Emerging Evidence Toward a 2:1 Clinical to Simulation Ratio: A Study Comparing the Traditional Clinical and Simulation Settings

A simulation educational intervention to enhance preclinical family nurse practitioner student preparation

ABSTRACT

Simulation has been shown to improve communication and psychometric skills in advanced practice nursing students. Little is known about the impact of a simulation educational intervention with a faculty-facilitated debriefing on the preparation of novice nurse practitioner students for their first clinical practicum. This article describes the development of an educational intervention to accomplish this. The simulation education intervention was implemented with preclinical nurse practitioner students designed to improve their preparation for their first precepted clinical experience. Students were surveyed preintervention and postintervention to explore their self-perception of confidence and preparation for clinicals looking at six domains: health history, physical examination, diagnostics, differentials, final diagnosis, and plan of care. Quantitative results were statistically significant for each domain. Qualitative findings gave deeper insight into the students' perceptions of how the intervention prepared them for clinicals. Advanced practice educators can use educational interventions such as this to prepare students for their first clinical practicums.

Life-Threatening Clinical Simulations for Nursing Students: Promoting Critical Thinking and Satisfaction

BACKGROUND

Integrating life-threatening clinical simulations improves learning outcomes. This study assessed nursing students' critical thinking factors before and after simulation, evaluated nursing clinical reasoning ability and learning satisfaction at two time points, and explored relationships and predictions among critical thinking, clinical reasoning, and satisfaction before and after simulation.

METHOD

Surveys and focus groups were used for this mixed-methods study.

RESULTS

Quantitative findings revealed increased critical thinking scores for curiosity, skepticism, and systematicity; clinical reasoning; and satisfaction after simulation. Qualitative results supported these improvements and indicated enhanced curiosity for clinical knowledge and iterative phases of clinical reasoning. Students expressed satisfaction with the simulations. Objectivity significantly influenced clinical reasoning and satisfaction in nursing students following life-threatening simulations.

CONCLUSION

Fostering a culture of critical thinking in life-threatening simulations is crucial. Educators must teach the importance of objectivity in clinical practice, encourage critical evaluation, and foster self-reflection in simulations. [J Nurs Educ. 2024;63(9):595-603.].

Student Engagement in Patient Safety and Healthcare Quality Improvement: A Brief Educational Approach

Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles. This study aimed to assess activities and tools implemented to improve PS and HQI education, as well as student engagement, in medical schools. We designed a two-week course for fourth-year medical students at the Autonomous University of Guadalajara, incorporating Fink's taxonomy of significant learning to create engaging activities. The course featured daily synchronous and asynchronous learning, with reinforcement activities using tools, like augmented reality and artificial intelligence. A total of 394 students participated, with their performance in activities and final exam outcomes analyzed using non-parametric tests. Students who passed the final exam scored higher in activities focused on application and reasoning (p = 0.02 and p = 0.018, respectively). Activity 7B, involving problem-solving and decision-making, was perceived as the most impactful. Activity 8A, a case-based learning exercise on incident reporting, received the highest score for perception of exam preparation. This study demonstrates innovative teaching methods and technology to enhance student understanding of PS and HQI, contributing to improved care quality and patient safety. Further research on the long-term impact is needed.

Preparing for the Next Generation NCLEX Using a Virtual Simulation

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

A qualitative study of the value of simulation-based training for nursing students in primary care

BACKGROUND

Clinical placement is an essential component of nursing education, providing students with the opportunity to apply theoretical knowledge to practice. However, challenges such as lack of supervision and passive involvement in tasks can hinder the learning experience. Supplementing clinical placement with simulation-based training (SBT) has been explored as a potential solution, though this approach has been underexplored within primary care. This study aimed to explore the educational value of a supplemental SBT course for nursing students during primary care placement, as well as the adaption of this approach to a primary care setting.

METHODS

A qualitative descriptive study was conducted at a medical education and simulation academy in Denmark. Sixth-semester nursing students on placement in primary care were invited to participate. The intervention consisted of a three-day simulation course covering core nursing competencies and common clinical conditions encountered within primary care. Simulation adopted a standardised patient approach. Data was collected using focus group interviews, which was analysed using inductive thematic analysis.

RESULTS

Thirty-one nursing students participated in the study. Seven themes emerged from the analysis, including perceptions, educational value, simulation adjustments to primary care, educators' competencies, learning needs within primary care, challenges of clinical placement and career guidance. Generally, participants perceived the intervention positively, appreciating its relevance to their clinical placement and its educational impact in this context. Participants also provided insights into the adaptation of SBT to a primary care setting, as well as nursing students' learning needs within this context.

CONCLUSION

The findings indicate that the intervention had a positive impact on participant competencies within this context and enhanced their clinical practice within primary care. Furthermore, the results inform educators on how to effectively employ primary care-related SBT. Overall, this study supports the need for an increased application of SBT within primary care.

TRIAL REGISTRATION

Not relevant.

Development of a Telehealth Simulation Using Intraprofessional Collaboration

ABSTRACT

Telehealth allows access to high-quality, holistic patient care, including diagnosis, interventions, treatments, monitoring, and patient education. As the use of telehealth continues to increase, faculty considered the need for entry-level nursing students to be introduced to telehealth and its services. Faculty from the medical-surgical II and mental health courses developed a learning experience for students that blends concepts from both courses, as patients often present with multiple problems. The telehealth experience helped students utilize assessment skills, learn delegation, and connect concepts from two courses to provide care for a patient remotely.

Learning Nursing Skills of Practice Virtually: The Rough Ground of Engagement

BACKGROUND

In spring 2020, nursing education programs abruptly transitioned the teaching and learning of nursing practice skills to virtual environments as the result of the coronavirus disease 2019 (COVID-19) pandemic.

METHOD

This study sought to describe ethnographically how faculty and students formed and integrated clinical judgment and other nursing practice skills within this quickly formed virtual subculture. Thirty-seven associate-degree nursing students participated in small group interviews, and four faculty participated in one-to-one interviews.

RESULTS

Two overarching themes were identified: (1) the pervading mood of learning through the pandemic; and (2) the primacy of the nursing traditions of direct care experience. Themes were nested further within the five essentials for human learning: curiosity, authenticity, emotion, sociality, and failure.

CONCLUSION

Virtual simulation cases with focused prebriefing and debriefing sessions provided experiences that were targeted, shared, guaranteed, and safe. Adequately supported virtual simulation platforms can enhance the learning of nursing skills. [J Nurs Educ. 2023;62(10):541-547.].

Effect of Storytelling and Empathy Training to Support Affective Learning in Undergraduate Nursing Students

BACKGROUND

Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation.

PURPOSE

This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning.

METHODS

A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed.

RESULTS

Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed.

CONCLUSIONS

Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students.

Lasater clinical judgment rubric reliability for scoring clinical judgment after observing asynchronous simulation and feasibility/usability with learners

BACKGROUND

There is strong evidence supporting using the Lasater Clinical Judgment Rubric (LCJR) for scoring learners' clinical judgment during in-person simulation performance and clinical experience reflections. However, a gap exists for using LCJR to evaluate clinical judgment after observing asynchronous simulation.

OBJECTIVE

We aimed to determine the reliability, feasibility, and usability of LCJR for scoring learners' written reflections after observing expert-modeled asynchronous simulation videos.

DESIGN/SETTING/PARTICIPANTS

We used a one-group, descriptive design and sampled pre-licensure, junior-level bachelor's learners from the Southwestern United States.

METHODS

Participants observed eight expert-modeled asynchronous simulation videos over one semester and provided written responses to clinical judgment prompts. We scored clinical judgment using LCJR. We studied reliability by measuring internal consistency of 11 clinical judgment prompts and interrater reliability with two raters. This study also investigated feasibility and usability of the asynchronous simulation learning activity using descriptive statistics. Feasibility included time learners spent completing written responses and time raters spent evaluating written responses. Learners reported usability perceptions using an instructor-developed survey.

RESULTS

Sixty-three learners completed 504 written responses to clinical judgment prompts. Cohen's kappa ranged from 0.34 to 0.86 with a cumulative κ = 0.58. Gwet's AC ranged from 0.48 to 0.90, with a cumulative AC = 0.74. Cronbach's alpha was from 0.51 to 0.72. Learners spent on average 28.32 ± 12.99 min per expert-modeling video observation. Raters spent on average 4.85 ± 1.34 min evaluating written responses for each participant. Learners reported the asynchronous learning activity was usable.

CONCLUSIONS

Nurse educators can reliably use LCJR for scoring learners' clinical judgment after observing asynchronous expert-modeled simulation. Logistically, learners complete the reflective learning activity and faculty use LCJR to measure clinical judgment in feasible time. Further, participants perceived the asynchronous learning activity usable. Nurse educators should utilize this learning activity for evaluating and tracking observer clinical judgment development.

Evolving Approaches to Meet Clinical Hours for Undergraduate Nursing Students during COVID-19

BACKGROUND

The COVID-19 pandemic challenged all healthcare professionals to re-think how patient care is provided. Faculty in nursing schools faced similar challenges in offering adequate clinical hours to nursing students, because of the limited availability of clinical placements.

METHODS

A faculty in one school of nursing introduced virtual simulation resources to supplement in-person clinical hours. The faculty developed a revised clinical curriculum for students that included weekly objectives and deliverables for virtual simulations. The Simulation Effectiveness Tool-Modified (SET-M) was utilized to evaluate the effectiveness of the virtual simulations.

RESULTS

130 students (88.4%) completed the post-implementation survey. After using the virtual simulations, 50% of the students reported feeling confident in providing interventions that foster patient safety. Furthermore, students reported a sound understanding of disease pathophysiology (60%) and medications (53.8%). The qualitative data indicated that students found the virtual simulations beneficial and a safe learning environment.

CONCLUSION

Pre-pandemic virtual simulations were not used by this school of nursing to replace the traditional in-person clinical experiences. However, the pandemic demonstrated that the utilization of innovative virtual simulations are effective methods for student learning to augment traditional clinical experiences.

Ethical Considerations of Replacing Clinical Hours With Simulation in Undergraduate Nursing Education: Means to an End, or an End in Itself?

In the current health-care environment, undergraduate nursing programs are expected to provide high-quality clinical experiences for students despite increasing difficulty accessing clinical placements. Expectations for newly graduated nurses have increased in the last few years, with an emphasis on "work-ready" graduates. At the same time, the availability of a variety of clinical practicum placements has decreased in some areas, increasing the difficulty of meeting the increasing numbers of nursing students required for future workforce planning, a situation exacerbated by the ongoing COVID-19 global pandemic. Nursing educators are caught between industry requirements for clinically prepared students and the regulatory requirements of their educational institutions. One solution being espoused internationally is substituting simulation for clinical practicum hours. Simulation offers many advantages, especially for patient safety, providing students with opportunities to link theory to practice in a controlled environment. This article discusses the ethical considerations of substituting simulation for clinical hours in undergraduate nursing education. Is this substitution justified as a means to an end or an end in itself?

Prevalence and factors associated with academic burnout risk among nursing and midwifery students during the COVID-19 pandemic: A cross-sectional study

AIM

The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID-19 pandemic.

DESIGN

A correlational cross-sectional study.

METHODS

An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI-SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID-19 pandemic.

RESULTS

The prevalence of overall AB risk was 50.0% (95% CI 48.5-53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS-CoV-2 infection and having a relative who died related to COVID-19.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs

Background

The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward.

Purpose

To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic.

Methods

We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data.

Results

The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19.

Conclusion

This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

A Conceptual Model to Strengthen Integrated Management of HIV and NCDs among NIMART-Trained Nurses in Limpopo Province, South Africa

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian's structure process outcome model and Miller's pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes.

The Use of Structured, Active, In-Person Learning to Connect Didactic Content with Clinical Scenarios in a Senior Level Nursing Leadership Course

BACKGROUND

The senior leadership course at the University of Pennsylvania School of Nursing includes both didactic and clinical components. The didactic portion delves into leadership topics and during clinical rotations the students witness nurses and patients navigate through complicated and emotional patient care experiences.

METHOD

Structured, active, in-class learning (SAIL) activities in a classroom were used to connect didactic content with clinical scenarios. Different specialty-related clinical scenarios were presented to the students, and they were allocated a certain amount of time for discussion in small groups before sharing their outcomes with the whole group (think-pair-share).

RESULTS

Student evaluations showed that the percentage of students who rated each session as excellent increased each semester and feedback remained overwhelmingly positive; the consistently identified area for improvement is the timing and we plan to lengthen the sessions to address that.

CONCLUSION

Our team discovered that by shifting most of our simulation scenarios to SAIL, we provided the students with ample opportunities to speak in a dialectically rich environment about clinical scenarios while maintaining the interrelation between theory and practice. [J Nurs Educ. 2023;62(X):XXX-XXX.].

Exploring learning effectiveness for participant roles during healthcare simulation

BACKGROUND

Universities face challenges in preparing future nurses for the workforce. It is essential to guide educators on strategies to achieve similar learning objectives to overcoming these challenges. Educators widely use the observer role in simulation, but researchers do not study the role thoroughly in current simulation research. There is a lack of discipline-specific research exploring how observers learn in simulation and if they can engage in the experiential learning intended in the simulation activity.

OBJECTIVES

The objective of this research is to determine the difference in simulation effectiveness between the process-based role versus the response-based role (observers) in participants during simulation-based learning experiences.

DESIGN

This research used a quasi-experimental posttest only design to determine differences in simulation effectiveness among learner roles using the Simulation Effectiveness Tool-Modified (SET-M).

SETTING & PARTICIPANTS

The researcher collected data from 193 prelicensure nursing students enrolled in any semester of one Midwestern undergraduate baccalaureate nursing program.

METHODS

Nursing students completed the assigned face-to-face simulations in their current curriculum plan. Each participant was randomly assigned to a participant role: direct participant role as either a primary or secondary nurse, non-directed observer with no briefing or observer guide, direct observer with an observation guide, or in-scenario observer assigned to a non-clinical or other professional role within the scenario. After debriefing of the simulation, participants completed the demographic survey and SET-M.

RESULTS

There were no significant differences found in prelicensure nursing students' simulation effectiveness among the four participant roles studied.

CONCLUSION

This study suggests simulation effectiveness (learning and confidence) happens regardless of the participants role during the simulation activity. Educators should consider what roles are necessary within each scenario and assign observation roles as needed.

Replacing community clinical hours with an antepartum simulation-based experience

BACKGROUND

Community and population health is an essential part of pre-licensure nursing education. Securing community clinical sites for large cohorts of nursing students is challenging. Individual community sites in nursing specialty areas, such as women's health, limit the number of students, making it difficult to provide a consistent clinical experience for all students. The literature shows simulation is an effective alternative to traditional clinical hours.

PURPOSE

This article describes a pilot simulation-based antepartum experience in the community setting. This simulation-based experience replaced the clinical hours for a previous traditional clinical experience in the community setting, for which students were only able to observe and not interact. The objectives were to allow students to be engaged in communication, patient education, and anticipatory guidance with a live patient.

METHOD

Faculty at a large southeastern university created an antepartum simulation-based clinical experience focused on important elements of obstetrics and maternal health assessment utilizing standardized patients.

RESULTS

Student responses from the post-simulation survey showed 96 % strongly agreed they were more confident in communicating with clients.

CONCLUSION

Faculty concluded this simulation-based experience is an effective alternative to traditional community clinical experiences in the antepartum setting.

Where Are We Now? A Follow-up Survey on Regulation of Simulation Use in United States Prelicensure Nursing Programs

Background

Approval of simulation in substitution of traditional clinical hours increased in nursing programs during the COVID-19 pandemic, yet these temporary and inconsistent between states. Variability and a return to "pre-pandemic" limits on simulation use amplify questions about consistency of learner outcomes.

Methods

Boards of Nursing (BONs) of the United States and District of Columbia (DC) were queried to verify accuracy of simulation regulations posted on the International Nursing Association for Clinical Simulation and Learning (INACSL) regulatory map and to identify factors contributing to regulatory changes.

Results

Approximately half of respondents indicated information posted on the INACSL regulatory map is accurate for their state. Almost 30% of respondents indicated information is not accurate. Some states could not confirm accuracy of simulation regulations posted.

Conclusions

Many nursing programs expanded the use of simulation during the COVID-19 pandemic. Reverting to "prepandemic" limited simulation use presents a missed opportunity to advance nursing education and align simulation regulation with the growing body of evidence supporting its outcomes.

Alternative Clinical Learning Experiences for Nursing Education Using Virtual Individual Patients

ABSTRACT

Acute care pediatric clinical experiences for undergraduate nursing students can present a challenge given the limited availability of clinical sites, increased restrictions, and variations in direct patient care experiences. Unfolding virtual individual patient pediatric simulations were developed using complex pediatric disorders with multiple physiological, psychosocial, and developmental components. Ten unfolding simulations were implemented to standardize clinical experiences and replace clinical hours. Students were evaluated using the Quint Leveled Clinical Competency Tool, demonstrating overall progressing ability to use clinical reasoning skills. Unfolding virtual individual patients allow for deliberate, coordinated, and consistent exposure to clinical experiences and are a valuable substitution for traditional clinicals.

The Role of Fundamental Nursing Practices Simulation on Students’ Competencies and Learning Satisfaction: Repeated Measured Design

Few studies have examined the simulation of fundamental nursing practices regarding nursing competencies and learning satisfaction via repeated measured methods. Objectives: To evaluate a simulation of fundamental nursing practices on nursing students’ competencies and learning satisfaction in three time points: before (T1), immediately after (T2), and one month after simulation (T3), and to examine nursing students’ competency predictors to learning satisfaction, immediately after conducting the simulation and one month after. Methods: The study design was a one-group, repeated measures study. Ninety-three undergraduate nursing students were convenience sampled and conducted a simulation of fundamental nursing practices. The students completed a questionnaire at T1, T2, and T3. The Competency Inventory for Registered Nurses questionnaire was distributed, and question about the level of learning satisfaction were asked. Results: All nursing competencies and learning satisfactions increased significantly. Only the legal/ethical practice competency succeeded in predicting the learning satisfaction in T2 and in T3 after conducting simulations. Conclusions: This study has established that a simulation of fundamental nursing practices is effective not just immediately after performing the simulation but also one month after the simulation. Therefore, it is recommended to implement a pedagogical structure of simulations of fundamental nursing practices in other nursing education areas.

Integrating simulation training during clinical practice in nursing homes: an experimental study of nursing students' knowledge acquisition, self-efficacy and learning needs

BACKGROUND

Limited access to supervision, feedback and quality learning experiences pose challenges to learning in the clinical setting for first-year nursing students who are beginning their clinical experiences. Prior studies have indicated that simulation training, as a partial replacement of clinical practice hours, may improve learning. However, there has been little research on simulation training integrated as a partial replacement during first-year students' clinical practice in nursing homes. The primary aim of this study was to examine first-year nursing students' knowledge acquisition and self-efficacy in integrating a partial replacement of clinical hours in nursing homes with simulation training. Its secondary aim was to examine perceptions of how learning needs were met in the simulated environment compared with the clinical environment.

DESIGN

The primary aim was addressed using an experimental design that included pre- and post-tests. The secondary aim was investigated using a descriptive survey-based comparison.

METHODS

First-year students at a Norwegian university college (n = 116) were asked to participate. Those who agreed (n = 103) were randomly assigned to the intervention group (n = 52) or the control group (n = 51). A knowledge test, the General Self-efficacy Scale and the Clinical Learning Environment Comparison Survey were used to measure students' outcomes and perceptions. The data were analysed using independent samples t-tests, chi-square tests and paired samples t-tests.

RESULTS

Knowledge scores from pre- to post-tests were significantly higher in the intervention group than in the control group with a medium to large effect size (p < 0.01, Hedges' g = 0.6). No significant differences in self-efficacy were identified. Significant differences (p <  0.05) were observed between the simulated and the clinical environment with regard to meeting learning needs; effect sizes ranged from small and medium to large (Cohen's d from 0.3 to 1.0).

CONCLUSION

Integrating the partial replacement of clinical hours in nursing homes with simulation training for first-year nursing students was positively associated with knowledge acquisition and meeting learning needs. These findings are promising with regard to simulation as a viable partial replacement for traditional clinical practice in nursing homes to improve learning.

Meeting our students' educational needs during a global pandemic: Creating online clinical learning experiences

The purpose of this paper is to describe the conversion of in-person simulations into online evolving case study activities in an undergraduate nursing curriculum as a result of COVID-19 precautions. The School of Nursing at Eastern Kentucky University utilized technological resources to provide meaningful online learning activities to meet student learning outcomes. The key teaching strategies to maintain were application and synthesis of knowledge through guided reflective activities and discussion. Interactive evolving case studies were selected with critical thinking questions and video clips to promote student engagement. The curricular concepts were medication administration, prioritization of patient care, communication, patient safety, and clinical judgment. Student and faculty evaluations were overwhelmingly positive, resulting in sustained use of these teaching strategies within the curriculum.

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

Aim

To explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.

Background

The World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.

Design

Cross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.

Methods

A cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.

Results

Of 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.

Conclusions

Students were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.

Transforming National League for Nursing Advancing Care Excellence for Seniors Unfolding Cases into Virtual Simulations: An Innovative Approach for Interactive Learning

Background

Two National League for Nursing (NLN) Advancing Care Excellence for Seniors (ACE.S) cases were transformed into engaging and interactive virtual simulation learning experiences due to the COVID-19 pandemic.

Methods

The purpose of this article is to describe the process of designing and implementing this novel approach to virtual simulation.

Results

Faculty aligned each virtual simulation with existing course outcomes, student learning outcomes, concept-based learning principles, and best practices of The International Nursing Association for Clinical Simulation and Learning (INACSL) standards.

Conclusions

Practical strategies used to convert these unfolding case studies into virtual simulations for a small private Christian university of undergraduate junior level accelerated nursing students will be revealed.

Pandemic Crisis: Simulation Contingency Plans

Background

The COVID-19 pandemic has disrupted the typical delivery of nursing education. Multifactorial issues related to the pandemic and clinical placements have forced nurse educators to employ innovative strategies for content delivery.

Methods

This article is an accounting of a simulation team response to the move to all remote or virtual simulated learning experiences over a two-week period and lessons learned on how to move forward with simulated learning contingency plans.

Results

Learning outcomes were achieved via the delivery of online commercial and faculty made experiences to simulate clinical practice. Simple and easy to use guides assisted both students and faculty for a positive experience.

Conclusion

Creating a detailed formal contingency plan for emergencies is essential for nursing programs. Additionally, the pandemic highlighted the importance of continuing faculty development and education in online, virtual, and simulation pedagogy. Finally, it is recommended that schools of nursing implement formal policies for replacement of clinical hours with simulation.

P Stands for Pivot: Pivoting Face-to-Face Practicum to Virtual Simulation during the Pandemic

Virtual simulation has been widely used to temporarily replace face-to-face clinical practicum experiences in nursing education in response to the global COVID-19 pandemic. While more traditional clinical settings were prioritized and made available only to senior students, the use of virtual simulation provided an opportunity to safely pivot from the usual placement to a comparable practical learning modality to maintain clinical competence during unprecedented public health restrictions and mitigation strategies. Like many others across the globe, nursing students in a Canadian university continued their nursing education predominantly using virtual simulation for an entire academic year to avoid catastrophic delays in entering the workforce and to ultimately protect the health service delivery needs throughout the oncoming waves of the pandemic. The purpose of the paper is to describe guiding principles established in a School of Nursing as a means to responsibly and ethically adopt a replacement of traditional clinical practicum experiences with virtual simulation. The principles for incorporating virtual simulation included the need to achieve and maintain a high level of quality of learning experiences, a fluid delivery articulated in phases, and a financial commitment by the learning institution. As the global pandemic may see a fourth wave, the use of virtual simulation will continue to present a major change for clinical practicum and establishing principles for the use of virtual simulation has demonstrated to be an integral part of safe pandemic response and post-pandemic recovery.

Transitioning Child Health Clinical Content From Direct Care to Online Instruction

BACKGROUND

The global pandemic of 2020 forced preli-censure nursing degree programs to rapidly reevaluate clinical teaching methodologies. To maintain high educational standards with minimal anxiety and disruption for students, a child health teaching team developed an innovative revised plan for facilitation of clinical experiences within the virtual learning environment.

METHOD

Experienced faculty employed a series of clinical learning activities in the online environment using existing virtual simulations, along with new innovations including a digital escape room, unfolding case studies, and blended prioritization simulations.

RESULTS

Information gleaned from student evaluations identified self-reported increases in clinical reasoning, prioritization, communication, and critical thinking skills. Students appreciated a more relaxed pace that allowed for more time to think through the processes.

CONCLUSION

Virtual activities can be as effective as in-person clinical learning methodologies. Integrating virtual activities into clinical curricula can be a viable option, especially in areas where clinical placement is limited. [J Nurs Educ. 2021;60(3):177-179.].

Health Care Professional Students' Perceptions of Teamwork and Roles After an Interprofessional Critical Care Simulation

BACKGROUND

Educational opportunities for health care professional students to learn collaborative communication and the roles and responsibilities of other disciplines are minimal unless faculty are intentional about facilitating this interdisciplinary learning.

OBJECTIVES

The aim of this study was to determine how a simulation-enhanced interprofessional education (Sim-IPE) teaching strategy fostered communication and interdisciplinary awareness between students from multiple disciplines.

METHOD

This pretest-posttest design surveyed undergraduate students from 5 disciplines. The Student Perceptions of Interprofessional Clinical Education-Revised tool examined students' perceptions of teamwork and roles after an in-depth, multistate critical care simulation experience.

RESULTS

All students' perceptions of teamwork increased after the Sim-IPE. More experience in the health care field is associated with an increased perception of teamwork and roles/responsibilities.

DISCUSSION

On the basis of these findings, the critical care Sim-IPE was an effective teaching strategy to increase the perception of roles and responsibilities of interprofessional critical care team members with applicability to many other specialty topics.

Cognitive load experienced by nurses in simulation-based learning experiences: An integrative review

BACKGROUND

Simulation based learning experiences help nurses gain skills necessary for independent practice. However, increased cognitive load placed on learners in simulation may affect learning outcomes.

OBJECTIVES

The purpose of this integrative review was to synthesize what is known about nurses' cognitive load in simulation and summarize measurement approaches.

DATA SOURCES

A search of CINAHL, Medline, ProQuest Nursing and Allied Health, and ERIC databases was limited to peer-reviewed studies published after 2006 in the English language, using the key words nurse, simulation, and cognitive load.

REVIEW METHODS

Whittemore and Knafl's (2005) integrative review method was used. Studies investigating advanced practice nurses or interprofessional teams were excluded.

RESULTS

Database and reference lists searches identified a total of 3077 records, and 20 met inclusion criteria. Simulation fidelity, time pressure, dual-tasking, interruptions, task complexity, distractions, and mismatched simulation objectives to learner ability increase nurses' cognitive load. However, past experience, pre-briefing, repeated scenarios, and worked-out modeling optimize cognitive load. Subjective and objective cognitive load measures help researchers understand cognitive load and define its relationship with other variables.

CONCLUSIONS

Simulation impacts nurses' cognitive load. Varying simulation designs to optimize cognitive load will improve learning outcomes. Future nursing simulation research should utilize well-validated cognitive load measures and measure cognitive load alongside other variables to further understand how cognitive load affects simulation outcomes.

Assessment Practices of Student’s Clinical Competences in Nurse Education

Background:

Clinical competence in nursing practices includes all the theoretical and clinical knowledge used by the student in a clinical setting. It also involves psychomotor as well as problem-solving skills. The assessment focuses on evaluating the student's ability to provide both safe and competent care for the patients. However, it requires the use of several assessment methods that must be varied according to the components of the clinical competence.

Several studies have revealed that the evaluation of this competency is mostly limited to knowledge testing or the acquisition of technical skills verification.

Aims:

This study has two objectives. Firstly, it aims to analyze the assessment practices related to clinical competence and adopted by teachers in higher institutes of nursing and health technology in Morocco. Secondly, it seeks to identify the difficulties faced by them in using a variety of appropriate assessment tools to target all the components of clinical competence.

Methods:

Based on the theoretical model adapted from the Miller’s pyramid by Mehay and Burns in 2009, relating to the assessment of clinical competence, a self-administered questionnaire was shared with 129 nursing teachers.

Results:

The results indicate that 98.06% of participants use a given tool to assess clinical competence; however, using the appropriate tools to evaluate all its components is limited, and the assessment tools are not characterized by variety.

Conclusion:

Reflecting on the evaluation of clinical competences, a clinical assessment model could be proposed to be in accordance with the theoretical model and to measure its impact on nursing students' learning.

Identifying and Addressing Statewide Nursing Simulation Needs

ABSTRACT

A statewide simulation assessment was conducted in one southeastern state using the Program Assessment Survey for Simulation. Simulation coordinators from 22 prelicensure nursing programs were interviewed. The findings revealed several areas where faculty education was needed: theory, design, facilitation, debriefing, interprofessional education, and evaluation. A free online simulation fundamentals course was effective in addressing the areas where education was required.

Traditional Clinical Outcomes in Prelicensure Nursing Education: An Empty Systematic Review

BACKGROUND

Effectiveness of traditional apprenticeship models used in undergraduate nursing education has been questioned in the literature for over 50 years. This systematic review aimed to examine best evidence available upon which to base decisions regarding use of traditional clinical experience with prelicensure nursing students.

METHOD

A systematic review was conducted following Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine electronic databases were searched. Full-text review was completed for 118 articles meeting inclusion criteria.

RESULTS

No studies reported learning outcomes attributed to clinical education models, resulting in an empty review. Studies were commonly self-reports of perceptions and confidence, lacking quantitative outcomes.

CONCLUSION

No sufficient evidence was found to support traditional clinical models. The scope of nursing practice and patient complexity requires higher order thinking skills, ability to prioritize, and leadership in interdisciplinary care environments. This review raises serious concerns about how nurse educators assess learning in traditional clinical environments. [J Nurs Educ. 2021;60(3):136-142.].

Clinical Learning Evaluation Questionnaire: A Confirmatory Factor Analysis

INTRODUCTION

The Clinical Learning Evaluation Questionnaire (CLEQ) is a multidimensional, reliable instrument designed to measure the effectiveness of the clinical learning environment for undergraduate medical students. This study seeks to measure and examine the underlying construct along with the latent variables by conducting a confirmatory factor analysis, using structural equation modeling (SEM) so that the instrument can be utilized as an evaluation tool for the continuous improvement of educational environments and curricula.

METHODS

A cross-sectional study was carried out on 185 third- and fourth-year medical students. A confirmatory factor analysis was conducted, beginning with principal component analysis for standardized factor loadings, using varimax rotation in SPSS to explore the underlying construct of items. The constructs to which each item was tied were determined, and then the data were run through AMOS to assess construct validity through item reduction based on the modification indices, and estimates were made of the standardized residual covariance of each item in order to determine the best model fit.

RESULTS

A total of 185 students completed the CLEQ Inventory. The original six-factor structure of the CLEQ did not achieve model fit (X²=1587.475, RMSEA=0.092, RMR=0.146, GFI=0.651, AGFI=0.601, CFI=0.728, NFI=0.626). However, the suggested four-factor model of CLEQ displayed good model fit with the improvement of values (X²=86.184, RMSEA=0.052, RMR=0.062, GFI=0.903, AGFI=0.865, CFI=0.951, NFI=0.871). Internal consistency analysis showed that Cronbach's alpha values of the original six-factor model ranged from 0.68 to 0.88, while four-factor model ranged from 0.72 to 0.87.

CONCLUSION

This study did not support the proposed six-factor structure of the CLEQ tool. However, the four-factor CLEQ structure demonstrated an adequate degree of good fit and was found to be as reliable as the original structure. Further research on the predictive validity of CLEQ is required as well as a comparison of the psychometric properties across different institutions and countries.

Simulation in Undergraduate Education

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences.

‘It is a different type of learning’. A survey-based study on how simulation educators see and construct observer roles

Background

Simulation is reported as an appropriate replacement for a significant number of clinical hours in pregraduate programmes. To increase access for learners, educators have looked to understanding and improving learning in observer roles. Studies report equivalent learning outcomes and less stress in observer roles. However, reports on the prevalence, use and perceived value of observer roles from the educator’s perspective are lacking.

Methods

An exploratory survey for Australian and New Zealand (ANZ) simulation educators based on literature findings was developed and piloted with a small sample (n=10) of like subjects for language, clarity, skip logic and completion time. The final survey comprised 36 questions. Quantitative data were analysed using Pearson’s chi-squared test, Welch’s ANOVA and exploratory factor analysis. Select qualitative data were analysed using content analysis and summarised with frequency counts and categorisation.

Results

Two hundred and sixty-seven surveys were completed, with 221 meeting criteria for analysis. The observer role is widely used in ANZ and most learners experience both hands-on and observer roles. The location of observers is dependent upon several factors including facility design, learner immersion, scenario design and observer involvement. Verbal briefings and/or other guides are provided to 89% of observers to direct their focus and 98% participate in the debrief. Educators value observer roles but tend to believe the best learning is hands-on.

Conclusions

The learning in observer roles is less valued by educators than hands-on roles. Focused observation provides opportunities for noticing and attributing meaning, an essential skill for clinical practice. Learning spaces require consideration of scenario design and learning objectives. Scenario design should include objectives for observer roles and incorporate the observer into all phases of simulation. Attention to these areas will help promote the value of the different type of learning available in observer roles.