Simulation Exposure Improves Clinical Skills for Postgraduate Critical Care Nurses

Exploring intensive care nurses' perception of simulation-based learning: A systematic review and meta-synthesis

AIM(S)

To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL).

DESIGN

A systematic review and meta-synthesis.

METHODS

The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool.

RESULTS

Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration.

CONCLUSION

The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education.

IMPLICATIONS FOR PRACTICE

These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting.

NO PATIENT OR PUBLIC CONTRIBUTION

This review involved analysis of existing literature and as such no unique patient or public involvement occurred.

REPORTING METHOD

The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students

BACKGROUND

The concept of collaborative practice within health professions is viewed as "best practice." Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities.

OBJECTIVES

This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve.

METHODS

Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results.

RESULTS

Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students.

CONCLUSIONS

This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.

State of the evidence on simulation-based electronic health records training: A scoping review

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O'Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.

Improving Quality in Neonatal Care Through Competency-Based Simulation

Approximately 440,000 patients die each year due to preventable errors. Although human error is inevitable, we can mitigate this risk by enhancing skills and clinical competencies by improving the quality of neonatal care through competency-based simulation. Clinical skills are learned activities necessary to function within an environment. Skills gained during pre-licensure nursing education, on-site clinical training, and experience as a clinical care provider, collectively demonstrate a clinician's overall competence to function within a clinical setting. Simulation is a method of supporting nurses to establish, maintain, and remediate competency-based skills for safe and effective healthcare. Evidence suggests that simulation improve clinical skills and maintain patient safety. With this knowledge, many professional organizations have adopted and set standards for the use of simulation, as an educational methodology, to improve clinician skills and competence providing only the highest quality care to neonates within the Neonatal Intensive Care Unit.

Implications of the COVID-19 pandemic: Virtual nursing education for delirium care

Background

Technology is increasingly used in nursing education, particularly during the SARS-CoV-2 (COVID-19) pandemic. COVID-19 also brought new challenges to patient care and limited access to in-person clinical experiences for nursing students. Pivoting to virtual simulation (VS) for clinical was necessary during the height of the pandemic. With students' return to clinical settings, VS experiences continue to be needed, due to quarantine of clinical settings and/or shortage of available clinical sites. VS clinical experiences have been successfully utilized over the past decade; however, the literature lacks resources on the use of VS for delirium care of patients.

Method

In this article, the authors describe the creation and provision of a VS clinical day using interactive computer-based technology to educate nursing students to prevent, recognize, and manage delirium. The VS clinical was in conjunction with a Behavioral Health course.

Results

Evaluation of students demonstrated attainment of objectives. Students reported satisfaction with the VS experience.

Conclusion

Technology in nursing education and use of VS clinical provide effective strategies for clinical learning when in-person clinical experiences are unavailable, either due to access limitations or lack of patients with specific health needs.

Graduate Student Outcomes Following Critical Care Simulation: An Italian Pilot Study

ABSTRACT

High-fidelity simulation provides nursing students with the opportunity to learn and achieve competence in a safe context. The aim of the study was to assess learning outcomes following multiple exposures to high-fidelity simulation sessions. The sample consisted of 18 graduate students enrolled in a critical care nursing course. A four-hour high-fidelity simulation experience was conducted, with a four-hour retraining one month after. Group performance, self-efficacy, self-confidence, and satisfaction improved after multiple exposures to high-fidelity simulation. High-fidelity simulation is a valid adjunct to nursing education in the short term and may improve learning when offered at multiple time points.

A review of virtual-simulation for assessing healthcare students' clinical competency

OBJECTIVES

Health professional education is transitioning to online platforms to meet students' need for flexibility and international access. However, there is a necessity for authentic presentation of educational material particularly in regard to clinical skills development. There has been major growth in the delivery of virtual simulated-based learning and assessment to provide clinical skill acquisition in an online platform. The aim of this review was to explore the use of virtual simulation to assess clinical competence in health education.

DESIGN

Integrative review.

DATA SOURCES

Peer reviewed studies published between 2008 to March 2020 were searched across PubMed, Embase, Cochrane Library, CINAHL Medline, Scopus, and PsycINFO.

REVIEW METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed. Twenty-three studies, which met the inclusion criteria, were downloaded, and a quality appraisal and analysis was completed by the research team.

RESULTS

A thematic analysis identified four themes; pedagogy differences across disciplines, debriefing to enhance learning, preparing healthcare professionals in a safe and cost-effective environment, and managing challenges of virtual simulation. Debriefing with students within the online environment enabled students to share experience and reflect on choices for a deeper learning experience.

CONCLUSIONS

Virtual simulation can prepare students for the clinical environment by providing safe practice within complex clinical situations. Challenges related to managing and debriefing students must be overcome to ensure best student learning outcomes. Virtual simulation is a feasible strategy to assess students' clinical competency and support their learning in both medical and nursing programs, however simulation should be authentic and incorporate reflection.

Knowledge of patient observation among critical care nurses

BACKGROUND

The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive.

AIM

The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it.

STUDY DESIGN

A cross-sectional knowledge test survey with critical care nurses in Finland was used.

METHODS

Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics.

RESULTS

Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum-variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit.

CONCLUSION

The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care.

RELEVANCE TO CLINICAL PRACTICE

Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career.

Development of a safe drug administration assessment instrument for nursing students

OBJECTIVE

to determine the content and face validity of a safe drug administration assessment instrument for nursing students.

METHOD

quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice.

RESULTS

nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice.

CONCLUSION

the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.