Virtual Clinical Simulation: The State of the Science

Preparing for the Next Generation NCLEX Using a Virtual Simulation

BACKGROUND

Virtual clinical simulation is a digital innovation that augments clinical reasoning and clinical judgment, narrowing the theory-practice gap, preparing new graduates for the Next Generation NCLEX (National Council Licensure Examination), and mitigating the demand for clinical placement and clinical faculty.

METHOD

The purpose of this article is to describe an educational innovation employing a virtual clinical simulation using the tenets of Tanner's Clinical Judgment Model and a National League for Nursing Advancing Care Excellence for Seniors unfolding case.

RESULTS

A virtual clinical simulation successfully served to replace direct care clinical for 86 undergraduate nursing students enrolled in a foundation nursing course, augmenting the students' ability to transfer and apply theoretical knowledge to clinical practice.

CONCLUSION

This virtual clinical simulation served as a viable platform for teaching clinical reasoning and clinical judgment, mitigating the education-practice gap for new graduate registered nurses. [J Nurs Educ. 2024;63(7):485-489.].

Effects of Immersive Straight Catheterization Virtual Reality Simulation on Skills, Confidence, and Flow State in Nursing Students

Core nursing procedures are essential for nursing students to master because of their high frequency in nursing practice. However, the experience of performing procedures in actual hospital settings decreased during the coronavirus disease 2019 pandemic, necessitating the development of various contents to supplement procedural training. This study investigated the effects of a straight catheterization program utilizing an immersive virtual reality simulation on nursing students' procedural performance, self-confidence, and immersion. The study employed a nonequivalent control group pretest-posttest design with 29 participants in the experimental group and 25 in the control group. The experimental group received training through a computer-based immersive virtual reality program installed in a virtual reality hospital, with three weekly sessions over 3 weeks. The control group underwent straight catheterization using manikin models. The research findings validated that virtual reality-based straight catheterization education significantly improved students' procedural skills, self-confidence, and flow state. Therefore, limited practical training can be effectively supplemented by immersive virtual reality programs.

CyPVICS: A framework to prevent or minimise cybersickness in immersive virtual clinical simulation

Cybersickness is a global issue affecting users of immersive virtual reality. However, there is no agreement on the exact cause of cybersickness. Taking into consideration how it can differ greatly from one person to another, it makes it even more difficult to determine the exact cause or find a solution. Because cybersickness excludes so many prospective users, including healthcare professionals, from using immersive virtual reality as a learning tool, this research sought to find solutions in existing literature and construct a framework that can be used to prevent or minimise cybersickness during immersive virtual clinical simulation (CyPVICS). The Bestfit Framework by Carrol and authors were used to construct the CyPVICS framework. The process started by conducting two separate literature searchers using the BeHEMoTh (for models, theories, and frameworks) and SPIDER (for primary research articles) search techniques. Once the literature searches were completed the models, theories and framework were used to construct a priori framework. The models' theories and frameworks were analysed to determine aspects relevant to causes, reducing, eliminating, and detecting cybersickness. The priori framework was expanded by, first coding the findings of the primary research study into the existing aspects of the priori framework. Once coded the aspects that could not be coded were added in the relevant category, for example causes. After reviewing 1567 abstracts and titles as part of the BeHEMoTh search string,19 full text articles, a total of 15 papers containing models, theories, and frameworks, were used to construct the initial CyPVICS framework. Once the initial CyPVICS was created, a total 904 primary research studies (SPIDER) were evaluated, based on their titles and abstracts, of which 100 were reviewed in full text. In total, 67 articles were accepted and coded to expand the initial CyPVICS framework. This paper presents the CyPVICS framework for use, not only in health professions' education, but also in other disciplines, since the incorporated models, theories, frameworks, and primary research studies were not specific to virtual clinical simulation.

The Evaluation of the Distance Learning Combining Webinars and Virtual Simulations for Senior Nursing Students during the COVID-19 Period

Background

The outbreak of COVID-19 has forced many schools to adopt distance teaching. This study developed a distance learning program that combines webinars and virtual simulations to meet students’ learning needs.

Methods

A descriptive and quasi-experimental design was used. Thirty-five students participated in this distance learning program. Toward the middle and the end of the webinars, computer-based examinations were conducted to assess students’ theoretical knowledge. The Clinical Thinking Ability Scale was administered before and after virtual simulation. Academic Self-efficacy, Student Engagement, and Students’ Satisfaction Scales were administered after completing the learning program.

Results

The students obtained high scores on the theoretical knowledge examinations and virtual simulation scenarios. The virtual simulation led to an improvement in clinical thinking ability. Students displayed high levels of academic self-efficacy and student engagement and expressed high satisfaction with this program. Moreover, there were significant differences between genders in learning behavior self-efficacy, and learning effectiveness.

Conclusion

This distance learning program could meet the learning requirements of senior nursing students, in a flexible manner, in a safe environment during the COVID-19 outbreak.

Virtual clinical simulation in nursing education: a concept analysis

OBJECTIVES

To analyze the concept of virtual clinical simulation in nursing education.

METHODS

The Walker and Avant concept analysis model guided the study process and the data collection followed the integrative literature review method. Databases searched were: CINAHL, PubMed, Education Resources Information Center, and Scopus. Search terms and Boolean operators were: e-simulation OR virtual clinical simulation OR computer-simulation OR computer simulation OR virtual gaming OR virtual reality AND nursing education OR nursing. The sample comprised 45 studies.

RESULTS

Virtual clinical simulation in nursing education was defined as the innovative teaching and learning technological strategy that provides immersive self-regulated training of nursing practice, reproducing real-life experiences and feedback in a virtual environment that is safe, interactive, dynamic and enjoyable.

CONCLUSIONS

Clarification of this concept contributes to the development of a standardized terminology to include in the nursing nomenclature system and its dissemination for the construction of nursing science.

The Effects of Virtual Simulation on Undergraduate Nursing Students' Mental Health Literacy: A Prospective Cohort Study

This prospective cohort study aimed to evaluate the long-term effects of virtual simulation on nursing education by measuring undergraduate nursing students' mental health literacy. Students' beliefs about the helpfulness of specific interventions for managing depression and schizophrenia were compared between the simulation cohort (n = 149) and the non-simulation cohort (n = 150) from a school of nursing in the U.S. Students in the simulation cohort showed significant increase in knowledge and acceptance of available treatment options for managing depression and schizophrenia over a one-year period. The finding supports the use of virtual simulation in undergraduate mental health nursing education with active faculty engagement.

Introducing Augmented Reality Technology to Enhance Learning in Pharmacy Education: A Pilot Study

There is increasing use of augmented reality (AR) technology, which combines the virtual and real world, in the tertiary education sector. AR enables flexibility in student learning, since this technology may be used in the face to face setting and may also be accessed by students at any time outside of this setting. The purpose of this study was to develop an AR tool and investigate its effectiveness for learning about the medication naloxone using AR in a MagicBook; and determine student opinions on its acceptability and usability. Using a sequential explanatory, mixed method design, 25 undergraduate pharmacy students were recruited to participate in the study. Pre- and post-tests were used to measure changes in knowledge and a survey was used to collect information on the usability and acceptability of AR for learning. The findings of the study indicated that AR technology was able to support student learning on the chosen topic, showing 42% improvement in quiz score p < 0.0001, and that students found using AR was stimulating, interactive, engaging and easy to follow. Thus, AR technology could be an effective way to enhance student learning about medicines.

Development of non-technical skills through virtual patients for undergraduate nursing students: An exploratory study

INTRODUCTION

Non-technical skills (NTS) are fundamental requirements for health professional graduates for safe and competent practice. Technology enhanced simulation, including virtual patients (VPs), is suggested to be effective in developing NTS.

PURPOSE

The purpose of this paper is to explore what participants learnt about NTS following interactions with the VPs in the case study.

DESIGN

Case study methodology was used to explore learning by undergraduate nursing students related to NTS following interactions with VPs. First- (n = 40) and third-year (n = 31) undergraduate nursing students from two universities in Victoria, Australia agreed to participate in focus groups and interviews. These were audio-recorded, transcribed and then underwent framework analysis. A priori codes in the framework used NTS categories including communication, situation awareness, teamwork, decision-making skills, leadership, managing stress and coping with fatigue.

FINDINGS

Overall, students in both years and universities reported that interactions with VPs developed knowledge and skills across all categories of NTS to varying degrees. Third-year students suggested that interactions with VPs enabled development of knowledge and skills, as well as practise of selected NTS in the clinical setting.

CONCLUSION

Interactions with VPs across the curriculum may assist undergraduate nursing students in developing knowledge, skill and practice of NTS categories including communication, situation awareness, teamwork, decision-making skills and duty, advocacy and empathy.

EATI Island - A virtual-reality-based elder abuse and neglect educational intervention

Despite high prevalence rates of elder abuse and neglect (EA/N), compliance with mandatory reporting remains low. A lack of practical training on EA/N has been identified as a barrier. This article describes the development, implementation, and evaluation of an innovative virtual-reality-based educational intervention intended to improve EA/N recognition and reporting among nurses and social workers providing in-home services. The educational intervention consisted of two parts, including an introductory course and advanced assessment training in virtual reality. The advanced assessment training was focused on learning to use the QualCare Scale, an instrument used to assess quality of family caregiving. Data was evaluated in terms of user satisfaction, changes in knowledge, and changes in practice. Results indicate that participants were satisfied with the content and format of the training program. Participants made gains in knowledge in identification and had 99% accuracy in their mandatory reporting decisions. Importantly, professionals reported making changes in their daily practice based on knowledge and skills learnt. Evaluation data indicate that this interdisciplinary training program was a satisfactory way to learn that produced changes in knowledge and impacted clinical practice. Few implementation barriers were encountered during this project suggesting it would be replicable.

Cost-Utility Analysis of Virtual and Mannequin-Based Simulation

INTRODUCTION

The purposes of this study were to (1) compare learning outcomes between students who participated in mannequin-based simulation activities and students who participated in virtual simulation activities and (2) describe a cost-utility analysis comparing the two types of simulation activities in terms of costs and multiple measures of effectiveness.

METHODS

Nursing student participants were randomly assigned to one of two experimental groups to complete either a mannequin-based or virtual simulation activity. The simulation scenario was the same for both groups and involved the care of a hospitalized patient experiencing a chronic obstructive pulmonary disease exacerbation. Participants completed presimulation and postsimulation assessments reflecting qualitative and quantitative measures of learning. A random sample of participants from each group completed a postsimulation performance assessment during which they interacted one on one with a standardized patient.

RESULTS

Eighty-four nursing students were enrolled in the study and completed the simulation activities. There were no significant differences in quantitative measures of learning or performance between participants in the mannequin-based and virtual simulation groups. Participants' qualitative responses to postintervention written reflections and questions yielded additional data for describing learning from the two interventions. In the cost-utility analysis, the virtual simulation activity had a more favorable cost-utility ratio of US $1.08 versus the mannequin-based simulation activity's US $3.62.

CONCLUSIONS

Healthcare educators striving to make evidence-based decisions about how to best employ simulation pedagogy may consider these findings about the cost utility of various simulation modalities. However, additional research is needed.

Norwegian nursing students' evaluation of vSim® for Nursing

Background

vSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students’ perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students’ experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing.

Methods

A descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study.

Results

The majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program.

Conclusions

Introducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.

Evaluating a Serious Gaming Electronic Medication Administration Record System Among Nursing Students: Protocol for a Pragmatic Randomized Controlled Trial

Background

Although electronic medication administration record systems have been implemented in settings where nurses work, nursing students commonly lack robust learning opportunities to practice the skills and workflow of digitalized medication administration during their formative education. As a result, nursing students’ performance in administering medication facilitated by technology is often poor. Serious gaming has been recommended as a possible intervention to improve nursing students’ performance with electronic medication administration in nursing education.

Objective

The objectives of this study are to examine whether the use of a gamified electronic medication administration simulator (1) improves nursing students’ attention to medication administration safety within simulated practice, (2) increases student self-efficacy and knowledge of the medication administration process, and (3) improves motivational and cognitive processing attributes related to student learning in a technology-enabled environment.

Methods

This study comprised the development of a gamified electronic medication administration record simulator and its evaluation in 2 phases. Phase 1 consists of a prospective, pragmatic randomized controlled trial with second-year baccalaureate nursing students at a Canadian university. Phase 2 consists of qualitative focus group interviews with a cross-section of nursing student participants.

Results

The gamified medication administration simulator has been developed, and data collection is currently under way.

Conclusions

If the gamified electronic medication administration simulator is found to be effective, it could be used to support other health professional simulated education and scaled more widely in nursing education programs.

Trial Registration

ClinicalTrials.gov NCT03219151; https://clinicaltrials.gov/show/NCT03219151 (Archived by WebCite at http://www.webcitation.org/6yjBROoDt)

Registered Report Identifier

RR1-10.2196/9601

Evaluation of vSim for Nursing in an Adult Health Nursing Course: A Multisite Pilot Study

Virtual simulation technology is the next step in using simulation as an accepted teaching-learning pedagogy in nursing. The purpose of this multisite, quasi-experimental, three-group, posttest-only design was to evaluate the effectiveness and participant satisfaction of vSim for Nursing in an Adult Health Nursing course. Although the quantitative findings (examination scores and postsimulation scores) were not statistically significant, participants overwhelmingly found vSim for Nursing to be a positive experiential learning endeavor. Ninety-one percent of the participants (n = 61) indicated that vSim for Nursing helped them understand adult health concepts and that vSim for Nursing was beneficial to learning. vSim for Nursing warrants further investigation, using other methods to measure effectiveness to ascertain whether knowledge acquisition is indeed improved as indicated by participant data in this study.

Virtually Nursing: Emerging Technologies in Nursing Education

Augmented reality and virtual simulation technologies in nursing education are burgeoning. Preliminary evidence suggests that these innovative pedagogical approaches are effective. The aim of this article is to present 6 newly emerged products and systems that may improve nursing education. Technologies may present opportunities to improve teaching efforts, better engage students, and transform nursing education.

Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: A randomized controlled trial

BACKGROUND

Clinical simulations can provide students with realistic clinical learning environments to increase their knowledge, self-confidence, and decrease their anxiety prior to entering clinical practice settings.

OBJECTIVE

To compare the effectiveness of two maternal newborn clinical simulation scenarios; virtual clinical simulation and face-to-face high fidelity manikin simulation.

DESIGN

Randomized pretest-posttest design.

SETTING

A public research university in Canada.

PARTICIPANTS

Fifty-six third year Bachelor of Science in Nursing students.

METHODS

Participants were randomized to either face-to-face or virtual clinical simulation and then to dyads for completion of two clinical simulations. Measures included: (1) Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale (NASC-CDM) (White, 2011), (2) knowledge pretest and post-test related to preeclampsia and group B strep, and (3) Simulation Completion Questionnaire. Before and after each simulation students completed a knowledge test and the NASC-CDM and the Simulation Completion Questionnaire at study completion.

RESULTS

There were no statistically significant differences in student knowledge and self-confidence between face-to-face and virtual clinical simulations. Anxiety scores were higher for students in the virtual clinical simulation than for those in the face-to-face simulation. Students' self-reported preference was face-to-face citing the similarities to practicing in a 'real' situation and the immediate debrief. Students not liking the virtual clinical simulation most often cited technological issues as their rationale.

CONCLUSIONS

Given the equivalency of knowledge and self-confidence when undergraduate nursing students participate in either maternal newborn clinical scenarios of face-to-face or virtual clinical simulation identified in this trial, it is important to take into the consideration costs and benefits/risks of simulation implementation.

Simulation in the Internet age: the place of web-based simulation in nursing education. An integrative review

OBJECTIVE

The objective of this article was to review the literature on utilisation and place of Web-based simulation within nursing education. Web-based simulation combines electronic multimedia options with a central video or virtual world to produce interactive learning activities mediated by the learner.

DESIGN

An integrative review.

DATA SOURCES

A search was conducted of healthcare databases between 2000 and 2014 and of Internet sources for hosted simulation programs in nursing. Eighteen primary programs were identified for inclusion.

REVIEW METHODS

A strategy for integrative review was adopted in which studies were identified, filtered, classified, analysed and compared.

RESULTS AND DISCUSSION

Of 18 programs, two game-based programs were identified which represented a 'virtual world' in which students could simultaneously or individually immerse themselves in a character role-play. However, most programs (n=10) taught an aspect of procedural patient care using multimedia (e.g. video, audio, graphics, quiz, text, memo). Time-limited sequences, feedback and reflective activities were often incorporated. Other studies (n=8) taught interpersonal communication skills or technical skills for equipment use. Descriptive study outcomes indicated ease of program use, strong satisfaction with learning and appreciation of program accessibility. Additionally, four studies reported significant improvements in knowledge post-intervention.

CONCLUSION

Web-based simulation is highly acceptable to students and appears to provide learning benefits that align with other simulation approaches and it augments face-to-face teaching. Web-based simulation is likely to have a major place in nursing curricula in the next decade, yet further research is necessary to objectively evaluate learner outcomes and to justify its use.

Nursing education focus of nursing informatics research in 2013

The Nursing Informatics Year in Review 2013 revealed an increase in publications associated with nursing education. Specifically, the articles addressed technology in nursing curricula, use of technology to teach nursing education, and use of technology to form collaborative relationships. In this article we present questions such as: how do these programs assist student nurses to transition to nurse providers where technology is infused into their work and workflow and what is the influence of the collaborative relationships with nurse educators, administrators, and informatics specialists increase patient safety and quality.