NLN/Jeffries Simulation Framework State of the Science Project: Simulation Design Characteristics

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis

AIM

To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation.

REVIEW METHODS

This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods.

RESULTS

Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence.

CONCLUSIONS

Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions.

RELEVANCE TO CLINICAL PRACTICE

These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Effectiveness of Simulation-Based Education for Caring Patients with COVID-19

PURPOSE

The role of medical staff gained immense significance in the context of the prolonged coronavirus disease (COVID-19) pandemic. However, few studies had explored the impact of simulation-based education on the ability of nursing students to care for the patients of COVID-19. This study provided nursing students with simulation-based education in caring for the patients of COVID-19 and confirmed its effectiveness.

METHODS

This study used a non-equivalent control group pretest-posttest design. The participants were recruited from the nursing departments of two universities in Korea through convenience sampling. A total of 79 participants were included: 37 in the intervention group and 42 in the control group. The intervention group received four sessions of simulation training based on the National League for Nursing Jeffries simulation theory.

RESULTS

The intervention group showed an improvement compared to the control group in terms of knowledge related to coronavirus, confidence in performing infection control skills, and perception of preparedness for caring for the patients of COVID-19, with a high-level of satisfaction and self-confidence in learning. There was no significant difference between the two groups in terms of anxiety.

CONCLUSION

This simulation is expected to be a significant strategy for alleviating the global burden in terms of staff safety and patient outcomes by improving the competencies of prospective medical staff in responding to pandemics.

The simulation design in health and nursing: A scoping review

AIMS

The aims of this study were to map the components of the simulation design in health and nursing and to propose a classification based on their definitions to support the planning of simulation-based experiences.

DESIGN

Scoping review.

METHOD

Searches were performed in the databases LILACS, Embase, MEDLINE/PubMed, SCOPUS, Web of Science, Google Scholar and ProQuest Thesis and Dissertation were performed, without time limitation, to identify studies about simulation design.

RESULTS

This study mapped 19 components of the simulation design found in 26 studies included, which can contribute to the development of simulation-based experiences, classified into structural, methodological and theoretical-pedagogical components. The simulation design can be described according to its fundamental components: structural-define the basic formulation of a simulation in terms of infrastructure and conceptual framework; methodological-define the participants, roles and the instruction format; and theoretical-pedagogical-define the educational references used to support the simulation strategy.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions

Background

High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators’ guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator’s role during simulated scenarios.

Methods

A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.

Results

One main category, “Alternating between active and passive facilitation,” emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students’ understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator’s presence in the simulation room during the simulated scenarios influenced students’ emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.

Conclusions

The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00233-0.

Nursing Students’ Satisfaction and Self-Confidence Levels After Their Simulation Experience

Background

Nursing students should be well prepared before going to clinical setting as they provide direct care to patient. Simulation gives the learners the opportunity to be active learners who practice, train, and give a reflection on a specific experience.

Objective

To obtain an understanding of the human patient simulation experience and nursing students’ perceptions of satisfaction and self-confidence.

Method

Cross-sectional, descriptive design was undertaken. Using purposive sampling, 273 nursing students were enrolled in basic adult nursing courses at levels four and five at female nursing college at King Saud University, Riyadh, Saudi Arabia. A questionnaire was used to measure the demographic characteristics, simulation design characteristics, and simulation educational practice context. Student Satisfaction and Self-confidence in Learning Scale was used to measure students’ satisfaction and self-confidence. Bivariate analyses were utilized where needed and multiple linear regression analysis was performed to find the relationship between variables.

Results

The current study revealed overall, nursing students were satisfied and self-confident after their human patient simulation experience. A relationship was observed between demographic characteristics, simulation design characteristics, and simulation educational practice context with students’ satisfaction and self-confidence.

Conclusion

Simulation is an effective teaching strategy that prepares nursing students for real clinical practice. Findings provided policymakers with information on nursing students’ current levels of satisfaction and self-confidence that can lead to developing future policies.

The effectiveness of palliative care simulation in newly hired oncology nurses’ training

Objective

The aim of the study was to evaluate the effectiveness of palliative care simulations with standardized patients in improving the knowledge, skill performance, and critical thinking of newly hired oncology nurses.

Methods

By convenience sampling, 59 newly hired oncology nurses in 2019 were enrolled as control group and 50 in 2020 as simulation group at a grade-A tertiary cancer hospital. Simulation group accepted theory (3 sessions) and simulation teaching includes three representative scenarios (6 sessions) in palliative care: pain management, special scenario communication, and turn over. Control group accepted traditional theory and skill teaching (9 sessions). Then both groups underwent four weeks clinical practice. The knowledge score was assessed by knowledge questionnaires, skill performance by standardized clinical evaluations, and critical thinking by the California Critical Thinking Disposition Inventory in both groups before and after intervention. The satisfaction of two groups was assessed by the learning satisfaction scale. Analysis of variance was conducted among the two groups by SPSS20.0. A difference was considered significant when P ​< ​0.05.

Results

After intervention, the simulation group was significantly greater in knowledge of pain management (t ​= ​−7.560, P ​< ​0.001), and knowledge of special scenario communication (Z ​= ​5.031, P ​< ​0.001), as well as the skill score of turnover (Z ​= ​2.808, P ​= ​0.005) than the control group. The critical-thinking score was also significantly greater in the simulation group (Z ​= ​6.229, P ​< ​0.001). The simulation group had higher satisfaction (Z ​= ​5.144，P ​< ​0.001).

Conclusions

Palliative care simulation with standardized patients can improve newly hired oncology nurses’ knowledge, skill performance, and critical thinking and satisfaction of teaching. It would be an effective strategy to train newly hired oncology nurses.

Effect of simulation on cognitive load in health care professionals and students: protocol for a systematic review and meta-analysis

OBJECTIVE

The objective of this review is to assess the effect of simulation activities and their design features on cognitive load in health care professionals and students.

INTRODUCTION

Simulation activities are now widely implemented in health care professionals' education. However, the mechanisms by which simulations and their design features lead to health care professionals' and students' learning remains unclear. Still, because of their high interactivity and complexity, simulation activities have the potential to impact the cognitive load of learners. Synthesizing evidence regarding this phenomenon could help simulation educators identify the design features that affect learners' cognitive load, and explain why some simulation activities are more effective than others.

INCLUSION CRITERIA

This review will consider experimental and quasi-experimental studies in which the effect of a simulation activity on cognitive load in health care professionals or students from any discipline or level of practice is evaluated. All academic and health settings will be included.

METHODS

Following the guidelines of the JBI methods for systematic reviews of effectiveness, CINAHL, Embase, ERIC, MEDLINE, PsycINFO, and Web of Science will be searched for studies published in English or French, without a date limit. Retrieved studies will be independently screened for inclusion, then critically appraised for methodological quality by two reviewers using standardized JBI tools. Data extraction will be done independently using adapted tools from JBI. Where possible, data will be pooled using meta-analytical methods.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020187723.

Implementing Cardiac Surgical Unit-Advanced Life Support Through Simulation-Based Learning: A Quality Improvement Project

BACKGROUND

The European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons endorse Cardiac Surgical Unit-Advanced Life Support, a protocol designed specifically for cardiothoracic surgical patients who suffer postoperative cardiac arrests. To enhance patient outcomes and to reduce death rates, cardiothoracic intensive care unit nurses must be able to perform the protocol with confidence, proficiency, and without delays. To this end, simulation-based learning (SBL) is a pedagogical method ideal for optimized learning.

OBJECTIVES

This quality improvement project was designed to implement a post-cardiac surgery resuscitation protocol in a nonacademic, community medical center to enhance nurse knowledge, confidence, and proficiency for optimal patient outcomes.

METHODS

The Cardiac Surgical Unit-Advanced Life Support is an evidence-based resuscitation protocol that was implemented using didactic, hands-on training, and SBL. It was evaluated using knowledge surveys, comparisons in nurse confidence and performance measures, and patient outcomes data.

RESULTS

Nurses' knowledge gains (ie, mean test scores) on our test were statistically significant between 3 time points (F2,60 = 81.204, P < .001). Knowledge significantly increased from pre-education to immediate post-education (P < .001), but declined from immediate post-education to 3-month post-education assessments (P < .001); however, the 3-month post knowledge mean was still higher than the pre-education knowledge mean (P < .001). Nurses were confident in their ability to apply the protocol, although results failed to show a correlation between confidence and performance ability. Statistical significance for delay in cardiopulmonary resuscitation was found between pre- and post-nursing education patient cardiac arrest events (P = .05).

CONCLUSIONS

Didactic and hands-on learning supported knowledge retention over time for cardiothoracic surgical intensive care unit nurses. Improving self-confidence and the application of an unfamiliar resuscitation protocol through SBL and any impact a training program has on patient outcomes will require ongoing practice and more evaluation.

Contribuições da simulação clínica versus prática convencional em laboratório de enfermagem na primeira experiência clínica

Resumo Objetivo Comparar a percepção de estudantes de enfermagem e as contribuições do ensino com simulação clínica ou aula prática convencional em laboratório de habilidades, na primeira experiência clínica hospitalar. Método Pesquisa descritiva, qualitativa, envolvendo estudantes de graduação em enfermagem de uma universidade pública do Brasil, submetidos à simulação clínica de alta fidelidade ou aula prática convencional, ocorrida entre 2015 e 2016. Para avaliação dos dados, utilizaram-se a nuvem de palavras e a análise de similitude do software IRAMUTEQ®. Resultados Participaram 54 estudantes, sendo 27 em cada grupo. As palavras mais evocadas pelo grupo simulação foram: “paciente real, não, mais e simulador”, relacionadas à capacidade de reflexão quanto ao seu conhecimento e preparo. As mais evocadas no grupo prática convencional foram: “mais, não, muito e sentir”, relacionadas com a percepção de que a aula convencional ajuda na aquisição de habilidades, contudo, é necessária maior frequência. Conclusão As duas estratégias contribuíram positivamente para a primeira experiência clínica hospitalar. Porém, a simulação proporcionou uma visão crítico-reflexiva sobre as competências, deficiências e maior autoconfiança em relação à prática convencional. Este estudo fortalece as evidências dos benefícios proporcionados pelo ensino baseado em simulação, e a importância de instituições de ensino fazerem uso adequado dessa estratégia.

The art of balancing: the facilitator's role in briefing in simulation-based learning from the perspective of nursing students - a qualitative study

Background

Facilitators plays a key role in nursing student’s learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator’s role in preparing students from the students’ perspective. The aim of this study was to explore undergraduate nursing students’ perspectives of the facilitator’s role in briefing.

Methods

An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation.

Results

Two main categories were identified: “The importance of framing the subsequent scenario” and “The importance of instructing students how to execute nursing actions in the subsequent scenario”. The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin.

Conclusion

A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students’ understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator’s role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students’ learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students’ needs and the time available for briefing.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.

Reliability and validity study of the Spanish adaptation of the "Educational Practices Questionnaire" (EPQ)

The Educational Practices Questionnaire is an instrument for assessing students perceptions of best educational practices in simulation. As for other countries, in Spain, it is necessary to have validated rubrics to measure the effects of simulation. The objective of this study was to carry out a translation and cultural adaptation of the Educational Practices Questionnaire into Spanish and analyze its reliability and validity. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 626 nursing students. Psychometric properties were analyzed in terms of reliability and construct validity by confirmatory and exploratory factor analysis. The exploratory and confirmatory factor analyses showed that the one-dimensional model is acceptable for both scales (presence and importance). The results show that the participants' scores can be calculated and interpreted for the general factor and also for the four subscales. Cronbach's alpha and the Omega Index were also suitable for all the scales and for each of the dimensions. The Educational Practices Questionnaire is a simple and easy-to-administer tool to measure how nursing degree students perceive the presence and importance of best educational practices.

From theory to practice, operating the clinical simulation in Nursing teaching

OBJECTIVE

To report the experience of the operationalization of clinical simulation as a pedagogical strategy in a subject of an undergraduate course in Nursing.

METHOD

Clinical simulation cycles were carried out following the steps of action research, such as: planning, action, observation and reflection, from March 2014 to July 2015 with 10 professors and 44 students from a Primary Care and Mental Health subject of an undergraduate course in Nursing.

RESULTS

Five cycles of clinical simulation were performed, at the end of each cycle modifications were suggested by students and professors and the operation was adjusted to meet the needs of the subject. The main points of change were: professor role, logistics, equipment, debriefing model and preparation of "simulated patients".

FINAL CONSIDERATIONS

The clinical simulation is a possible method to be operationalized in undergraduate course in Nursing, needs pedagogical and logistic planning as well as, sensitization of professors and students.

Self-Reflection of Video-Recorded High-Fidelity Simulations and Development of Clinical Judgment

BACKGROUND

Nurse educators are increasingly using high-fidelity simulators to improve prelicensure nursing students' ability to develop clinical judgment. Traditionally, oral debriefing sessions have immediately followed the simulation scenarios as a method for students to connect theory to practice and therefore develop clinical judgment. Recently, video recording of the simulation scenarios is being incorporated.

METHOD

This qualitative, interpretive description study was conducted to identify whether self-reflection on video-recorded high-fidelity simulation (HFS) scenarios helped prelicensure nursing students to develop clinical judgment. Tanner's clinical judgment model was the framework for this study.

RESULTS

Four themes emerged from this study: Confidence, Communication, Decision Making, and Change in Clinical Practice.

CONCLUSION

This study indicated that self-reflection of video-recorded HFS scenarios is beneficial for prelicensure nursing students to develop clinical judgment. [J Nurs Educ. 2016;55(9):522-527.].

The Relationship Between Levels of Fidelity in Simulation, Traditional Clinical Experiences and Objectives

The purpose of this study was to explore the relationship of baccalaureate nursing students' (BSN) perceived learning effectiveness using the Clinical Learning Environments Comparison Survey of different levels of fidelity simulation and traditional clinical experiences. A convenience sample of 103 first semester BSN enrolled in a fundamental/assessment clinical course and 155 fifth semester BSN enrolled in a leadership clinical course participated in this study. A descriptive correlational design was used for this cross-sectional study to evaluate students' perceptions after a simulation experience and the completion of the traditional clinical experiences. The subscales measured were communication, nursing leadership, and teaching-learning dyad. No statistical differences were noted based on the learning objectives. The communication subscale showed a tendency toward preference for traditional clinical experiences in meeting students perceived learning for communication. For student perceived learning effectiveness, faculty should determine the appropriate level of fidelity in simulation based on the learning objectives.

Using a Standardized Patient to Improve Collaboration and Problem Solving Skills With CPAP Usage in the Home

A review of literature revealed a lack of research pertaining to nurses' or student nurses' knowledge of continuous positive airway pressure (CPAP) and the ability to troubleshoot CPAP malfunction. This study sought to answer the following questions: What are associate degree nursing (ADN) students' knowledge, interdisciplinary communication, and problem-solving skills regarding patients' home use of CPAP? Is there a change after participation in a simulation with a patient on CPAP in home setting? Twenty-one ADN students enrolled in small Midwest college participated. A preexperimental design of one group pretest posttest was used. Each student completed a demographic questionnaire, Mayo High Performance Teamwork Scale, Interprofessional collaborative simulation experience survey, and a CPAP knowledge base survey before and upon completion of the simulation. There were no changes in students' comfort, baseline knowledge, and basic understanding regarding CPAP. However, after the simulation, students described more detailed problem-solving skills, which included using respiratory therapists, durable medical equipment providers, and community resources. On the Mayo High Performance Teamwork Scale, all 16 items demonstrated improved scores (baseline mean = 21.65 and postsimulation mean = 25.6).

Structured debriefing: What difference does it make?

Debriefing in simulation is a cornerstone of learning. However, in-depth studies examining simulation debriefing are scarce. This study explored four key debriefing attributes-feedback, reflection, knowledge development, and psychological safety-prior and subsequent to the implementation of a new pedagogical intervention in a pre-clinical scenario simulation course. The scenarios focused on patients with deteriorating conditions and took place at bachelor's nursing degree level. The new intervention for the debriefing sessions contained a detailed observation tool describing specific, correct nursing actions for deteriorating patients; video playback watched only by students acting as nurses, and debriefing organized into two sections. The study design was explorative. To generate data, 12 debriefing sessions were audio and video recorded in 2013 and 11 in 2014. Two student groups participated each year, comprising 16 and 10 students, respectively. Qualitative analysis was performed to examine the transcribed audio and video recordings. Relative to the 2013 cohort, the reflections of observers and the students acting as nurses were more assertive, and students' feedback was more specific and comprehensive in the 2014 cohort. Conducting in-depth studies examining debriefing is important to increase knowledge regarding the impact of pedagogical underpinnings on debriefing content and processes.

The reliability and validity of three questionnaires: The Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and Educational Practices Questionnaire

PURPOSE

The purpose of this study was to adapt the "Student Satisfaction and Self-Confidence in Learning Scale" (SCLS), "Simulation Design Scale" (SDS), and "Educational Practices Questionnaire" (EPQ) developed by Jeffries and Rizzolo into Turkish and establish the reliability and the validity of these translated scales.

METHODS

A sample of 87 nursing students participated in this study. These scales were cross-culturally adapted through a process including translation, comparison with original version, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Perceived Learning Scale, Patient Intervention Self-confidence/Competency Scale, and Educational Belief Scale.

FINDINGS

Cronbach's alpha values were found as 0.77-0.85 for SCLS, 0.73-0.86 for SDS, and 0.61-0.86 for EPQ.

CONCLUSIONS

The results of this study show that the Turkish versions of all scales are validated and reliable measurement tools.

Beginning and advanced students' perceptions of the use of low- and high-fidelity mannequins in nursing simulation

BACKGROUND

There is little research evidence that demonstrates the difference between the use of low- and high-fidelity mannequins in assisting students to acquire their skills when students are at different points in their nursing education experience.

OBJECTIVES

Our study examined differences between the use of low- and high-fidelity mannequins on student outcomes with both beginner and advanced students.

DESIGN

A quasi-experimental investigation.

SETTINGS

Participants performed two simulations, one simulation using a low-fidelity mannequin and the other simulation using a high-fidelity mannequin.

PARTICIPANTS

First and fourth semester pre-licensure students from a Bachelor of Science in Nursing program and an accelerated nursing entry program participated in this study.

METHODS

A Students' Satisfaction and Self-confidence Scale and Simulation Design Scale were used to obtain data. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 17.0. The results obtained from scales were compared using Wilcoxon sign test and Mann-Whitney U test. A p value of <0.05 was considered statistically significant.

RESULTS

The student satisfaction score of the students in the low-fidelity mannequin group was 3.62±1.01, while that of the students in the high-fidelity mannequin group was 4.67±0.44'dir (p=0.01). The total score of the simulation design scale in the low-fidelity mannequin group was 4.15±0.63, while it was 4.73±0.33 in the high-fidelity mannequin group (p=0.01).

CONCLUSIONS

Students' perceptions of simulation experiences using high-fidelity mannequins were found to be higher in contrast to their perceptions of experiences using low-fidelity mannequins.

The effect of simulation courseware on critical thinking in undergraduate nursing students: multi-site pre-post study

BACKGROUND

The use of simulations has been considered as opportunities for students to enhance their critical thinking (CT), but previous studies were limited because they did not provide in-depth information on the working dynamics of simulation or on the effects of the number of simulation exposures on CT.

OBJECTIVES

This study examined the effect of an integrated pediatric nursing simulation used in a nursing practicum on students' CT abilities and identified the effects of differing numbers of simulation exposures on CT in a multi-site environment.

DESIGN

The study used a multi-site, pre-test, post-test design.

PARTICIPANTS AND SETTINGS

A total of 237 nursing students at three universities enrolled in a pediatric practicum participated in this study from February to December 2013.

METHODS

All three schools used the same simulation courseware, including the same simulation scenarios, evaluation tools, and simulation equipment. The courseware incorporated high-fidelity simulators and standardized patients. Students at school A completed one simulation session, whereas students at schools B and C completed two and three simulation sessions, respectively. Yoon's Critical Thinking Disposition tool (2008) was used to measure students' CT abilities.

RESULTS

The gains in students' CT scores varied according to their numbers of exposures to the simulation courseware. With a single exposure, there were no statistically significant gains in CT, whereas three exposures to the courseware produced significant gains in CT. In seven subcategories of critical thinking, three exposures to the simulation courseware produced CT gains in the prudence and intellectual eagerness subcategories, and the overall simulation experience produced CT gains in the prudence, systematicity, healthy skepticism, and intellectual eagerness subcategories.

CONCLUSIONS

Simulation courseware may produce positive learning outcomes for prudence in nursing education. In addition, the findings from the multi-site comparative study may contribute to greater understanding of how patient simulation experiences impact students' CT abilities.

Survey of Australian schools of nursing use of human patient (mannequin) simulation

Rapid adoption of high-fidelity human patient (mannequin) simulation has occurred in Australian Schools of Nursing in recent years, as it has internationally. This paper reports findings from a 2012 online survey of Australian Schools of Nursing and builds on findings of earlier studies. The survey design allowed direct comparison with a previous study from the USA but limited its scope to the pre-registration (pre-service Bachelor of Nursing) curriculum. It also included extra mental health specific questions. Australian patterns of adoption and application of high-fidelity human patient (mannequin) simulation in the pre-registration nursing curriculum share features with experiences reported in previous US and Australian surveys. A finding of interest in this survey was a small number of Schools of Nursing that reported no current use of high-fidelity human patient (mannequin) simulation and no plans to adopt it, in spite of a governmental capital funding support programme. In-line with prior surveys, mental health applications were meagre. There is an absence of clearly articulated learning theory underpinnings in the use of high-fidelity human patient (mannequin) simulation generally. It appears the first stage of implementation of high-fidelity human patient (mannequin) simulation into the pre-registration nursing curriculum has occurred and the adoption of this pedagogy is entering a new phase.