The Integration of Virtual Simulation Gaming Into Undergraduate Nursing Resuscitation Education: A Pilot Randomised Controlled Trial

Effects of educational methods using extended reality on pre-registration nursing students' knowledge, skill, confidence, and satisfaction: A systematic review and meta-analysis

AIMS

This study examined whether educational methods utilizing extended reality (XR) improve pre-registration nursing students' knowledge, skills, confidence, and satisfaction compared with traditional methods.

DESIGN

We conducted a systematic review and meta-analysis of the effectiveness of XR in nursing education based on the Cochrane methodology.

DATA SOURCES

Randomized controlled trials (RCTs) were searched in MEDLINE, CINAHL, ERIC, Web of Science, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi from inception of each database to March 21, 2024.

REVIEW METHODS

Two authors independently screened study titles and abstracts to identify potentially relevant studies. Subsequently, two reviewers independently assessed the eligibility of the studies based on full-text reviews and extracted the data. They calculated the pooled effect estimates associated with pre-registration nursing students' knowledge and skills, confidence, and satisfaction using a random-effects meta-analytic model.

RESULTS

Among the 1615 records identified, 128 studies were identified. Following full-text evaluation, 38 studies were included in the systematic review. The meta-analysis included 34 studies. XR had significant positive effects on knowledge (N = 1926, standard mean difference [SMD] = 0.55, 95 % confidence interval [CI]: 0.34 to 0.77), skills (N = 904, SMD = 1.00, 95 % CI: 0.46 to 1.54), and satisfaction (N = 574, SMD = 1.19, 95 % CI: 0.09 to 2.30). In particular, immersive virtual reality (VR) had significant positive effects on knowledge (N = 707, SMD = 0.60, 95%CI: 0.36 to 0.83), skills (N = 302, SMD = 1.60, 95%CI: 0.70 to 2.50), and satisfaction (N = 406; SMD = 1.63, 95%CI: 0.04 to 3.22).

CONCLUSIONS

XR may be a viable teaching strategy for improving knowledge, skills, and satisfaction acquisition. In particular, immersive VR improves knowledge, skills, and satisfaction. XR could not be a direct replacement for traditional methods but can complement pre-registration nursing students' traditional education methods.

The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis

AIM

The purpose of this study was to analyze the effectiveness of virtual reality technology in nursing education.

BACKGROUND

Virtual reality technology is regarded as one of the advanced and significant instructional tools in contemporary education. However, its effectiveness in nursing education remains a subject of debate, and there is currently limited comprehensive research discussing the impact of varying degrees of virtual technology on the educational effectiveness of nursing students.

DESIGN

Systematic review and meta-analysis.

METHODS

The present systematic review and meta-analysis were applied according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The PubMed, Embase, CINAHL, ProQuest, Cochrane Library, Web of Science, and Scopus were searched for relevant articles in the English language. The methodologies of the studies evaluated were assessed using Cochrane Risk of Bias2 (ROB 2) tool and Joanna Briggs Institute (JBI) assessment tool. We took the learning satisfaction, knowledge, and skill performance of nursing students as the primary outcomes, and nursing students' self-efficacy, learning motivation, cognitive load, clinical reasoning, and communication ability were assessment as secondary outcomes. The meta-analysis was performed using R 4.3.2 software according to PRISMA guidelines. Heterogeneity was assessed by I2 and P statistics. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were used as effective indicators.

RESULTS

Twenty-six studies were reviewed, which involved 1815 nursing students. The results showed that virtual reality teaching, especially immersive virtual reality, was effective in improving nursing students' learning satisfaction (SMD: 0.82, 95%CI: 0.53-1.11, P < 0.001), knowledge (SMD: 0.56, 95%CI: 0.34-0.77, P < 0.001), skill performance (SMD: 1.13, 95 % CI: 0.68-1.57, P < 0.001), and self-efficacy (SMD: 0.64, 95%CI: 0.21,1.07, P < 0.001) compared to traditional teaching methods. However, the effects of virtual reality technology on nursing students' motivation, cognitive load, clinical reasoning, and communication ability were not significant and require further research.

CONCLUSIONS

The results of this study show that virtual reality technology has a positive impact on nursing students. Nonetheless, it is crucial not to underestimate the effectiveness of traditional education methods, and future research could analyze the impact of different populations on nursing education while improving virtual reality technology, to more comprehensively explore how to improve the quality of nursing education. Moreover, it is imperative to emphasize the integration of virtual education interventions with real-world experiences promptly. This integration is essential for bridging the gap between the virtual learning environment and real-life scenarios effectively.

REGISTRATION NUMBER

CRD42023420497 (https://www.crd.york.ac.uk/PROSPERO/#recordDetails).

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BACKGROUND

Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation.

METHODS

A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.

RESULTS

Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability.

CONCLUSIONS

The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

Effectiveness of Virtual Reality Simulation Among BSN Students: A Meta-analysis of Randomized Controlled Trials

This study aimed to evaluate the effect of virtual reality simulation in nursing education in five domains: knowledge, skill performance, self-confidence, self-efficacy, and satisfaction. Randomized controlled trials were obtained from the databases SCOPUS, Web of Science, PubMed, and EBSCO from inception until September 2021. The standardized mean differences with 95% confidence intervals were determined for the main variables, and heterogeneity was analyzed using the I2 test. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used. Meta-analysis was performed using the Stata 15.0 software. Among the 2074 records identified, 18 trials were included. The meta-analysis of these trials indicated that virtual reality simulation caused a significant improvement in knowledge with a moderate effect, skill performance with a moderate effect, and satisfaction with a moderate effect compared with the control group. However, virtual reality simulation did not significantly influence self-confidence and self-efficiency. The findings of this study suggested that virtual reality simulation might significantly benefit knowledge, skill performance, and satisfaction but not self-confidence and self-efficiency. Further well-designed randomized controlled trials with a larger sample size are recommended to confirm these findings.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods

OBJECTIVES

This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.

INTRODUCTION

Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.

INCLUSION CRITERIA

Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.

METHODS

The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.

RESULTS

Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.

CONCLUSION

This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

The effects of virtual gaming simulation on nursing students' diagnosis, goal setting, and diagnosis prioritization: A randomized controlled trial

BACKGROUND

Virtual gaming simulation is a 2D computer game used to enhance the knowledge and skills of nursing students.

OBJECTIVES

This research was conducted to investigate the effects of virtual gaming simulation on the nursing diagnosis, goal setting and diagnosis prioritization of first-year nursing students.

DESIGN

Randomized controlled trial conducted between March and April 2022.

PARTICIPANTS

In this study, 102 first-year nursing students registered in Fundamentals of Nursing-II were included. The students were divided at random into two groups: control (n = 51) and intervention (n = 51).

METHOD

Data were collected using the descriptive characteristics form, nursing diagnosis, goal setting, diagnosis prioritization form, virtual evaluation simulation and virtual gaming simulation evaluation form. Didactic training in the nursing process was provided to all students in the classroom simultaneously. The day following the didactic training, the training scenario was explained to the control group in the classroom. On the same day, a simulation of the virtual training scenario developed for the intervention group was played in the computer lab. One week later, the control group completed the nursing diagnosis, goal setting and diagnosis prioritization form prepared for the evaluation scenario in the classroom and the intervention group played the virtual evaluation simulation that was developed based on the same case on the same day in the computer lab. Then, students' opinions regarding virtual gaming simulation were obtained.

RESULTS

The findings showed that the mean scores of nursing diagnosis and goal-setting knowledge of the intervention group were significantly higher than those of the control group (p < 0.05), whereas there was no significant difference between the groups regarding the mean scores of diagnosis prioritization knowledge (p > 0.05).

CONCLUSIONS

Virtual gaming simulation increased the mean scores of nursing diagnosis and goal-setting knowledge of the students. Most of the students stated positive statements related to virtual gaming simulations.

Developing simulation games to advance public health nursing competence in baccalaureate education

We describe the development of an innovative baccalaureate nursing education strategy for public health nursing. Virtual simulation pedagogy is known to be effective for acute care nursing practice while less known for public health nursing. Three Canadian nursing schools, the Canadian Association of Schools of Nursing (CASN), and the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) partnered to develop three public health nursing virtual simulation games. Learners work through unfolding population health scenarios, simulating public health nursing practice focused on entry level public health nursing competencies. Each game fosters clinical reasoning and collaborative, community decision-making to respond to population health issues during community assessment, evidence-informed health promotion planning, and evaluation processes. A companion guide was developed to support best practices in implementing virtual simulation and promote optimum student learning using the public health nursing games.

Global Trends and Hot-Spots in Research on Virtual Simulation in Nursing: A Bibliometric Analysis From 1999 to 2021

Background

Virtual simulation has been widely used in nursing education and nursing training. This study aims to characterize the publications in terms of countries, institutions, journals, authors, collaboration relationships, and analyze the trends of virtual simulation in nursing research.

Methods

Publications regarding virtual simulation in nursing were retrieved from Web of Science core collection. Microsoft Excel 2010, VOSviewer were used to characterize the contributions of the authors, journals, institutions, and countries. The trends, hot-spots and knowledge network were analyzed by Citespace and VOSviewer.

Results

We identified 677 papers between 1999 and 2021. The number of publications grew slowly until 2019, after that, it got a sharp increase in 2020 and 2021. The USA, Canada and Australia were three key contributors to this field. Centennial College and University of San Paulo, University of Ottawa and Ryerson University were top major institutions with a larger number of publications. Verkuyl M was the most productive and highest cited author. Clinical Simulation in Nursing, Nurse Education Today, Journal of Nursing Education were the three productive journals. The foundational themes of virtual simulation research in nursing are “virtual learning during COVID-19, clinical nursing care, education in nurse practitioners, education technology”.

Conclusion

Virtual simulation in nursing field has attracted considerable attention during COVID-19 pandemic. The research hotspot is gradually shifting from clinical nursing care to studies of nursing education using different virtual simulation technologies

Incidence of Recurrent Venous Ulcer in Patients Treated at an Outpatient Clinic: Historical Cohort

The recurrence of venous ulcers is the wound reopening after a period of completed epithelisation of a previous ulcer due to exposure to causal factors and lack of prevention. Venous ulcers have a high recurrence rate that may increase through the years. Epidemiological evidence on its incidence and risk factors is scarce due to the lack of patient follow-up in outpatient clinics and adherence to treatment after healing. The objective was to analyze the incidence of venous ulcers recurrency in outpatients and the risk factors for its occurrence. It is an observational historical cohort with retrospective data collection, performed through electronic medical records. Setting: private health insurance outpatient clinic. The participants were adult patients with healed venous ulcers. Incidence of venous ulcer recurrence was calculated within individuals with healed ulcers from 2014 and 2018 with a follow-up of at least one year. Bivariate analysis and logistic regression were used to explore risk factors considering demographic, clinical, and wound-related variables. As a result, sixty-five (65) of the 134 patients with healed venous ulcers had a recurrence, leading to an incidence of 48.5%, with a mean onset time of 230.1 (SD 267) days. Patients with recurrent venous ulcers were primarily women (39/48.1%), with a mean age of 64 (SD 15.5) years, 57 (50.8%) had some comorbidity, with systemic arterial hypertension as the most frequent (47/51%). Obesity (15/88.2%) increased the risk of venous ulcers recurrence by 8.7 (OR 95% CI 2.1-60.8; P = .009) times. In conclusion, venous ulcers recurrence incidence was 48.5%, with obesity as a risk factor. This study demonstrates that the clinical approach of people with venous ulcers should not finish when the wound is healed. For ulcer recurrence prevention interventions addressing systemic factors, besides topical management of the wound, are essential.