The effect of mannequin fidelity on the achievement of learning outcomes for nursing, midwifery and allied healthcare practitioners: Systematic review and meta-analysis

The efficacy of high-fidelity simulation on knowledge and performance in undergraduate nursing students: An umbrella review of systematic reviews and meta-analysis

OBJECTIVES

This umbrella review aimed to consolidate the evidence base on the impact of high-fidelity simulation on knowledge and performance among undergraduate nursing students.

DESIGN

Umbrella review with meta-analyses of pooled effect sizes, followed by an additional meta-analysis of primary studies from the included systematic reviews, excluding overlapping results.

DATA SOURCES

Systematic searches were performed up to August 2023 in PubMed, Embase, and Cochrane Library. We included reviews that compared high-fidelity simulation against other learning strategies.

REVIEW METHODS

The risk of bias was assessed for each included systematic review (ROBIS tool) and primary study (RoB 2 or ROBINS-I as appropriate). Random-effect meta-analyses of meta-analyses were performed to estimate the pooled effects of high-fidelity simulation on knowledge and performance. Further random-effect meta-analyses of primary studies were conducted, with overlapping studies excluded (12 %). Subgroup analyses were performed to provide a more comprehensive analysis of the findings. Trim-and-fill analyses were conducted to adjust for potential publication bias.

RESULTS

Six systematic reviews were included and encompassed 133 primary studies (2767 and 3231 participants concerning performance and knowledge, respectively). The adjusted pooled effects for knowledge (SMD = 0.877, 95 % CI: 0.182 to 1.572) and performance (SMD = 0.738, 95 % CI: 0.466 to 1.010) closely aligned with those obtained from meta-analyzing the primary studies for knowledge (SMD = 0.980) and performance (SMD = 0.540), both showing high statistical heterogeneity. Traditional lectures represented the more common comparison. The subgroup analysis revealed significant differences in effect sizes across geographic locations, topics, types of control, and how interventions were reported.

CONCLUSIONS

The results provide robust evidence supporting the integration of high-fidelity simulation into undergraduate nursing programs to enhance students' knowledge and performance. The high reported heterogeneity may be attributed to variations in study contexts or methodologies. Future research should explore the optimal use of high-fidelity simulation in different educational and cultural contexts.

Teaching nursing students: As an umbrella review of the effectiveness of using high-fidelity simulation

AIM

To conduct an umbrella review of the effectiveness of using high-fidelity simulation in nursing student teaching, thereby supporting continuous improvement in teaching practitioners' implementation of high-fidelity simulation intervention strategies.

BACKGROUND

Several systematic reviews have investigated the effectiveness of high-fidelity simulation in nursing student teaching in recent years. However, conclusions vary and a systematic assessment is lacking.

DESIGN

This review encompasses an umbrella review.

METHODS

A search of PubMed, Embase, Cochrane Library, Web of Science and OVID databases was conducted to retrieve data on an umbrella review of high-fidelity simulation effectiveness in nursing student teaching from database inception to November 2023. The quality of the included systematic reviews was independently assessed by two reviewers using the AMSTAR 2 and PRISMA scales. Outcome indicators from the included systematic reviews were graded using the GRADE system.

RESULTS

Twelve systematic reviews focusing on high-fidelity simulation effectiveness in nursing student teaching were included. Notably, all 12 systematic reviews exhibited very-low methodological quality, with 9 exhibiting some degree of reporting deficiencies, 2 exhibiting severe information deficiencies and 1 reporting relatively complete information. A total of 22 outcome indicators and 53 pieces of evidence were included. The results revealed 15 pieces of low-quality evidence and 38 pieces of very-low-quality evidence. Mounting evidence suggests that high-fidelity simulation teaching effectively enhances nursing students' theoretical performance, practical skills and various clinical comprehensive abilities, highlighting a positive teaching effect. However, further validation through high-quality, large-sample studies is warranted.

CONCLUSION

The overall evidence quality of the current systematic reviews evaluating high-fidelity simulation effectiveness in nursing student teaching is low. Additionally, the methodological quality and the degree of reporting standardization require further improvement. Therefore, high-quality, large-sample randomized controlled trials are essential for further substantiating high-fidelity simulation effectiveness in nursing student teaching.

A Comparison of Virtual Reality to Traditional Simulation in Health Professions Education: A Systematic Review

ABSTRACT

With the increasing availability of virtual reality (VR) and its lower overall costs of use, the objective of this review was to compare VR to traditional simulation in terms of learning outcomes. Studies were included if they met the following criteria: ( a ) research study (of any design), ( b ) focused on learners in health professions, and ( c ) compared VR with traditional simulation. Studies were excluded for the following reasons: ( a ) not a research study, ( b ) focused on learners outside health professions, ( c ) used screen-based or computer-based simulation, ( d ) used a task trainer, and ( e ) did not involve a comparison of VR to traditional simulation. The searches were run on November 11 and 12, 2021, in CINAHL via EBSCO, Ovid Embase, ERIC via EBSCO, IEEE Xplore, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided the review. A team of researchers applied Kirkpatrick's Levels, Melnyk's Levels of Evidence, and Critical Appraisal Skills Programme guidelines to assess the level of evidence and look for bias. Fifteen studies were reviewed including 11 randomized controlled trials. The lead researcher synthesized the study results into 3 categories: (1) traditional simulation performed better, (2) VR performed better, and (3) comparable outcomes. There is insufficient evidence to endorse one form of simulation (VR or traditional) as more effective at this time. The body of evidence contained too few studies to draw meaningful conclusions to answer the guiding question. The studies covered a large range of modalities, learner groups, and healthcare topics, preventing a meta-analysis. Based on the literature and experience, we recommend that VR experiences be proctored, include debriefing, have a backup plan for cybersickness or myopia, and have time and costs documented. Use of VR is likely to expand; thus, research is needed to inform the best contexts and applications.

Developing a virtual reality (VR) application for practicing the ABCDE approach for systematic clinical observation

BACKGROUND

The Airways, Breathing, Circulation, Disability, Exposure (ABCDE) approach is an international approach for systematic clinical observation. It is an essential clinical skill for medical and healthcare professionals and should be practiced repeatedly. One way to do so is by using virtual reality (VR). The aim was therefore to develop a VR application to be used by inexperienced health students and professionals for self-instructed practice of systematic clinical observation using the ABCDE approach.

METHODS

An iterative human-centred approach done in three overlapping phases; deciding on the ABCDE approach, specifying the requirements, and developing the application.

RESULTS

A total of 138 persons were involved. Eight clinical observations were included in the ABCDE approach. The requirements included making it possible for inexperienced users to do self-instructed practice, a high level of immersion, and a sense of presence including mirroring the physical activities needed to do the ABCDE approach, allowing for both single and multiplayer, and automatic feedback with encouragement to repeat the training. In addition to many refinements, the testing led to the development of some new solutions. Prominent among them was to get players to understand how to use the VR hand controllers and start to interact with the VR environment and more instructions like showing videos on how to do observations. The solutions in the developed version were categorised into 15 core features like onboarding, instructions, quiz, and feedback.

CONCLUSION

A virtual reality application for self-instructed practice of systematic clinical observation using the ABCDE approach can be developed with sufficient testing by inexperienced health students and professionals.

The impact of healthcare assistant education on pressure ulcer prevention: a systematic review

OBJECTIVE

To investigate the impact of education for healthcare assistants (HCAs) on their knowledge and skills in pressure ulcer (PU) prevention and on the incidence of PUs. A secondary aim was to evaluate education methodologies used in PU prevention programmes.

METHOD

Using systematic review methodology, key databases were searched with no limitations on date of publication. The search was conducted in November 2021 using the following databases: CINAHL, Embase, Scopus, MEDLINE, Cochrane Wounds Group Specialist Register and Cochrane Central Register of Controlled Trials. Inclusion criteria focused on studies that employed the use of education as an intervention, delivered to HCAs in any setting. The PRISMA guidelines were followed. The methodological quality of the studies was evaluated using the Evidence-Based Librarianship (EBL) appraisal checklist. Data were analysed using narrative analysis and meta-analysis.

RESULTS

The systematic search yielded an initial 449 records, of which 14 studies met the inclusion criteria. Outcome measures of HCA knowledge scores were reported in 11 (79%) studies. Outcome measures related to PU prevalence/incidence were reported in 11 (79%) studies. An increase in knowledge scores of HCAs post-educational intervention was reported in five (38%) studies. A significant reduction in PU prevalence/incidence rates post-educational intervention was reported in nine (64%) studies.

CONCLUSION

This systematic review affirms the benefits of education of HCAs on their knowledge and skills of PU prevention, and on PU incidence. The results must be treated with caution due to quality appraisal issues of included studies.

Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis

Several studies have examined the effect of virtual reality (VR) education. However, they are mostly systematic reviews or meta-analyses focusing on doctors and residents; they fail to consider VR medical education for a broader range of learners. We evaluated the effectiveness of VR education for health professionals and identified the essential features of education. Randomized controlled trials published from January 2000 to April 2020 were identified from PubMed, Embase, CINAHL, and the Cochrane Library (n = 299). The randomized studies' bias risk was evaluated using Cochrane's Risk of Bias tool. Meta- and subgroup-analyses were conducted using Review Manager 5.4.1. The overall effect was measured using Hedges' g and determined using Z-statistics (p < 0.05). Heterogeneity was assessed using X² and I² statistics. Among the identified records, 25 studies were selected through systematic review, and 18 studies were included in the meta-analysis. We identified a significant improvement in the VR group's skill and satisfaction levels, and that less immersive VR was more efficacious for knowledge outcomes than fully immersive VR. Maximizing the advantages of VR will increase learning opportunities and complement the limited clinical experience, thus improving medical services. A systematic and efficient VR medical education program will greatly enhance learners' core competencies.

A scoping review of clinical skill development of preregistration registered nurses in Australia and five other English-speaking countries

AIM

The aim of this scoping review is to synthesise current evidence around the clinical skill development of preregistration registered nurses (RNs) in Australia, United Kingdom (UK), Ireland, United States (US), Canada and New Zealand, to inform nurse education, policy and clinical practice.

BACKGROUND

Nursing is a practical profession, and registered nurses require specific skills, knowledge and attributes in order to care for patients safely. The context for health care delivery is shifting, and the education of nurses must adapt to effectively equip the registered nurse of the future.

DESIGN

A scoping review was conducted of clinical skill development in preregistration nurses. CINAHL Plus, MEDLINE, Health Source (Nursing/Academic edition) and Scopus were searched. Included studies were primary Australian studies and international literature reviews, which focussed on preregistration nursing education. Papers were written in the English language and focussed on clinical skill development. Results were synthesised narratively. The review is reported here in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Scoping Review extension (PRISMA-ScR) guidelines.

RESULTS

One hundred fifty-five Australia studies and 89 international reviews were included in the review. Six key themes were identified, namely clinical skills, approaches to teaching and learning, interprofessional education, assessment of learning, clinical placement and simulation.

CONCLUSION

There is substantial variation in strategies and programmes to facilitate clinical skill development both within Australia and internationally, indicating a genuine shift away from traditional didactic pedagogy. New graduate registered nurses were expected to be "work-ready," albeit at a novice level, when they enter the workplace. Future research should consider measures of impact on actual clinical practice and focus on developing work-ready graduates for the range of clinical settings in which they may practice. Educators, policymakers and educational institutions can use these findings to inform curriculum developments to ensure that clinical skill development is evidence-based.

A Description of Breast Models Used to Teach Clinical Skills

Background: Health care trainees lack opportunities to practice breast assessment and clinical skills with patients, making breast models significant for hands-on training. Insufficient training leads to low competence across practitioners in breast health areas of practice, including clinical lactation. The aim of this review was to describe types of breast models used to teach clinical skills of the breast across breast health areas. The secondary aims were to describe education interventions that included each model and identify whether multiple skin tones were available in models. Methods: Authors conducted a scoping review to identify which types of breast models are used to teach clinical skills across breast health areas of practice and determine gaps in literature regarding how clinical lactation skills are taught. The literature search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MedLine, and ProQuest. Inclusion criteria were students/professionals engaging in breast model simulation. Eighteen studies were reviewed. Authors extracted data on participants, breast health area, breast model, intervention, evaluation, general outcomes, skin tone, and research design. Results: The most common skill area was clinical breast exam (n = 7), while least was breastfeeding education (n = 1). Most models were commercial (n = 12). Zero studies described skin tone. Generally, breast model simulations were correlated with increased clinical skills and confidence regardless of model used. Conclusions: Despite demonstrated gain of skills, this review reveals inconsistent use of breast models and evaluation, exclusion of diverse skin tones, and lack of breast models reported to teach clinical lactation skills.

Mapping the research hotspots and theme trends of simulation in nursing education: A bibliometric analysis from 2005 to 2019

BACKGROUND

Simulation-based nursing training has been used incorporated into nursing education for decades, however, there is limited information related to simulation research hotspots and theme trends over time.

OBJECTIVES

To investigate the research hotspots and theme trends of simulation in nursing education through bibliometric analysis.

METHODS

Relevant articles on simulation in nursing education published between 2005 and 2019 were retrieved from PubMed. The Bibliographic Item Co-occurrence Matrix Builder (BICOMB) was used to extract and quantitatively analyze the Medical Subject Headings (MeSH) terms and subheadings. The biclustering analysis was conducted using gCluto1.0 to identify the research hotspots. A strategic diagram was employed to reveal the development trend of the theme.

RESULTS

A total of 4102 publications were retrieved from PubMed showing an overall increasing trend. Based on the results, the United States was the most productive country (2868,55.7 %), the journal Nurse Education Today journal was the top journal concerning this field, and Cooper SJ and Holtschneider ME were authors with the highest number of publications on this topic. Quantitative and co-word biclustering analyses were used in this study. The research hotspots in recent 5 years were focused on: (1) interprofessional simulation in patient-care teams; (2) patient simulation in psychiatric nursing education; (3) virtual reality simulation (VRS) in midwifery and nursing education; (4) simulation in critical care nurses' continuing education/training, and (5) simulation in pediatric resuscitation education. The strategic diagram showed that the VRS in midwifery and nursing education might have a significant potential to become an emerging hotspot soon.

CONCLUSION

The research literature production of simulation in nursing education was increasing over the past 15 years. Through co-word biclustering analysis, five research hotspots were identified. Among them, simulation in psychiatric education and critical care continuing education had a central priority that researchers should pay further attention to, and VRS could be the major trend for future study. Furthermore, this study described the overall range of research interests and provided ideas for innovative and efficient research projects.

Development of Low-Fidelity Virtual Replicas of Products for Usability Testing

Designers perform early-stage formative usability tests with low-fidelity prototypes to improve the design of new products. This low-tech prototype style reduces the manufacturing resources but limits the functions that can be assessed. Recent advances in technology enable designers to create low-fidelity 3D models for users to engage in a virtual environment. Three-dimensional models communicate design concepts and are not often used in formative usability testing. The proposed method discusses how to create a virtual replica of a product by assessing key human interaction steps and addresses the limitations of translating those steps into a virtual environment. In addition, the paper will provide a framework to evaluate the usability of a product in a virtual setting, with a specific emphasis on low-resource online testing in the user population. A study was performed to pilot the subject’s experience with the proposed approach and determine how the virtual online simulation impacted the performance. The study outcomes demonstrated that subjects were able to successfully interact with the virtual replica and found the simulation realistic. This method can be followed to perform formative usability tests earlier and incorporate subject feedback into future iterations of their design, which can improve safety and product efficacy.

Virtual simulation debriefing in health professions education: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and map the existing literature on virtual simulation debriefing methods utilized in health professions education.

INTRODUCTION

Virtual simulation has emerged as a feasible alternative to in-person learning, allowing learners to continue their education despite constraints of space, finances, and clinical placement opportunities. Virtual simulation has proven to be a vital resource for health care students during the COVID-19 pandemic. While virtual simulation provides students with continued opportunities to develop knowledge and critical thinking in a safe environment, debriefing is a crucial step for successful knowledge uptake and deeper learning. Several studies have examined this topic in various health care settings; however, there are currently no scoping reviews that have explored virtual simulation debriefing in health professions education.

INCLUSION CRITERIA

This review will consider primary and secondary source articles that explore debriefing of virtual simulation within any undergraduate or graduate health education programs. Any setting that provides virtual simulation and debriefing, in any country, will be included.

METHODS

The review will be conducted in accordance with JBI methodology for scoping reviews and will search the following databases: Cochrane Library, JBI Evidence-based Practice Database, MEDLINE, CINAHL, Epistemonikos, Embase, ERIC, PsycINFO, Nursing and Allied Health Database, and Web of Science. Studies published from 2016 onward will be considered. The data extracted will include specific details about the concept, context, studymethod, and critical findings relevant to the review objective. Data will be presented in diagrammatic or tabular format in a manner that aligns with the objective of this scoping review.

SCOPING REVIEW REGISTRATION

Open Science Framework https://osf.io/36s5x.

A Study of the Educational Needs of Clinical Nurses Based on the Experiences in Training Programs for Nursing COVID-19 Patients

PURPOSE

This study aimed to explore the experience of clinical nurses regarding training programs for critically ill patients with coronavirus disease 2019 (COVID-19) and their educational needs.

METHODS

Qualitative data were analyzed using content analysis, and quantitative data were analyzed according to Borich's formula. Data for the study were collected in March 2021 from 16 nurses who had completed a nursing program for critically ill patients with COVID-19 and were working at three hospitals designated for COVID-19.

RESULTS

Participants' experiences were classified into three major categories, namely "Participation experiences and perceptions of the training program," "Recommendations for improving the training program," and "Perceptions of working in an infectious environment," and 10 subcategories. According to Borich's formula, the most pressing educational needs in respiratory and non-respiratory nursing, respectively, were for "nursing care for patients on extracorporeal membrane oxygenation" and "application of continuous renal replacement therapy and caring for patients."

CONCLUSION

To prepare for the periodic emergence of communicable infectious diseases throughout the world and cultivate nursing staff to care for critically ill patients, it is necessary to develop nursing education programs with content corresponding to nurses' needs. This study can be used as base data for cultivating nursing staff for critically ill patients with communicable infectious diseases in keeping with clinical nurses' educational needs and basic educational materials for nursing students.

TRIAL REGISTRATION

CRIS, KCT0006359. Registered 20 July 2021 - Retrospectively registered, https://cris.nih.go.kr/cris/.

High-fidelity simulation in undergraduate nursing education: A meta-analysis

OBJECTIVES

To explore the effectiveness of high-fidelity simulation (HFS) in undergraduate nursing education.

DESIGN

A meta-analysis of randomized controlled trials and quasi-experiment.

DATA SOURCES

Web of Science, PubMed, Embase, Cochrane Library, WANFANG, and CNKI were searched for eligible articles published in English and Chinese until May 28, 2021.

REVIEW METHODS

The Quality Appraisal Check-list for Quantitative Intervention Studies was applied to the quality evaluation. Standard mean differences (SMD) were pooled using a random effects model. The results of the individual and combined intervention effects estimation of was displayed in a forest plot, with weight, SMD, its corresponding 95% confidence interval (CI), Z-test, p, I².

RESULTS

Thirty-eight studies were included and 37 were analyzed. High-fidelity simulation (HFS) revealed significantly larger effect sizes for knowledge (SMD = 0.89, 95% CI [0.54 to 1.23]), skill (SMD = 0.93, 95% CI [0.69 to 1.17]), collaboration (SMD = 0.52, 95% CI [0.26 to 0.78]), caring (SMD = 1.40, 95% CI [0.23 to 2.58]) and learning interest (SMD = 0.85, 95% CI [0.00 to 2.04]) when compared with other teaching methods. However, no significant difference between HFS and other teaching methods in critical thinking (SMD = 0.46, 95% CI [-1.12 to 1.58]), self-confidence (SMD = 0.22, 95% CI [-0.32 to 0.75]) and learning satisfaction (SMD = 0.58, 95% CI [-0.25 to 1.41]) was shown.

CONCLUSIONS

High-fidelity simulation (HFS) can more effectively cultivate knowledge, skills, collaboration, caring, and learning interest of undergraduate nursing students. Since the effect of HFS is equivalent to other teaching methods in cultivating undergraduate nursing students' critical thinking, self-confidence and learning satisfaction, nursing educators can choose the most appropriate methods to achieve the intended learning outcomes according to the actual situation.

Neonatal Resuscitation Skill-Training Using a New Neonatal Simulator, Facilitated by Local Motivators: Two-Year Prospective Observational Study of 9000 Trainings

Globally, intrapartum-related complications account for approximately 2 million perinatal deaths annually. Adequate skills in neonatal resuscitation are required to reduce perinatal mortality. NeoNatalie Live is a newborn simulator providing immediate feedback, originally designed to accomplish Helping Babies Breathe training in low-resource settings. The objectives of this study were to describe changes in staff participation, skill-training frequency, and simulated ventilation quality before and after the introduction of “local motivators” in a rural Tanzanian hospital with 4000–5000 deliveries annually. Midwives (n = 15–27) were encouraged to perform in situ low-dose high-frequency simulation skill-training using NeoNatalie Live from September 2016 through to August 2018. Frequency and quality of trainings were automatically recorded in the simulator. The number of skill-trainings increased from 688 (12 months) to 8451 (11 months) after the introduction of local motivators in October 2017. Staff participation increased from 43% to 74% of the midwives. The quality of training performance, measured as “well done” feedback, increased from 75% to 91%. We conclude that training frequency, participation, and performance increased after introduction of dedicated motivators. In addition, the immediate constructive feedback features of the simulator may have influenced motivation and training quality performance.

Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study

Aim

This research is designed to establish and evaluate the effectiveness of a virtual reality simulation program using COVID‐19 scenario for nursing students.

Design

This is a quasi‐experimental study using a non‐equivalent control group pre‐test‐posttest design.

Methods

The participants were 65 students in their fourth year in nursing college. The knowledge about communicable infectious diseases in the respiratory system, self‐efficacy, clinical reasoning capacity and learning satisfaction was evaluated.

Results

The experimental group showed a significantly higher learning satisfaction (t = 3.01, p = .004). Both groups presented statistically significant differences in knowledge on infectious respiratory diseases, self‐efficacy and clinical reasoning between pre‐test and posttest. However, knowledge (t = 0.47, p = .643), self‐efficacy (t = 0.70, p = .944) and clinical reasoning were not different between the groups.

Online-synchronized clinical simulation: an efficient teaching-learning option for the COVID-19 pandemic time and: beyond

Face-to-face clinical simulation has been a powerful methodology for teaching, learning, and research, and has positioned itself in health science education. However, due to the COVID-19 pandemic, social distancing has forced universities to abandon simulation centers and make use of alternatives that allow the continuation of educational programs safely for students and teachers through virtual environments such as distance simulation. In Latin America, before the pandemic, the use of non-presential simulation was very limited and anecdotal. This article has three main objectives: to establish the efficacy of online-synchronized clinical simulation in the learning and performance of medical students on the management of patients with COVID-19 in simulation centers of three Latin American countries, to determine the quality of the online debriefing from the students' perspective, and to deepen the understanding of how learning is generated with this methodology.

Effectiveness of simulation-based peripheral intravenous catheterization training for nursing students and hospital nurses: A systematic review and meta-analysis

BACKGROUND

Peripheral intravenous catheterisation (PIVC) is a complex procedure.

AIM

This study reviewed studies evaluating the effects of different simulators in comparison with traditional methods used in PIVC training for nursing students and hospital nurses.

DESIGN

A systematic review and meta-analysis of randomised (RCT) and non-randomised controlled (N-RCT) studies.

METHODS

MEDLINE, Cochrane, Scopus, ERIC, Web of Science, and ScienceDirect were searched using PIVC, simulation and nursing education. The quality of evidence was assessed using the GRADE system; the risk of bias was assessed using the RoB 2 (for RCTs) and A Cochrane Risk of Bias Assessment Tool for N-RCTs. The study was conducted as per the PRISMA guidelines.

RESULTS

In total, 2,812 records were identified, and 12 studies published between 2002 and 2018 were finally included. Most studies included Virtual IV simulator and the plastic IV arm model in PIVC training for hospital nurses and nursing students, reported on outcomes such as PIVC-related knowledge, skills, confidence, state/trait anxiety and satisfaction. Seven studies were included in the meta-analysis, the effect sizes for all the outcomes ranged from small to moderate. However, the effect sizes were non-significant for all outcomes. The quality of evidence was assessed as being low for skills, knowledge, satisfaction, and trait/state anxiety, and moderate for confidence.

CONCLUSIONS

The effect of Virtual IV training on PIVC-related skills, knowledge, satisfaction and anxiety among nursing students and hospital nurses, in comparison with the plastic arm training method, remains unclear. However, Virtual IV training was found to increase PIVC confidence.

RELEVANCE TO CLINICAL PRACTICE

There is a small effect in favour of VR in PIVC education although non-significant. More evidence is needed to determine the superiority of simulation methods. In PIVC training of nurses and nursing students, hospitals and schools can choose a method in accordance with their resources.

TRIAL REGISTRATION

PROSPERO 2019 CRD42019124599.

Effects of Virtual Reality Simulation Program Regarding High-risk Neonatal Infection Control on Nursing Students

PURPOSE

Virtual reality simulation can give nursing students a safe clinical experience involving high-risk infants where access to neonatal intensive care units is limited. This study aimed to examine the effects of a virtual reality simulation program on Korean nursing students' knowledge, performance self-efficacy and learner satisfaction.

METHODS

A nonequivalent control group design was applied. Senior nursing students were divided into an experimental group (n = 25) experiencing virtual reality simulation and routine neonatal intensive care unit practice and a control group (n = 25) having routine neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management and skin care and environmental management for prevention of neonatal infection. The total execution time for the three scenarios was 40 minutes. The simulation created immersive virtual reality experiences using a head-mounted display with hand-tracking technology. Data were collected from December 9, 2019, to January 17, 2020, and were analyzed using descriptive statistics and the t-test, paired t-tests, Mann-Whitney test and Wilcoxon signed-ranks test.

RESULTS

Compared to the control group, the experimental group showed significantly greater improvements in high-risk neonatal infection control performance self-efficacy (t = -2.16, p = .018) and learner satisfaction (t = -5.59, p < .001).

CONCLUSION

The virtual reality simulation program can expand the nursing students' practice experience in safe virtual spaces and enhance their performance self-efficacy and learning satisfaction.

The Efficacy of Hybrid Telesimulation with Standardized Patients in Teaching Medical Students Clinical Lactation Skills: A Pilot Study

Introduction: Medical students lack competencies in clinical lactation. We determined the effect of hybrid telesimulation with a standardized patient (SP) on medical students' clinical performance in lactation support. We assessed students' engagement and satisfaction with the experience. Materials and Methods: Undergraduate medical students (n = 13) completed (1) preparatory case scenarios with multiple-choice questions and (2) three telesimulations with SPs wearing a high-fidelity breast model. Students had the option to complete the Encounter Documentation. SPs used the Formative Assessment Rubric (FAR) to evaluate students' interpersonal skills and clinical lactation experts used the Summative Assessment Rubric to evaluate documentation skills. Investigators collected satisfaction data from a focus group and written evaluation. Dunn's multiple comparison and Freidman tests were used to measure differences in FAR scores between cases and telesimulations. Qualitative data were analyzed using thematic analysis. Results: Most students (70%) attempted case questions multiple times and scores improved (p < 0.0001) between attempts. FAR scores suggest students were prepared for telesimulations (5.5/6-pt Likert) and interpersonal skills were appropriate (5.4/6), with no differences by case (p = 0.11). FAR scores increased between telesimulation 1-2 (+24.5/114, p = 0.002) and 2-3 (+17.5/114, p = 0.014). Students were satisfied with the experience and would recommend it to classmates (both 4.6/6). Thematic analysis revealed feedback regarding interpersonal skills was helpful. Conclusions: Medical students must develop skills to support breastfeeding in virtual settings. Telesimulation can be incorporated into existing curricula to support clinical lactation competencies.

Nursing Students' Experiences with Computer Simulation-Based Communication Education

Simulation-based communication education has improved nursing students’ communication knowledge and skills. However, communication patterns that students commonly exhibit in simulated situations and students’ responses to specific clinical situations have not been systematically examined. The specific aims of the present study were (1) to identify non-therapeutic communication patterns that nursing students exhibit in simulated situations in the computer simulation-based education (ComEd) program, and (2) explore students’ responses to challenging clinical situations. This study used a mixed-method research design and a convenience sampling method to recruit participants. Frequency analysis and a conventional content analysis method were used to analyze answers provided by participants. A total of 66 students from four Korean nursing schools participated in the study. “False reassurance” was found to be the most common non-therapeutic communication pattern used by nursing students. Nursing students had difficulty in clinical situations such as reporting a patient’s condition to a doctor, communicating with a patient and perform basic nursing skills at the same time, and managing conflicts between patients. Technology-based communication simulation programs, which reflect various clinical situations, are considered a new alternative that can supplement the limitations of clinical practicum and improve the quality of nursing education.

Setting the Foundation for an In Situ Simulation Program Through the Development of a Malignant Hyperthermia Simulation in the Operating Room

This article reviews the VA Manchester Healthcare System's journey to develop a robust simulation program and how an in situ simulation for malignant hyperthermia (MH) laid the foundation. Nurse educators collaborated with a certified registered nurse anesthetist to develop a simulation in the operating room using our MH protocol, which included the support of the Malignant Hyperthermia Association of the United States. The positive reaction from this in situ training led to additional simulation requests for the education department. [J Contin Educ Nurs. 2020;51(11):523-527.].

Midwifery students better approximate their self-efficacy in clinical lactation after reflecting in and on their performance in the LactSim OSCE

Background

Midwives are expected to support women with lactation initiation and maintenance. Midwifery students engaged in a simulation-based exercise (LactSim OSCE) where they role-played the clinician and the breastfeeding patient by wearing a high-fidelity breast model. We provided participants opportunities for reflecting in and on practice to compare their perceived self-confidence in clinical lactation skills to actual clinical performance. We also describe feasibility of implementing the LactSim OSCE with an emphasis on preparation and time spent on tasks during the OSCE.

Methods

Audio-video recordings from the LactSim OSCE were viewed and assessed using a technical skills checklist by an independent rater and by the study participants as part of the self-reflection. Mixed data on participants’ self-efficacy in clinical lactation, experience with the LactSim OSCE, and self-assessment of clinical performance were collected in survey instruments and a focus group. Time spent on each component and clinical lactation skill during the LactSim OSCE was documented.

Results

Immediately following the LactSim OSCE, participants’ confidence in clinical lactation was high (5.7/7), but after a guided video reflection exercise, their self-efficacy was 4.4/7. Participants spent approximately 2 of the allotted 10 min per case scenario discussing the OSCE logistics due to inadequate preparation. Participants spent approximately 2 min of the total encounter performing hands-on clinical lactation skills by touching, looking at, or using the high-fidelity breast model worn by their peer.

Conclusion

We described the development and evaluation of the first simulated experience in clinical lactation with all three components of fidelity: conceptual, psychological, and physical. Multiple opportunities for reflecting on performance allowed the nurse-midwifery students to evaluate their competence in decision-making, technical, and counseling skills which resulted in a more realistic approximation of their perceived self-confidence in breastfeeding skills. Another innovation of this pilot work is the documentation of how long a learner spends on various tasks relevant to lactation support in a simulated encounter. Our findings highlight the importance of providing multiple opportunities for self-reflection using guided video reflection and checklists for objective self-assessment in the clinical lactation field.

Efficacy of the computer simulation-based, interactive communication education program for nursing students

BACKGROUND

Simulation-based education using standardized patients or high fidelity patient simulators is resource-intensive and can be limited in its consistency and repeatability. Standardized, interactive, and effective computer simulation-based education programs that improve communication skills among nursing students are greatly needed.

OBJECTIVES

This study aimed to (1) compare the efficacy of a computer simulation-based, interactive communication education (ComEd) program and an attention control (AC) program on communication knowledge, learning self-efficacy, and communication efficacy at baseline and twice after the intervention (immediately after and two weeks after); and (2) assess the acceptability and satisfaction of the ComEd reported by the participants.

DESIGN

This study employed a mixed-method, randomized controlled design with repeated measures.

METHODS

Students were recruited from four nursing schools and randomly assigned to either the intervention or AC group. They received either the ComEd or AC program installed on a tablet PC or a desktop computer in the classrooms and completed a 15-item communication knowledge scale, 10-item learning self-efficacy scale, 22-item communication efficacy scale, and 14-item satisfaction scale. In addition, six open-ended questions were used to help participants reflect on their learning experiences and explore their satisfaction with the programs. The Generalized Estimating Equation (GEE) model was the main model employed to examine the effects of the ComEd program over time in comparison with the AC program, and the content analysis method was used for qualitative data.

RESULTS

In total, 131 nursing students (66 in ComEd and 65 in AC) completed the programs and 127 participated through the two-week follow-up test. Compared to the AC group, the ComEd group significantly improved communication knowledge, learning self-efficacy, and communication efficacy; these effects were maintained at two weeks. The ComEd program was well accepted by the participants.

CONCLUSIONS

The ComEd is a promising approach because it is highly accessible, consistent, and repeatable, and has positive learning effects.

Male nursing students' experiences of simulation used to replace maternal-child clinical learning in Qatar

BACKGROUND

In today's health care context, nurse educators teach with limited clinical placement availability, competition for available spaces and increasingly complex clients.

SETTING

As part of the baccalaureate of nursing program at the University of Calgary in Qatar, students are required to complete 208 h of maternal-child clinical. Unfortunately, due to social and cultural norms in this predominantly Muslim country, male nursing students are prohibited from practicing with mothers and babies in Qatar. In order to address this need, we developed a fully simulated clinical practice module for these male students.

OBJECTIVES

The aim of the current study was to better understand the learning experiences of the students undertaking this experience.

DESIGN

The authors developed and implemented a fully simulated, campus-based, maternity clinical experience that used a variety of levels of fidelity, incorporated the tenets of Kolb's (1984) experiential learning theory, and Jeffries' (2005) simulation design framework. Post-simulation debriefing sessions were recorded and transcribed. Typed weekly reflections were provided. All data was blinded.

PARTICIPANTS

A convenience sample of ten adult, male participants was obtained.

METHODS

Using an inductive qualitative approach, researchers analyzed transcripts of debriefing sessions and reflective journals.

RESULTS

The main themes were knowledge application, clinical judgement, communication, and crossing cultural barriers.

CONCLUSIONS

Themes from this study can be used to support and/or change existing practices in a way that supports learner-centered, experiential teaching practices.

Non-technical skills: a review of training and evaluation in urology

PURPOSE

With non-technical skills (NTS) deficits being recognised as a major cause for error in surgery, there is an increasing interest in their training and evaluation. A growing number of training courses are emerging and some NTS curricula have also been created. Many different training methods are described in the literature but there is still uncertainty with regards to their optimum combination within a curriculum.

METHODS

A literature review of the electronic database Medline was performed. All articles published before December 2018 were screened by abstract and included if deemed relevant by the author. The included articles' reference lists were also screened for further relevant studies.

RESULTS

Simulation training is accepted as the most effective way to train NTS. Within simulation training, it is shown that the 'igloo' full immersion/distributed simulation environment is appropriate for teaching NTS in urological scenarios where a designated operating room or space is not available. The use of multiple settings, for example wards and clinics as well as the operating room, is advantageous, as is training in an interprofessional team. Classroom teaching also plays a role in NTS training as an adjunct to simulation, with evidence that it improves some parameters of NTS. All levels, including qualified surgeons, benefit from NTS training; however, adaptation to both trainee level and specialty is important. Although less time consuming, training juniors and seniors together mainly benefits juniors, and training NTS at the same time as technical skills detracts from the quality of teaching. Debriefing is an important part of training and should be well structured; there are many debriefing models in existence, allowing for choice of method based on examiner preference and participant demographic. Furthermore, examiners should be well briefed in their task and trained in NTS assessment.

CONCLUSION

To move forward, studies should combine tried and tested learning techniques into a curriculum covering all training levels, which should then be validated and followed up long term to ensure a positive impact on patient safety.