Situated Cognition: Its Relationship to Simulation in Nursing Education

Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders - A Systematic Review of the Literature

INTRODUCTION

First responders' training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.

METHODS

A systematic integrative literature review was used according to Whittemore and Knafl's descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.

RESULTS

Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.

CONCLUSIONS

This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.

Using objective structured clinical examination to teach medication rights in undergraduate nursing education

INTRODUCTION

Clinical partner feedback identified insubstantial student preparation and limited understanding of safe medication administration process. Faculty initiated a new teaching and evaluation approach to prepare students for safe medication administration processes in the practice setting.

METHODS

The teaching method is a synthesis of situated cognition learning theory that emphasizes use of deliberate practice case scenarios in low fidelity simulation. Objective Structured Clinical Examination (OSCE) evaluates student critical thinking and application of the medication rights administration process.

OUTCOMES

Data collection includes first and second attempt OSCE pass rates, occurrence of incorrect answers, and student feedback regarding the testing experience. Findings include a greater than 90 % pass rate on first attempt, 100 % pass rate on second attempt, and positive testing experience.

CONCLUSION

Faculty now use situated cognition learning methods and OSCE in one course within the curriculum.

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.

Wow, woo, win"- Healthcare students' and facilitators' experiences of interprofessional simulation in three-dimensional virtual world: A qualitative evaluation study

BACKGROUND

In an age disrupted by COVID-19 pandemic, three-dimensional virtual world (3DVW) offers an opportunity for healthcare students from different higher education institutions to participate in interprofessional education. Despite its growing evidence, there is a need to unravel the complex learning process in order to ensure high quality of interprofessional education delivery.

AIM

This study aimed to explore the experiences of healthcare students and facilitators on the use of 3DVW for interprofessional team-based virtual simulation.

METHODS

Interprofessional teams, each comprising six different healthcare students (Medicine, Nursing, Pharmacy, Physiotherapy, Occupational Therapy, and Medical Social Work) and two clinicians who acted as facilitators, logged into the 3DVW from their own remote locations to participate in team-based care delivery that included an interprofessional bedside round and a family conference. A qualitative descriptive study was conducted on a purposive sample of 30 healthcare students and 12 facilitators using focus group discussions and individual interviews.

RESULTS

Four themes emerged from their experiences: the "wow experience", authentic experience on collaborative care, ease of learning, and preeminent role of the facilitator. The simulation provided the "wow" experiences through contextual, collaborative and experiential learning approaches. Despite technical challenges, the participants were wooed by the comforts of learning from home and the psychological safety in virtual environment. The facilitators played a critical role in optimizing learning engagement to win learners over.

CONCLUSION

Our study explicates how attention to the "wow, woo and win" trilateral factors can transform the interprofessional learning experiences offered by 3DVW simulation. Future developments in the use of this learning technology should include developing the clinicians' facilitation skills and the provision of technical support to make this 3DVW a success calls in winning students' learning engagement.

Development and evaluation of a technology-enhanced, enquiry-based learning program on managing neonatal extravasation injury: A pre-test/post-test mixed-methods study

BACKGROUND

Extravasation injury remains a significant preventable cause of morbidity and mortality in neonates. Equipping nursing students with the requisite knowledge and skills is essential for appropriate prevention, early detection, and management of extravasation injury.

OBJECTIVES

To develop a technology-enhanced, enquiry-based learning program for nursing students on the prevention and management of neonatal extravasation injury and examine its impact on their knowledge, approaches to studying and experience of learning.

DESIGN

A pre-test/post-test study with qualitative evaluation.

SETTINGS

Two university pre-registration nursing programs in Hong Kong.

PARTICIPANTS

A total of 192 senior-year nursing students.

METHODS

A novel learning program was developed comprising 25 scenario-based video vignettes supplemented with critical-thinking exercises, discussion guides, interactive games, reading materials and a 3-hour in-class interactive workshop. Students received unlimited online access to the program. Data were collected at baseline and one-month post-workshop. Outcomes were students' level of knowledge of prevention and management of extravasation injuries and related care, approaches to studying, and experience of learning. Paired t-tests were performed on pre- post-test outcome data and individual semi-structured interviews were conducted at one-month post-workshop, transcribed verbatim and analyzed thematically.

RESULTS

There were statistically significant improvements in students' level of knowledge and use of a deep approach to learning at one month compared with baseline. Students were highly satisfied with the program, appreciating the video vignettes and interactive small group discussions with academics and clinicians. Suggestions for enhancing the program included more time for the workshop, interaction with clinicians, and details on the administration of neonatal medications and dosages.

CONCLUSIONS

This study showed that a novel technology-enhanced, enquiry-based learning program was effective in enhancing nursing students' knowledge of the prevention and management of neonatal extravasation injury, approaches to studying and experience of learning.

State of Simulation Research in Advanced Practice Nursing Education

Simulation is used in advanced practice nursing education for both formative learning experiences and summative competency testing. However, there has been a lack of cohesive data to support the use of simulation as a replacement for direct patient care hours. This chapter presents an overview of research designs and the leveled Kirkpatrick framework used in simulation research. Research articles evaluating the effect of simulation on advanced practice learners are presented by research design and Kirkpatrick level. There is evidence that simulation has a positive impact on Kirkpatrick Level 1 (Reactions) and Kirkpatrick Level 2 (Changes in Knowledge, Skills, and Attitudes). However, there is a tremendous need for evidence that simulation can impact Kirkpatrick Level 3 (Behavior) and Level 4 (Results and Outcomes).

Based on Delphi method and Analytic Hierarchy Process to construct the Evaluation Index system of nursing simulation teaching quality

BACKGROUND

Simulation has been widely adopted in nursing education, as is known to all, the quality of simulation could be affected by many factors. Since there is not a comprehensive and scientific evaluation Index system, it is important to construct an evaluation Index system to guide high-quality simulation.

OBJECTIVES

To construct the Evaluation Index system of Nursing Simulation teaching Quality and determine the weight of each indicator.

DESIGN

It is a phenomenological research study.

SETTINGS

The study was mainly conducted in one universities in China.

PARTICIPANTS

27 nursing education experts from China participated in this study.

METHODS

This study combines the Delphi method and Analytic Hierarchy Process method.

RESULTS

Evaluation Index system of Nursing Simulation teaching Quality is built using Delphi method, including five first level index (Teacher, Student, Simulation design characteristics, Educational practices and Outcomes), 14 secondary index and 62 tertiary index. It's determined through a two-rounded experts consultation involving 27 experts. The recovery rates of two rounds consultation questionnaire were respectively 96.43% and 100%, and coefficient authority was 0.89. The Kendall's W of second and third level index were respectively 0.515 and 0.589 (P < 0.001). And the weighted value of quality index are established at all levels with the consistency ratio (C.R.) <0.1, demonstrating that Teacher (0.4109) came first among the five first-level index followed by Student (0.2593), the Educational practices (0.1812), Simulation design characteristics (0.096) and Outcomes (0.0527).

CONCLUSIONS

The quality index of nursing simulation education is scientific and reliable, so as its weight assignment. It can be a guidance for high-quality simulation teaching, and it is a valid tool to evaluate the quality of simulation teaching in nursing.

Evaluating the quality of simulation teaching in Fundamental Nursing Curriculum: AHP-Fuzzy comprehensive evaluation

BACKGROUND

Simulation has been widely adopted in nursing education, while it is difficult to evaluate the quality of simulation. AHP-Fuzzy comprehensive evaluation could be an effective method based on one a comprehensive and scientific evaluation Index system.

OBJECTIVES

To evaluate the quality of simulation teaching in ⟨Fundamental Nursing Curriculum⟩ with fuzzy comprehensive method, and to provide a scientific evaluation method for the improvement of simulation teaching.

DESIGN

It is a phenomenological research study.

SETTINGS

The study was mainly conducted in one university in China.

PARTICIPANTS

94 second-year nursing students participated in this study.

METHODS

The grade 2015 nursing undergraduate students in Peking university school of nursing as the evaluation subjects were to evaluate the simulation teaching quality on ⟨Fundamental Nursing Curriculum⟩, Fuzzy Comprehensive Evaluation method was used.

RESULTS

The quality score is 73.55-100 (91.71 ± 6.98) points of 94 students. According to the result of fuzzy comprehensive evaluation, the simulation teaching quality belonging to the "excellent, good, moderate, poor, very poor" of membership degree are respectively "0.6794, 0.2500, 0.00640, 0.0039, 0.0028", and by maximum membership degree of effective inspection, calculate ɑ = 2.3965, 1 ≤ ɑ < + ∞.

CONCLUSIONS

The application of simulation teaching in ⟨Fundamental Nursing Curriculum⟩ proves high quality. The fuzzy comprehensive evaluation combining subjective evaluation and objective evaluation proves to be a scientific and feasible methodology in nursing education.

Undergraduate nursing students' experiences of anxiety-producing situations in clinical practicums: A descriptive survey study

BACKGROUND

Clinical practicums are regarded as one of the most anxiety-producing aspects of the curriculum by nursing students. Practicum-associated anxiety has negative impacts on learning, performance, and well-being. Little is known about what makes final year nursing students anxious during their practicum experience and the impact of clinical and student characteristics on their level of anxiety.

OBJECTIVES

The objectives of the study were (1) to explore which clinical situations final year nursing students perceive as anxiety-producing; (2) to identify if perceived level of anxiety associated with clinical tasks differ by clinical and student characteristics; and (3) to determine the relationship between clinical and student characteristics and perceived level of anxiety among nursing students.

DESIGN

Descriptive, cross-sectional survey.

SETTING

One university in Ontario, Canada.

PARTICIPANTS

A convenience sample of 93 final year undergraduate nursing students.

METHODS

The Clinical Experience Anxiety Form (CEAF) was administered to assess perceived level of anxiety associated with common practicum tasks. Descriptive statistics, one-way analysis of variance, and Pearson's correlation tests were used to address the research questions. Content analysis was conducted for open-ended questions.

RESULTS

Participants reported the following three situations as most anxiety-producing: fear of making mistakes, being observed by instructors, and initial clinical experience on a unit. Differences were noted between younger (18 to 24 years-old) and older (25 to 34 years-old) students, with the older student group reporting lower levels of anxiety associated with the following clinical situations: being observed by instructors and asking questions of faculty. Age was also found to be negatively correlated with CEAF scores wherein younger students reported higher CEAF scores. Content analysis indicated common areas that worried participants most about their practicum and their academic year.

CONCLUSIONS

Findings emphasize the importance of nursing educators to recognize anxiety-producing practicum situations and develop anxiety management interventions to ensure optimal learning.

The Impact of a New Pedagogical Intervention on Nursing Students' Knowledge Acquisition in Simulation-Based Learning: A Quasi-Experimental Study

Simulation-based learning is an effective technique for teaching nursing students' skills and knowledge related to patient deterioration. This study examined students' acquisition of theoretical knowledge about symptoms, pathophysiology, and nursing actions after implementing an educational intervention during simulation-based learning. A quasi-experimental study compared theoretical knowledge among two groups of students before and after implementation of the intervention. The intervention introduced the following new components to the existing technique: a knowledge test prior to the simulation, video-recording of the performance, and introduction of a structured observation form used by students and facilitator during observation and debriefing. The intervention group had significantly higher scores on a knowledge test conducted after the simulations in comparison to the scores in the control group. In both groups scores were highest on knowledge of symptoms and lowest on knowledge of pathophysiology; the intervention group had significantly higher scores than the control group on both topics. Students' theoretical knowledge of patient deterioration may be enhanced by improving the students' prerequisites for learning and by strengthening debriefing after simulation.

The impact of a multimodal education strategy (the DeTER program) on nurses' recognition and response to deteriorating patients

Nurses are ideally positioned to recognise and respond to patient deterioration. However, premonitory signs of patient deterioration are often overlooked, not managed, or not communicated in a timely fashion. Education programs aimed at improving nurses' technical and non-technical skills have been developed, however, the outcomes of these educational strategies remain unclear. A quasi-experimental time series design was used in this study to evaluate the impact of a multi-modal education program (DeTER) on acute care nurses' technical and non-technical skill development and recognition and response to patient deterioration. Participants were asked to complete a survey on four occasions: one month prior to commencement of the DeTER program, immediately prior and post workshop attendance and two-three months' post workshop completion. Pre-intervention, data were collected on participants' demographic profile and their responses to the Clinical Emergency Recognition and Response Survey designed by (Buckley and Gordon, 2011). Post intervention these data were collected again and, in addition, respondents were asked to report on their recent experiences of deteriorating patients and report on their confidence in managing these incidents. Sixty staff consented to participate in the study and all completed the surveys at time 2 and 3. In total 32 staff (45%) responded at all time points. Participants included registered nurses (n = 51; 85%), and enrolled nurses (n = 9; 15%), on average they had worked for 10.4 years (sd = 11.1). Participants rated patient advocacy and assertiveness skills as the most useful aspects of the workshop. Recognition and response to deteriorating patients by ward nurses is a multifaceted process influenced by many factors. Our study supports the importance of multimodal educational strategies in sustaining changes to ward nurses' technical and non-technical skills over time.

Interactive Anatomy-Augmented Virtual Simulation Training

BACKGROUND

Traditionally, clinical psychomotor skills are taught through videos and demonstration by faculty which does not allow for the visualization of internal structures and anatomical landmarks that would enhance the learner skill performance.

METHODS

Sophomore and junior nursing students attending a large Midwestern Institution (N=69) participated in this mixed methods study. Students demonstrated their ability to place a nasogastric tube (NGT) after being randomly assigned to usual training (Control group) or an iPad anatomy-augmented virtual simulation training module (AR group). The ability of the participants to demonstrate competence in placing the NGT was assessed using a 17-item competency checklist. After the demonstration, students completed a survey to elicit information about students' level of training, prior experience with NGT placement, satisfaction with the AR technology, and perceptions of AR as a potential teaching tool for clinical skills training.

RESULTS

The ability to correctly place the NGT through all the checklist items was statistically significant in the AR group compared with the control group (P = 0.011). Eighty-six percent of participants in the AR group rated AR as superior/far superior to other procedural training programs to which they had been exposed, whereas, only 5.9% of participants in the control group rated the control program as superior/far superior (P < 0.001).

CONCLUSIONS/IMPLICATIONS

Overall the AR module was better received compared with the control group with regards to realism, identifying landmarks, visualization of internal organs, ease of use, usefulness, and promoting learning and understanding.

A Health Care-Academic Partnership: Developing Pediatric Nursing Education

An acute care pediatric hospital and a university school of nursing joined forces to develop a comprehensive, interactive, online course in pediatric health assessment. The course was intended to increase nurses' knowledge and confidence in caring for children and families. The need for pediatric health assessment education varies depending on learners' prior experience. This article describes the course development and shares insights into the successful health care-academic partnership, which combined clinical, scholarly, and technological expertise. J Contin Educ Nurs. 2017;48(12):557-562.

Promoting synergistic partnerships in low resource countries: a case study exemplar

OBJECTIVES/AIMS

The purpose of this discussion is to explore the dynamics of partnership and its impact on both nursing faculty at Hue University of Medicine and Pharmacy (HueUMP) and Health Volunteers Overseas (HVO) volunteers.

DESIGN

A case study approach was used to promote understanding of partnerships in global health.

DISCUSSION

Collaboration between HueUMP's nursing program and HVO is one of the most dynamic HVO nurse educator programs with five volunteer visits to Vietnam within a two-year period. Volunteer efforts include workshops to meet the diverse needs and interests of nursng faculty. We also emphasize the potential for ongoing strategic program planning integrating components from other nursing partnerships in the Southeast Asian region.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

If we are to continue meeting partnership goals, we must recognize that partnerships should evolve according to the goals of HueUMP nursing faculty and the context of nursing in Vietnam.

Systematic review of effectiveness of situated e-learning on medical and nursing education

OBJECTIVES

Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education.

METHODS

Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals.

RESULTS

Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians.

CONCLUSIONS

Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.