The Use of Hospital-Based Simulation in Nursing Education—A Systematic Review

Improving performance and self‐efficacy of novice nurses using hybrid simulation‐based mastery learning

AIM

Acute chest pain is a commonly encountered symptom in hospital medical/surgical units; however, almost half of nurses in their second year of clinical experience in our facility have reported struggling to care for acute chest pain patients. We developed, implemented, and examined the effectiveness of a simulation-based, mastery learning clinical nursing educational program to improve self-efficacy and performance in caring for patients with acute chest pain.

METHODS

The study adopted a single-site, single-cohort design using simulation-based performance assessment and self-efficacy surveys on a convenience sample of 37 second-year clinical nurse participants in multi-stage hybrid mastery learning educational intervention using asynchronous e-learning, and hands-on simulation training and assessment with feedback on caring for chest pain patients. Performance assessments and self-efficacy surveys were administered pre-, post-, and 5 months post-intervention.

RESULTS

Clinical performance on the post- and 5 months follow-up assessments were significantly higher than those for the pre-test (P < .0001). The self-efficacy scores for the post- and the 5 months follow-up assessments were significantly higher than the pre-course scores (P < .0001). Participants' self-efficacy perceptions were positively correlated with their performances at 5 months post-intervention.

CONCLUSION

Performance and self-efficacy of novice nurses in caring for acute chest pain patients improved significantly with the multi-stage hybrid mastery learning educational intervention, with improvements retained 5 months post-intervention. The results suggest the applicability of simulation-based mastery learning in a clinical setting for novice nurses to attain specific skills, and raise their self-perception of competence to care for patients in acute settings.

Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study

OBJECTIVE

To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies.

DESIGN

A prospective quasiexperimental design with a control group.

PARTICIPANTS

A total of 120 nurses were recruited and randomly divided into the control group and the intervention group.

INTERVENTION

Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire.

RESULTS

After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05).

CONCLUSION

The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.

Psychometric Evaluation of the Creighton Competency Evaluation Instrument in a Population of Working Nurses

BACKGROUND AND PURPOSE

This study explored the psychometric properties of the Creighton Competency Evaluation Instrument (C-CEI), previously validated for use with nursing students, to assess simulation performance among registered nurses working 12-hour shifts. Valid and reliable measurements are needed to test clinical and simulation competencies and characterize the effects of fatigue on nursing performance.

METHODS

Trained raters scored nurses' patient care performance in simulation scenarios using the C-CEI. We analyzed the instrument's principal components, internal reliability, and construct validity.

RESULTS

Internal reliability of the C-CEI aggregate score and the Clinical Decision-making component were high (>.70). The latter robustly correlated with predicted cognitive effectiveness, a measure of fatigue.

CONCLUSIONS

The C-CEI is a reliable measure for use among registered nurses and its further development will be important for testing performance of working nurses and fatigue-mitigation innovations.

The Effect of Simulation-Enhanced Orientation on Graduate Nurses: An Integrative Review

The purpose of this review is to examine the state of science of simulation-enhanced orientation and its effect on graduate nurses (GNs).

BACKGROUND

GNs are essential to the alleviation of staffing deficits, mitigation of patient safety events, and provision of clinically adept care. Successful transition from academia to clinical practice is often influenced by factors that compromise retention, increase attrition, and impair professional development.

METHOD

The method used was an integrative literature review.

RESULTS

There is a paucity of research in the literature regarding the effect of simulation-enhanced orientation on clinical competency, confidence outcomes, and other benchmarks of professional development that may influence retention or attrition.

CONCLUSION

This integrative review confirmed the paucity of research of qualitative and quantitative outcomes of simulation-enhanced orientation on GNs. Stakeholders of organizational and educational institutions may find this review valuable, as it highlights the necessity for additional research. [J Contin Educ Nurs. 2021;52(3):150-156.].

British and Finnish nurses' attitudes, practice, and knowledge on deteriorating patient in-service education: A study in two acute hospitals

AIM

The aim was to assess both nurses' attitudes about in-service education, and the impact had by attending in-service education on nurses' management and knowledge of deteriorating patients.

BACKGROUND

In-service education cannot reach its best potential outcomes without strong leadership. Nurse managers are in a position of adopting leadership styles and creating conditions for enhancing the in-service education outcomes.

DESIGN

We conducted a comparative cross-sectional study between British and Finnish nurses (N = 180; United Kingdom: n = 86; Finland: n = 94).

METHODS

A modified "Rapid Response Team Survey" was used in data collection. A sample of medical and surgical registered nurses were recruited from acute care hospitals. Self-reporting, self-reflection, and case-scenarios were used to assess nurses' attitudes, practice, and knowledge. Data were analyzed by Mann-Whitney-U and Chi-square tests.

RESULTS

Nurses' views on education programs were positive; however, low confidence, delays caused by hospital culture, and fear of criticism remained barriers to post education management of deteriorating patients. Nurses' self-reflection on their management of deteriorating patients indicates that 20-25% of deteriorating patients are missed.

CONCLUSION

Nurse managers should promote a no-blame culture, mitigate unnecessary hospital culture and routines, and facilitate in-service education focusing on identification and management of deteriorating patients, simultaneously improving nurses' confidence.

Shaping clinical imagination as new graduate nurses in maternal-child simulation

BACKGROUND

Combined with traditional placement, simulation has been used as an experiential learning opportunity to integrate theory and practice in maternal-child nursing.

METHOD

van Manen's phenomenology of practice uncovered the lived experience of new graduate nurses adopting maternal-child simulation in their practice. Narrative methods included a three-phased approach to phenomenological interviews to capture the new graduate's entry into practice.

RESULTS

Thematic analysis revealed four main themes: acting like a nurse, forming a clinical imagination, embodying the role of the novice nurse, and embracing in-situ simulation.

DISCUSSION

The essence of being a nurse required immersion into the ethics of caring and creation of an optimal simulation debriefing using a skilled and thoughtful approach to trigger imaginative thinking. While an inventory of simulation in nursing education was deemed necessary to understand the current blend of traditional placement and simulation in practice education, the new graduate nurses in the study looked for specialty training, and exposure to advanced roles in the simulation experiences.

CONCLUSION

An integrated traditional placement with the use of simulation fostered clinical imagination where the new graduate nurse visualized and embodied the role of the novice nurse. Future research is required to describe the impact of simulation on practice readiness.

Umbrella review: Impact of registered nurses' continuing professional education informed by contemporary reviews of literature

This paper aims to explore and classify studies of the impact and effectiveness of continuing professional education for registered nurses, using existing reviews of literature. Four healthcare databases were searched for publications from 2010 to July 2019 and electronic keywords searches were conducted. Umbrella review methodology was applied and Kirkpatrick's Four-Level Model of training evaluation was used to synthesise results and explicate the levels of educational impact. Of 16 included reviews, 13 were of simulation-based education activities. Three reviews of experimental studies demonstrated strong positive evidence of education impact on nurses' learning. Objective evidence of transfer of knowledge and skills into practice included improved interprofessional team performance and less time taken to complete clinical tasks. Reports of practice improvements and intention to change practice provided further evidence of impact. A small number of individual studies measured impact on service delivery, reporting positive and neutral results. We conclude that nurses learn and newly acquired knowledge and skills are often transferred into practice. Collection of robust evaluative data after completion of education is limited by practical considerations such as access to learners, resources and time constraints. Further studies of translational impact are needed, specifically, of the impact on patient care.

Reliability and validity of the simulation learning effectiveness inventory

BACKGROUND

Instruments developed to measure simulation learning outcomes need evidence of their reliability and validity for rigorous research. The purpose of this paper is to report psychometric properties of the English version of the Simulation Learning Effectiveness Inventory.

METHODS

Psychometric properties of the English version of the Simulation Learning Effectiveness Inventory, which included internal consistency reliability and construct validity with factor analysis, were examined in a sample of 132 undergraduate nursing students.

RESULTS

Cronbach's alpha coefficients were >0.70 for all subscales. There was evidence of convergent, discriminant, and known-group validity. The factor analysis resulted in some items being associated with different subscales than in the original Chinese version.

CONCLUSIONS

The English version of the Simulation Learning Effectiveness Inventory has evidence of reliability and validity. Additional psychometric studies may result in changes in some of the subscales.

Simulation Use in Acute Care Hospitals in the United States

Three national nursing associations formed a collaborative partnership to research simulation use in acute care hospitals in the United States and military hospitals abroad. An electronic survey was used to determine simulation modalities used, participants engaged, space allocation, purposes of use, commonly taught skills, logistics, and barriers to use. Data from 521 respondents revealed widespread use of a variety of simulation modalities. However, use of this educational strategy could be expanded to patients and families.

Implementation of an in-hospital stroke simulation protocol

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting.

The effectiveness of virtual simulation in improving student nurses' knowledge and performance during patient deterioration: A pre and post test design

BACKGROUND

Preparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration.

OBJECTIVE

To investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration.

DESIGN

A pre- and post-test design was used.

SETTING

Nursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST²ACTWeb™, using their own computer devices.

PARTICIPANTS

A total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study.

METHODS

The simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database.

RESULTS

Findings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, p<0.001). Highest mean performance scores were obtained in the last scenario (M=19.7, median: 20.0, s.d. 3.41) indicating a learning effect. Knowledge was not a predictor of students' performance in the scenarios.

CONCLUSIONS

This study supports virtual simulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of undergraduate nurse education, to prepare students to manage complex situations as practicing nurses.

Using High-Fidelity Simulation and Video-Assisted Debriefing to Enhance Obstetrical Hemorrhage Mock Code Training

The purpose of this descriptive, one-group posttest study was to explore the nursing staff's perception of the benefits of using high-fidelity simulation during mandated obstetrical hemorrhage mock code training. In addition, the use of video-assisted debriefing was used to enhance the nursing staff's evaluation of their communication and teamwork processes during a simulated obstetrical crisis. The convenience sample of 84 members of the nursing staff consented to completing data collection forms and being videotaped during the simulation. Quantitative results for the postsimulation survey showed that 93% of participants agreed or totally agreed that the use of SimMan made the simulation more realistic and enhanced learning and that debriefing and the use of videotaped playback improved their evaluation of team communication. Participants derived greatest benefit from reviewing their performance on videotape and discussing it during postsimulation debriefing. Simulation with video-assisted debriefing offers hospital educators the ability to evaluate team processes and offer support to improve teamwork with the ultimate goal of improving patient outcomes during obstetrical hemorrhage.