Healthcare Simulation Standards of Best PracticeTM The Debriefing Process

Designing Evidence-based Simulation Scenarios for Clinical Practice

Simulation-based education is a widely used teaching technique in healthcare education. Simulation can provide a rich learning environment for caregivers at all levels. Creating simulation-based scenarios is a systematic, evidence-based, learner-centered process that requires skill and expertise. There are 11 known criteria of best practice in simulation design. Using best practices in simulation scenario design development can provide the bedrock for learners to engage in clinical practice with competency, confidence, and caring. Examples and suggestions are provided to guide readers to create quality, learner-centered simulation scenarios using the Healthcare Simulation Standards of Best Practice: Simulation Design.

Implementation of a Mental Health Objective Structured Clinical Examination (OSCE) Using Standards of Best Practice

ABSTRACT

The objective structured clinical examination (OSCE) is effective for the evaluation of clinical competence. Studies examining the use of OSCEs in undergraduate mental health nursing education in the United States are limited. A pilot study and a follow-up study were conducted to establish the reliability and validity of a mental health OSCE to evaluate the clinical competence of prelicensure nursing students. International Nursing Association for Clinical Simulation and Learning Standards of Best Practice were used to guide the design and implementation. Results from both studies provide evidence for the use of OSCE in undergraduate mental health nursing education.

Trauma-Informed Care in Nursing Curricula: Development of a Simulation-Based Educational Framework to Guide Health Professions

AIM

This research aimed to uncover elements of a comprehensive, trauma-informed (TI) multidisciplinary health professions simulation framework to improve the delivery of care to traumatized patients.

BACKGROUND

Trauma is a pervasive public health problem requiring a TI approach. Simulation is an evidence-based teaching strategy that advances knowledge and clinical reasoning. There is a lack of scientifically based simulation education models addressing the delivery of TI care for the health professions.

METHOD

A Delphi study utilizing a panel of experts was conducted to identify the most critical elements of a simulation framework.

RESULTS

Phase one identified 10 content areas and 111 subcontent areas. Phase two analysis revealed 99 percent of the 111 subcontent areas achieved expert consensus.

CONCLUSION

This Delphi study provides the first scientifically based framework to guide the development of a comprehensive, TI, multidisciplinary simulation framework to recognize trauma survivors and subsequently display concern and respect.

Breaking Barriers with Simulation-Enhanced Interprofessional Education: Transforming Interprofessional Education Through Simulation

Simulation-enhanced interprofessional education (SIM-IPE) offers an avenue to teach and facilitate communication, collaboration, and teamwork while gaining an appreciation for the unique roles different healthcare professionals from a variety of settings bring to such learning experiences. This article provides an initial overview of the current trajectory of interprofessional simulation-based education in healthcare practice. An introduction to the Interprofessional Education Collaborative Core Competencies and the Healthcare Simulation Standards of Best Practice will have a TM after Practice in superscript. Practical applications of integrating Sim-IPE into the varied workplaces where nurses are leaders within interdisciplinary teams are provided.

Implementing Simple and Effective Simulation Experiences

Implementing simple and effective nursing simulation experiences at the bedside or in a simulation center in a hospital setting can be an impactful way to enhance skill development, encourage critical thinking, and improve patient safety. However, there are often challenges and barriers to the bedside nurses participating in simulation in the hospital setting. Applying the Healthcare Simulation Standards of Best Practice will give the bedside nurse and educator consistency in implementing and planning effective simulations.

Creating an Effective Simulation Environment

Simulation is a teaching and learning strategy that is used commonly in healthcare education in academia and practice settings. Nurses at the bedside may recall times in their formal education where simulation was used as a form of clinical learning or evaluation of their performance. It is possible that with the rise of nurse residency programs and in situ simulation that bedside nurses are experiencing simulation regularly within the workplace as a means of professional development. This article will set the stage for educators to develop high-quality simulation experiences.

Learner Perception of Disaster Simulation Modalities: A Pilot Study

BACKGROUND

Both simulation and tabletop exercises are used in disaster training, but the efficacy of one approach versus the other is lacking.

PURPOSE

This pilot study explored the satisfaction, confidence, and perception of effectiveness among nursing students regarding 2 disaster preparedness training methods: simulation and tabletop exercises.

METHODS

A comparative quasi-experimental design assessed the effectiveness of 2 simulation experiences. Validated effectiveness and confidence survey tools were completed by 126 self-selected senior prelicensure baccalaureate nursing students after the completion of simulation experiences.

RESULTS

Tabletop exercises may be more effective to build confidence and understand pathophysiology. Full-scale simulations may be more effective in facilitating participant expression of feelings and providing a constructive evaluation of the simulation.

CONCLUSIONS

Variability among facilitators may have impacted the results of this pilot project. Further research is needed to enhance understanding of the effectiveness of tabletop and full-scale simulations for disaster preparedness in nursing education.

Innovative Insights: Teaching Best Debriefing Practices Through Debriefing the Debrief

BACKGROUND

Debriefing is essential in nursing education, aiding self-reflection and knowledge comprehension. Following the International Nursing Association for Clinical Simulation and Learning Standards of Best Practice for Debriefing is key in promoting self-awareness and achieving learning objectives. Nurse educator students must practice designing, prebriefing, facilitating, and debriefing simulations to identify areas for improvement.

METHOD

A simulation experience was developed for graduate nurse educator students who participated in a postoperative scenario as nurses. Debriefing followed using the Promoting Excellence and Reflective Learning in Simulation (PEARLS) method. Students debriefed the debrief gaining insight from an educator's perspective.

RESULTS

The experience was valuable, gaining insights into the application of simulation. Debriefing the debrief allowed for reflection and dialogue from the educators' perspective.

CONCLUSION

Debriefing the debrief allows nurse educator students to effectively analyze simulation-based education. Utilizing the PEARLS method allows for active engagement and reflection, improving the simulation's debrief. Deliberate practice and reflective debriefing prepare nurse educator students for their roles, by enhancing simulation outcomes and nursing education. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Post-simulation debriefing as a stepping stone to self-reflection and increased awareness - a qualitative study

BACKGROUND

The voice of the students should be engaged in simulation curriculum development. Involving the students in the development of debriefing strategies might result in a deeper understanding of learning. However, few studies have investigated the students' perspectives on debriefing strategies. The aim of the study was to explore nursing students' perspectives on the post-simulation debriefing.

METHODS

An explorative, descriptive design with a qualitative approach was used. Data were collected in December 2017 and May 2018 through focus group interviews with undergraduate nursing students in Norway immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing degree. Data were analysed using systematic text condensation.

RESULTS

Thirty-two nursing students participated in the study. The data analysis identified two main categories. The category 'Facilitator as a catalyst for reflection' illustrated the facilitator's multifaceted and vital role in initiating and guiding the students' reflection process in the debriefing. The category 'A process towards increased awareness' encompasses the students' guided process of acquiring new insight into their professional development, and how they put parts together to see the wholeness in what was simulated.

CONCLUSIONS

This study provides knowledge to facilitators regarding nursing students' perspectives on facilitating reflection and learning during debriefing discussions. The facilitator's multifaceted role in guiding the students' reflections and their process of acquiring new insight into their professional development were identified as critical to learning during debriefing.

Exploring communicative interactions in debriefing sessions with nursing students: A qualitative study

INTRODUCTION

Debriefing as a learning activity aims to elevate participants' competence through communicative interaction. This activity is an integral component of any formative simulation. Thus, the primary objective of this study was to explore debriefing as a communicative experience in nursing students within the context of interactive virtual simulation. The secondary objectives were: 1) To investigate the typology of interactions based on participants' discourse and 2) To identify the actions that students use to develop knowledge during debriefing.

METHOD

A qualitative exploratory study design involving six debriefing groups was conducted with 105 s-year nursing students. The debriefing sessions were analyzed following interactive virtual simulations in an in-person setting in the classroom. All sessions were recorded and transcribed verbatim. A mixed (deductive and inductive) content analysis approach was used.

RESULTS

A total of 2187 units of meaning were identified and categorized into 3 themes (interaction by participant, interaction by communicative action, and interaction by participant's communicative goal); nine subthemes (facilitator-student, student-student and student-facilitator; declarative - unidirectional, reactive - bidirectional and multidirectional-interactive; individualistic, competitive, and collaborative), and 5 categories (providing information; generating creative solutions; processing critical and deliberative information; positive interdependence and psychosocial relationships).

CONCLUSION

The students developed knowledge and practical communication skills, particularly reinforcing soft skills through collaborative interactions, predominantly multidirectional-interactive in nature. The facilitator and the interpersonal relationships among the participants fostered a safe and positive environment.

Educating Nurses in Sleep Screening, Brief Intervention, and Referral for Treatment

BACKGROUND

Poor sleep is an unrecognized problem among cancer survivors that affects quality of life. However, screening for sleep disorders is not routine in cancer care. To fill this gap, a self-paced online training program was designed for RNs to screen patients for sleep disturbance and provide brief intervention or referral for treatment (Sleep-SBIRT).

METHOD

A three-phase evaluation pilot study included the following steps: (a) develop an online training program with in situ simulation; (b) implement the program with RNs at a comprehensive cancer center; and (c) evaluate module and quiz completion rates and focus group thematic analysis.

RESULTS

Of the 22 RNs participating, 17 completed online modules and in situ simulation. The RNs were satisfied (M = 4.74/5, SD = 0.42) and self-confident (M = 4.45/5, SD = 0.45) with the learning. Focus group themes were learning new knowledge, learning online effectively, applying learning to in situ simulation, and intending to implement.

CONCLUSION

The RNs gained knowledge applying Sleep-SBIRT, but future larger studies are warranted. [J Contin Educ Nurs. 2024;55(8):387-392.].

Social Determinants of Health in Graduate Nursing Simulation Education: An Integrative Review

BACKGROUND

This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH).

METHODS

The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science.

RESULTS

Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023.

CONCLUSION

The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity.

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).

Promoting infant safe sleep practices among neonatal and paediatric nurses through simulation-based training program

PURPOSE

To evaluate the effect of a Simulation-based training (SBT) program on neonatal and paediatric nurses' knowledge regarding infant safe sleep practices.

BACKGROUND

Sudden infant death syndrome (SIDS) presents a major public health concern, preventable through the promotion of optimal safe sleep practices, particularly among neonatal and paediatric nurses. Despite its effectiveness in enhancing nurses' knowledge and clinical skills, SBT is not an adopted training method for nurses in Egypt.

DESIGN AND METHODS

A single-group pre- and post-test design involved 57 nurses from Neonatal Intensive Care Unit, Paediatric Intensive Care Unit, and Paediatric In-patient Unit. The study consisted of two stages. In the first stage, knowledge assessment to identify deficiencies. The second stage, researchers developed four SBT scenarios. Two of these scenarios were recorded for training purposes, while the other two were intended for nurses to actively participate in. Data were collected from May 2022 to January 2023.

RESULTS

A significant improvement in nurses' knowledge of infant safe sleep practices and SIDS prevention was observed (p = 0.000). Nurses expressed high satisfaction with the training program (mean score 45.035 ± 4.38).

CONCLUSION

This study provides evidence that simulation-based training is an effective approach to promoting safe infant sleep practices among neonatal and paediatric nurses.

PRACTICE IMPLICATIONS

Integrating SBT programs into nursing education can enhance nurses' knowledge and skills in infant-safe sleep practices, providing a realistic and interactive learning experience.

Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos

AIMS

To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS.

BACKGROUND

Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed.

DESIGN

A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education.

METHODS

The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting.

RESULTS

Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point.

CONCLUSION

Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.

The Interprofessional Standardized Patient Experience: An Effective Interprofessional Education Activity for Prelicensure Health Professional Students

Introduction

For future success in the modern health care environment, health professions students require effective interprofessional education experiences to develop their perceptions of other professionals on the health care team. The Interprofessional Standardized Patient Experience (ISPE) is an interprofessional education activity for prelicensure health professional students in nursing, pharmacy, physical therapy, medicine, social work, and occupational therapy.

Methods

The ISPE involved collaboration among students to conduct a subjective interview. Students from six health care professions individually interviewed a simulated patient while being observed by students from other professions. A structured faculty-guided debriefing session followed the comprehensive interview process. Students completed a voluntary pre- and post-ISPE survey with interprofessional questions and feedback on the activity. Descriptive statistics were used to analyze individual responses. Differences in student opinions by student profession and by the number of professions present were examined using chi-square tests.

Results

Over 4 consecutive academic years, 1,265 students completed the ISPE, and 1,028 completed the pre- and post-ISPE surveys. Analysis of the survey responses indicated that the ISPE enhanced student awareness of the functions of an interprofessional team and increased student knowledge of the roles of different health care professions. Students rated the ISPE as a valuable experience. Differences were noted in some of the measures by profession and group size.

Discussion

A single ISPE had a significant impact on prelicensure students' perceptions. The ISPE is a novel and effective approach to interprofessional education that students appreciate.

Interprofessional collaboration between health professional learners when breaking bad news: a scoping review of teaching approaches

OBJECTIVE

The objective of this scoping review was to examine teaching approaches used to teach interprofessional health professional learners how to break bad news collaboratively.

INTRODUCTION

When breaking bad news, health professionals must be equipped to deliver it skillfully and collaboratively; however, the literature shows that this skill receives little attention in program curricula. Consequently, health professionals can feel inadequately prepared to deliver bad news, which may lead to increased burnout, distress, and compassion fatigue.

INCLUSION CRITERIA

Studies that describe teaching approaches used to teach learners how to break bad news collaboratively were considered for inclusion. Studies must have included 2 or more undergraduate and/or postgraduate learners working toward a professional health or social care qualification/degree at a university or college. Studies including lay, complementary and alternative, or non-health/social care learners were excluded. Due to the primary language of the research team, only English articles were included.

METHODS

The JBI 3-step process was followed for developing the search. Databases searched included MEDLINE (Ovid), CINAHL (EBSCOhost), Embase, Education Resource Complete (EBSCOhost), and Social Work Abstracts (EBSCOhost). The initial search was conducted on February 11, 2021, and was updated on May 17, 2022. Title and abstract screening and data extraction were completed by 2 independent reviewers. Disagreements were resolved through discussion or with a third reviewer. Results are presented in tabular or diagrammatic format, together with a narrative summary.

RESULTS

Thirteen studies were included in the scoping review, with a range of methodologies and designs (pre/post surveys, qualitative, feasibility, mixed methods, cross-sectional, quality improvement, and methodological triangulation). The majority of papers were from the United States (n=8; 61.5%). All but 1 study used simulation-enhanced interprofessional education as the preferred method to teach interprofessional cohorts of learners how to break bad news. The bulk of simulations were face-to-face (n=11; 84.6%). Three studies (23.1%) were reported as high fidelity, while the remainder did not disclose fidelity. All studies that used simulation to teach students how to break bad news utilized simulated participants/patients to portray patients and/or family in the simulations. The academic level of participants varied, with the majority noted as undergraduate (n=7; 53.8%); 3 studies (23.1%) indicated a mix of undergraduate and graduate participants, 2 (15.4%) were graduate only, and 1 (7.7%) was not disclosed. There was a range of health professional programs represented by participants, with medicine and nursing equally in the majority (n=10; 76.9%).

CONCLUSIONS

Simulation-enhanced interprofessional education was the most reported teaching approach to teach interprofessional cohorts of students how to break bad news collaboratively. Inconsistencies were noted in the language used to describe bad news, use of breaking bad news and interprofessional competency frameworks, and integration of interprofessional education and simulation best practices. Further research should focus on other interprofessional approaches to teaching how to break bad news; how best to incorporate interprofessional competencies into interprofessional breaking bad news education; whether interprofessional education is enhancing collaborative breaking bad news; and whether what is learned about breaking bad news is being retained over the long-term and incorporated into practice. Future simulation-specific research should explore whether and how the Healthcare Simulation Standards of Best Practice are being implemented and whether simulation is resulting in student satisfaction and enhanced learning.

A Collaborative Simulation: Navigating Care and Advocacy for Diverse Patients in Crisis

BACKGROUND

Collaboration and cultural competence are essential to nursing practice. Simulation-based training allows students to explore sensitive topics safely while surveying their own biases.

METHOD

Faculty created a collaborative simulation involving baccalaureate nursing students based on a transgender adolescent with suicidal ideations and a controlling parent.

RESULTS

Three themes emerged during debriefings: empathy, communication, and safety. The faculty found this experience was ideal for students to process their perceptions while fine tuning soft skills needed to create a safe and inclusive environment.

CONCLUSION

Nurse educators should tailor simulation-based experiences to incorporate didactic concepts such as collaboration, ethics, diversity, and conflict management to afford students an opportunity to learn skills needed to provide safe and inclusive care. [J Nurs Educ. 2024;63(6):399-401.].

Perception of Knowledge Transfer from Clinical Simulations to the Care Practice in Nursing Students

Objective

This work sought to assess the perception of knowledge transfer from clinical simulations to the care practice in nursing students through effective debriefing.

Methods

An observational, descriptive, and cross-sectional study was conducted with a sample of 281 students during the 2020-2021 course, through una ad hoc survey from the Debriefing Assessment for Simulation in Healthcare (DASH) in Spanish, to assess competence areas that undergraduate students must reach to complete their studies.

Results

The survey conducted after each simulation showed that the students valued positively the debriefing sessions conducted by experts, with a mean score of 6.61 over 7 [6.56%-6.65%] based on 675 surveys analyzed, given that each student conducted more than one simulation within the academic course. It was observed in 221 completed answers that what was learned in the simulation was transferred to the practice in 89.23% [86.39%-92.06%], specifically in areas of Communication, Patient safety, Teamwork, and Leadership.

Conclusion

In the perception by the participating students, the use of effective debriefing in clinical simulation enabled knowledge transfer to the care practice, proving to be a crucial tool that helps to improve the formation of the future nurses.

Factors Affecting Nursing Students' Reflective Thinking During Simulation Debriefing

BACKGROUND

Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear.

PURPOSE

This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students.

METHODS

This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking.

RESULTS

Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students.

CONCLUSIONS

Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing.

Just Another Patient? Student Reflections on Providing Mental Health Care to Transgender and Gender Expansive People During Simulated Encounters

AIM

This study analyzed psychiatric-mental health nurse practitioner (PMHNP) students' reflections following a virtual simulated encounter with a patient who identified as transgender or gender expansive (TGE).

BACKGROUND

To reduce mental health disparities, PMHNP students must be prepared to deliver affirming care. Engaging in and reflecting on simulated encounters with standardized patients can improve PMHNP students' affirming care competency.

METHOD

A thematic analysis process was used to analyze student reflections during simulation debriefings.

RESULTS

Five themes emerged: application of affirming care principles, recognizing minority stressors, treating all patients the same, desire to learn more, and valuing authentic practice.

CONCLUSION

PMHNP students' reflections on the experience of providing care to a standardized patient who identified as TGE support the use of virtual simulations to prepare future providers to deliver affirming, person-centered care.

Use of different debriefing methods after in situ simulation with intensive care unit nurses

BACKGROUND

The debriefing phase is the simulation phase where performance improves and learning occurs. This study examined the effects of the learning conversation (LC)-based, 3D (defusing, discovering and deepening) model-based and unstructured debriefing methods on satisfaction and debriefing experience after in-situ simulation among intensive care unit (ICU) nurses.

METHODS

In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In- situ simulation was performed with an intensive care patient scenario. p < .05 was considered statistically significant.

RESULTS

The total Debriefing Experience Scale-Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p > .05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics.

CONCLUSION

Debriefing experience and satisfaction do not differ between the methods.

RELEVANCE TO CLINICAL PRACTICE

Implementation of the simulation in the ICU in - situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards.

Assessing Healthcare Simulation Facilitation: A Scoping Review of Available Tools, Validity Evidence, and Context Suitability for Faculty Development in Low-Resource Settings

SUMMARY STATEMENT

Assessment tools support simulation facilitation skill development by guiding practice, structuring feedback, and promoting reflective learning among educators. This scoping review followed a systematic process to identify facilitation assessment tools used in postlicensure healthcare simulation. Secondary objectives included mapping of the validity evidence to support their use and a critical appraisal of their suitability for simulation faculty development in low-resource settings. Database searching, gray literature searching, and stakeholder engagement identified 11,568 sources for screening, of which 72 met criteria for full text review. Thirty sources met inclusion; 16 unique tools were identified. Tools exclusively originated from simulation practice in high-resource settings and predominantly focused on debriefing. Many tools have limited validity evidence supporting their use. In particular, the validity evidence supporting the extrapolation and implications of assessment is lacking. No current tool has high context suitability for use in low-resource settings.

Engagement in Distance Healthcare Simulation Debriefing: A Concept Development and Framework

SUMMARY STATEMENT

Understanding distance health care simulation debriefing is crucial in light of the increased use of and emerging technology in remote education for reasons of accessibility, global collaboration, and continuous professional development. This article is a confluence of a number of previously published studies designed to serve as a foundation to develop the concept of "engagement in health care distance simulation debriefing" using the Schwartz-Barcott & Kim hybrid mixed methods model. The model uses 3 phases: theoretical (a realist systematic review of the literature), fieldwork (3 exploratory studies and 2 pilot experimental studies), and analytical (analysis of the theoretical and fieldwork findings through expert discussion). This study defines the concept of "engagement in health care simulation distance debriefing" through exploration of its uses and analysis in literature, interviews, and expert review. The hybrid approach to the analysis provided rigor to generate a new, reflective conceptual model. This conceptual model defines the complexity in engagement during distance debriefing and helps shape the development of simulationists and debriefers, leading to more effective distance simulations and debriefings.

Improving the quality of care and patient safety in oncology, the contribution of simulation-based training: A scoping review

Objective

Simulation-based training (SBT) is an effective educational method widely used in many clinical settings, including oncology. This study aimed to undertake a scoping review of research related to SBT in oncology to provide a comprehensive understanding of the role of SBT in enhancing the skills of healthcare professionals and thereby improving the quality of care and patient safety in oncology.

Methods

We conducted a scoping review to map published studies in Medline, Scopus, and Web of Science databases. Peer-reviewed articles about data on the role of SBT in improving and enhancing the skills of healthcare professionals in oncology published in English and French from 2012 to 2022 were retrieved. Two researchers screened, extracted, and analyzed all identified studies independently.

Results

Of the 1,013 publications identified in the initial phase, 29 studies were included in the analysis. Twenty-five of these studies focused on non-technical skills, such as decision-making, communication, teamwork, and cognitive abilities. Thirteen studies focused on technical skills. The results of all included studies showed significant improvement in the skills of oncology healthcare professionals through SBT programs. Fourteen studies subjectively assessed the role of this educational tool, while nine objectively evaluated it. Six studies used a combined subjective and objective evaluation method.

Conclusions

SBT is a very effective tool for improving the skills of healthcare professionals in oncology. Supporting and promoting SBT is essential to providing high-quality care and ensuring patient safety in all areas of health care.

[Status of the implementation of simulation-based education in Germany: A cross-sectional study]

Status of the implementation of simulation-based education in Germany: A cross-sectional study Abstract. Background: The importance of simulation-based learning in nursing education is growing. Its success depends on the qualification of facilitators and the use of standards. Up to now, there has been a lack of data on the state of implementation of simulation-based learning in nursing education in Germany. Research question: Which qualification level do simulation facilitators show in nursing education in Germany and which concepts and standards are used? Methods: A cross-sectional survey was conducted among simulation facilitators in three different educational areas. The questionnaire included socio-demographic and professional characteristics as well as qualification measures completed, and concepts and standards applied. Data were analysed descriptively by determining arithmetic means plus standard deviation (SD) or absolute and relative frequencies. Results: A total of 156 simulation facilitators (mean age 41.5 (SD 9.8) years, 74.2% female) participated. 95.4% of participants reported being (very) highly motivated for simulation-based learning. Specific simulation pedagogy training was completed by 16.8% of participants. The application of evidence-based concepts is not occurring across the board. Conclusions: Against the background of international standards, qualification needs for simulation facilitators in Germany become apparent. Increased specific, standardized continuing education and training as well as the establishment of evidence-based concepts are important for high quality in simulation facilitation.

Review of Objective Structured Clinical Examination Practices Within Pharmacy Programs Throughout the United States

OBJECTIVE

To update the description of current objective structured clinical examination (OSCE) practices within pharmacy schools in the United States and identify barriers to OSCE implementation and expansion.

METHODS

A survey was deployed to all accredited Doctor of Pharmacy programs within the United States. The survey was designed to collect information regarding the curricular mapping of OSCEs, OSCE design, OSCE delivery, assessment of OSCE performance, and barriers to OSCE implementation and expansion.

RESULTS

Of the 135 US-accredited programs identified, 109 (81%) programs completed the survey. In total, 93 (85%) programs reported using OSCEs to assess students; however, implementation throughout the curriculum and current practices varied by institution. Most programs place OSCEs within specific courses (96%), with the applied skills coursework being the most used (80%). The most common number of OSCEs that occur throughout a curriculum is 6 (18%), however, 20 (22%) programs execute 10 or more OSCEs throughout their curriculum. Forty (43%) programs use OSCEs as high-stakes assessments where poor performance could prevent a student from progressing to advanced pharmacy practice experiences. Of the responding programs, over half (56%) use teaching objective structured examinations to enhance learning. Common barriers to OSCE expansion exist and are related to resource utilization.

CONCLUSION

Significant expansion of OSCE development and implementation has occurred over the last decade. There is substantial variability in implementation and utilization among programs. Although standards of best practice for OSCEs exist for other health professions, best practices in pharmacy education have not been widely accepted or adopted.

Nurturing a Nursing Workforce: Developing and Implementing Role-Play

Nurses' demands and challenges can sometimes lead to burnout, compassion fatigue, and a lack of focus on self-care. Implementing innovative strategies, such as role-play, may be instrumental in nurturing and rejuvenating the health care workforce. Role-play simulations offer a promising method to support essential skills and practices for health care workers. Using health care simulation is a widely accepted method to enhance critical thinking and decision-making among health care professionals. The International Nursing Association for Clinical Simulation and Learning (INACSL) Standards Committee in 2021 released the Healthcare Simulation Standards of Best Practice (HSSOBP), providing a structured framework to build and implement quality simulation-based education. These standards guide simulation scenarios' development, implementation, and evaluation, ensuring they align with educational objectives and promote experiential learning. This article describes role-play and how to develop and implement role-play scenarios built upon the HSSOBP.

Creating and running an escape room for healthcare curricula: AMEE Guide No. 168

In this guide we provide instructions and recommendations about creating and running escape rooms for healthcare education. In recent years there has been a growing interest in adopting escape rooms as an educational tool to be included in healthcare curricula, and we attempt to explain why and how these tools are fit for the particularities of this type of education. We first describe the steps that a design team will have to follow to create an educational escape room from scratch, from core characteristics like target audience and learning goals to actual puzzle design and testing. We then continue by providing recommendations to operators and lecturers about how to run such escape room as part of an overall teaching session that also includes a lecture, briefing, debriefing and evaluation. We finalise this guide by listing a set of tools for validating and evaluating these types of escape rooms.

Stroke Admission Simulation: Engaging Novice and Expert Nurses

In today's changing health care climate, clinical nurse educators are being challenged to educate nurses with a wide range of experience. This article describes the development and facilitation of a low-fidelity simulation used to educate nurses about identified gaps in standardized care during stroke admissions on a medical-surgical stroke unit at Legacy Emanuel Medical Center. The simulation was developed for use by novice and expert medical-surgical stroke nurses simultaneously. With the use of Bloom's Revised Taxonomy (Anderson et al., 2001), roles within the simulation were tailored to encourage the learning of nurses with varying levels of expertise. Overall, learners appeared to benefit from the class, which included the stroke admission simulation. Mean test scores increased from 55% pretest to 80% posttest. Additionally, 98% of learners found the simulation and lecture moderately helpful or extremely helpful. [J Contin Educ Nurs. 2024;55(3):113-119.].

Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format

AIM

This study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students' perceptions and how peer processes influenced reflection and learning.

BACKGROUND

Debriefing, a key component of clinical simulation, promotes development of nursing students' reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students' anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education.

DESIGN

This qualitative study used a Straussian grounded theory design.

METHODS

Senior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming.

RESULTS

The sample consisted of 34 students. Study findings revealed the core category of the constructed theory, 'Fluctuating cohesion', involved students' pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback.

CONCLUSIONS

The study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants' experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.

Instructional Video of a Standardized Interprofessional Postsimulation Facilitator-guided Debriefing of a Fatality in Plastic Surgery

Background

Postsimulation facilitator-guided debriefing (PSFGD) is the process of intentional discussion of thoughts, actions, and events that took place during simulation amongst the facilitator(s) and trainees. Despite the significance of delivering high-quality debriefings, there is a lack of evidence-based guidelines. Our study aimed to provide an instructional video demonstration of a PSFGD of a fatality.

Methods

Fifty surgical interns participated in a burn simulation scenario in two groups. Group 1 (control, or "no exposure," n = 25) consisted of residents who received oral postsimulation debriefing from an independent faculty member who had no exposure to our instructional video on how to debrief effectively. Group 2 (intervention, or "exposure," n = 25) consisted of interns who were debriefed by the second faculty member who did watch our instructional video before the simulation and learned about "advocacy and inquiry" techniques. The outcome measures were the Debriefing Assessment for Simulation in Healthcare score and the postdebrief multiple-choice question (MCQ) quiz scores to assess debriefers' performance and interns' knowledge consolidation, respectively.

Results

The "exposure" group presented statistically significantly higher values for the Debriefing Assessment for Simulation in Healthcare score (P < 0.001) and MCQ score (P < 0.001) compared with the "no exposure" group.

Conclusions

Debriefers who followed the methodology as demonstrated in our instructional video were considered more competent, and the residents achieved higher MCQ scores. The quality of the debriefing ensures improved critical thinking and problem-solving skills. Safer practice and better patient outcomes are achieved by developing debriefing programs for educators.

Nursing students satisfaction and self-confidence with standardized patient palliative care simulation focusing on difficult conversations

OBJECTIVES

Lack of experience communicating with patients and families at the end of life are key concerns for nursing students. Palliative care simulation using standardized patients (SPs) focusing on difficult conversations may lead to increased self-confidence in providing palliative and end-of-life care in clinical practice. There is currently a paucity of research on SP palliative care simulations in undergraduate nursing education. The objective of this research was to assess 3rd year undergraduate nursing students' levels of satisfaction and self-confidence with palliative and end-of-life care simulations focusing on difficult conversations, as measured by the Student Satisfaction and Self-Confidence in Learning Scale (SSSCLS) and the Simulation Design Scale (SDS).

METHODS

A descriptive post-intervention study. Four palliative care simulation days, consisting of 2 clinical scenarios, were conducted over 4 weeks. The first simulation was an outpatient palliative care clinic scenario, and the second was an inpatient hospital scenario. Nursing students enrolled in a 3rd year nursing palliative care elective (n = 51) at an Australian university were invited to participate. Students who attended simulation days were eligible to participate (n = 31). Immediately post-simulation, students were invited to complete the SSSCLS and the SDS. Fifty-seven surveys were completed (simulation 1, n = 28; simulation 2, n = 29). The data were analyzed using descriptive statistics.

RESULTS

Results showed that students had high levels of self-confidence in developing palliative care and communication skills after both simulation experiences and high levels of satisfaction with the SP simulations.

SIGNIFICANCE OF RESULTS

The lack of published literature on palliative care and end-of-life SP simulation highlights the need to collect further evidence to support this as an innovative approach to teaching palliative care. SP palliative care simulation focusing on difficult conversations assists in developing students' communication skills and improves satisfaction and self-confidence with palliative and end-of-life care.

Stronger together: learner reactions on a team-based, interprofessional first death simulation experience

Patient death is a common experience that may be traumatic for health care providers. Although current rates of burnout are high, evidence supports that interprofessional coping can improve clinician mental health. While health care simulation affords learners freedom of safety to participate in a variety of educational experiences, current application of simulation during patient death is limited to professional duties, without explicitly addressing learner emotional well-being. We designed a patient death simulation scenario within a supportive and reflective interprofessional environment to teach foundational coping and well-being strategies to preclinical nursing, medical, and pharmacy students. Sixty-one students participated in this team-based, First Death simulation experience. Debriefings were analyzed using qualitative inductive content analysis methodology. Students reacted to being part of an interprofessional team after having participated in simulation about the death of a patient as described by five categories: emotional awareness, communication insight, feeling stronger together, with role curiosity, and through reflections on support. Findings suggested that simulation is an effective teaching modality for mentoring interprofessional students on humanistic well-being strategies. Furthermore, the experience fostered reactions transcending interprofessional competencies, which are transferrable to future clinical practice.

Ethics: Crisis Standards of Care Simulation

Ethical dilemmas exist with decision-making regarding resource allocations, such as critical care, ventilators and other critical equipment, and pharmaceuticals during pandemics. Triage artificial intelligence (AI) algorithms based on prognostication tools exist to guide these decisions; however, implicit bias may affect the decision-making process leading to deviation from the algorithm recommendations. Conflict within the ethical domain may be affected as well. A knowledge gap was identified within the Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) curriculum regarding ethics in crisis standards of care (CSC) medical decision-making. Incorporating a CSC simulation looked to address this knowledge gap. A simulation-based learning (SBL) experience was designed as a critical access setting where CSC are in place and three diverse, medically complex patients in need of critical care present to the hospital where one critical care bed remains open. Given the complexity of the simulation scenario, a table-top pilot test was selected. Three AG-ACNP fourth-quarter students in their critical care rotation volunteered for the pilot test. Students were provided with the topic, "ethics crisis standards of care" and the article, "A catalogue of tools and variables from crisis and routine care to support decision-making during pandemics" by M. Cardona et al. (2021), to read in advance. Students were provided with the triage AI algorithm (M. Cardona et al., 2021) utilizing prognostication tools to prioritize which patient requires the critical care bed. The expectation was that implicit bias would enter the decision-making process, causing deviation from the triage AI algorithm and moral distress. The debriefing session revealed that students deviated from the triage AI algorithm, experienced implicit bias, moral distress, and utilized clinical judgment and experience to care for all three patients. The pilot test results support that a CSC SBL experience addresses a critical knowledge gap in AG-ACNP education and an SBL experience incorporating ethical decision-making curriculum with standardized patients should be developed and trialed as the next step.

Shaping Social Justice Values Through Inclusive Assessment and Debriefing of eLearning Modules

BACKGROUND

Nurses need to recognize how intersectionality shapes the experiences of individuals and families navigating complex health systems. Guided reflection on complex social justice issues serves as an approach to move beyond simply understanding social determinants of health toward shaping core professional values of developing nurses to promote lasting change.

METHOD

Third-year Canadian undergraduate prelicensure nursing students co-created assignment expectations, completed online modules, and submitted initial reflections before class in a mandatory social justice course. In-class debriefing was based on students' reflections and cofacilitated by subject matter experts. Students completed a final reflection that focused on advocating for social change.

RESULTS

Student feedback, reflections, and grades as well as faculty observations support the success of this interactive student-centered approach.

CONCLUSION

A flexible approach to debriefing modular content informed by universal design for learning and simulation theory enables nurse educators to promote in-depth, meaningful, and lasting student learning. [J Nurs Educ. 2024;63(1):48-52.].

Clinical simulation scenarios for the planning and management of infusion therapy by nurses

OBJECTIVE

to build, evaluate and test two clinical simulation scenarios for the planning and management of infusion therapy by nurses.

METHODS

methodological study, with construction of scenarios based on the NLN Jeffries Simulation Theory and the theoretical model Vessel Health Preservation; evaluation of the scenario design by judges, with calculation of the Modified Kappa Coefficient (MKC); testing scenarios with the target audience. Results: scenarios built for: 1. Patient assessment and vascular device selection; and 2. Identification and management of deep vein thrombosis. In the evaluation by judges, testing of validated scenarios in relation to educational practices and simulation design, the items evaluated presented MKC values ≥ 0.74.

CONCLUSION

two evidence-based scenarios related to infusion therapy were constructed, with high levels of agreement among judges regarding their design. In testing with nurses, good results were obtained regarding the design and structuring of educational practice.

An Evaluation of the Use of Low-Fidelity and High-Fidelity Mannequins in Clinical Simulations in a Module Preparing Final Year Children's and General Nursing Students for Internship Placement

Internationally, the use of simulation-learning environments in nursing education has escalated over the last number of years. Simulations have been recognized as providing clinical opportunities for student nurses to gain experience in a safe and controlled learning environment. A module specifically preparing fourth year children's and general nursing students for internship was developed. Preparation work for these simulation sessions included a video for the students to watch which demonstrated evidence-based care using sample simulations. This research aims to evaluate two simulation scenarios, using low-fidelity and high-fidelity mannequins for children's nursing students as part of a nursing module preparing them for internship practice placement. This mixed-methods evaluation survey of students was conducted in one School of Nursing in a Higher Education Institute in Ireland in the academic year 2021-2022. A simulated learning package was created using a partnership approach with members from the Higher Education Institute and the clinical learning site and piloted with 39 students. This was evaluated using an anonymous, online questionnaire with 17 student responses. An ethical exemption was granted for this evaluation. All students reported the use of the simulations, including the pre-simulation video as beneficial to enhance their learning and to prepare them for internship. The use of low-fidelity and high-fidelity mannequins enhanced their learning process. Students recommended implementing further simulations throughout their programme to enhance their learning experiences. The findings of this evaluation can provide guidance to aid future development of interactive simulations in preparing students for practice placements. Both low fidelity and high fidelity have their places in simulation and education, depending on the scenario and associated learning outcomes. Collaboration between academia and clinical practice is crucial, to bridge the theory-practice gap and demonstrate a positive relationship between staff in both settings.

Distance simulation in the health professions: a scoping review

BACKGROUND

Distance simulation is defined as simulation experiences in which participants and/or facilitators are separated from each other by geographic distance and/or time. The use of distance simulation as an education technique expanded rapidly with the recent COVID-19 pandemic, with a concomitant increase in scholarly work.

METHODS

A scoping review was performed to review and characterize the distance simulation literature. With the assistance of an informationist, the literature was systematically searched. Each abstract was reviewed by two researchers and disagreements were addressed by consensus. Risk of bias of the included studies was evaluated using the Risk of Bias 2 (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools.

RESULTS

Six thousand nine hundred sixty-nine abstracts were screened, ultimately leading to 124 papers in the final dataset for extraction. A variety of simulation modalities, contexts, and distance simulation technologies were identified, with activities covering a range of content areas. Only 72 papers presented outcomes and sufficient detail to be analyzed for risk of bias. Most studies had moderate to high risk of bias, most commonly related to confounding factors, intervention classification, or measurement of outcomes.

CONCLUSIONS

Most of the papers reviewed during the more than 20-year time period captured in this study presented early work or low-level outcomes. More standardization around reporting is needed to facilitate a clear and shared understanding of future distance simulation research. As the broader simulation community gains more experience with distance simulation, more studies are needed to inform when and how it should be used.

Reflective learning conversations model for simulation debriefing: a co-design process and development innovation

BACKGROUND

Health practitioners must be equipped with effective clinical reasoning skills to make appropriate, safe clinical decisions and avoid practice errors. Under-developed clinical reasoning skills have the potential to threaten patient safety and delay care or treatment, particularly in critical and acute care settings. Simulation-based education which incorporates post-simulation reflective learning conversations as a debriefing method is used to develop clinical reasoning skills while patient safety is maintained. However, due to the multidimensional nature of clinical reasoning, the potential risk of cognitive overload, and the varying use of analytic (hypothetical-deductive) and non-analytic (intuitive) clinical reasoning processes amongst senior and junior simulation participants, it is important to consider experience, competence, flow and amount of information, and case complexity related factors to optimize clinical reasoning while attending group- based post-simulation reflective learning conversations as a debriefing method. We aim to describe the development of a post-simulation reflective learning conversations model in which a number of contributing factors to achieve clinical reasoning optimization were addressed.

METHODS

A Co-design working group (N = 18) of doctors, nurses, researchers, educators, and patients' representatives collaboratively worked through consecutive workshops to co-design a post-simulation reflective learning conversations model to be used for simulation debriefing. The co-design working group established the model through a theoretical and conceptual-driven process and multiphasic expert reviews. Concurrent integration of appreciative inquiry, plus/delta, and Bloom's Taxonomy methods were considered to optimize simulation participants' clinical reasoning while attending simulation activities. The face and content validity of the model were established using the Content Validity Index CVI and Content Validity Ratio CVR methods.

RESULTS

A Post-simulation reflective learning conversations model was developed and piloted. The model was supported with worked examples and scripted guidance. The face and content validity of the model were evaluated and confirmed.

CONCLUSIONS

The newly co-designed model was established in consideration to different simulation participants' seniority and competence, flow and amount of information, and simulation case complexity. These factors were considered to optimize clinical reasoning while attending group-based simulation activities.

Development and evaluation of a problem-based learning simulation module for home-visit nursing

OBJECTIVES

Although home-visit healthcare programs in Korea are expected to expand, providing hands-on experience to nursing students may be limited. This study aimed to develop and evaluate a problem-based learning (PBL) simulation module that reflects home-visit healthcare services provided by public health centers for pre-frail older adults.

DESIGN AND SAMPLE

The simulation module, including PBL as prebriefing, was developed by the researchers and revised based on expert reviews. The module was evaluated using a mixed-method embedded one-group post-test-only design with focus group interviews (FGIs). Quantitative data (n = 29) were collected between April and June, 2021. FGIs (n = 10) were conducted twice in June 2021, and qualitative data were analyzed using an inductive content analysis approach.

RESULTS

The average score of the Simulation Design Scale was 4.67 ± 0.36. The overall mean score of the Educational Practices Questionnaire was 4.75 ± 0.37. Three themes emerged from the FGIs: immersive learning experience, changes in perspective on nursing, and enhanced nursing competency.

CONCLUSION

This PBL-based simulation module was evaluated as a systematic learning process in which nursing students could become self-directed learners, interacting and collaborating with colleagues, instructors, and environments. The module encourages them to practice home visit services.

The Impact of Single-Dose Debriefing for Meaningful Learning Training on Debriefer Quality, Time, and Outcomes: Early Evidence to Inform Debriefing Training and Frequency

AIM

This study evaluated the impact of a single dose of training in Debriefing for Meaningful Learning (DML) on learner knowledge outcomes and time spent in debriefing.

BACKGROUND

Regulatory bodies recommend that faculty who debrief receive training and competence assessment to ensure positive student learning outcomes, yet there is little literature describing the training needed. There is also little understanding of the impact of a single training on the length of debriefing, debriefer skill, and learner outcomes.

METHOD

Following training, debriefers submitted a recorded debriefing for assessment by experts; their learners completed knowledge assessment tests at three time points.

RESULTS

Longer debriefing time led to higher DML Evaluation Scale scores. Learner knowledge scores improved and later decayed.

CONCLUSION

The results of this study contribute to the evidence about the importance of training to debrief well, the impact of training on the length of debriefing time, and subsequent learner outcomes.

The development of a marker system for Pharmacists' Behavioural Skills

OBJECTIVES

Pharmacists increasingly require complex behavioural skills to fulfil enhanced roles within healthcare teams. Behavioural marker systems are used to assess behavioural (or non-technical) skills during immersive simulation. This study aimed to develop a marker system for pharmacists' behavioural skills in patient-focussed care scenarios, and to investigate its content validity.

METHODS

Literature describing existing marker systems and the requisite behavioural skills of pharmacists were presented to two expert panels, alongside video examples of pharmacists in patient-focussed care simulations. The expert panels used this information to develop a new behavioural marker system. A third expert panel assessed the content validity, and the item- and scale-content validity indices were calculated.

KEY FINDINGS

The resulting tool contains four categories, each with three or four skill elements: situation awareness (gathering information; recognising and understanding information; anticipating, preparing and planning), decision-making and prioritisation (identifying options; prioritising; dealing with uncertainty; implementing or reviewing decisions), collaborative working (involving the patient; information sharing; leadership or followership), self-awareness (role awareness; speaking up; escalating care; coping with stress). The scale-content validity index was 0.95 (ideal) and the only item below the acceptable cut-off was 'leadership or followership' (0.7).

CONCLUSIONS

This tool is the first marker system designed to assess the behavioural skills of pharmacists in patient-focussed care scenarios. There is evidence of good content validity. It is hoped that once validated, the Pharmacists' Behavioural Skills marker system will enable pharmacy educators to provide individualised and meaningful feedback on simulation participants' behavioural skills.

Health Care and Social Work Students' Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study

BACKGROUND

Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students' experiences with such a learning activity.

OBJECTIVE

The aim of this study was to explore occupational therapy, social education, nursing, and social work students' experiences with virtual reality simulation as a learning activity in an interdisciplinary subject.

METHODS

The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke.

RESULTS

The analysis revealed 3 overall themes for students' experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students' experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students' learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity.

CONCLUSIONS

Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services.

Effects of a Clinical Simulation-Based Training Program for Nursing Students to Address Social Isolation and Loneliness in the Elderly: A Quasi-Experimental Study

INTRODUCTION

The population of older adults is rapidly increasing worldwide, presenting both prospects and complexities for society and healthcare professionals to maximize the functional capacity of this age group. Social isolation and loneliness significantly affect this population. The objective was to determine the effectiveness, satisfaction, and perceptions of the simulation-based education practices of a training program for nursing students, which was created to palliate the social isolation and loneliness of older adults.

METHOD

A quasi-experimental study was conducted with nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronous practical training using an online platform. Five scenarios were designed using simulated phone calls to address the social isolation and loneliness of older adults.

RESULTS

Twenty-five nursing students participated in the program, and they had a mean age of 27.44, with 76% of them being women. After the training program, the participants showed statistically significant improvements (p < 0.05) with respect to their knowledge and attitudes towards older adults, and the program was adapted to the best educational practices in simulations.

CONCLUSIONS

Simulation-based online training efficiently improved the knowledge and attitudes of nursing students towards older adults, improving their ability to address social isolation and loneliness. The high satisfaction and adhesion to the best educational practices underline the usefulness of high-fidelity online simulations, especially in situations in which face-to-face training is not feasible, and accessibility and equilibrium could be guaranteed between work and personal life.

Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study

BACKGROUND

Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces.

METHODS

This qualitative study used focus group interviews with 24 VAST FC graduates (from 12 low- and middle-income and 12 high-income countries) to explore how they had applied new learning in the workplace. Focus groups were conducted by videoconferencing with data transcribed verbatim. Data were analyzed using inductive thematic analysis.

RESULTS

Enabler themes for knowledge and skill translation following facilitator training were (1) the structured debriefing framework, (2) the ability to create a supportive learning environment, and (3) being able to meaningfully discuss nontechnical skills. Two subthemes within the debriefing framework were (1.1) knowledge of conversational techniques and (1.2) having relevance to clinical debriefing. Barrier themes limiting skill application were (1) added time and effort required for comprehensive debriefing, (2) unsupportive workplaces, and (3) lack of opportunities for mentorship and practice postcourse.

CONCLUSIONS

Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.

Testing the Impact of an Asynchronous Online Training Program With Repeated Feedback

BACKGROUND

Learning to effectively debrief with student learners can be a challenging task. Currently, there is little evidence to support the best way to train and evaluate a debriefer's competence with a particular debriefing method.

PURPOSE

The purpose of this study was to develop and test an asynchronous online distributed modular training program with repeated doses of formative feedback to teach debriefers how to implement Debriefing for Meaningful Learning (DML).

METHODS

Following the completion of an asynchronous distributed modular training program, debriefers self-evaluated their debriefing and submitted a recorded debriefing for expert evaluation and feedback using the DML Evaluation Scale (DMLES).

RESULTS

Most debriefers were competent in DML debriefing after completing the modular training at time A, with DMLES scores increasing with each debriefing submission.

CONCLUSION

The results of this study support the use of an asynchronous distributed modular training program for teaching debriefers how to implement DML.

Challenges for future directions for artificial intelligence integrated nursing simulation education

Artificial intelligence (AI) has tremendous potential to change the way we train future health professionals. Although AI can provide improved realism, engagement, and personalization in nursing simulations, it is also important to address any issues associated with the technology, teaching methods, and ethical considerations of AI. In nursing simulation education, AI does not replace the valuable role of nurse educators but can enhance the educational effectiveness of simulation by promoting interdisciplinary collaboration, faculty development, and learner self-direction. We should continue to explore, innovate, and adapt our teaching methods to provide nursing students with the best possible education.