Healthcare Simulation Standards of Best PracticeTM Evaluation of Learning and Performance

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.

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.

The Role of Simulation in Graduate Nursing Education: Preparing Learners for Practice

The effectiveness of simulation to reduce the theory-practice gap in graduate nursing education is supported by an extensive body of research, and numerous studies have demonstrated improved learner outcomes in such areas as clinical competence, confidence, and preparedness for practice. This paper explores the types of simulation-based education available for graduate nursing programs and provides examples of graduate nursing simulations that educators can use in their own programs to prepare clinicians for practice.

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.

Nursing Students' Perceptions of a Novel Education Approach to Prevention and Control of Healthcare-Associated Infections: Insights from PrevInf Pilot Study

BACKGROUND

Healthcare-associated infections (HAIs) pose a significant global threat, particularly in developing regions such as Southeast Asia. International bodies emphasize the role of formal undergraduate training in the prevention and control of HAIs. To address this, we aimed to explore the perceptions of Southeast Asian nursing students regarding a novel educational approach developed by a European-Southeast Asian project consortium.

METHODS

A pilot study was conducted in four nursing higher education institutions from Cambodia and Vietnam. First, local nursing educators conducted a 2 h classroom-based training session. Then, students were invited to participate for the first time in one of twelve evidence-based simulation scenarios developed by the research team, covering a range of nursing care situations related to the prevention and control of HAIs. After attending both components, students were asked to complete a paper-based questionnaire and rate their agreement with a set of statements on the appropriateness and meaningfulness of both components.

RESULTS

A total of 430 nursing students enrolled in the pilot study; 77.4% were female, with an average age of 19.8 years. The PrevInf educational intervention received positive feedback from participating students across settings, with strong agreement on the importance of proactiveness in competency development (M = 5.9, SD = 1.4). Notable differences between Cambodian and Vietnamese students were observed in terms of their receptiveness to the pre-selected teaching materials (p = 0.001) and strategies (p = 0.01) used by the nursing educators during their experience with the simulation scenarios.

CONCLUSIONS

The PrevInf educational intervention shows promise in engaging Southeast Asian nursing students and fostering a deeper understanding of the prevention and control of HAIs. Further studies are warranted to refine the learning content and standardize the pedagogical strategies used by nursing educators across settings. This study was not registered.

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.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies

Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.

Systematic review: Self-efficacy and skill performance

AIM

The aim of this systematic review was to investigate the relationship between self-efficacy and skill performance in undergraduate student nurses.

BACKGROUND

Across higher education, self-efficacy is an important predictor of student success in skill-based learning. Nursing students are required to demonstrate skills prior to caring for hospitalized patients. Understanding the relationship between self-efficacy and nursing student skill performance may support patient safety.

METHODS

Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a systematic search was conducted of four databases: CINAHL, Medline, Psychinfo, and Web of Science. Quantitative, peer-reviewed studies published in English were included with no limitation on year. Hands-on skill performance had to be performed in laboratory or simulation settings and evaluated by an expert. Identified studies were assessed for methodological rigor using Joanna Briggs Institute's Critical Appraisal Tools.

FINDINGS

A total of 2,450 items were identified by database search and screened, resulting in 20 eligible studies. Most of the studies included novice first- or second-year students. Self-efficacy was operationalized as either a general or skill-specific measure, while the type of skill and associated instrumentation varied widely. Sixteen (80%) of the included study reports showed weak to no correlation between self-efficacy and skill performance. The remaining 4 reports noted a moderate-to-strong relationship.

CONCLUSION

Our findings conflict with existing research in other higher education disciplines where self-efficacy is a significant predictor of performance success. Explanations for this contradiction likely center around how self-efficacy was operationalized and rigor of the included studies.

IMPLICATIONS FOR NURSING

Larger studies controlling for confounding variables are needed to understand this relationship with a goal of developing more consistent approaches to teaching and learning skills within prelicensure curriculums.

The effectiveness of high-fidelity simulation methods to gain Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students: A randomized controlled trial

BACKGROUND

The use of high-fidelity simulation (HFS) methods provides probable benefits and advantages for nursing students to retain knowledge, acquire skills, improve satisfaction, and gain self-confidence in a safe, realistic and supportive environment.

OBJECTIVES

To evaluate the effect of HFS methods to develop Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students when compared to low-fidelity simulation (LFS). The specific aim was to examine the effects of outcome variables between the intervention group and the control group, through multi-group path analysis.

DESIGN

A randomized controlled trial was designed.

SETTINGS AND PARTICIPANTS

80 nursing students were randomly assigned to the HFS group (high-fidelity manikin and scenario) and the LFS group (female catheterization simulator) at a nursing faculty between May and July 2019 in Türkiye.

METHODS

The intervention group experienced HFS and the control group experienced LFS in order to learn Foley catheterization. Students' knowledge was evaluated before and after the intervention, while affective and psychomotor skills, and satisfaction and self-confidence in learning were evaluated after the intervention.

RESULTS

The HFS group had better skill performance and significantly higher self-confidence in learning than the LFS group. While each group had a high level of knowledge, affective skills and satisfaction, there was no significant difference between the groups' mean scores.

CONCLUSIONS

The HFS and scenario improved the knowledge, affective and psychomotor skills, satisfaction and self-confidence of novice nursing students on Foley catheterization. When compared to LFS, HFS had more advantages for the development of psychomotor skills and self-confidence in learning.

Competency-based assessment in neonatal simulation-based training

Simulation is a cornerstone of training in neonatal clinical care, allowing learners to practice skills in a safe and controlled environment. Competency-based assessment provides a systematic approach to evaluating technical and behavioral skills observed in the simulation environment to ensure the learner is prepared to safely perform the skill in a clinical setting. Accurate assessment of competency requires the creation of tools with evidence of validity and reliability. There has been considerable work on the use of competency-based assessment in the field of neonatology. In this chapter, we review neonatal simulation-based training, examine competency-based assessment tools, explore methods to gather evidence of the validity and reliability, and review an evidence-based approach to competency-based assessment using simulation.

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.

Development and psychometric testing of the non-technical skills scale in medical and surgical hospital units for nursing students

OBJECTIVE

To develop and validate a tool to assess the non-technical skills of medical and surgical hospital units undergraduate nursing students.

BACKGROUND

In the area of healthcare, non-technical skills complement technical ones, and contribute to patient safety. High-fidelity simulation is an ideal resource for working on these skills. Thus, evaluation instruments are needed to understand the efficiency of this methodology. Although many evaluation instruments already exist, none measure non-technical skills of undergraduate nursing students in medical and surgical hospital units.

DESIGN

An instrumental study design was employed.

METHODS

Two-phases were used to develop and validate the scale: 1) Scale development. A group of experts defined the dimensions and components. Afterwards, the content was validated by experts, and a pilot study was conducted with undergraduate Nursing students. 2) Analysis of the psychometric properties of the scale. A total of 393 students were evaluated in high-fidelity simulation scenarios by three evaluators, through the use of the Non-Technical Skills in Medical and Surgical Hospital Units (NTS-Nursing) Scale.

RESULTS

The content validity indexes were adequate for the total of the items and the total of the scale. The statistical descriptors of the items, the internal structure, and the reliability (internal consistency and inter-evaluator reliability) were analyzed, as well as the external evidence of validity, with adequate values obtained.

CONCLUSION

The NTS-Nursing scale is a valid and reliable instrument. Its structure of 10 items makes its use fast and easy.

The Effects of a Scenario-Based Spiritual Care Course on Spiritual Care Competence among Clinical Nurses: A Quasi-Experimental Study

Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses' spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses' ability to support patients with spiritual care needs.

Best Educational Techniques in High-Fidelity Simulation According to Nursing Students-Adaptation and Validation of the Educational Practices Questionnaire (EPQ)

The purpose of this study was to evaluate the best educational techniques used during high-fidelity simulations in training nursing students and to introduce the Polish version of the Educational Practices Questionnaire (EPQ) scale after its cultural adaptation and determination of its psychometric properties. The research group was composed of 361 second- and third-year nursing students in the licentiate program. The Cronbach's alpha reliability coefficients for the adapted tool were 0.90 for the EPQ-PO (presence of educational techniques) subscale and 0.93 for the EPQ-IO subscale (importance of educational techniques). Additionally, the model fit rates in the CFA and EFA (as indicators of theoretical validity) proved to be high enough for the tool to be successfully used in scientific research. Preliminary results are also presented; the mean value of the response for the entire EPQ scale for both the PO and IO sections was M = 4.3, SD ± 0.90. The students in the study rated the opportunity for collaboration with other students and for working jointly on a given clinical situation very highly at M = 4.5, SD ± 0.70. The analysis of the scores of the individual scales and subscales of the EPQ showed statistically significant differences in results obtained for such variables as gender, place of residence, and year of studies.

Utilization of Phone Simulations to Assess Competency Within Nursing Education

BACKGROUND

Phone simulations offer educators unique opportunities for teaching and assessment with reduced scheduling and location barriers.

PROBLEM

Challenges to learner assessments are multifaceted, including decreased availability of clinical sites, preceptors, and, at times, clinical instructors.

APPROACH

This article describes the creation and implementation of diverse phone simulations at multiple levels of nursing education and provides suggestions for broader replication and adaptation.

OUTCOMES

Phone simulations are easily implemented, well received, and helpful in assessing student learning and progression. At the generalist level, telephone SBAR (situation, background, assessment, and recommendation) simulations promote essential communication skills imperative in the delivery of safe and effective care. For advanced practice learners, phone simulations are easily applied across multiple populations and specialties. Guided reflections following simulation offer learners an opportunity to immediately self-remediate.

CONCLUSIONS

Phone simulations provide adaptable opportunities to support learning and assess knowledge and competency within educational and clinical settings.

Simulation-based clinical assessment identifies threshold competence to practise physiotherapy in Australia: a crossover trial

BACKGROUND

Although evidence exists for the efficacy of high-fidelity simulation as an educational tool, there is limited evidence for its application in high-stakes professional threshold competency assessment. An alternative model of simulation-based assessment was developed by the Australian Physiotherapy Council (APC), using purpose-written standardised patients, mapped to the appropriate threshold level. The aim of this two-phase study was to investigate whether simulation-based clinical assessments resulted in equivalent outcomes to standard, real-life assessments for overseas-trained physiotherapists seeking registration to practice in Australia.

METHODS

A randomised crossover trial comparing simulation-based assessment to real-life assessment was completed. Participants were internationally trained physiotherapists applying for registration to practice in Australia, voluntarily recruited from the Australian Physiotherapy Council (APC) assessment waiting list: study 1 n = 25, study 2 n = 144. Study 1 participants completed usual APC real-life assessments in 3 practice areas, completed on different days at APC partner healthcare facilities. Participants also underwent 3 practice area-matched simulation-based assessments, completed on the same day at purpose-designed simulation facilities. Study 2 participants completed 3 simulation-based assessments and 1 real-life assessment that was randomly allocated for order and practice area. Assessment of competency followed the standard APC procedure of 90-minute examinations using The Moderated Assessment Form (MAF).

RESULTS

The overall pass rate was higher for real-life assessments in both studies: study 1, 50% versus 42.7%; study 2, 55.6% versus 44.4%. Chi-square analysis showed a high to moderate level of exact matching of pass/fail grades across all assessments: study 1, 73.4% (p < 0.001); study 2, 58.3% (p = 0.027). Binary logistic regression showed that the best predictors of real-life pass/fail grade were simulation-based MAF pass/fail grade (study 1, OR 7.86 p < 0.001; study 2, OR 2.037, p = 0.038) and simulation-based total MAF score (study 1, OR 1.464 p < 0.001; study 2, OR 1.234, p = 0.001).

CONCLUSION

Simulation-based assessment is a significant predictor of clinical performance and can be used to successfully identify high stakes threshold competence to practice physiotherapy in Australia.

Can a high-fidelity simulation tutorial improve written examination results? Review of a change in teaching practice

BACKGROUND

Undergraduate nursing students prefer technology-based learning. Simulation has been used in nursing education to provide skills acquisition and clinical exposure. Can high-fidelity simulation (HFS) be used to teach tutorial content to prepare students for a written examination?

AIMS

To design a pilot HFS tutorial.

METHOD

203 second year undergraduate nurses were timetabled to attend an HFS tutorial. Examination results at first attempt were compared with the previous cohort's results.

RESULTS

81% of the students from the HFS tutorial cohort passed at the first attempt compared with 85% from the previous cohort.

CONCLUSION

The HFS tutorial needs to be developed further, incorporating simulation standards, to further assess its ability to improve a student's written examination results. Students found the post-simulation discussion difficult and wanted guidance in how to participate. Involvement of the university's skills and simulation team would be recommended for future cohorts to assist with design and facilitation.

The Use of Simulation-Based Education With New Graduate Nurses in Emergency Department and Acute Care Settings: A Scoping Review

Background The literature questions if newly graduated nurses are truly ready to practice at the bedside. Simulation has been shown to bridge the gap between theory and practice. The purpose of this study was to investigate what is known about the use of simulation education with novice graduate nurses in critical care settings in the hospital. Method A scoping review was conducted using the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Articles published in English between 2015 and September 2021 that focused on simulation education with novice graduate nurses in a critical care setting were included. Results The review yielded six articles. Conclusion The literature is scant on the use of simulation in critical care areas with novice graduate nurses. Additional inquiry is needed related to the role of learners, cost, timing, setting, and educational practices. More studies with stronger research designs and valid and reliable measurement instruments are also needed. Finally, there is a need to better understand the effects of simulation on novice nurse graduates' knowledge and skills as well as patient outcomes. [J Contin Educ Nurs. 2022;53(7):301-306.].