The impact of clinical simulation on learner self-efficacy in pre-registration nursing education

The impact of applying unfolding case-study learning on critical care nursing students' knowledge, critical thinking, and self-efficacy; a quasi-experimental study

BACKGROUND

The unfolding case-study learning approach is a growing modernized learning strategy implemented in different health disciplines. However, there is a lack of existing research that examines the effects of unfolding case studies in advanced nursing courses.

AIM

To examine the impact of applying an unfolding case-study learning approach on critical care nursing students' knowledge, critical thinking, and self-efficacy.

METHODS

This posttest-only, quasi-experimental study was conducted at XXX University in Palestine. A single-stage cluster sampling was used to assign nursing students enrolled in the critical care nursing course into experiment and conventional groups. The intervention group (n= 91) underwent unfolding case-study learning for selected cardiovascular topics, whereas the conventional group (n= 78) was taught using the traditional teaching methods. The posttest assessment was conducted using Knowledge Acquisition tests, Yoon`s Critical Thinking Disposition Instrument (YCTD), and the Self-Efficacy for Learning and Performance instruments. The Social Constructivist Theoretical Framework was integrated into the study.

RESULTS

Homogeneity was achieved between both groups concerning Age, Gender, and GPA. The experiment group scored significantly higher than the conventional group regarding the posttest knowledge acquisition tests (7.12 vs. 5.49, respectively, t=-12.7, P<0.001, CI: -1.89 to -1.38), critical thinking (4.32 vs. 3.63 respectively, t=17.390, p<0.001, CI: -77 to -61) and self-efficacy (6.12 vs. 4.4 respectively, t=-30.897, p<0.001, CI: -1.82 to -1.60). Multivariate analysis revealed that 69 % of the variations of posttest scores were influenced by critical thinking scores (Adjusted R Squared=0.690, F=3.47, P=0002, η2=0.969). Similarly, self-efficacy has been shown to contribute by 74 % to the variations of scores after conducting the study program (Adjusted R Squared=0.743, F=4.21, P=0001, η2=0.974). However, the variations of both critical thinking and self-efficacy scores were not significantly influenced by the contribution of knowledge acquisition (p=0.772 and 0.857, respectively) and students' GPA (p=0.305 and 0.956, respectively).

CONCLUSIONS

Irrespective of knowledge level and GPA, the unfolding case-study learning approach can enhance the critical thinking and self-efficacy of students enrolling in advanced nursing courses.

UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey

AIM

This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring.

DESIGN AND SETTING

An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences.

PARTICIPANTS

Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom.

FINDINGS

Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses.

CONCLUSION

This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.

The approaches and motivations to learning of student nurses: a phenomenological study

This research study was undertaken to elicit a group of final-year student nurses' perceptions of their motivations and approaches to learning, and the implications of their views. It is important to explore this subject because students' motivations and approaches to learning can potentially impact patient care. This study was part of a larger research project. The sample consisted of 18 final-year student nurses at a large UK university. Students completed semi-structured interviews that used a qualitative constructivist approach to explore their educational experience. Students described what motivated them to learn, and how they approached their learning because of their understanding of which subjects they believed were and were not important. Students felt that clinical skills were the most important subjects, and topics such as health promotion, law and ethics, were less important and therefore they approached these subjects in a superficial way, learning just enough to pass their course. Clinical skills were perceived as more useful because they would be used directly in clinical practice. The findings of this study are significant to inform nurse educators as they plan curricula and provide an insight into what may potentially adversely affect patient care when students become registered nurses.

Nursing students' perceived level of satisfaction and self-confidence in learning using unfolding case studies

Coronavirus disease 2019 (COVID-19) pandemic interrupted the clinical placements of nursing students across the globe. This required teaching and learning in nursing to adapt to continue, despite the interruption. The study aims to describe the students' perceived level of satisfaction, and their level of self-confidence in learning using the unfolding case studies. An online survey of nursing students enrolled in a higher educational institution in Angeles City, Philippines was conducted. A total of 166 nursing students completed the online survey. The majority of them were female (N=136; 81.93%). Respondents reported high levels of satisfaction (M=22.02; SD=0.29 out of a possible 25), and self-confidence (M=34.60; SD=0.48 out of a possible 40). The findings bolster the utility of the unfolding case studies in improving students' satisfaction and self-confidence in learning.

Learning beyond a single field of nursing through a virtual case-based approach to pre-registration nurse education

Ensuring that pre-registration student nurses gain the richness of clinical practice to allow them to feel confident and knowledgeable to care for patients of the 21st century is often a challenge. Clinical practice challenges often mean that students will be strategic learners. This article discusses the development of a virtual case-based learning site to provide a rich experience for students to learn.

Nursing students' experience during their practicum in an intensive care unit: A qualitative meta-synthesis

Background

Clinical practicum provides nursing students with more opportunities to learn their professional knowledge and develop basic nursing skills. Intensive care unit (ICU) is often used as one of the clinical practicum departments for nursing students. Due to the characteristic fast-paced working environments, high acuity of patient care, and technical complexities of an ICU, nursing students are more susceptible to experiencing stress and lack of confidence in these settings, which hinders their professionalization and affects patient care.

Objective

The study aimed to summarize and evaluate the nursing students' experience in an ICU during their practicum and to provide a supportive ICU clinical practicum environment for them. One of the main objectives was to increase the ICU specialty nurse reserve and improve nursing care in the ICU.

Methods

The following databases were searched for related qualitative publications in Chinese and English by systematic searches across January 2022, including the nursing students' experience in ICU during their practicum: PubMed, Cochrane Library, Web of Science, and so on. The qualitative meta-synthesis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Two reviewers independently selected these studies and carefully evaluated the quality of each study. Meta-synthesis was then used to summarize the results.

Results

Eleven sub-themes and 3 themes were revealed in 9 studies: challenges of clinical practicum in the ICU, the expectation of support from multiple sources, and the importance and necessity of practicum in the ICU.

Conclusion

Performing one's practicum in ICU was considered by the nursing students in this review as a beneficial practicum despite the challenges involved. The appropriate guidance and monitoring should be given by hospital managers and college educators.

Nursing students' perceived stress, self-efficacy, control and evaluation of a course in systematic clinical observation, physical assessment and decision-making: An observational study in Norway

AIM

Simulation-based nursing education interventions have a strong educational effect on psychomotoric skills, but students may experience physiological stress and anxiety during simulation. The aims of this study were to explore (1) nursing students' perceived stress, self-efficacy, control and evaluation before and after simulation as part a structured course in physical assessment, (2) whether factors such as gender, age or previous work experience were associated with perceived stress during simulation and (3) nursing students evaluation of the course.

DESIGN

An observational, cross-sectional study before and after simulation and a course in physical assessment.

METHODS

We utilized "the Self-Assessment Manikin for measuring emotion" before and after simulation, a questionnaire to identify symptoms of stress after simulation, and a questionnaire to evaluate the physical assessment course.

RESULTS

A total of 59 students participated. Students perceived stress before simulation but reported a lower degree of activation, a more positive mood, increased feeling of control and self-efficacy after the simulation. They also felt more secure about their assessments. Even though students reported of several symptoms of stress before simluation, the course increased students' self-reported competence and feeling of security.

Effectiveness of Virtual Reality-Based Training on Oral Healthcare for Disabled Elderly Persons: A Randomized Controlled Trial

(1) Background: Virtual reality (VR) technology is a widely used training tool in medical education. The present study aimed to evaluate the effectiveness of VR training of oral hygiene students on providing oral healthcare to disabled elderly persons. (2) Methods: A randomized controlled trial was conducted. In 2021, oral hygiene students were randomly assigned to a VR experimental group (EG; n = 11) and a control group (CG; n = 12). The EG received two-hour, thrice-repeated VR-based training interventions at 2-week, 4-week, and 6-week follow-ups. The CG received no VR-based interventions. Data were collected using a self-administered questionnaire before and immediately after each intervention. We performed generalized estimating equations to compare the responses. (3) Results: The EG exhibited a more significant improvement in oral care-related knowledge, attitude, self-efficacy, and intention at the 6-week follow-up than the CG. The students’ intention to assist the elderly in using interdental brushes (β = 0.91), with soft tissue cleaning (β = 0.53), and with oral desensitization (β = 0.53), and to have regular dental visits (β = 0.61) improved significantly at the 6-week follow-up. (4) Conclusions: VR training positively affected students’ knowledge, attitude, self-efficacy, and intentions on providing oral healthcare to disabled elderly persons.

'Walking in the shoes of our patients': a scoping review of healthcare professionals learning from the simulation of patient illness experiences

BACKGROUND

Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness, but to date, there has been no overarching review of the extent of this practice or the impact on empathic skills.

OBJECTIVE

To determine from the evidence-what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills.

STUDY SELECTION

Arksey and O'Malley's methodological framework informed our scoping review of articles relevant to our research question. Three databases (MEDLINE, Embase and Web of Science) were searched, and a sample of 516 citations was screened. Following review and application of our exclusion criteria, 77 articles were selected to be included in this review.

FINDINGS

Of the 77 articles, 52 (68%) originated from the USA, 37 (48%) of studies were qualitative based and 17 (22%) used a mixed-methods model. Of all the articles in our scope, the majority (87%) reported a positive impact and range of emotions evoked on learners. However, some studies observed more negative effects and additional debriefing was required post-simulation. Learners were noted to internalise perceived experiences of illness and to critically reflect on their empathic role as healthcare providers.

CONCLUSIONS

A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.

Reliability and validity study of the Spanish adaptation of the "Student Satisfaction and Self-Confidence in Learning Scale" (SCLS)

The European Higher Education Area (EHEA) recommends the use of new educational methodologies and the evaluation of student satisfaction. Different instruments have been developed in Spain to evaluate different aspects such as clinical decisions and teamwork, however no instruments have been found that specifically evaluate student self-confidence and satisfaction during clinical simulation. The aim was to translate the Student Satisfaction and Self-Confidence in Learning Scale (SCLS) questionnaire into Spanish and analyse its reliability and validity and understand the level of satisfaction and self-confidence of nursing students with respect to learning in clinical simulations. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 489 nursing students. The reliability and exploratory and confirmatory factorial analyses were performed. To analyse the relationship of the scale scores with the socio-demographic variables, the Fisher Student T-test or the ANOVA was used. The scale demonstrated high internal consistency reliability for the total scale and each of its dimensions. Cronbach’s alpha was 0.88 (0.83 to 0.81) for each of the dimensions. The exploratory and confirmatory factor analysis showed that both the one-dimensional and two-dimensional models were acceptable. The results showed average scores above 4 for both dimensions. The SCLS-Spanish translation demonstrated evidence of its validity and reliability for use to understand the level of satisfaction and self-confidence of nursing students in clinical simulation. Clinical simulations help students to increase their levels of confidence and satisfaction, enabling them to face real scenarios in clinical practice.

Impact of Initial Emotional States and Self-Efficacy Changes on Nursing Students' Practical Skills Performance in Simulation-Based Education

Training through simulation has shown to increase relevant and specific skills sets across a wide range of areas in nursing and related professions. Increasing skills has a reciprocal relation to the development of self-efficacy. A study was conducted to assess changes in the development of self-efficacy in simulation training for 2nd year nursing students. Initial emotional states, pre and post self-efficacy, and expert ratings of simulation performance were assessed. Results show that students who displayed an increase in self-efficacy as a result of simulation training were also judged to perform better by expert ratings. The effect of simulation on self-efficacy could be influenced by initial states of physiological activation and over control. Results also showed that initial emotional states did not moderate self-efficacy development on outcome measures. These findings improve our understanding on the relationship between students’ self-efficacy and performance of practical skills and inform pedagogical designs and targeted interventions in relation to feedback and supervision in nursing education.

Association between self-efficacy and general health: a cross-sectional study of the nursing population

BACKGROUND

The present research aimed to explore the association of self-efficacy and general health among nurses.

METHODS

This was a descriptive-analytical. A total of 470 nurses were selected through the stratified sampling method. To collect the required data, GSE-10 and GHQ-28 were used. Independent-sample T-test, Pearson correlation coefficient, Chi-squared test, and regression were also used to analyze the obtained data.

RESULTS

The results reveal a statistically significant correlation between general health and self-efficacy (t=-6.72, p < .001). Among general health parameters, social functioning has significantly predicted self-efficacy.

CONCLUSIONS

As shown in the present findings, an acceptable level of self-efficacy can positively affect all aspects of nurses' general health.

Rising to the Challenge: The Delivery of Simulation and Clinical Skills during COVID-19

The declaration of a global pandemic in March 2020 resulted in all higher education institutions having to quickly transform traditional didactic teaching and learning to online delivery. This involved delivering lectures and seminars virtually, and student contact time in University ceased immediately. Although many Universities had existing resources such as Blackboard® and Microsoft Teams® in place to assist with this delivery, the facilitation of clinical skills and simulation would prove to be more of a challenge. This paper explores how one University adapted and utilized innovative ways to provide students with virtual learning experiences, specifically in relation to the facilitation of clinical skills and simulation.

Shared learning to improve the care for young people and mental health within nurse education (SHYNE). Improving attitudes, confidence and self-efficacy

Preparing students for the complexities of practice is an ongoing challenge of pre-registration nurse education. One such complexity is the increase in children and young people with mental health problems. Pre-registration student nurses from child and mental health specialisms from one University participated in an innovative simulation session, whereby actors from a youth theatre group simulated young people admitted to an acute non-mental health hospital setting for treatment of self-harm injuries. This study used an uncontrolled pre and post design to determine the impact of the session on student nurses' attitudes, confidence and self-efficacy when caring for young people who self-harm. Attitudes towards self-harm was measured using a 13 item self-report questionnaire. Confidence was measured through Likert scale responses. Self-efficacy for working with children and young people who have self-harmed was measured through an adapted version of the Self-Efficacy Towards Helping (SETH) scale. In total 101 student nurses took part in the study and 99% completed post simulation outcome measures. At post-session, the students reported a statistically significant improvement in attitudes, self-efficacy and confidence towards children and young people who self-harm. A lack of confidence is frequently reported in the literature when caring for this client group in practice settings. Improvements in attitudes, confidence and self-efficacy can positively impact individual nursing practice. Furthermore the simulation literature indicates that the skills consolidated using such an educational approach are taken forward into clinical practice. While broad claims of success should be avoided, it is promising to find a learning method that is effective in addressing a contemporary and complex health issue. Shared Learning to Improve the Care for Young People and Mental Health within Nurse Education (SHYNE): Improving Attitudes, Confidence and Self-Efficacy.

Paediatric nurses' general self-efficacy, perceived organizational support and perceived professional benefits from Class A tertiary hospitals in Jilin province of China: the mediating effect of nursing practice environment

Background

General self-efficacy is considered one of the most influential parameters affecting the quality of clinical practice and nurses’ perceived professional benefits (NPPB). Perceived organizational support (POS) is regarded as being central in understanding job-related attitudes, and it is important to enhance POS for nurses to maintain their current employment. NPPB can further reduce nurses’ job burnout and turn-over intention. Many studies have explored the relationships among general self-efficacy, POS, nursing practice environment (NPE) and NPPB. However, a moderating effect of NPE has not been fully explored in nurses, especially among paediatric nurses.

Methods

A descriptive cross-sectional study was conducted from July to October 2018 with 300 paediatric nurses from 3 Class A tertiary hospitals in Jilin Province. The respondents completed the General Self-Efficacy Scale, Perceived Organizational Support Scale, Practice Environment Scale and Nurses’ Perceived Professional Benefits Scale. The data were analyzed using path analysis and SPSS (version 23.0, IBM).

Results

General self-efficacy and POS were significantly positively associated with NPPB, which showed that the model had a good fit to the data. NPE was found to play a partial mediating role between POS and NPPB and also had a complete mediating role between general self-efficacy and NPPB.

Conclusions

The results suggest that general self-efficacy indirectly influences NPPB, and POS directly and indirectly influences NPPB by NPE. Effective measures should be taken to improve nurses’ practice environment in hospitals to raise nurses’ enthusiasm and confidence in their work.

Perinatal palliative care education: An integrative review

OBJECTIVES

The aim of this review was to analyze the effectiveness of teaching healthcare professionals in perinatal palliative care, methods of evaluating the teaching, and the teaching strategies used.

DESIGN

An integrative review.

METHODS

A systematic search was conducted for English language peer reviewed publications of any research design via SCOPUS, Medline/PubMed, EBSCOhost, Science Direct, ERIC, Web of Science, Wiley, Nursing Ovid, and ProQuest databases. Fourteen research papers published between 2002 and 2017 that met the selection criteria were included in the review.

FINDINGS

All 14 studies considered perinatal bereavement education to be effective. Eight studies reported statistical improvements in knowledge, security/comfort in providing end-of-life care, or increased perceptions of the emotional care needs of bereaved families, after attending an educational program. Questionnaires or interviews were used to evaluate the educational programs. Innovative teaching strategies, in particular, were evaluated positively (e.g., simulation, discussion, and arts-based methods).

CONCLUSION

Perinatal palliative care education is essential in pregradual education for midwives and neonatal nurses. Other research is vital for finding out the effectiveness of this education for pregraduate nursing students. Perinatal palliative care education programs need to be available in postgraduate education for professionals who encounter perinatal death and bereaved families in hospital and community care.

Final year pre-registration student nurses perceptions of which taught theoretical knowledge is important for practice

This research illuminates the perceptions of eighteen final year undergraduate pre-registration student nurses, to understand what theoretical knowledge was perceived to be useful during their pre-registration nursing education, and what was not. The research adopted a qualitative phenomenological approach, and utilised a sample size of eighteen final year student nurses as the data source. The data collection method consisted of semi-structured interviews and the study took place at a Higher Education Institution within the North West of England approved to provide pre-registration nurse education. Participants provided their data during their final year of their undergraduate pre-registration nursing programme, via semi-structured, digitally recorded interviews, which were transcribed verbatim. The transcribed interviews were then analysed using Interpretive Phenomenological Analysis. The findings generated three themes, these were; important knowledge to learn for everyday practice, irrelevant for my future role, and, can we have some more? Findings demonstrate what aspects of the taught curriculum student nurses perceive to be of use to their practice, and why they perceive this to be the case. This affects how student nurses approach their learning during their nursing education. In addition it was clear what participants perceived was not useful for their practice and why this was the case. Additionally, participants offered suggestions of what they would also like adding to their curriculum, and provided insights for what they would like adding to the curriculum, which can be used for enhancing this. This is useful when developing future curricula to understand which aspects student nurses learn in a deep and superficial way. This can provide a useful insight for to ensure that patient care is not compromised.

An Exploration of Student Midwives’ Lived Experiences Regarding Confidence and Satisfaction in Medium-Fidelity Simulation

Background

Newly qualified midwives are expected to exhibit some level of confidence in practice when they enter the clinical environment.

Objective

To explore the lived experiences of student midwives after exposure to medium-fidelity simulation concerning confidence and satisfaction.

Methods

This qualitative, interpretive, phenomenological analysis study was conducted on a purposive sample of five, fourth-year Baccalaureate of Nursing Science student midwives at the University of Fort Hare. In-depth semi-structured interviews were conducted. Data analysis applied the interpretative phenomenological analysis approach.

Results

Superordinate theme sense of fulfilment elicited six sub-ordinate themes namely 1) Transferability of skills 2) Knowledgeable 3) Equipment used during simulation 4) Realism of simulation 4) Sense of accomplishment 5) Sure/unsure of performance. The use of a standardised patient during the simulation instead of a mannequin prepared participants for the real clinical environment. After being involved in the simulation, participants became more inquisitive regarding the management of the simulated condition. Satisfaction with simulation depended on whether the simulation activity met the student’s expectations, and if the simulation equipment resembled real clinical equipment. Post-partum haemorrhage simulation bridged the gap between theory and practice.

Conclusion

Confidence and satisfaction of student midwives during simulation is depended on the realism of the simulated activity. Exposure to simulated activity increases student knowledge. The student acknowledged that simulation can bridge the gap between theory and practice.

Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others.

OBJECTIVES

To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication.

DESIGN

A single group pre-test and post-test quasi-experimental design was adopted.

SETTINGS AND PARTICIPANTS

Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school.

METHODS

Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale.

CONCLUSIONS

Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs.

Experiences of nursing undergraduates on a redesigned blended communication module: A descriptive qualitative study

BACKGROUND

Education is going through accelerated changes to accommodate the needs of contemporary students. However, there are ongoing concerns regarding the quality of education in communication skills for nurses and other healthcare professionals. Many studies have been conducted to evaluate the effectiveness of a blended learning pedagogical tool in enhancing the learning of nursing undergraduates. However, little is known about students' experiences of a blended learning model for teaching communication skills.

OBJECTIVE

To explore first year nursing students' experiences of the blended learning design adopted in a communication module.

DESIGN

A descriptive qualitative design was adopted.

SETTINGS AND PARTICIPANTS

Data were collected in the form of written reflections from 74 first year nursing undergraduates who were enrolled in a university-affiliated nursing school.

METHODS

Students were asked to complete an online reflective exercise regarding an undergraduate communication module on their last day of class, and the submitted reflections were analyzed. A thematic analysis was conducted and ethics approval was obtained for this study.

RESULTS

Six overarching themes and fifteen subthemes were generated. The six overarching themes were: 1) Helpful and engaging classroom experience, 2) valuable online activities, 3) meaningful assessment, 4) appreciation for interprofessional education, 5) personal enrichment, and 6) overall feedback and recommendations.

CONCLUSIONS

The students in this study felt that the blended pedagogy communication module enhanced their learning and boosted their confidence in facing similar situations. Interprofessional education was well-accepted among students as they attained a deeper understanding on the importance of interprofessional learning and an appreciation towards other professionals. Blended pedagogy can be used in teaching communication skills to nursing students to provide a holistic and up-to-date learning experience. Future studies should consider engaging students in face-to-face interviews to obtain a deeper understanding on their experiences of a blended pedagogy incorporated communication module.

Evaluation of a simulation clinic for improving occupational therapy students’ perceptions of interaction with parents and infants

Introduction

Occupational therapy education programmes need to graduate students who can confidently and safely deliver child and youth services. This study explores whether a simulation clinic could increase student perceived knowledge and confidence and decrease student anxiety to better prepare them for professional child and youth practice.

Method

This study used a pre–post quasi-experimental design. Second-year undergraduate and first-year graduate entry master's level occupational therapy students participated in the simulation clinic as a component of an occupational therapy child and youth course. Students completed pre- and post-simulation questionnaires to measure perceived knowledge, confidence, and anxiety related to infant and parent interactions.

Findings

A sample of 100 students reported significant improvements for perceived knowledge (all p < 0.001) and confidence (all p < 0.001) across all four skills targeted for development in this simulation: Communication, Information Gathering, Information Sharing, and Clinical Intervention Skills. Students reported a significant decrease in anxiety for parental ( p < 0.001) and infant ( p < 0.001) interaction, and felt the experience to have been highly valuable and realistic.

Conclusion

Findings indicate that simulation is a valuable tool for preparing occupational therapy students to work with infant and parent interaction. Further research investigating the effect of simulation on student competence is recommended.

Ensuring relational competency in critical care: Importance of nursing students' communication skills

OBJECTIVES

The aim of this study was to analyse the communication skills of students in interactions with simulated critically-ill patients using a new assessment tool to study the relationships between communication skills, teamwork and clinical skills and to analyse the psychometric properties of the tool.

METHODS

A cross-sectional study was conducted to assess the communications skills of 52 students with critically-ill patients through the use of a new measurement tool to score video recordings of simulated clinical scenarios.

RESULTS

The 52 students obtained low scores on their skills in communicating with patients. The reliability of the measuring instrument showed good inter-observer agreement (ICC between 0.71 and 0.90) and the validity yielded a positive correlation (p<0.01).

CONCLUSIONS

The results provide evidence that nursing students lack skills when communicating with critically ill patients in simulated scenarios. The measuring instrument used is therefore deemed valid and reliable for assessing nursing students through a clinical simulation.

Using a videogame to facilitate nursing and medical students' first visit to the operating theatre. A randomized controlled trial

BACKGROUND

First experiences in the operating theatre with real patients are always stressful and intimidating for students. We hypothesized that a game-like simulation could improve perceptions and performance of novices.

METHODS

A videogame was developed, combining pictures and short videos, by which students are interactively instructed on acting at the surgical block. Moreover, the game includes detailed descriptive information. After playing, students are given feedback on their performance. A randomized controlled trial was conducted with 132 nursing and medical students with no previous experience in surgery. Sixty two (47.0%) were allocated to a control group (CG) and 70 (53.0%) to an experimental group (EG). Subjects in EG played the game the day prior to their first experience in the theatre; CG had no access to the application. On the day after their experience at surgery, all students filled in a questionnaire in a 7-point Likert format collecting subjective data about their experience in the surgical block. Four constructs related to students' feelings, emotions and attitudes were measured through self-reported subjective scales, i.e. C1: fear to make mistakes, C2: perceived knowledge on how to behave, C3: perceived errors committed, and C4: attitude/behaviour towards patients and staff. The main research question was formulated as follows: do students show differences in constructs C1-C4 by exposure to the game?

RESULTS

EG reported statistically significant higher scores on the four aspects measured than CG (p<0.05; Mann-Whitney U tests; Cohen's d standardized effect size d1=0.30; d2=1.05; d3=0.39; d4=0.49).

CONCLUSIONS

Results show clear evidence that the exposure to the game-like simulation had a significant positive effect on all the constructs. After their first visit to the theatre, students in EG showed less fear (C1) and also perceived to have committed fewer errors (C3), while they showed higher perceived knowledge (C2) and a more collaborative attitude (C4).

Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration

AIMS AND OBJECTIVES

To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration.

BACKGROUND

Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions.

DESIGN/METHODS

A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis.

RESULTS

Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice."

CONCLUSIONS

Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.

Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings

Background

A central feature of clinical simulation training is human factors skills, providing staff with the social and cognitive skills to cope with demanding clinical situations. Although these skills are critical to safe patient care, assessing their learning is challenging. This study aimed to develop, pilot and evaluate a valid and reliable structured instrument to assess human factors skills, which can be used pre- and post-simulation training, and is relevant across a range of healthcare professions.

Method

Through consultation with a multi-professional expert group, we developed and piloted a 39-item survey with 272 healthcare professionals attending training courses across two large simulation centres in London, one specialising in acute care and one in mental health, both serving healthcare professionals working across acute and community settings. Following psychometric evaluation, the final 12-item instrument was evaluated with a second sample of 711 trainees.

Results

Exploratory factor analysis revealed a 12-item, one-factor solution with good internal consistency (α=0.92). The instrument had discriminant validity, with newly qualified trainees scoring significantly lower than experienced trainees (t(98)=4.88, p<0.001) and was sensitive to change following training in acute and mental health settings, across professional groups (p<0.001). Confirmatory factor analysis revealed an adequate model fit (RMSEA=0.066).

Conclusion

The Human Factors Skills for Healthcare Instrument provides a reliable and valid method of assessing trainees’ human factors skills self-efficacy across acute and mental health settings. This instrument has the potential to improve the assessment and evaluation of human factors skills learning in both uniprofessional and interprofessional clinical simulation training.

Piloting Augmented Reality Technology to Enhance Realism in Clinical Simulation

We describe a pilot study that incorporated an innovative hybrid simulation designed to increase the perception of realism in a high-fidelity simulation. Prelicensure students (N = 12) cared for a manikin in a simulation lab scenario wearing Google Glass, a wearable head device that projected video into the students' field of vision. Students reported that the simulation gave them confidence that they were developing skills and knowledge to perform necessary tasks in a clinical setting and that they met the learning objectives of the simulation. The video combined visual images and cues seen in a real patient and created a sense of realism the manikin alone could not provide.

Nursing students' perception of high-fidelity simulation activity instead of clinical placement: A qualitative study

BACKGROUND

The high-fidelity simulation (HFS) has been utilized in nursing education for more than 20 years. Advantages of the use of high-fidelity simulation in nursing education have been documented in the literature. Based on the advantages, it has been arranged as a part of the clinical study course of the first year baccalaureate nursing program in one of the nursing colleges in Macau recently.

OBJECTIVE

The aim of this study is to explore undergraduate nursing students' perception of using high-fidelity simulation as part of their clinical study course in Macau.

DESIGN

This is a qualitative study using open-ended questionnaire.

SETTING

This study was implemented at the nursing laboratory between 1 April and 17 April 2015, which was the period of preliminary clinical study course of year one nursing students.

PARTICIPANTS

A purposive sample was sought from the voluntary year one undergraduate nursing students who participated in the clinical study course.

METHODS

Students received two high-fidelity simulation sections during the course, while a self-administered open-ended questionnaire was allocated afterward. Qualitative content analysis was performed after data collection.

RESULTS

Two themes emerged in this study, which included "appreciation" and "misunderstanding". They were further divided into five categories; as "positive feelings", "gaining a suitable atmosphere for learning", "assist of adequate emergency preparation: resourceful ability", "contempt", and "rote learning".

CONCLUSION

This was the first time to utilize HFS activities as a part of the clinical study course in one nursing college in Macau. These HFS activities instead of a part of real clinical placement were appreciated by nursing students. And it mainly contributed to the resourceful ability in students' view. During the HFS activities, nursing educators should consider the misunderstanding of HFS activities of students that a few nursing students despised simulator's life and got rote learning method.

Learning to nurse: combining simulation with key theory

Following a recent Nursing and Midwifery Council revalidation of a university undergraduate nursing programme, simulation skills sessions and anatomy and physiology theory were integrated into one unit (module). This was done in order to integrate the basis for patient assessment and care provision with the anatomical and physiological theory and thereby enhance student learning and nursing practice. Students evaluated the new unit well and valued the close link between theory and practice simulation. Improvements were seen in the simulation skills sessions as students were better able to apply their underlying theory to their actions. Learning was enhanced as both simulation and theory were seen as more meaningful to practice and patient care.

Learning by simulation in prehospital emergency care - an integrative literature review

BACKGROUND

Acquiring knowledge and experience on high-energy trauma is often difficult due to infrequent exposure. This creates a need for training which is specifically tailored for complex prehospital conditions. Simulation provides an opportunity for ambulance nurses to focus on the actual problems in clinical practice and to develop knowledge regarding trauma care. The aim of this study was to describe what ambulance nurses and paramedics in prehospital emergency care perceive as important for learning when participating in simulation exercises.

METHODS

An integrative literature review was carried out. Criteria for inclusion were primary qualitative and quantitative studies, where research participants were ambulance nurses or paramedics, working within prehospital care settings, and where the research interventions involved simulation.

RESULTS

It was perceived important for the ambulance nurses' learning that scenarios were advanced and possible to simulate repeatedly. The repetitions contributed to increase the level of experience, which in turn improved the patients care. Moreover, realism in the simulation and being able to interact and communicate with the patient were perceived as important aspects, as was debriefing, which enabled the enhancement of knowledge and skills. The result is presented in the following categories: To gain experience, To gain practice and To be strengthened by others.

CONCLUSION

Learning through simulation does not require years of exposure to accident scenes. The simulated learning is enhanced by realistic, stressful scenarios where ambulance nurses interact with the patients. In this study, being able to communicate with the patient was highlighted as a positive contribution to learning. However, this has seldom been mentioned in a previous research on simulation. Debriefing is important for learning as it enables scrutiny of one's actions and thereby the possibility to improve and adjust one's caring. The effect of simulation exercises is important on patient outcome.

Using high-fidelity simulation as a learning strategy in an undergraduate intensive care course

Using high-fidelity simulations to facilitate student learning is an uncommon practice in Turkish nursing programs. The aim of the present study was to understand students' perceptions of the use of simulation in nursing courses. Subjects included 36 senior nursing students taking an intensive care course. This study revealed that high-fidelity simulation is an ideal method of promoting learning by helping students transfer theory into practice, build confidence and teamwork, and raise professional awareness.

Development and validation of the Simulation Learning Effectiveness Inventory

AIM

To develop and psychometrically test the Simulation Learning Effectiveness Inventory.

BACKGROUND

High-fidelity simulation helps students develop clinical skills and competencies. Yet, reliable instruments measuring learning outcomes are scant.

DESIGN

A descriptive cross-sectional survey was used to validate psychometric properties of the instrument measuring students' perception of stimulation learning effectiveness.

METHODS

A purposive sample of 505 nursing students who had taken simulation courses was recruited from a department of nursing of a university in central Taiwan from January 2010-June 2010. The study was conducted in two phases. In Phase I, question items were developed based on the literature review and the preliminary psychometric properties of the inventory were evaluated using exploratory factor analysis. Phase II was conducted to evaluate the reliability and validity of the finalized inventory using confirmatory factor analysis.

RESULTS

The results of exploratory and confirmatory factor analyses revealed the instrument was composed of seven factors, named course arrangement, equipment resource, debriefing, clinical ability, problem-solving, confidence and collaboration. A further second-order analysis showed comparable fits between a three second-order factor (preparation, process and outcome) and the seven first-order factor models. Internal consistency was supported by adequate Cronbach's alphas and composite reliability. Convergent and discriminant validities were also supported by confirmatory factor analysis.

CONCLUSION

The study provides evidence that the Simulation Learning Effectiveness Inventory is reliable and valid for measuring student perception of learning effectiveness. The instrument is helpful in building the evidence-based knowledge of the effect of simulation teaching on students' learning outcomes.

Enhancing student communication during end-of-life care: A pilot study

Background:

Quality end-of-life care requires effective communication skills, yet medical and nursing students report limited opportunities to develop these skills, and that they lack confidence and the related competence.

Objectives:

Our purpose was to design, implement, and evaluate an educational intervention employing simulated patient actors to enhance students' abilities to communicate with dying patients and their families.

Methods:

A study employing a mixed-methods design was conducted with prequalification nursing and medical students recruited from a London university. The first phase involved focus groups with students, which informed the development of an educational intervention involving simulated patient actors. Questionnaires measuring students' perceptions of confidence and competence levels when communicating with dying patients and their families were administered before and after the intervention.

Results:

The themes from focus groups related to responding to grief and anger, difficulties dealing with emotions, knowing the “right thing” to say, and a lack of experience. A significant increase (p< 0.5) in competence and confidence from baseline levels followed participation in the simulated scenarios.

Significance of Results:

Simulation was found to be an effective means of preparing students to communicate with dying patients and their families. The opportunity to develop communication skills was valued. Integration of educational interventions employing simulated patient actors into nursing and medical curricula may assist in improving the care provided to patients at the end of life.

Threats to Pediatric Nurses' Perception of Caring Self-efficacy: A Qualitative Study

Background:

Nurses are considered the largest and most important human resource for healthcare organizations. Self-efficacy as the main predictor of nurses’ behavior plays an important role in nurses’ professional behavior. However, the various dimensions and threats of caring self- efficacy concept have not been taken into consideration.

Objectives:

The present paper attempts to identify threats to self-efficacy as an important aspect of the concept of pediatric nurses’ caring self-efficacy.

Materials and Methods:

This study is part of a larger study on the caring self-efficacy concept that was conducted through content analysis and from a qualitative approach in 2014 in Iran. Twenty-seven nurses and pediatric clinical instructors participated in this research according to the purposive sampling method employed in the study. Data were collected through semi-structured interviews. The collected data were analyzed using the conventional content analysis method.

Results:

“Threats to self-efficacy” was one of the main themes extracted from the interview analysis results in the present study. The theme consists of two main categories “individual barriers,” including not having a caring attitude and not being interested in children, and “organizational barriers,” including an inefficient educational system, not developing professional capabilities, non-valuation of the organization in a caring context, a poor rewards system, and inappropriate managerial policies.

Conclusions:

Nursing management and custodians of nursing trainings can break through the barriers to self-efficacy by knowing these factors and making changes in the educational programs and providing supporting policies. This can be an important step toward improving nurses’ inefficacy and ultimately improving the provision of quality healthcare services.

The simulation method in learning interpersonal communication competence--experiences of masters' degree students of health sciences

BACKGROUND

This article describes the experiences of master students of nursing science in learning interpersonal communication competence through the simulation method. The exercises reflected challenging interactive situations in the field of health care. Few studies have been published on using the simulation method in the communication education of teachers, managers, and experts in this field.

OBJECTIVES

The aim of this study is to produce information which can be utilised in developing the simulation method to promote the interpersonal communication competence of master-level students of health sciences.

DESIGN

This study used the qualitative, descriptive research method.

SETTINGS

At the Department of Nursing Science, the University of Eastern Finland, students major in nursing science specialise in nursing leadership and management, preventive nursing science, or nurse teacher education.

PARTICIPANTS

Students from all three specialties taking the Challenging Situations in Speech Communication course participated (n=47).

METHODS

Essays on meaningful learning experiences collected using the critical incident technique, underwent content analysis.

RESULTS

Planning of teaching, carrying out different stages of the simulation exercise, participant roles, and students' personal factors were central to learning interpersonal communication competence.

CONCLUSION

Simulation is a valuable method in developing the interpersonal communication competence of students of health sciences at the masters' level. The methods used in the simulation teaching of emergency care are not necessarily applicable as such to communication education. The role of teacher is essential to supervising students' learning in simulation exercises. In the future, it is important to construct questions that help students to reflect specifically on communication.

Advancing renal education: hybrid simulation, using simulated patients to enhance realism in haemodialysis education

BACKGROUND

Simulation is a well-established and proven teaching method, yet its use in renal education is not widely reported. Criticisms of simulation-based teaching include limited realism and a lack of authentic patient interaction.

METHOD

This paper discusses the benefits and challenges of high-fidelity simulation and suggests hybrid simulation as a complementary model to existing simulation programmes.

CONCLUSION

Through the use of a simulated patient, hybrid simulation can improve the authenticity of renal simulation-based education while simultaneously teaching and assessing technologically enframed caring.