Simulation: an effective pedagogical approach for nursing?

The role of extended reality in optometry education: a narrative review

The evolution of digitally based pedagogies, such as extended reality (XR) - a group of simulated learning environments that include virtual simulation, virtual reality, and augmented reality - has prompted optometry educators to seek evidence to guide the implementation of these teaching and learning activities within their curricula. Looking more broadly across the medical and allied health fields, there is a wealth of evidence to guide the incorporation of XR, as it is increasingly being integrated into the curricula of other select health professions disciplines. Educators from these disciplines continue to explore and embed XR in practice. This narrative review summarises the findings and appraises the literature on the use of XR in optometry education. It identifies the learning domains in which XR has been implemented in optometry education and proposes areas for further investigation. The review questions the technology-focused approach that has driven the literature within the review and calls for richer pedagogical foundations with suggestions for future research agendas. As such, this narrative review provides optometry educators with new ways of understanding XR and its relationship with the curriculum.

Evaluation of the Effectiveness of Standardized Patient Simulation as a Teaching Method in Psychiatric and Mental Health Nursing

Background: The use of standardized patient simulation in psychiatric nursing education addresses the unique challenges presented by mental healthcare settings. Students' attitudes toward clinical simulation remain predominantly favorable, with many expressing enthusiasm for the opportunities it provides in terms of embracing challenges, enhancing realism, and promoting critical thinking through problem solving, decision-making, and adaptability. Methods: This quantitative study used a cross-sectional, descriptive, correlation design to investigate the effectiveness of standardized patient simulation as a teaching method in the Psychiatric and Mental Health nursing course in a university setting. A total of 84 nursing students were recruited for the convenience sample. Data were collected using a three-part questionnaire survey which included the following: a demographic data sheet, the Student Satisfaction and Self-confidence in Learning Scale, and a narrative open-ended question asking the participants to write the advantages and disadvantages of their simulation experience. Data were analyzed using the statistical software JMP pro17. Results: The total satisfaction with learning subscale score ranged between 5 and 25 with a mean score of 19.36 ± 6.32. The total self-confidence subscale score ranged between 8 and 40 with a mean score of 30.87 ± 9.1. Pearson's correlation coefficient r revealed a statistically significant positive relationship between the participants' satisfaction with the learning experience and their self-confidence (t = 0.923, p < 0.0001). Approximately 91.7% of the students recommended using simulation. The results confirmed the students' recommendations of simulation use in teaching psychiatric and mental health courses; furthermore, the results showed a statistically significant positive correlation with the total SSLS (p = 0.01) and satisfaction with learning subscale (0.003). Participants reported that authentic, practical, comfortable, and safe learning environments contributed to an enriched learning experience. Additionally, factors such as timesaving, access to information, cost-effectiveness, standardized teaching, varied exposure, skill development, and immediate feedback also enhanced the learning experience through patient simulation in psychiatric and mental health nursing. Conclusion: Simulations can contribute efficiently and positively to psychiatric and mental health nursing education in a manner that optimizes the learning experience while ensuring the consistency of student learning in a safe learning environment.

The Impact of Clinical Training Seminars on Stress and Perception of Clinical Placement Stressors among Spanish Undergraduate Nursing Students: A Two-Phase Mixed-Methods Study

Stress and stressors related to clinical practice are some of the main reasons for the discomfort reported by nursing students. It is important to identify the causes of stress and seek strategies to reduce the stress levels in nursing students. Clinical training seminars have proven to be a useful tool to reduce stress levels. This study aims to evaluate the effects of a series of clinical training seminars on the levels of stress and perception of stress factors before the start of clinical practice among undergraduate Spanish nursing students. A two-phase, sequential mixed-methods design was used. For the quantitative phase, data were collected using Cohen's Perceived Stress Scale and the KEZKAK questionnaire before and after the clinical training seminars. Qualitative data were collected through a focus group session held after the clinical training period. The results show a significant reduction (p = 0.002) in perceived stress levels after the clinical training seminars, and also a change in students' perception of stressors in the clinical placement. This study provides valuable information for the development of content for clinical training seminars. Universities should develop strategies to reduce stress in their students caused by the clinical placement.

High-fidelity simulation: A practice model for nurse educators at a South African private higher education institution

Background. The clinical skills development of student nurses is one of many challenges facing nursing education owing to a lack of available clinical placements and learning opportunities. Simulation training as an optional teaching-learning method creates an environment where clinical skills are developed and students are prepared for the nursing profession. The successful implementation of high-fidelity simulation (HFS) strategies as part of the nursing curricula requires nurse educators to have knowledge and skills. At the South African private higher education institution (SAPHEI) where the research for this study was done, it became evident that nurse educators do not have the required knowledge, skills or support to implement HFS. The absence of evidence in the literature of a practice model for a SAPHEI to facilitate the implementation of HFS reveals a gap in the practice base of nursing education. Objective. To develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS.Methods. The researcher used a theory-generative research design. The study was conducted in two phases, with two steps in each phase, to address four objectives in all.Results. Phase 1 identified and described the main and related concepts. A resulting conceptual framework was used for the development of the practice model. Phase 2 addressed the relational meaning of the main and related concepts, as well as the construction of the practice model through theory synthesis.Conclusion. The main aim of this research study was to develop a practice model for nurse educators at a SAPHEI to facilitate the implementation of HFS as part of the clinical skills development of student nurses. The practice model offers a schematic outline that represents HFS as a teaching-learning method. The importance of the outline lies therein that it specifies the context and situations in which the model is useful.

Final year undergraduate nursing and midwifery students’ perspectives on simulation-based education: a cross-sectional study

Background

Simulation-based education is a teaching and learning approach that can enhance learning experiences for students on healthcare programmes. Within undergraduate nursing and midwifery education, simulation can support students in developing graduate attributes necessary to become practice-ready professionals. This paper reports on the evaluation of a simulation-based education initiative, which was introduced to support final year undergraduate nursing and midwifery students in preparation for their upcoming clinical internship in practice.

Methods

This study aimed to evaluate a simulation-based education initiative from the perspectives of final year undergraduate nursing and midwifery students (N = 95). An online survey, using the validated Simulation Effectiveness Tool – Modified (SET-M), was distributed to final year nursing and midwifery students at one university in Ireland. This study was conducted and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

Results

The results of the study highlight final year nursing and midwifery students’ perceptions, experiences, and satisfaction with learning in a simulated environment. Students reported their simulation-based learning experiences as worthwhile, motivating, and as important opportunities to build on previous learning, increase confidence and gain experience in preparation for real-life practice. Students reported feeling more confident in their assessment skills, in providing care and interventions in responding to changes in a person’s health status. All students reported that the simulation-based learning experiences enabled them to think more critically about the clinical case scenarios and critically question their actions and decision-making processes. Pre-briefing and debriefing sessions were highlighted as important aspects of the simulation which helped to increase student confidence and cultivate meaningful learning.

Conclusion

Simulation-based education is a valuable teaching and learning modality, particularly for final year students who are transitioning to real-life clinical practice. Student-centred simulation-based learning experiences can cultivate professional development and support learners in their transition from university student to healthcare professional.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01084-w.

Alternating between active and passive facilitator roles in simulated scenarios: a qualitative study of nursing students' perceptions

Background

High-fidelity simulation refers to realistic interactivity between students and an advanced simulator. During simulated scenarios, the facilitator often needs to provide guidance to the active students to bridge the gap between their insufficient practical nursing skills and clinical learning needs. Facilitators’ guidance should support students in problem-solving and help them progress in their simulation experiences. The aim of this study was to explore and describe nursing students´ perspectives on the facilitator’s role during simulated scenarios.

Methods

A qualitative design was used. Thirty-two nursing students participated in five focus groups conducted immediately after a 2-day high-fidelity simulation course in the second year of their Bachelor of Nursing in Norway. The analysis used structured text condensation.

Results

One main category, “Alternating between active and passive facilitation,” emerged along with three sub-categories: (1) practical support: the facilitator played an important role in ensuring the flow of the simulated scenarios. Some students sought cues from the facilitator or responses to their actions. Other students wanted to act independently, reassured by the possibility of asking for assistance. (2) Guiding communication: the facilitator was important to students in paving their way to achieve the learning outcomes. The way facilitators supported students influenced students’ understanding and their feelings about how they handled the situation and whether they achieved the learning outcomes. (3) Emotional influence: the facilitator’s presence in the simulation room during the simulated scenarios influenced students’ emotions, for example having a calming or aggravating effect or making them feel distressed. In some cases, students were undisturbed.

Conclusions

The facilitation of simulated scenarios requires special skills in providing individually suitable cues at the right time to students with a variety of learning preferences. It is vital that facilitators have well-developed relational, pedagogical, and emotional competence combined with clinical, technical, and simulation-based learning skills in monitoring different learning preferences. As the facilitator role is challenging and complicated, more research is needed to explore how facilitators could monitor and adjust cues individually in simulated scenarios.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00233-0.

Developing Situation Awareness in Simulation Prebriefing

BACKGROUND

Prebriefing before simulation is a recommended practice that increases learner satisfaction and improves performance. Promoting situation awareness through prebriefing facilitates optimal learning outcomes.

METHOD

Endsley's Model of Situation Awareness is applied to the cognitive work of nursing practice that occurs during the prebriefing phase of simulation. Perceiving, comprehending, and projecting about elements of a situation lead to clinical judgement, reasoning, decision making, and ultimately nursing actions.

RESULTS

Developing situation awareness in prebriefing is a supported process that connects learners' prior knowledge and experience with the needed knowledge, skills, and abilities in the simulation environment. These mental models become the foundation for understanding the relevance of perceived information, comprehending its meaning, and directing nursing actions.

CONCLUSION

The simulation facilitator influences the development of situation awareness by focusing perception on key elements and scenario objectives, fostering psychological safety, and enhancing familiarity with the simulation environment during prebriefing. [J Nurs Educ. 2022;61(5):250-256.].

Evaluation of the Effectiveness of Digital Game-Based Learning Given to Nursing Students for the Developmental Care of Infants in Neonatal Intensive Care Unit

Although simulation laboratories are widely used in today's nursing education programs, it is becoming more and more difficult to find adequate physical space, equipment, and instructors for laboratory practices in schools. With increasing access to quality technology, schools prefer Web-based education or virtual games as another way of learning through simulation laboratories. This study was carried out to evaluate the effect of digital game-supported teaching activity given to nursing students for the developmental care of infants in neonatal ICU on learning. This study is a quasi-experimental study with a control group. Within the scope of the study, the researchers, together with the technical team, developed a digital game in accordance with the purpose of the study. The study was conducted in a health sciences faculty, nursing department, between September 2019 and March 2020. Sixty-two students were included in the study, which were divided into two groups, with 31 students in the experimental group and 31 students in the control group. The study data were collected using a personal information tool and a developmental care information tool. Whereas the digital game learning method was used for the students in the experimental group, the traditional teaching method was used for the students in the control group. No significant difference has been found between the pretest knowledge scores of the students in the experimental and control groups (P > .05). A statistically significant difference has been found in the rates of giving correct answers between the groups in the posttest and retention test (P < .05). The students in the experimental group gave more correct answers in the posttest and retention test than the students in the control group. In line with these results, the learning method with digital games is effective in increasing the knowledge level of nursing undergraduate students. Therefore, it is recommended to integrate digital games into education.

Simulated Wound Care as a Competence Assessment Method for Student and Registered Nurses

OBJECTIVE

To describe the development and use of a wound care simulation assessing RNs' and graduating student nurses' practical wound care competence and to describe observations of participants' wound care competence.

METHODS

A descriptive, qualitative design was used. Data were collected in 2019 from 50 healthcare professionals and students using a simulated wound care situation and an imaginary patient case. The simulation was based on a previously developed and tested wound care competence assessment instrument, which included a 14-item checklist that assesses practical wound care competence of chronic wounds. The data were analyzed and described based on the 14 competence areas or as other competencies.

RESULTS

Participants showed competence in identification of wound infection, debridement, dressing selection, tissue type identification, and consultation. Participants' shortcomings were related to pain assessment and management, asepsis, offloading, and documentation. Simulation was shown to be a promising tool to assess healthcare professionals' and students' practical wound care competence in a safe and standardized situation.

CONCLUSIONS

This study provided new information about simulation as a method to assess student nurses' and RNs' wound care competence. The results could be used in wound care education planning and development in both undergraduate nursing education and continuing education for nursing professionals.

Co-developing and implementing a community nursing simulated learning resource for undergraduate nursing students

Policy agendas across the developed world privilege systems transformation, notably shifting the balance of service provision from hospital to community settings. Primary and community health services have pivotal roles in the United Kingdom's longstanding policy ambition of healthcare services transformation, and it is imperative that undergraduate nursing students comprehend community settings as valuable learning environments, places of care and community nurses' roles therein. However, limited community placement learning opportunities means nursing students may be inadequately prepared to work in community settings at the point of initial registration. High fidelity simulated learning is well established within undergraduate nursing curricula. Currently, this learning approach predominantly focuses on acute and secondary care nursing and takes place in simulation centres. Within undergraduate nursing curricula there is limited evidence to support that community-based simulation is utilised with the result that students may struggle to recognise the value of learning opportunities in the community environment. This underpins the rationale for the development of this educational initiative which reflects current health policy agenda of care being provided closer to home. In addition, the new pre-registration 'Future nurse: Standards of proficiencies' (NMC, 2019) acknowledge that registered nurses need to be able to care for people in their own home and in the community setting. This paper describes the co-development and implementation of a pilot, community nursing focused, simulated learning resource within an undergraduate adult field nursing programme in Wales, UK. TWEETABLE ABSTRACT: How one university co-developed and implemented a community focused simulation resource for undergraduate nursing students.

Developing Mental Health-Related Simulation Activities for an Australian Undergraduate Nursing Curriculum

BACKGROUND

Although simulation-based learning experiences have been widely used in nursing curricula to develop confidence, knowledge, and skills, the use of mental health-related simulation in undergraduate nursing education is sparse.

METHOD

This project aimed to develop a simulation activity that incorporated the National Safety and Quality Health Service standards in acute mental health for undergraduate nursing students to prepare them for their clinical practicum in mental health. Clinical confidence was evaluated using the Mental Health Clinical Confidence scale.

RESULTS

Mental health clinical confidence increased in students following the activity.

CONCLUSION

The findings show simulation activities that build on existing knowledge improve student confidence in providing care for people with mental health conditions. This article reports on the development and implementation of a mental health-related simulation-based learning experience in an undergraduate nursing program and builds on the existing knowledge of simulation-based learning in health care education. [J Nurs Educ. 2021;60(6):356-361.].

Students' Perspectives on Learning Practical Nursing Skills: A Focus Group Study in Norway

Practical nursing skills are complex and involve technical, theoretical, and practical aspects, caring perspectives adjusted to both patient and circumstances, as well as ethical and moral considerations. Patients' length of stay in hospitals is decreasing, and more advanced patient treatment is conducted in primary healthcare settings. Hence, education and nursing skills need adjustment in line with the rapidly evolving field of practice. Studies emphasize a need to uncover whether the technical aspect of nursing skills, in general, is challenging in students' learning. The aim of this study was to explore students' perspectives on practical nursing skills and how they can best learn these. Three focus group interviews were conducted with registered nurse students and intellectual disability nurse students in their last semester (n = 11). Conventional, inductive content analysis in line with recommendations from Hsieh and Shannon was used to analyze the data. Two main categories with subcategories were identified: (1) the content of practical skills, with subcategories (a) human-to-human relations, (b) organizational competence, and (c) technical mastering and (2) building competence, with subcategories (a) need for supervision, (b) planning the learning situations, and (c) relevance for practice. Students experienced that practical skills did not only include technical aspects but also the ability to establish a relationship to the patient and to organize their working day. Supervising was assumed as essential both when training in the simulation center and in clinical placement, as well as planning of the training, respectively. Students experienced that some skills learned in the university college were less relevant in clinical practice and that certain skills were difficult to perform in practice due to the type of clinical placement. Hence, there is a need to review the approach to and content of practical nursing skills' learning in healthcare undergraduate programs, to prepare students for clinical practice, and to ensure that they build the competence needed in healthcare services.

First Italian validation of the "Satisfaction with simulation experience" scale (SSE) for the evaluation of the learning experience through simulation

BACKGROUND AND AIM OF THE WORK

Training in simulation through "mannequins" is increasingly widespread among nursing students. In the Italian context, however, there are no tools that measure the degree of student satisfaction after clinical training through simulation. The aim of the study is to provide a first validation in Italian of the Satisfaction with simulation experience" (SSE) scale, a tool already validated in several languages.

METHODS

After obtaining the author's consent, the SSE was subjected to forward and backward translation. The content validity was assessed by 5 training experts by calculating the Content Validity Index by Item and by Scale (I-CVI and S-CVI); the face validity was tested on 4 nursing students who had participated in a simulation experience. Subsequently, the SSE was administered to 10 nursing students with test-retest after 7 days in order to evaluate the reliability by calculating the reliability coefficient (r) and Cronbach's α.

RESULTS

The author approved the final version of the SSE translated into Italian: I-CVI values>0.80 and S-CVI was 0.94. r is 0.88 and the α of the scale is 0.713.

CONCLUSIONS

The detected values of I-CVI and S-CVI are satisfactory, demonstrating the validity of the content of the SSE-ITA. The test-retest showed "optimal" reliability and the α was considered acceptable given the little deviation from the original (0.776). Although the results demonstrate satisfactory values, this is a first validation and other studies with larger samples are needed.

The use of simulation in occupational therapy education: A scoping review

INTRODUCTION

Simulated learning experiences are a common feature of many health professions' pre-registration curricula. However, the use of simulation within occupational therapy is still largely undefined. This scoping review seeks to identify and summarise the available evidence exploring the use of simulation within occupational therapy pre-registration education.

METHODS

A search was conducted in four databases for articles published between 2009 and 2020 to identify international literature relevant to the use of simulation within occupational therapy education. Articles were evaluated using the appropriate Critical Appraisal Skills Programme (CASP) tool and key features and benefits of current simulation education were identified using thematic analysis.

RESULTS

A total of 32 papers were included within the review. Four themes were identified and explored: simulation methods, authenticity, global approaches to simulation, and relationship to practice education.

CONCLUSION

Simulation is taking place in many different forms within occupational therapy internationally. It is positively received by students and may provide an effective replacement for practice education if focussed on professional standards and competencies. Further research into the potential effectiveness of simulation in relation to practice learning is indicated.

Cultural competence development: The importance of incorporating culturally responsive simulation in nurse education

The continued reports of declining standards of care for culturally diverse patients, highlights the urgent need for nurse educators to critically examine how cultural competence development is facilitated in everyday teaching. Nurses frequently report experiencing difficulties when adapting caring practice to culturally diverse groups. Subsequently, there needs to be a rooting of continuous cultural competence development threaded throughout undergraduate curricula. Simulation pedagogy can be used as a vehicle for nurturing cultural competence, but this requires a review of how culturally responsive simulation is structured and designed. This paper focuses on culturally responsive simulation as a means of improving the preparation of nurses for working in a broadening culturally diverse healthcare context by outlining fundamental considerations when integrating cultural competence development in everyday simulation.

Moral reasoning as a catalyst for cultural competence and culturally responsive care

The importance of developing cultural competence among healthcare professionals is well recognized. However, the widespread reports of insensitivity and deficiencies in care for culturally diverse patients illuminate the need to review how cultural competence development is taught, learnt and applied in practice. Unless we can alter the 'hearts and minds' of practising nurses to provide the care that they know they should, culturally insensitive care will continue operating in subtle ways. This paper explores the ideas behind nurses' actions and omissions when caring for culturally diverse patients and proposes the need to examine cultural competence development through a moral reasoning lens. Examining cultural competence development through a moral reasoning lens can help empower nurses, whilst nurturing commitment and courage to providing quality care that meets the needs of culturally diverse patients. The model of morality provides a framework that explores how moral motivation and behaviour occur and can provide a vehicle for critically examining the knowledge, skills and attitudes required to provide culturally responsive care.

Face-to-Face and blended methods to improve oral competence in nursing students through simulation

Communication and interpersonal skills are relevant to the health professions, so it is important to promote these competencies at university. This research assesses the effectiveness of teaching oral competence through simulation using face-to-face and blended methods. A public speaking workshop was conducted in a group of 144 first year nursing students. Three groups were obtained according to the teaching method (Group 1: traditional method-3 sessions, Group 2: traditional method-2 sessions, Group 3: blended method-2 sessions). Public speaking confidence was measured at the beginning and end of the training, and oral competence was assessed at the end. As a result, all groups achieved a good level of oral competence after the training. However, while students in Group 1 showed greater oral competence, with regard to confidence in public speaking, students in Group 1 showed significantly worst results than those in Group 3. We concluded that simulation is a useful strategy to improve cognitive learning, and behavioural and practical competencies such as public speaking. As for the teaching method, although blended learning did not offer better results than traditional learning, it seems useful provide there is at least one face-to-face session so that the student can perform a speech and receive corrective feedback.

The art of balancing: the facilitator's role in briefing in simulation-based learning from the perspective of nursing students - a qualitative study

Background

Facilitators plays a key role in nursing student’s learning when briefing them for simulation scenarios. However, few studies have explored the importance of the facilitator’s role in preparing students from the students’ perspective. The aim of this study was to explore undergraduate nursing students’ perspectives of the facilitator’s role in briefing.

Methods

An explorative, qualitative approach was used. Four focus group interviews with a total of 30 nursing students constituted the data source. Data collection took place in December 2017 and in May 2018. The data was analysed using systematic text condensation.

Results

Two main categories were identified: “The importance of framing the subsequent scenario” and “The importance of instructing students how to execute nursing actions in the subsequent scenario”. The first category consisted of three subcategories: providing predictability, providing emotional support and providing challenges. The second main category also consisted of three subcategories: providing information about medical and technical equipment, providing a demonstration of the monitor and providing a demonstration of the manikin.

Conclusion

A briefing is more than a general introduction to a simulation scenario, learning objectives, roles, simulation environment and medical equipment. The information provided in a briefing is important for nursing students’ understanding of what they will encounter in the simulation scenario and what is being simulated, as well as possibly being a prerequisite for mastery. The facilitator’s role in the briefing is complex and requires a high level of educational expertise to balance the diversity of students’ learning approaches. Students have to learn how to simulate before the briefing. Therefore, we suggest separating the concepts of prebriefing and presimulation from the concept of briefing, introducing prebriefing and presimulation preparation before briefing, and possibly dividing students into groups based on their learning approach. Such interventions will make it possible for facilitators to balance between students’ needs and the time available for briefing.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12912-020-00493-z.

Optimising simulation learning experiences for mature, postgraduate nursing students

Mature students do not always approach learning activities according to expected adult learner behaviour. In addition, they may have never experienced simulation as a learning opportunity before. This creates a unique opportunity for nurse educators to contextualise education principles that are most applicable to mature students' learning needs. Education action research was conducted with two groups of mature postgraduate students, using nominal and focus groups to optimise their simulation learning experiences. Results showed that mature students should be thoroughly oriented beforehand about simulation practice and what is expected of them during participation. Through scaffolding and a succession of at least six to 10 simulation sessions, learner independence and adult learner behaviour can be developed. Begin with less complex scenarios before moving to ones that are more complex - this will prevent cognitive overload. Keeping the simulation environment as authentic and reliable as possible will promote suspension of disbelief. A non-punitive debriefing model is essential for enhancing student engagement and motivating improved performance in follow-up simulation learning sessions. If nurse educators stay open and responsive to the learning needs of mature students, the advantages of learning through simulation can be realised fully.

Interpreting the value of feedback: Older adult voices in nursing education

As patients, older adults are often involved informally with the teaching of nursing students in clinical environments. This involvement is recognised as valuable; however, the role of the patient is often passive. In recent years there has been recognition of the value that real people's lives, and health experiences can bring to student education, so much so that many programs now incorporate real patients into the formal education of students. In this educational initiative, older adults, from a Residential Aged Care Campus (RACC), participated as simulated patients in scenario based clinical learning activities, providing feedback to nursing students on the carative aspects of the learning activities. The aim of this study was to contribute toward the body of knowledge in engaging older adults in simulated clinical activities, specifically in the provision of feedback to nursing students. A qualitative interpretive methodology was applied to capture the older adults' experiences of providing feedback as simulated patients. This included the collection of data through participant observation, recording of field notes, collection of a written feedback form and semi-structured interviews with the participants. Thematic analysis was undertaken to identify emergent themes in the data. Findings from this study have emphasised the value of including the patient voice in nursing education. The provision of feedback by older adults during direct care interactions supports and nurtures student awareness of the patient and the caring process of nursing. Unique to this study, was the finding that although the participants received no formal training in the delivery of feedback, all utilised a clear process recognised within the literature. A recommendation linked to this finding is that a feedback training program would be of benefit in reducing some of the feelings of uncertainty expressed by the older adults when giving feedback and better equipping them to deliver constructive feedback.

'Ward for the day': A case study of extended immersive ward-based simulation

BACKGROUND

Simulation is an important teaching strategy in the preparation of nursing students for professional practice. The focus of simulation has shifted from single patient encounters to multiple case studies provoking immersion in all the activities that are regularly performed on the ward. Extended immersive simulation cannot replicate completely the stresses of working on a 'real' ward, but it does provide a safe environment for students to practice the role of being a registered nurse.

OBJECTIVE

To evaluate satisfaction associated with student experiences of mentorship by industry partners, self-reflection on performance, and responses to clinical situations following an episode of extended immersive ward-based simulation.

DESIGN

Mixed methods case study.

SETTING

School of Nursing and Midwifery metropolitan Western Australian university.

PARTICIPANTS

A cohort of 278 final year students enrolled in a three-year Bachelor of Nursing program.

METHOD

Eight demonstration rooms were re-configured to resemble a mixed medical/surgical ward. Nursing students and manikins in each room simulated different patient scenarios. Students were organised in three-hour shifts in which to undertake the role of a registered nurse. Industry partners undertook shift coordinator and senior nursing roles. Surveys were distributed to students at the end of the two-day simulation. Student satisfaction was evaluated using the Satisfaction with Simulation Experience scale and content analysis of open-ended questions.

RESULTS

A total of 243 students (87.4%) responded to the survey. None of the scaled items had a mean score of below 4.5. Content analysis of 458 written responses identified three themes: simulation, role of registered nurse and learning.

CONCLUSION

Extended immersive ward-based simulation offers the opportunity for educators to mirror what happens in clinical practice. Students value the opportunity to safely experience simulated demands of working on a busy ward and learn how to meet workplace pressures in the delivery of patient care.

Nursing simulation: a community experience

The education sector faces major challenges in providing learning experiences so that newly qualified nurses feel adequately prepared to work in a community setting. With this in mind, higher education institutions need to develop more innovative ways to deliver the community-nurse experience to student nurses. This paper presents and explores how simulation provides an opportunity for educators to support and evaluate student performance in an environment that models a complete patient encounter in the community. Following the simulation, evaluative data were collated and the answers analysed to identify key recommendations.

Avstick: An Intravenous Catheter Insertion Simulator for Use with Standardized Patients

An overwhelming majority of hospitalized patients undergo intravenous (IV) catheter insertion in order to receive hydration and necessary medication. Current IV insertion training techniques include manikins that are unable to react or give feedback to the trainee. The Avstick® is a realistic training device that can be worn by an actor, allowing a nurse trainee to perform an IV catheter insertion on a live patient without causing the person harm. The purpose of this study is to demonstrate the effectiveness of the Avstick in nursing education to increase nurse-patient communication and trainee self-efficacy.

[How to promote student nurses' psychological safety in the emergency care curriculum?]

Context : Since 2006, all students in healthcare, including student nurses, follow an emergency care curriculum. This curriculum uses simulation, which can be psychologically harmful to students. Objective : this study explores tutors' strategies to establish and maintain students' psychological safety during the emergency care simulations. Method : A qualitative study was conducted within an exploratory framework. Qualitative data were collected by semi-structured interviews. The sample subjects were emergency care tutors. Results : The tutors identified risk factors affecting the students' psychological wellbeing during simulations. Having assessed these risks, tutors deploy prevention strategies. When a student is in psychological distress, they implement several remedial tools. These strategies intervene at the three stages of the simulation : the briefing, the scenario, and the debriefing. Discussion : The importance of psychological risks for students must be taken into consideration by the tutors in simulation. Those risks must be anticipated from the design to the execution of simulation sessions. Conclusion : The management of students in psychological distress should be better addressed in the tutors' own training.

Clinical simulation in nursing education in intensive therapy: an integrative review

OBJECTIVE

to analyze the publications on clinical simulation practices for education in Nursing in Intensive Care.

METHOD

an integrative review carried out through LILACS, PubMed, Cochrane Library, CINAHL and SciELO databases, of articles published from 2008 to 2017.

RESULTS

29 articles were selected, of which 76% discuss the use of simulation in continuing education of nursing professionals, while the others describe their use for student education. There is a higher prevalence of studies with a level of evidence 6 (17), with 28 international publications. There was an increase in scientific production, with 16 articles published in the last three years.

CONCLUSION

variables after simulation use, such as confidence, communication skills, efficiency in the identification of clinical worsening of patients, development of technical skills, teamwork and clinical decision-making, presented a significant improvement, demonstrating that this tool is effective in qualifying care for critical patients.

Realistic health care simulation scenario: what is relevant for its design?

We sought to describe the stages of scenario development with emphasis on the most relevant aspects according to the literature and guidelines of The International Nursing Association for Clinical Simulation and Learning and Best Evidence Medical Education, which are discussed and exemplified on the basis of our professional experience. The following stages were described and commented on for scenario design: planning, objectives, simulation structure and format, case description and perception of realism, pre-debriefing, debriefing, evaluation, materials and resources, and pilot test. A scenario design based on good practices involves important elements, and each stage is closely interrelated and interdependent in its creation process.

Nursing students’ experience in performing intimate clinical procedures via high fidelity Mask-Ed simulation

Background

Didactic clinical skills training employing low fidelity simulation has been the traditional approach to teaching undergraduate nursing students the insertion of an indwelling urinary catheter. This approach, however, does not adequately prepare students for the intricacies and complexity of this procedure in the real world, which is associated with high rates of infection secondary to procedural contamination.

Objectives

To explore students’ confidence levels in developing clinical psychomotor skills associated with the insertion of an indwelling urinary catheter in a high-fidelity simulation using Mask-Ed.

Methods

A mixed methods study was conducted involving final year Bachelor of Nursing students. Preproceduraland postprocedural confidence was rated by students using a 5-point Likert scale. A focus group consisting of eleven students was conducted to further explore student’s experience of engaging with a Mask-Ed character and the procedural experience from a learning perspective.

Results

The findings indicated that students increased their procedure confidence when engaging with the Mask-Ed simulation (P=0.025). The ability to maintain procedural asepsis and ability to accurately identify the correct anatomical structures related to indwelling urinary catheter insertion were found to be related (rs=0.71, P<0.05). Three primary themes were identified: caring of a person, intimate care and communication.

Conclusion

Psychomotor skills related to communication, support and maintaining procedural asepsis were areas that required further clinical development, which are not concurrently integrated into the simulation approach using manikin based simulation. Mask-Ed provided a unique learning opportunity to replicate a clinically and anatomically realistic experience.

Promoting experiential learning through the use of high-fidelity human patient simulators in midwifery: A qualitative study

BACKGROUND

 The need to use innovative teaching and learning strategies in the nursing pedagogy is important in the 21st century. The challenges of clinical sites and opportunities for nursing students to gain clinical experience are a growing concern for many nurse educators. High-fidelity human patient simulators (HFHPS) are computerised mannequins that replicate a real-life patient, and when integrated into classroom teaching they allow students to become fully immersed into an almost real-life scenario.

OBJECTIVES

 The aim of this study was to describe how HFHPS can promote experiential learning following the management of postpartum haemorrhage as a midwifery clinical emergency.

METHOD

 A descriptive qualitative research approach was carried out in this study. The research setting was a local university in KwaZulu-Natal. The total population included all (N = 43) fourth-year baccalaureate of nursing undergraduate student midwives who participated as observers and/or role-players of a scenario role-play. An all-inclusive sampling was performed. There were 43 student midwives involved in the simulation teaching session with 6 of these students actively participating in each role-play at a time, while the remaining 37 observed. This occurred in two separate sessions and all the student midwives were involved in a debriefing session. These student midwives were then followed up and asked to participate in a focus group. The data in this article came from two separate focus groups which comprised 20 student midwives in total. Data were analysed using content analysis.

RESULTS

 Four categories emerged from the data, namely HFHPS offers a unique opportunity for student midwives to manage complex real-life emergencies; promotes reflection by allowing student midwives to reflect or review their roles, decisions and skills; allows student midwives to learn from their own experiences and encourages student midwives to try out what they learnt in a real-life situation.

CONCLUSION

 High-fidelity human patient simulators can be used in a complex case scenario to promote experiential learning of a clinical emergency.

Prioritizing the Fundamentals of Care Within the Prelicensure Nursing Curriculum

BACKGROUND

Little empirical research exists on how best to teach fundamentals of care to prelicensure nursing students. This pilot aims to develop this evidence base.

METHOD

A 6-week intervention embedded fundamentals of care explicitly, focusing on the integrated nature of such care, within a first-year prelicensure nursing curriculum at an Australian university. The intervention involved two components: (a) using the fundamentals of care framework to structure and guide teaching and shape students' conceptual understanding of the fundamentals of care, and (b) restructuring clinical skills sessions to reinforce this conceptual understanding.

RESULTS

Preliminary observations show that the intervention offers a practical and effective way to teach the fundamentals of care to prelicensure students, helping them to see the value of the fundamentals of care and to provide quality care for patients' fundamental needs.

CONCLUSION

Explicitly embedding the fundamentals of care within accredited nursing curricula is feasible and has observable, positive effects. [J Nurs Educ. 2018;57(8):498-501.].

Nursing Students' in Mental Health Nursing Shown by the Debriefing Phase in Low-Fidelity Simulation

There is a lack of documentation about how nursing students evaluate the debriefing phase in simulation in mental health nursing. The aim of this quantitative study was to describe nursing students' experiences of the debriefing phase after low-fidelity simulation activities in mental health nursing, and to investigate whether background data influence their experience. Data were collected using the "Debriefing Experience Scale" and analysed with descriptive and comparative tests. Students with more than 1 year's clinical praxis experienced significantly that debriefing helped them to clarify problems of communication when encountering persons suffering from psychosis compared to students who had less than 1 year of clinical praxis.

Simulation-based education: A narrative review of the use of VERT in radiation therapy education

Simulation has a long history in medical and health science training and education. The literature describing this history is extensive. The role simulation plays in many health disciplines has evolved, as has the focus of the literature around it. The Virtual Environment for Radiotherapy Training (VERT) system is a relative newcomer to radiation therapy education and, similar to the literature around radiation therapy (RT) education, is still in its infancy. This narrative review sets the scene of simulation-based education within the health sciences and considers the lessons learned from published work on VERT to date. The evidence suggests that future inquiry involving VERT should explore different ways in which VERT can be used to contribute to the skillset required by the radiation therapist of tomorrow.

High fidelity simulation to improve multidisciplinary team working with pre-registrants

Simulation has been introduced in recent years into international nursing curricula. Many educational establishments have developed simulation centres that resemble the ward settings nursing students will be exposed to so that they can use the same equipment as they will in clinical practice. This is referred to as high fidelity simulation training (HFST). This article reflects on an example of a multidisciplinary HFST scenario in the context of the assessment and accountability and learning domains of the Nursing and Midwifery Council standards. The article also discusses the assessment, feedback and evaluation process.

Exploring the use of high-fidelity simulation training to enhance clinical skills

The use of interprofessional simulation training to enhance nursing students' performance of technical and non-technical clinical skills is becoming increasingly common. Simulation training can involve the use of role play, virtual reality or patient simulator manikins to replicate clinical scenarios and assess the nursing student's ability to, for example, undertake clinical observations or work as part of a team. Simulation training enables nursing students to practise clinical skills in a safe environment. Effective simulation training requires extensive preparation, and debriefing is necessary following a simulated training session to review any positive or negative aspects of the learning experience. This article discusses a high-fidelity simulated training session that was used to assess a group of third-year nursing students and foundation level 1 medical students. This involved the use of a patient simulator manikin in a scenario that required the collaborative management of a deteriorating patient.

An educational intervention to enhance clinical skills learning: Experiences of nursing students and teachers

The simulation centre is a key setting for the acquisition of practical skills. However, pedagogical underpinnings of skills instruction in this setting are not always well founded. This study aimed to explore student and teacher experiences with an educational intervention to enhance clinical skills learning in the first semester of nursing education. The study had an exploratory design, where qualitative data were collected in focus group interviews involving 18 students and four teachers. The participants had generally positive experiences of the intervention. The findings showed that organisation, time usage, an observer role, re-training and structured reflection enhanced systematic feedback by students. We conclude that an educational intervention based on theoretically sound learning tools and pedagogical principles improved students' skills acquisition and gave the teachers a common educational platform.

Aprender com a Simulação de Alta Fidelidade

Resumo A Simulação de Alta-Fidelidade é um método pedagógico fundamental no processo de ensino-aprendizagem dos estudantes de enfermagem. Realizou-se um estudo exploratório e descritivo, de abordagem qualitativa, com o objetivo de compreender a percepção dos estudantes do curso de Licenciatura em Enfermagem sobre o contributo da Prática Simulada de Alta-Fidelidade para a aprendizagem das suas competências clínicas. Utilizou-se o questionário de autopreenchimento, composto por questões abertas, e a técnica de análise de conteúdo para tratamento do material narrativo segundo Bardin. Com o desenvolvimento do cenário clínico, salienta-se a percepção dos estudantes de enfermagem na aprendizagem de competências profissionais em três domínios, com maior enfoque no da prestação e gestão de cuidados. Concluiu-se que a Simulação de Alta-Fidelidade é um pilar fundamental na formação dos estudantes de enfermagem, o que vem reforçar a prática pedagógica existente. Salientamos a necessidade de reformular os cenários de forma a um maior equilíbrio da aprendizagem nas diferentes dimensões das suas competências profissionais e desenvolver instrumentos de avaliação.

Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study

Learning practical nursing skills is an important part of the baccalaureate in nursing. However, many newly qualified nurses lack practical skill proficiency required to ensure safe patient care. The invasive skill peripheral vein cannulation (PVC) is particularly challenging to learn and perform. This study explored conditions influencing nursing students' learning and performance of the technical implementation of a PVC during their clinical placement period. A qualitative and descriptive case study design with two students in Norway practicing PVC during their clinical placement was conducted. One student who mastered the vein cannulation was compared with one student who did not. Data were collected in late 2012 using multiple data sources: semistructured interviews, ad hoc conversations, and video recordings. Video recordings of the two students' cannula implementations were used to help clarify and validate the descriptions and to identify gaps between what students said and what they did. Thematic analysis of the transcribed text data enabled identifying themes that influenced skill performance. There were two overall themes: individual and contextual conditions influencing the technical implementation of a peripheral vein cannula. These findings were evaluated in terms of Benner's work on scientific and practical knowledge, defined as “knowing that” and “knowing how.”

Clinical simulation with dramatization: gains perceived by students and health professionals

Objective:

to identify in the literature the gains health students and professionals perceive when using clinical simulation with dramatization resources.

Method:

integrative literature review, using the method proposed by the Joanna Briggs Institute (JBI). A search was undertaken in the following databases: Latin American and Caribbean Health Sciences Literature, Web of Science, National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, Scientific Electronic Library Online.

Results:

53 studies were analyzed, which complied with the established inclusion criteria. Among the different gains obtained, satisfaction, self-confidence, knowledge, empathy, realism, reduced level of anxiety, comfort, communication, motivation, capacity for reflection and critical thinking and teamwork stand out.

Conclusion:

the evidence demonstrates the great possibilities to use dramatization in the context of clinical simulation, with gains in the different health areas, as well as interprofessional gains.

Student-Perceived Influences on Performance During Simulation

BACKGROUND

Understanding the effect of the context of simulation to learning and performance is critical to ensure not only optimal learning but to provide a valid and reliable means to evaluate performance. The purpose of this study is to identify influences on performance from the student perspective and understand the contextual barriers inherent in simulation before using simulation for high-stakes testing.

METHOD

This study used a qualitative descriptive design. Senior nursing students (N = 29) provided nursing care during simulation. Vocalized thoughts during simulation and reflective debriefing were digitally recorded and transcribed verbatim. Thematic analysis was conducted on transcribed data.

RESULTS

Student performance during simulation was influenced by anxiety, uncertainty, technological limitations, and experience with the patient condition. Students had few previous simulation-based learning experiences that may have influenced performance.

CONCLUSIONS

More needs to be understood regarding factors affecting simulation performance before pass-or-fail decisions are made using this technology. [J Nurs Educ. 2016;55(7):396-398.].

Evaluation of nursing students about learning with clinical simulation

OBJECTIVE

to describe the contributions of clinical simulation for learning cognitive and procedural attributes through debriefing, from the perspective of nursing students.

METHOD

descriptive exploratory study. Twenty nursing undergraduate students from a university in the interior of the state of São Paulo participated in this study. Data collection was performed at the debriefing stage. Student's perceptions about the simulation, positive aspects and what they could have done differently were registered. The students' statements were grouped according to the central themes and the framework of Bardin's content analysis (2011) and were analyzed using descriptive statistics.

RESULTS

enhancement of active, critical and reflective learning (47.5%) was identified due to the closeness to reality in nursing care (20.3%), manifestation of feelings experienced during the simulation (15.3%) and composition of the scenario (15.3%).

CONCLUSION

the clinical simulation followed by debriefing promotes the understanding of the link between action and achievements in learning.