Factors Influencing Nursing Students' Flow Experience during Simulation-Based Learning

Effect of Infection Control Simulation Based on a Negative Pressure Isolation Room Using Mixed Reality

This study aimed to examine the effectiveness of an infection control simulation using mixed reality, comparing simulation fidelity with a high-fidelity mannequin (MN) group and problem-based learning with written cases group. This study used a three-group pretest-posttest quasi-experimental design. Two universities with similar curricula were conveniently selected, and a total of 72 nursing students were recruited. Participants were randomly assigned to three groups of 24 each. In the final analysis, there were 22 participants in the mixed reality groups, 21 in the mannequin groups, and 23 in the problem-based learning with written cases groups. Data were analyzed using descriptive statistics and the χ 2 , Kruskal-Wallis, and Wilcoxon signed rank tests. The mixed reality groups had a significantly positive effect on clinical reasoning ability and clinical competence than the problem-based learning with written cases groups, whereas the mannequin groups had a significantly positive effect on clinical competence than the problem-based learning with written cases groups. Mixed reality simulation is an appropriate simulation method that enhances learning immersion, satisfaction, and self-confidence in simulation. Additionally, it can substitute for mannequin simulation in terms of clinical reasoning ability and clinical competence. This study suggests that it is important to the various approaches in simulation fidelity to diversely enhance the competency of nursing students in simulation outcomes.

Integrating mixed reality preparation into acute coronary syndrome simulation for nursing students: a single-group pretest-posttest study

BACKGROUND

Timely and effective intervention within the 'golden hour'-the critical first 90 min after the symptom onset-is crucial for initiating life-saving treatment and reducing mortality in acute coronary syndrome (ACS). This highlights the need for nursing students to be proficient in ACS care, emphasizing the importance of preparatory training. This study enhanced traditional simulation methods by integrating a mixed reality (MR) preparation step, offering a more immersive learning experience. We aimed to evaluate the effectiveness of integrating MR preparation into ACS simulation education, focusing on enhancements in knowledge, self-confidence in learning, and self-efficacy in learning. Additionally, we examined performance, practice immersion, and satisfaction to comprehensively evaluate the MR application.

METHODS

One-group pretest-posttest design was implemented in a convenience sample of thirty-nine senior nursing students from a university in South Korea in August 2022. We developed a simulation program integrating MR preparation into ACS simulation (IMRP-ACSS), which was validated through expert review for content validity. The students participated in the simulation program over six hours across two days, including a 40-minute individual session of MR-based simulation preparation using head-mounted displays (the HoloLens 2). Individual changes in knowledge, self-confidence in learning, and self-efficacy in learning evaluated by the survey were analyzed using paired t-tests. Additionally, group performance assessed using the checklist was analyzed. Immersion and satisfaction were measured with a tool and a 10-point Likert scale, respectively.

RESULTS

Individually, participants demonstrated significantly increased knowledge (t = 11.87, p < .001), self-confidence in learning (t = 7.17, p < .001), and self-efficacy in learning (t = 4.70, p < .001) post-education. Group performance yielded a mean score of 56.43/70 ± 7.45. Groups scored higher in electrocardiogram interpretation, patient safety, and heparin administration. Participants reported a practice immersion level of 37.82/50 ± 9.13 and expressed satisfaction with the program, achieving an average score of 8.85/10 ± 1.35.

CONCLUSION

Integrating MR preparation into ACS simulation enhanced nursing students' knowledge, self-confidence in learning, and self-efficacy in ACS care, providing a replicable and immersive learning experience. This method is an effective addition to nursing education, preparing students through comprehensive, technology-enhanced training.

Relationship of high-fidelity simulation experience, clinical reasoning, and clinical competence of new nurses: A cross-sectional study

AIM

This study aimed to determine which high-fidelity simulation (HFS) experiences were associated with clinical reasoning and clinical competence among new nurses.

BACKGROUND

HFS has been actively used in nursing education. It is necessary to verify the effects of HFS transfer to the clinical environment.

DESIGN

A cross-sectional study reported following STROBE criteria.

METHODS

Data were collected on new nurses (n = 224) who experienced HFS in their fourth-year undergraduate courses. The number of HFSs, the inclusion of simulation elements, the importance of elements to learning, clinical reasoning, and clinical competence were measured. Hierarchical regression models examined factors associated with clinical reasoning and clinical competence.

RESULTS

Feedback was the most sufficiently included element of the HFS learning, and participants perceived it as the most important. A significant factor associated with clinical competence was clinical reasoning, and HFS design indirectly affected clinical competence through clinical reasoning.

CONCLUSIONS

HFS learning is one of the best ways to improve clinical reasoning. Improving students' clinical reasoning should be an important goal of HFS learning in undergraduate courses to prepare students to be clinically competent nurses.

IMPLICATIONS FOR NURSING

The ultimate goal of nursing education is to prepare nursing students to be competent nurses. Validating the outcomes of nursing education in the clinical environment setting is an essential task to improve clinical practice.

IMPLICATIONS FOR NURSING POLICY

Nurse educators and leaders can increase nurses' clinical competence by emphasizing education to foster nurses' clinical reasoning in nursing education policies.

The mediating role of flow in the relationship between simulation design and simulation educational satisfaction in korean nursing students: a cross-sectional study

BACKGROUND

In Korea, there has been recent interest in nursing simulation education. In nursing, simulation education has many advantages, such as improving nursing students' problem-solving and judgment skills. Simulation education satisfaction is an indicator for evaluating educational performance from the learners' perspective and an important criterion for the development and progress of nursing education. Therefore, based on NLN/Jeffries simulation theory, this study aims to identify the relationship between simulation design and educational satisfaction and to confirm the mediating effect of flow.

METHODS

This cross-sectional study was conducted using 143 fourth-year nursing students who had participated in classes using simulations at three universities in Seoul, Daegu, and Jeonbuk. Data were collected from April 24 to May 3, 2023. Demographic data, simulation design scale (SDS), flow in simulation, and the educational satisfaction scale in simulation were collected via an online questionnaire. The collected data were analyzed through t-test, ANOVA, Scheffé test, and Pearson's correlation coefficient using SPSS 25.0. The mediating effect of flow was analyzed through the three-stage mediation effect procedure using hierarchical regression analysis and the Sobel test.

RESULTS

The simulation educational satisfaction had a statistically significant positive correlation with simulation design (r = .65, p < .001) and flow (r = .47, p < .001), and simulation design was positively correlated with the flow (r = .55, p < .001). The simulation design had a statistically significant effect on flow, which was the mediating variable (β = 0.55, p < .001). Additionally, simulation design had a statistically significant effect on simulation educational satisfaction (β = 0.56, p < .001). The significance of the mediating effect of flow on the relationship between simulation design and simulation educational satisfaction was investigated using the Sobel test, and the mediating effect of flow was found to be statistically significant (Z = 5.36, p < .001).

CONCLUSION

The significance of the current study lies in its confirmation of the link between simulation design and simulation educational satisfaction, as well as the mediating function of flow. Nursing students can achieve simulation educational satisfaction through simulation-based education if simulation educators follow best practices that improve flow through well-organized simulation design.

Determinants of high school students’ digital reading flow experience: an experimental study

Purpose

This study aims to explore the influence of information presentation conditions on the flow experience of digital reading for high school students.

Design/methodology/approach

Firstly, a survey determines the preferred reading medium and the types of texts that high school students frequently read. Secondly, Experiment 1 focuses on the effects of the text type and reading medium on flow experience and reading comprehension. Finally, Experiment 2 addresses a narrative text presented on a smartphone, and discusses the influence of advance organizer, presentation format and page layout on flow experience and reading comprehension.

Findings

In digital reading, the narrative text has a stronger flow experience than explanatory text; the flow experience of reading narration on smartphones is more evident than on computers. The advance organizer and text combined with pictures are more conducive to a flow experience when a smartphone is used as a reading medium. From the perspective of reading comprehension, scrolling is more suitable for reading text combined with pictures and paging best suits pure text.

Originality/value

Through experimental methods, this study reveals the influence of information presentation conditions on the digital reading flow experience, which is a meaningful and innovative topic. The findings can provide more enlightenment and reference for the design and promotion of digital resources and digital reading by teenagers.

Instructional design and educational satisfaction for virtual environment simulation in undergraduate nursing education: the mediating effect of learning immersion

BACKGROUND

Schools were closed after the onset of COVID-19, with non-face-to-face practices or distance education in nursing education replacing video learning or simulation classes in nursing education clinical practicum. This led to an increase in interest in virtual environment simulation education. While technology-based teaching methods might feel new and intriguing to learners, it is necessary to evaluate learner satisfaction with such an educational method beyond its novelty value. Therefore, this study examined the mediating effect of learning immersion on the relationships between instructional design and educational satisfaction, for virtual environment simulation.

METHODS

A descriptive cross-sectional research design was used. The study sample included students in the third or fourth year of the nursing curriculum in South Korea. The participants were 164 nursing students, who had an experience with virtual environment simulation practices during the past year, prior to September 2021. Data were collected using an online questionnaire. The questionnaire addressed the characteristics of nursing students, instructional design, learning immersion, and educational satisfaction. The collected data were analyzed using path analysis.

RESULTS

The indirect effect of the path between instructional design and educational satisfaction, mediated through learning immersion in virtual environment simulation was found to be significant. Furthermore, the direct path was also statistically significant.

CONCLUSION

Educational content, based on virtual environment simulation, should be implemented based on instructional design. It is necessary to recognize the importance of instructional design that can promote learning immersion in virtual environment simulation, as well as to prepare consistent standards for such design.

Self-Regulated Learning Strategies for Nursing Students: A Pilot Randomized Controlled Trial

Distance learning (DL) based on information and communication technologies is gaining importance due to its convenience and cost savings. However, there is not enough evidence to identify the effect of DL on students requiring a high level of self-regulated learning (SRL). Therefore, this study aims to compare the effects of the use of augmented reality (AR) as an innovative learning method and the use of a textbook as a conventional learning method. Both methods were based on SRL strategies. In this pilot randomized controlled trial (RCT), SRL using an AR group (n = 31) and a textbook group (n = 31) was performed. Perceived learning (PL) competency, knowledge, SRL competency, academic stress, and learning flow were measured to evaluate the effect of intervention. Although, there was not significant interaction between the effects of time and the intervention in PL competency, knowledge, academic stress, and learning flow. In the subdomains of SRL competency, environmental structuring, task strategies, time management, help seeking, and self-evaluation were significantly improved after intervention. SRL using innovative methods is more important after COVID 19. Therefore, well-designed larger RCTs are required to identify the effect of SRL strategy using innovative method.

The Influence of Innovation Climate on Creative Role Identity: The Mediating Role of Flow

Creative role identity is an important antecedent of innovative behaviors. Both the mechanism of how external factors and individual factors affect the formation of creative role identity and details of this process have yet to be discovered. Based on data collected from 226 students in 6 classes at a university in Guangdong during the development of innovative projects, the influence of innovation climate on the students' creative role identity, especially the mediating effect of flow, was investigated. The results show that the innovation climate has a positive impact on creative role identity and that flow plays a partial mediating role in this relationship.

Development and psychometric testing of learning immersion scale in clinical simulation: A methodological study

BACKGROUND

Immersion during clinical simulation has been suggested to be important for learning effects. However, no valid and reliable instruments have been available for measuring the learner's immersion during simulation experience.

OBJECTIVES

To develop a Learning Immersion Scale in Simulation (LISS) and evaluate its psychometric properties.

DESIGN

A methodological study design was employed to develop and validate the instrument.

SETTINGS

Two universities in South Korea.

PARTICIPANTS

A convenience sample of 204 nursing students.

METHODS

A literature review and a focus group interview were conducted to determine the properties of learning immersion during simulation experience. Content validity was assessed by a panel of 10 experts. Nursing students who participated in high-fidelity patient simulation (n = 204) were asked to complete the preliminary LISS, after which Students Satisfaction and Self-Confidence in Learning Scale and Learning Flow Scale for Adults were administered for assessing the convergent and criterion validity. Data were analyzed using exploratory factor analyses, Pearson's correlation, and Cronbach's alpha.

RESULTS

Exploratory factor analyses extracted a four-factor solution, explaining 65.2% of the total variance. The convergent and criterion validity and internal consistency and half reliability were satisfied.

CONCLUSIONS

The LISS is a short multi-dimensional instrument with good psychometric validity and reliability that has potential utility for clinical simulation education and research.

SBL Effectiveness in Teaching Entrepreneurship Skills to Young Immigrant Mothers Head of Household in Colombia: An Experimental Study

This article analyses the perception of the effectiveness of the Simulation-Based Learning method in enhancing entrepreneurship skills and academic performance in 78 young immigrant mothers head of household in Colombia in an entrepreneurship course titled Youth and Entrepreneurship. A Wilcoxon signed rank test, and a Kendall Tau correlation coefficient were used to analyze the perceptions and academic performance from the sample studied during a five-month period. A pre-test, post-test, and achievement of academic objectives questionnaire were applied, as well as a verification test of previous knowledge and a focus group at the end of the entrepreneurship course. It was found that SBL enhance the Planning and Management Skills and the Communication Skill and does not fulfill all the course objectives. This study contributes to the analysis of the effectiveness of unconventional teaching methods in different socioeconomic contexts.

Effects of Manikin Fidelity on Simulation-Based Nursing Education: A Systematic Review and Meta-Analysis

BACKGROUND

Few studies have examined whether higher-fidelity manikins are superior to lower-fidelity manikins in nursing simulation-based education.

METHOD

A database search initially yielded 2,656 studies written in English or Korean. Duplicates and irrelevant studies were excluded. Ancestry searches generated 3 additional studies, and 15 studies met the criteria.

RESULTS

Higher-fidelity manikins were more effective than lower-fidelity manikins in improving skill performance/clinical competence and perception of nursing students and nurses. In terms of learners' knowledge, satisfaction, and self-confidence, both higher- and lower-fidelity manikins were similarly effective for nursing students.

CONCLUSION

This article provides evidence that higher-fidelity manikins do not always ensure a superior educational effect compared with lower-fidelity manikins. [J Nurs Educ. 2022;61(2):67-72.].

Effectiveness of Incorporating Situation-Background-Assessment-Recommendation (SBAR) methods into simulation-based education for nursing students: A quasi-experimental study

BACKGROUND

Situation-Background-Assessment-Recommendation reporting is a structured communication tool. In other studies of simulation-based education, learning was found to increase with increases in the level of flow during scenarios. Also, communication using SBAR was found to facilitate more focus on clinical situations. However, the generalizability of those findings in nursing education and the specific benefits of combining SBAR with simulation remain unclear.

OBJECTIVES

The aims of this study are to incorporate SBAR reporting into simulation-based nurse education, and measure its effects on the students' flow, communication competence, and communication self-efficacy among nursing students, to collect basic data for the development of effective nursing curricula.

DESIGN

This study used a non-equivalent, quasi-experimental pre-post parallel design.

SETTING

The intervention was administered in a simulation center at a nursing school in South Korea.

PARTICIPANTS

One hundred and twenty fourth-year nursing students were recruited through convenience sampling.

METHODS

The participants were quasi-randomly allocated to the control (n = 52) and SBAR (n = 68) groups. The integrated simulation course was conducted twice each week. Learning and reporting SBAR was included as a component of simulation-based education for the intervention group in each session (three scenarios). The dependent variables were communication competence, communication self-efficacy, and flow in the simulation.

RESULTS

SBAR did not affect communication competence or communication self-efficacy in simulation-based education. In contrast, while flow increased in both groups, the increase was greater in the SBAR group.

CONCLUSIONS

SBAR can increase nursing students' flow in simulations. Further studies should focus on how SBAR during simulation-based education affects nursing students' practical competency.

Predictors of academic achievement in distance learning for nursing students

BACKGROUND

Distance learning (DL) is no longer simply an alternative method in the new educational environment induced by COVID-19. The ability of learners to control the learning process is becoming an essential prerequisite for DL because learners are physically separated from their instructors. Therefore, it is necessary to understand the factors influencing DL and investigate the appropriate learning strategy.

OBJECTIVES

This study aimed to identify the relationships between academic achievement and the factors influencing DL.

DESIGN

This study adopted a cross-sectional design.

SETTING

This study was conducted in nursing colleges in Korea.

PARTICIPANTS

Two hundred and one undergraduate nursing students in Korea participated in this study.

METHODS

An online survey of academic achievement, self-regulated learning (SRL), learning flow, engagement, academic stress, and grade point average was conducted using Google Surveys on December 22 and 23, 2020 at four nursing colleges. A hierarchical multiple linear regression model was conducted to identify the predictors of academic achievement. Age and sex were included in the regression model in the first step. Then, learning flow and engagement were included in the second step, and SRL was included in the final step.

RESULTS

Learning flow (β = 0.37, p < .001), engagement (β = 0.23, p = .001), and SRL (β = 0.22 p = .003) explained 49.5% of the variance in academic achievement (Adj R² = 0.50, F = 40.21, p < .001). After controlling for sex, age, flow state, and engagement in learning, SRL explained an additional 2% of the variance in academic achievement (R² change = 0.02, p = .003).

CONCLUSIONS

The development of learning strategies, including SRL ability, learning flow and engagement in DL, contributes not only to students achieving high academic competency but also to educating students about perceptions of their 'future possible self'.

Motivation: bringing up the rear in nursing education. Motivational elements in simulation. The participants' perspective

BACKGROUND

Motivation is a fundamental element of human behavior and learning. We believe that this aspect has not been sufficiently addressed in the field of simulation-based learning in nursing.

PURPOSE

The aim of this study was to explore the views and perspectives of students involved in simulation-based learning related to their process of motivation. Also, to identify the motivational elements they perceived, as well as the aspects that could reduce their motivation in the simulation sessions.

METHODS

A qualitative study was conducted based on content analysis from 7 focus groups composed of simulation students (n = 101).

RESULTS

The study obtained 26 subcategories, 10 categories, and 2 emerging themes (in total, 17 motivational elements and 7 demotivational elements).

CONCLUSION

The motivational elements were related with the non-directive/imposing style of the facilitator, the adequate structure and planning of the sessions, the possibility of transferring what was learned to the real world, and especially the atmosphere created in the simulation session. The main demotivational elements were directed simulation, an uncomfortable environment, and the planning and structure of the sessions (with an excessive theoretical content or with stringent evaluations).

A qualitative study of perioperative nursing students' experiences of interprofessional simulation-based learning

AIM

To explore perioperative nursing students' experiences of interprofessional simulation-based learning to gain a deeper understanding of how this educational tool can be used to support students' learning and enable them to achieve the intended learning outcomes.

BACKGROUND

Despite extensive research, it remains unclear what and how participants learn from interprofessional simulation-based learning. There is a need to specify how interprofessional simulation-based learning should be organised to support and promote learning processes, especially for postgraduate learners. In particular, there seems to be little evidence in the existing literature in the field of educating perioperative nurses, where advanced technical skills and high-quality nursing care are required.

DESIGN

The study's qualitative and explorative design is reported in accordance with the COREQ guideline.

METHOD

Between May-October 2019, thirty-four perioperative nursing students from four educational institutions participated in six focus group interviews, with four to eight students in each. All participants had previous experience of interprofessional simulation-based learning in acute settings. Data were transcribed verbatim and were then subjected to phenomenological hermeneutical analysis involving three steps: naïve reading, structural analysis and comprehensive understanding.

RESULTS

Three themes were identified the following: customised interprofessional simulation-based learning; reality of the experience of interprofessional simulation-based learning; and preparedness for clinical practice.

CONCLUSION

Customised interprofessional simulation-based learning was found to be of value to the participants and reflected their feeling of mental preparedness entering interprofessional simulation-based learning. Furthermore, participants' experience of reality when using the tool was a key theme that also impacted how prepared participants felt for clinical practice.

RELEVANCE TO CLINICAL PRACTICE

The study findings contribute to the further expansion of interprofessional simulation-based learning in perioperative nursing education as a means of developing students' professional competence. This is essential knowledge, as professional practitioners must reflect on practice to further enhance that practice and patient safety.