation, participants became more inquisitive regarding the management of the simulated condition. Satisfaction with simulation depended on whether the simulation activity met the student’s expectations, and if the simulation equipment resembled real clinical equipment. Post-partum haemorrhage simulation bridged the gap between theory and practice.

Conclusion

Confidence and satisfaction of student midwives during simulation is depended on the realism of the simulated activity. Exposure to simulated activity increases student knowledge. The student acknowledged that simulation can bridge the gap between theory and practice.

Effects of different education methods in peritoneal dialysis application training on psychomotor skills and self-efficacy of nursing students

BACKGROUND

Applying the proper technique for connections in Peritoneal Dialysis (PD) is crucial in preventing potential infectious complications.

OBJECTIVES

The aim of this study is to investigate the effects of different education methods in PD application training on the psychomotor skills and self-efficacy of nursing students.

METHODS

The randomized controlled and experimental study was conducted with a total of 28 nursing student participants. The PD training was provided theoretically and by using a PD simulator for the experimental group and by using videos for the control group. At the end of the training, each student who was included in the experimental and control group were asked to perform PD on the PD simulator one by one. Psychomotor skills were evaluated according to the PD application skill evaluation criteria. Self-efficacy of the students before and after the application was also measured.

RESULTS

Psychomotor skill scores of the students were found to be significantly higher in the experimental group, and there was no significant difference between the experimental and control groups in terms of self-efficacy scores. No statistically significant difference was detected between the self-efficacy scores of the experimental group regarding pre-test and post-test results.

CONCLUSION

This technique can be used to improve the development of psychomotor skills, since the demonstration of the PD application with the simulation technique is effective in the development of psychomotor skills.

Medium-fidelity simulation in clinical readiness: a phenomenological study of student midwives concerning teamwork

Background

Teamwork during obstetric emergency ensures good outcomes for both the woman and her baby. Effective teams are characterised by mutual respect, support, and cooperation among team members.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Bachelor of Nursing Science student midwives at the University of Fort Hare (UFH). In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis method.

Results

Superordinate theme demonstrated teamwork elicited four clustered themes namely delegation of duties, the importance of teamwork, team support, and confident team leader. The participants recognised that there should be a team leader who is capable of delegating duties to other team members in the management of an obstetric emergency, Participants were confident not only to assign duties but to be kept updated of the intervention. They expressed the need to work collaboratively as a team to achieve the desired goal of providing quality care to the woman. The participants maintained that the team must be supportive and be able to help in decision making during simulation of an obstetric emergency. A sense of mutual respect is echoed by some participants in the process of caring for the woman. Some participants were confident at being team leaders and could see themselves as leaders in the real-life clinical situation.

Conclusion

The participants acknowledge the importance of teamwork in resolving obstetric emergencies. The importance of delegating duties to other team members, providing updated progress report ensures better outcomes for the woman.

Mask-Ed: Breaking the Barrier of Fear of Intimate Care for Nursing Students

BACKGROUND

Nursing students learn to toilet, shower, and dress patients in the clinical laboratory with simulation modalities that lack the realism necessary to address the fears, values, and beliefs of nudity and intimate contact with patients.

METHOD

A high-fidelity Mask-Ed™ (KRS [Knowledgeable, Realistic, Spontaneous] simulation) intervention was developed and piloted with first-year nursing students around patient showering to increase confidence and skills around intimate care.

RESULTS

Students initially felt intimidated, awkward, nervous, and anxious about showering patients; however, after the Mask-Ed simulation, 93% reported feeling more confident and having insight into the patient experience. The realism of the scenario was a contributing factor.

CONCLUSION

Mask-Ed provides a platform for the educator to create realistic scenarios around intimate care that help students prepare, on many levels, for their initial clinical experiences. [J Nurs Educ. 2017;56(9):572-574.].

The value of simulation-based learning in pre-licensure nurse education: A state-of-the-art review and meta-analysis

Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25-6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses.

Evidence of clinical competence by simulation, a hermeneutical observational study

Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre-understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was "the way from suffering to health" in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering.

Who is that masked educator? Deconstructing the teaching and learning processes of an innovative humanistic simulation technique

Simulation learning in nursing has long made use of mannequins, standardized actors and role play to allow students opportunity to practice technical body-care skills and interventions. Even though numerous strategies have been developed to mimic or amplify clinical situations, a common problem that is difficult to overcome in even the most well-executed simulation experiences, is that students may realize the setting is artificial and fail to fully engage, remember or apply the learning. Another problem is that students may learn technical competence but remain uncertain about communicating with the person. Since communication capabilities are imperative in human service work, simulation learning that only achieves technical competence in students is not fully effective for the needs of nursing education. Furthermore, while simulation learning is a burgeoning space for innovative practices, it has been criticized for the absence of a basis in theory. It is within this context that an innovative simulation learning experience named "Mask-Ed (KRS simulation)", has been deconstructed and the active learning components examined. Establishing a theoretical basis for creative teaching and learning practices provides an understanding of how, why and when simulation learning has been effective and it may help to distinguish aspects of the experience that could be improved. Three conceptual theoretical fields help explain the power of this simulation technique: Vygotskian sociocultural learning theory, applied theatre and embodiment.