Learning Outcomes of the Observer Role in Nursing Simulation: A Scoping Review

Knowledge Acquisition Based on Participant Role Assignment in a High-Fidelity Simulation

BACKGROUND

Participant roles can vary with simulation. Some roles involve providing direct care during the simulation, whereas other roles involve observing the simulation either in the simulation environment or in another room with audiovisual capabilities.

PURPOSE

To determine whether learning outcomes are comparable for students regardless of role played in a simulation.

METHODS

A quasi-experimental design was used to determine whether knowledge acquisition was influenced by role assignment (primary or secondary nurse, family member, or observer) when participating in a high-fidelity simulation among 267 study participants.

RESULTS

There was a statistically significant increase in the mean score for knowledge acquisition for all participants ( P < .001). There was no difference in knowledge acquisition based on the role assignment in the simulation ( F = 0.28, P = .84).

CONCLUSIONS

Knowledge acquisition is possible regardless of the role played in a high-fidelity simulation.

Feasibility and Impact of an Online Simulation Focusing on Nursing Communication About Sexual Health in Gynecologic Oncology

Nurses' communication regarding the sexual health of women with gynecologic cancer is suboptimal and may be attributed to their lack of sexual health training and knowledge. Our study aims to document the learning experience, impacts, and feasibility of an online educational intervention activity between oncology nurses and a simulated participant on communication with patients regarding oncological sexual health. Using a qualitative approach, we conducted a feasibility study, which included 11 oncology nurses, and performed semi-structured individual interviews after our simulation exercise. We then conducted an iterative thematic data analysis. The participating nurses found the learning experience positive and satisfactory, despite issues with discussions between learners via Zoom™. Study nurse participants reported positive outcomes in knowledge, beliefs, attitudes, communication skills, and nursing practices. Finally, the educational intervention was found to be feasible. The online educational intervention involving a simulated participant appears to be a satisfactory, feasible, and promising module to improve communication regarding the sexual health of gynecologic cancer patients among oncology nurses. However, further studies are needed to verify this type of intervention's effectiveness and optimize oncology nurses' continuing education in sexual health.

Setting Observers Up for Success in Simulation

BACKGROUND

The assignment to be an observer in simulation is common. Despite evidence that learning outcomes are similar for participants and observers, there is uncertainty among simulation facilitators about how to create a valuable learning experience for learners in observer roles.

PROBLEM

The prebriefing practices of establishing a fiction contract and orienting learners to their role are frequently centered on learners in participant roles.

APPROACH

Tailoring a fiction contract to the opportunities and challenges that observers experience as well as the use of feedforward to provide specific objectives to learners in observer roles is discussed.

CONCLUSIONS

Including specific strategies in the prebriefing for learners in observer roles sets observers up for success in simulation learning experiences.

Measured task load in directed observers versus active participants undergoing high-fidelity simulation education in a critical care setting

Objectives

The use of directed observers in high-fidelity simulation education is increasingly common. While evidence suggests similar educational outcomes for directed observers compared to active participants in technical skills, it remains uncertain if this benefit also exists for senior clinicians, especially in mental workload. We sought to compare the workload between active participants and directed observers using an objective measure.

Methods

We performed a prospective, repeated-measures observational study during the New South Wales Ambulance Aeromedical Operations induction training from 2019 to 2020. Participants included senior critical care doctors, paramedics, and nurses undergoing high-fidelity simulation of prehospital and interhospital aeromedical missions. Task load was measured using the National Aeronautics and Space Administration task load index (NASA-TLX) administered following each simulation debrief. Prehospital and interhospital simulations were compared separately by building a multilevel model for complete case and all study data. Post hoc comparisons of NASA-TLX score for each group were performed using estimated marginal means (EMMs).

Results

We enrolled 70 participants, comprising 49 physicians (70%), 19 paramedics (27%), and two flight nurses (3%). From the complete case analysis, statistically significant differences were observed for total NASA-TLX scores between active participants and directed observers in both prehospital (participant EMM 78, observer EMM 65, estimated difference -13, 95% confidence interval [CI] -20 to -7) and interhospital simulations (participant EMM 69, observer EMM 59, estimated difference -10, 95% CI -16 to -3). When all available data were included, the pattern of results did not change.

Conclusions

In our sample of senior clinicians, the task load experienced by both active participants and directed observers in high-fidelity simulation education was high for both prehospital and interhospital simulation exercises. The statistically significant differences we report are unlikely to be practically significant. Our results support the use of directed observers when resource limitations do not allow all course attendees to participate in every simulation.

Vicarious learning and communication self-efficacy: A pediatric end-of-life simulation for pre-licensure nursing students

BACKGROUND

End-of-life clinical experiences, particularly in pediatrics, are quite limited for pre-licensure nursing students. Though effective, end-of-life simulations can be costly, require facilitators trained in palliative and end-of-life care, and are restricted by limited space and time availability. Such barriers prompt the question as to whether there is an effective alternative to simulation by which students can gain improved self-efficacy in therapeutic communication during pediatric end-of-life situations.

PURPOSE

Bandura's Social Cognitive Theory and work exploring self-efficacy posits that vicarious learning provides learners opportunities to gain experience and knowledge through observation of peers in simulated settings. This study evaluated the effectiveness of vicarious versus active learning on pre-licensure nursing students' perceived self-efficacy in providing therapeutic communication during a pediatric end-of-life situation.

METHOD

Data were collected over three time points - pre-simulation, post-simulation, and post-debriefing - using a modified Self-Efficacy in Communication Scale.

RESULTS

Learners in both groups had significant improvement in self-efficacy across all time points. Only two items had significant differences between vicarious and active learner groups, but the effect was minor.

CONCLUSION

Vicarious learning presents as a viable pedagogical approach for providing pre-licensure nursing students important learning opportunities related to pediatric end-of-life simulations during both the scenario and debriefing.

Beyond the technology: Applying the NLN Jeffries Simulation Theory in the context of aging simulation

BACKGROUND

Caring for older people has become a focus for simulation-based education. Specifically, aging simulation has emerged as an innovative and effective educational approach that utilizes aging-suits for nurses to gain insight into the aging process and the everyday difficulties faced by older people. There is limited evidence within the literature about how researchers and educators support decision-making processes in the design, implementation, and evaluation of aging simulation programs.

AIM

This is a theoretical development paper and its purpose is to explore the practical application of the Jeffries Simulation Theory in the design, implementation, and evaluation of an aging simulation program to contribute to knowledge development and guide educational practices for nurse educators and researchers.

RESULTS

The authors describe a practical application of the theory to an aging simulation program using the five key theory components: context, background, design, simulation experience, and outcomes. Specific theory strengths are highlighted in practical examples generated from the authors aging simulation interventional study example: engaging stakeholders, consideration of additional observer simulation roles, reflective debrief discussions, influence of facilitator and participant personal attributes, and outcomes beyond the participants.

CONCLUSION

The Jeffries Simulation Theory is well suited for underpinning the design, implementation, and evaluation of aging simulation programs.

Enablers of the successful implementation of simulation exercises: a qualitative study among nurse teachers in undergraduate nursing education

BACKGROUND

Simulation exercises are increasingly being used as a teaching method in the field of undergraduate nursing education. Thus, the present study sought to identify, describe and discuss enablers of the successful implementation of simulation exercises in undergraduate nursing education.

METHODS

This study had a qualitative descriptive design and involved individual interviews conducted between November and December 2018 with six nurse teachers from three different university campuses in Norway. The transcribed interviews were analysed by means of a qualitative thematic analysis.

RESULTS

The majority of the interviewees wanted to offer more simulation exercises as part of their respective undergraduate nursing education programmes. Moreover, creating a safe environment, facilitating student-centred learning and promoting reflection were all identified by the interviewees as enablers of the successful implementation of simulation exercises.

CONCLUSIONS

The findings of this study indicate that nurse teachers consider simulation to be a valuable teaching method for improving students' learning outcomes. In addition, the findings could guide the future implementation of simulation exercises in undergraduate nursing education.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT04063319 . Protocol ID: 52110 Nursing Students' Recognition of and Response to Deteriorating Patients.

Interactive Video Simulation for Remote Healthcare Learning

Simulation is an essential component of healthcare education as it enables educators to replicate clinical scenarios in a controlled learning environment. Simulation has traditionally been conducted in-person through the use of manikins, however, the COVID-19 pandemic has challenged the practice of manikin simulation. Social distance constraints were enforced during the pandemic to reduce the potential spread of the virus and as a result, many educators and students were denied physical access to their universities' simulation facilities. Healthcare educators sought remote alternatives to manikin simulation and many resorted to instructional videos to educate their learners. While the use of videos increases safety, passively watching videos lacks interactivity which is an important component of simulation learning. In response to these challenges, we developed an interactive video simulation software that uses educators' existing video content to conduct a simulation remotely, thereby promoting safety during the pandemic while also meeting the interactivity standards of best practice for healthcare simulation. In this paper, we compare the interactive video simulation to the current practice of watching non-interactive video of a simulation using the same content. We found that interactivity promotes higher order learning, increases teamwork and enhances the perception of authenticity. Additionally, the majority of participants demonstrated positive reception of the interactive simulation. The simulation software provides the safety desired of a remote simulation during the pandemic while also engaging students in interactive learning experiences.