Situated Cognition: A Learning Framework to Support and Guide High-fidelity Simulation

Peer Collaborative Clinical Decision Making in Nursing Simulation: A Theoretical Framework

BACKGROUND

Collaboration and decision making among nursing students are essential competencies in nursing education. However, how students collaborate and make decisions in simulation is a complex phenomenon and not well understood. This study aimed to develop a framework that describes peer collaborative clinical decision making (PCCDM) among nursing students in simulation.

METHOD

Charmaz's constructivist grounded theory method was used. The sample included 32 participants (16 dyads) from two nursing programs.

RESULTS

The PCCDM framework described three interrelated functional domains (cognition, behavior, and emotion) experienced through three interrelated processes (awareness, communication, and regulation), alternating between individual and collaborative spaces and changing across time according to the simulation's acuity levels.

CONCLUSION

The PCCDM framework provides a model that reflects how these processes unfold over time in simulations, which can be applied in nursing simulation, classroom, and clinical settings that require students to make collaborative decisions. [J Nurs Educ. 2024;63(7):435-443.].

The role of extended reality in optometry education: a narrative review

The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.

Teaching nursing students: As an umbrella review of the effectiveness of using high-fidelity simulation

AIM

To conduct an umbrella review of the effectiveness of using high-fidelity simulation in nursing student teaching, thereby supporting continuous improvement in teaching practitioners' implementation of high-fidelity simulation intervention strategies.

BACKGROUND

Several systematic reviews have investigated the effectiveness of high-fidelity simulation in nursing student teaching in recent years. However, conclusions vary and a systematic assessment is lacking.

DESIGN

This review encompasses an umbrella review.

METHODS

A search of PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted to retrieve data on an umbrella review of high-fidelity simulation effectiveness in nursing student teaching from database inception to November 2023. The quality of the included systematic reviews was independently assessed by two reviewers using the AMSTAR 2 and PRISMA scales. Outcome indicators from the included systematic reviews were graded using the GRADE system.

RESULTS

Twelve systematic reviews focusing on high-fidelity simulation effectiveness in nursing student teaching were included. Notably, all 12 systematic reviews exhibited very-low methodological quality, with 9 exhibiting some degree of reporting deficiencies, 2 exhibiting severe information deficiencies and 1 reporting relatively complete information. A total of 22 outcome indicators and 53 pieces of evidence were included. The results revealed 15 pieces of low-quality evidence and 38 pieces of very-low-quality evidence. Mounting evidence suggests that high-fidelity simulation teaching effectively enhances nursing students' theoretical performance, practical skills and various clinical comprehensive abilities, highlighting a positive teaching effect. However, further validation through high-quality, large-sample studies is warranted.

CONCLUSION

The overall evidence quality of the current systematic reviews evaluating high-fidelity simulation effectiveness in nursing student teaching is low. Additionally, the methodological quality and the degree of reporting standardization require further improvement. Therefore, high-quality, large-sample randomized controlled trials are essential for further substantiating high-fidelity simulation effectiveness in nursing student teaching.

Hybrid Concept Analysis: Peer Collaborative Clinical Decision-Making in Nursing Simulation

BACKGROUND

Nursing students collaborate and make clinical decisions in simulation scenarios. However, the literature does not clearly define the concept of peer collaborative clinical decision-making (PCCDM). This hybrid concept analysis explored and established the definition of PCCDM among nursing students in simulation.

METHOD

A total of 19 articles were reviewed, and 11 dyads of nursing students were interviewed after participating in virtual reality simulation for their perspectives on PCCDM.

RESULTS

Five major themes were identified: group (1) communication; (2) awareness; (3) regulation; (4) reasoning; and (5) emotion. The conceptual definition of PCCDM is a dynamic, nonhierarchical, and group-level process of cognitive and socioemotional interactions among peers about a clinical situation that involves group communication, awareness, and regulation of reasoning and emotion within the collaborative space.

CONCLUSION

This analysis provides a conceptual definition of PCCDM in nursing simulation as well as a pathway for developing a theoretical framework and instrument. [J Nurs Educ. 2023;62(5):269-277.].

Enablers of the successful implementation of simulation exercises: a qualitative study among nurse teachers in undergraduate nursing education

BACKGROUND

Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education.

METHODS

This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis.

RESULTS

The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises.

CONCLUSIONS

The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students' learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04063319 . Protocol ID: 52110 Nursing Students' Recognition of and Response to Deteriorating Patients.

Applying Talent Quality-Management System (TTQS) to Enhance Information Literacy, Learning Motivation, and Computational Thinking Competency of Nursing Undergraduates

In Taiwan, the Ministry of Education started promoting computational thinking (CT) and design skills in the programming curriculum in 2018 at all universities. CT, which has been widely discussed in the field of education, is the ability to solve problems that use computer science concepts. For students in non-information technology fields, such as nursing students, a curriculum that integrates nursing education and information literacy can bolster evidence-based practice, enhance professional development, and encourage lifelong learning. However, the programming courses were difficult for non-information learners to apprehend, given their lack of knowledge in programming, and had a low attrition rate. Therefore, it is necessary to establish a sustainable management system in the learning process. It is also important to support the interest and confidence of the nursing learner in the programming curriculum. In this study, a programming course for nursing students was completed. A talent quality-management system (TTQS) for this programming course was built and implemented. A technology acceptance model and learning attitude questionnaires were administered to investigate learners’ learning motivation and information literacy. Two nursing classes with 74 freshmen participated in the curriculum in the second semester of the 2020 academic year. The results showed that TTQS, which supports teachers in adjusting pedagogy in a timely manner, can enhance learners’ motivation and performance. In this programming course, nursing students can learn CT and information concepts and improve their learning motivation through the design of learner-centred and collaborative learning.

Training with cognitive load improves performance under similar conditions in a real surgical task

BACKGROUND

Enhancing cognitive load while performing a bimanual surgical task affects performance. Whether repeated training under this condition could benefit performance in an operating room was tested using a virtual reality simulator with cognitive load applied through two-digit math multiplication questions.

METHOD

11 subjects were randomized to Control, VR and VR + CL groups. After a pre-test, VR and VR + CL groups repeated the peg transfer task 150 times over 15 sessions with cognitive load applied only for the last 100 trials. After training, all groups took a post-test and two weeks later the retention test with and without cognitive load and the transfer task on a pig intestine of 150 cm long under cognitive load.

RESULTS AND CONCLUSION

Mixed ANOVA analysis showed significant differences between the control and VR and VR + CL groups (p = 0.013, p = 0.009) but no differences between the VR + CL and the VR groups (p = 1.0). GOALS bimanual dexterity score on transfer test show that VR + CL group outperformed both Control and VR groups (p = 0.016, p = 0.03). Training under cognitive load benefitted performance on an actual surgical task under similar conditions.

The Impact of Simulation Prebriefing on Perceptions of Overall Effectiveness, Learning, and Self-Confidence in Nursing Students

AIM

The aim of this study was to evaluate the impact of simulation prebriefing on nursing students' perceptions of overall effectiveness, learning, and self-confidence.

BACKGROUND

Most research highlights debriefing as the most important component influencing learning outcomes; the focus on prebriefing is limited.

METHOD

This quasiexperimental design study compared outcomes among four groups of undergraduate students (n = 119) at two schools of nursing: no prebriefing, prebriefing with learning engagement and orientation activities, prebriefing with orientation activities, and prebriefing with learning engagement activities.

RESULTS

Perceptions of overall simulation effectiveness, learning, and self-confidence were significantly higher with prebriefing (p = .000) compared to no prebriefing. No significant distinction (p >.05) was found among the prebriefing activities.

CONCLUSION

Findings from this study support the use of learning engagement and orientation activities during prebriefing in order to enhance overall simulation effectiveness.

Evaluating the impact of high- and low-fidelity instruction in the development of auscultation skills

CONTEXT

A principal justification for the use of high-fidelity (HF) simulation is that, because it is closer to reality, students will be more motivated to learn and, consequently, will be better able to transfer their learning to real patients. However, the increased authenticity is accompanied by greater complexity, which may reduce learning, and variability in the presentation of a condition on an HF simulator is typically restricted.

OBJECTIVES

This study was conducted to explore the effectiveness of HF and low-fidelity (LF) simulation for learning within the clinical education and practice domains of cardiac and respiratory auscultation and physical assessment skills.

METHODS

Senior-level nursing students were randomised to HF and LF instruction groups or to a control group. Primary outcome measures included LF (digital sounds on a computer) and HF (human patient simulator) auscultation tests of cardiac and respiratory sounds, as well as observer-rated performances in simulated clinical scenarios.

RESULTS

On the LF auscultation test, the LF group consistently demonstrated performance comparable or superior to that of the HF group, and both were superior to the performance of the control group. For both HF outcome measures, there was no significant difference in performance between the HF and LF instruction groups.

CONCLUSIONS

The results from this study suggest that highly contextualised learning environments may not be uniformly advantageous for instruction and may lead to ineffective learning by increasing extraneous cognitive load in novice learners.

Cultural Norms of Clinical Simulation in Undergraduate Nursing Education

Simulated practice of clinical skills has occurred in skills laboratories for generations, and there is strong evidence to support high-fidelity clinical simulation as an effective tool for learning performance-based skills. What are less known are the processes within clinical simulation environments that facilitate the learning of socially bound and integrated components of nursing practice. Our purpose in this study was to ethnographically describe the situated learning within a simulation laboratory for baccalaureate nursing students within the western United States. We gathered and analyzed data from observations of simulation sessions as well as interviews with students and faculty to produce a rich contextualization of the relationships, beliefs, practices, environmental factors, and theoretical underpinnings encoded in cultural norms of the students’ situated practice within simulation. Our findings add to the evidence linking learning in simulation to the development of broad practice-based skills and clinical reasoning for undergraduate nursing students.

Obstetrical staff nurses experiences of clinical learning

The clinical learning experience is used in nursing programs of study worldwide to prepare nurses for professional practice. This study's purpose was to use Naturalistic Inquiry to understand the experiences of staff nurses in an obstetrical unit with undergraduate nursing students present for clinical learning. A convenience sample of 12 staff nurses, employed on a Family Birth Center, participated in semi-structured interviews. The constant comparative method as modified by Lincoln and Guba was used to analyze data. Five themes related to staff nurses experiences of clinical learning were identified: Giving and Receiving; Advancing Professionally and Personally; Balancing Act; Getting to Know and Working with You; and Past and Present. This research highlights staff nurses' experiences of clinical learning in undergraduate nursing education. Staff nurses exert a powerful, long lasting influence on students. A need exists to prepare and judiciously select nurses to work with students. Clinical agencies and universities can take joint responsibility providing tangible incentives, financial compensation, and recognition to all nurses working with nursing students.

Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper

High-fidelity patient simulation is a method of education increasingly utilised by educators of nursing to provide authentic learning experiences. Fidelity and authenticity, however, are not conceptually equivalent. Whilst fidelity is important when striving to replicate a life experience such as clinical practice, authenticity can be produced with low fidelity. A challenge for educators of undergraduate nursing is to ensure authentic representation of the clinical situation which is a core component for potential success. What is less clear is the relationship between fidelity and authenticity in the context of simulation based learning. Authenticity does not automatically follow fidelity and as a result, educators of nursing cannot assume that embracing the latest technology-based educational tools will in isolation provide a learning environment perceived authentic by the learner. As nursing education programmes increasingly adopt simulators that offer the possibility of representing authentic real world situations, there is an urgency to better articulate and understand the terms fidelity and authenticity. Without such understanding there is a real danger that simulation as a teaching and learning resource in nurse education will never reach its potential and be misunderstood, creating a potential barrier to learning. This paper examines current literature to promote discussion within nurse education, concluding that authenticity in the context of simulation-based learning is complex, relying on far more than engineered fidelity.

Integrating a professional apprenticeship model with psychiatric clinical simulation

In this article, we present a theory-based application of clinical simulation in psychiatric-mental health nursing education. As described by Benner, Sutphen, Leonard, and Day, a three-pronged apprenticeship that integrates intellectual, practical, and ethical aspects of the professional role is critical in the development of practical reasoning in nursing education and training. Clinical encounters are often fraught with ambiguity and uncertainty. Therefore, educating for a practice discipline requires experiential and situated learning. Using the three-pronged experiential model in simulated psychiatric-mental health nursing practice supports the development of critical nursing skills, ethics, and theoretical concepts. A clinical scenario is presented that demonstrates the application of this model of professional apprenticeship in psychiatric-mental health education. Applications of the concept presented may be used in training nurses new to the practice of psychiatric-mental health nursing.