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Jhunjhunwala R, Monzon J, Faria I, Escalona G, Zinco A, Ottolino P, Reyna F, Raykar N, Asturias S. A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city. World J Surg 2024; 48:1282-1289. [PMID: 38526473 DOI: 10.1002/wjs.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/10/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components. METHODS The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement. RESULTS Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups. CONCLUSION This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.
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Affiliation(s)
- Rashi Jhunjhunwala
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose Monzon
- Rafael Landivar University Guatemala City, Guatemala City, Guatemala
| | - Isabella Faria
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Gabriel Escalona
- Faculty of Medicine, Experimental Surgery and Simulation Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Hospital Sotero del Rio, Puente Alto, Chile
| | | | | | - Favio Reyna
- Francisco Marroquin University, Guatemala City, Guatemala
| | - Nakul Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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Nyiringango G, Fors U, Tumusiime DK, Forsberg E. Acceptance of virtual patients as a continuous professional development approach among practicing nurses in primary health care settings in a low-income country: a quasi-experimental posttest setup design. BMC Nurs 2024; 23:332. [PMID: 38755655 PMCID: PMC11097534 DOI: 10.1186/s12912-024-02000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Virtual patients are an educational technological approach used in healthcare education. Its distinctive features have rendered virtual patient technology appealing for the training of medical and healthcare students, particularly in the enhancement of clinical reasoning. Virtual patients are less often applied for continuous professional development for practicing healthcare providers, and there is a scarcity of studies exploring this possibility. This study aimed to assess the acceptability of nurses for using virtual patients as a continuous professional development approach. METHOD The study used a quasi-experimental posttest setup design. The study was conducted in ten primary healthcare settings in Rwanda. Among 76 nurses who consented to participate in the study, 56 completed the intervention and responded to the study questionnaire. Following a one-week program of continuous professional development on four non-communicable diseases, the study used a self-administered questionnaire based on the Technology Acceptance Model 3 to collect data. Descriptive analysis served as the primary method for analyzing participants' responses. The study also used a correlation test to assess the relationship of variables. RESULTS Across all items in the questionnaire, the median response tended towards either agree or strongly agree, with only a minority number of participants expressing strong disagreement, disagreement, or neutrality. The results indicated a significant positive correlation between perceived usefulness and behavior intention (p < 0.001). CONCLUSION The findings indicate an acceptability and behavioral intention of adopting virtual patients as an alternative continuous professional development approach among nurses working at health centers in Rwanda or other locations with similar contexts.
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Affiliation(s)
- Gerard Nyiringango
- Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12, PO Box 7003, Stockholm, SE-164 07, Sweden.
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, P.O.Box 3286, Kigali, Rwanda.
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12, PO Box 7003, Stockholm, SE-164 07, Sweden
| | - David K Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Elenita Forsberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Nyiringango G, Fors U, Forsberg E, Tumusiime DK. Enhancing clinical reasoning for management of non-communicable diseases: virtual patient cases as a learning strategy for nurses in primary healthcare centers: a pre-post study design. BMC MEDICAL EDUCATION 2024; 24:441. [PMID: 38654323 PMCID: PMC11036556 DOI: 10.1186/s12909-024-05440-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND In Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning. METHOD The study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis. RESULTS The results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants' scores based on demographic factors, including whether they worked in urban or rural areas. CONCLUSION AND RECOMMENDATION: Utilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where nurses are required to perform diagnostic processes similar to those employed by physicians.
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Affiliation(s)
- Gerard Nyiringango
- Department of Computer and Systems Sciences (DSV), Stockholm University, Borgarfjordsgatan 12, PO Box 7003, 164 07, Kista, Sweden.
- Department of Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, P.O.Box 3286, Kigali, Rwanda.
| | - Uno Fors
- Department of Computer and Systems Sciences (DSV), Stockholm University, Borgarfjordsgatan 12, PO Box 7003, 164 07, Kista, Sweden
| | - Elenita Forsberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - David K Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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O'Connor S. Over twenty years of pedagogical research from Nurse Education in Practice: A bibliometric analysis from 2001 to 2023. Nurse Educ Pract 2024; 76:103912. [PMID: 38401344 DOI: 10.1016/j.nepr.2024.103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/30/2023] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
AIM To present a bibliometric overview of pedagogical research from Nurse Education in Practice from its inception in 2001 up until 2023. BACKGROUND Bibliometric methods are useful in analysing and understanding the characteristics of scientific publications in a particular field and the influence of specific journals. However, no bibliometric analysis of a nurse education journal has been undertaken to date which would highlight important research trends in this area of nursing and midwifery. METHODS A total of 2231 publications (articles and reviews only) from Nursing Education in Practice were retrieved from the Scopus database between 2001 and 2023. Several software applications including Microsoft Excel and VOSviewer were used to undertake bibliometric analysis on this dataset. Publication trends such as country analysis, author analysis, keywords analyses (cluster, content and trend analysis) were generated to help understand the volume and scope of pedagogical nursing and midwifery research in this journal. RESULTS There has been a steady increase in pedagogical research from Nurse Education in Practice since its launch in 2001 up until 2018, with a dip in publications in 2022 most likely due to the impact of restrictions during the coronavirus pandemic. The most prolific institutions publishing in the journal are mainly from the United Kingdom, Australia and the United States, with over eighty countries represented demonstrating its global reach and impact. Nursing students, nursing education, simulation and learning are some of the most frequent author keywords. CONCLUSION The diversity of pedagogies in nursing and midwifery education, clinical learning and supervision in practice environments, and competence and confidence when transitioning to practice are the most popular research areas in Nurse Education in Practice. This study informs nurse and midwife educators and scholars about the volume and scope of pedagogical research in nursing and midwifery. It also makes recommendations on how to improve aspects of scholarship in education and areas for future pedagogical research.
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Affiliation(s)
- Siobhan O'Connor
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom.
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Liu K, Zhang W, Li W, Wang T, Zheng Y. Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2023; 23:710. [PMID: 37770884 PMCID: PMC10540340 DOI: 10.1186/s12909-023-04662-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This study aims to assess the transformative potential of Virtual Reality (VR) has shown significant potential in transforming nursing education by providing immersive and interactive learning experiences. Our objective is to systematically evaluate and conduct a meta-analysizes on the impact effect of virtual reality technology in teaching nursing students. METHODS To achieve this, we conducted comprehensive computer searches on platforms including of PubMed, Web of Science, Wiley Online Library, Zhiwang database, Wanfang database, and China Biomedical Literature Service (SinoMed), were conducted to collect randomized controlled trial studies on the use of virtual reality's technology for teaching nursing students built up to until March 2023., and the Cochrane Furthermore, the quality of the included literature was assessed evaluated using the quality evaluation criteria specified for randomized controlled trial studies within the Cochrane provided in the evaluation handbook manual. In addition, a meta-analysis was performed using Review Manager 5.3 software. RESULTS The aggregate outcomes from a total of 12 randomized controlled trials, encompassing including 1167 students, indicate were included. Meta-analysis results showed that virtual reality technology significantly enhances could better improve nursing students'' theoretical knowledge [(SMD = 0.97, 95% CI [0.48, 1.46], p < 0.001)], practical skills (SMD = 0.52, 95% CI [0.33, 1.46], p < 0.001), skill retention, (SMD = 0.52, 95% CI [0.33, 0.71], p < 0.001), and satisfaction levels (SMD = 1.14, 95% CI [0.85, 1.43], p < 0.001), in comparison with traditional or alternative teaching methodologies. However, no statistically significant impact was observed on the enhancement of critical thinking skills (SMD = 0.79, 95% CI [-0.05, 1.64], p = 0.07) among nursing students. CONCLUSION Our findings underscore that compared to conventional teaching methods, virtual reality offers superior potential in advancing nursing students' theoretical knowledge, practice proficiencies, and overall satisfaction, while not yielding a significant advantage in enhancing critical thinking skills. The incorporated literature consisted exclusively of randomized controlled trials, albeit a subset of these studies omitted descriptions of the allocation concealment strategy.
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Affiliation(s)
- Kai Liu
- Nursing Department of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng district, Jining City, 272000, Shandong Province, China
| | - Weiwei Zhang
- Interventional Radiology of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng district, 272000, Jining City, Shandong, China
| | - Wei Li
- Nursing Department of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng district, Jining City, 272000, Shandong Province, China
| | - Ting Wang
- Nursing Department of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng district, Jining City, 272000, Shandong Province, China
| | - Yanxue Zheng
- Nursing Department of Affiliated Hospital of Jining Medical University, 89# Guhuai Road, Rencheng district, Jining City, 272000, Shandong Province, China.
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Kolcun K, Zellefrow C, Karl J, Ulloa J, Zehala A, Zeno R, Tornwall J. Identifying best practices for virtual nursing clinical education: A scoping review. J Prof Nurs 2023; 48:128-146. [PMID: 37775227 DOI: 10.1016/j.profnurs.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND COVID-19 forced nurse educators across the world to rapidly shift clinical experiences from face-to-face to the virtual world without identification of best practices to guide this transition. PURPOSE The purpose of this review was to identify best practices in virtual clinical experiences for undergraduate and graduate nursing students using the Community of Inquiry model as a framework. METHOD A scoping review was conducted using the Joanna Briggs Institute Scoping Review process. Ten databases were searched systematically for literature related to virtual nursing student clinical experiences. The 36 articles retained for review were appraised using evidence-based rapid critical appraisal tools. RESULTS The literature suggests virtual clinical experiences may positively impact clinical reasoning and judgement; knowledge gain, retention, and application; affective learning; communication and teamwork; competence; engagement; confidence; and satisfaction. However, increased anxiety, frustration with technology and access, difficulty asking questions, and increased cost were reported. Additional considerations included appropriate faculty training, student support, and accreditation and board certification requirements. Standards related to virtual clinical experiences and simulation for advanced practice registered nurses needs further study. CONCLUSION Virtual clinical experiences resulted in positive student learning outcomes. Through the provision of quality virtual clinical experiences, nurse educators have the potential to maximize student learning and professional growth.
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Affiliation(s)
- Kaitlyn Kolcun
- The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
| | - Cindy Zellefrow
- Helene Fuld Health Trust National Institute for Evidence Based Practice in Nursing and Healthcare at The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
| | - Joyce Karl
- 2050 Carriage Rd., Powell, OH 43065, United States of America
| | - Jodi Ulloa
- The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
| | - Anita Zehala
- The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
| | - Rosie Zeno
- The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
| | - Joni Tornwall
- The Ohio State University College of Nursing, 1585 Neil Ave., Columbus, OH 43210, United States of America.
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Bond WF, Mischler MJ, Lynch TJ, Ebert-Allen RA, Mou KM, Aiyer M, Park YS. The Use of Virtual Standardized Patients for Practice in High Value Care. Simul Healthc 2023; 18:147-154. [PMID: 35322798 DOI: 10.1097/sih.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes. METHOD After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method. Performance markers included automated VSP grading and, for SP cases, faculty-graded observational checklists and patient notes. Performance was compared between modalities using t tests and analysis of variance and then correlated with US Medical Licensing Examination performance. RESULTS Sixty-six students participated (VSP first: n = 37; SP-first: n = 29). Attitudes toward CCC significantly improved after training (Cohen d = 0.35, P = 0.043), regardless of modality. Simulation order did not impact learner performance for SP encounters. Learners randomized to VSP first performed significantly better within VSP cases for interview (Cohen d = 0.55, P = 0.001) and treatment (Cohen d = 0.50, P = 0.043). The HVC component of learner performance on the SP simulations significantly correlated with US Medical Licensing Examination step 1 ( r = 0.26, P = 0.038) and step 2 clinical knowledge ( r = 0.33, P = 0.031). CONCLUSIONS High value care didactics combined with either VSPs or SPs positively influenced attitudes toward CCC. The ability to detect an impact of VSPs on learner SP performance was limited by content specificity and sample size.
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Affiliation(s)
- William F Bond
- From Jump Simulation (W.F.B., M.J.M., T.J.L., R.E.A., K.M.M., and M.A.), a collaboration of OSF Healthcare and the University of Illinois College of Medicine at Peoria; the Department of Internal Medicine (T.J.L., M.J.M., M.A.), Department of Pediatrics (T.J.L., M.J.M), and Department of Emergency Medicine (W.F.B) University of Illinois College of Medicine at Peoria; and Department of Medical Education (Y.S.P.), University of Illinois College of Medicine at Chicago, Chicago, IL
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Lee E, Baek G, Hwang Y. Effectiveness of the Patient's Severity Classification Competency Promotion Virtual Reality Program of Nursing Students during the COVID-19 Pandemic Period. Healthcare (Basel) 2023; 11:healthcare11081122. [PMID: 37107957 PMCID: PMC10137825 DOI: 10.3390/healthcare11081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
The purpose of this study was to develop a virtual reality-based nursing education program aimed at improving nursing students' severity classification competency. Severity classification in the emergency room is key to improving the efficiency of emergency room services worldwide. Prioritizing treatment based on correctly identifying the severity of a disease or an injury also ensures patients' safety. The five actual clinical scenarios in the program helped to promptly classify patients into five clinical situations based on the 2021 Korean Emergency Patient Classification Tool. Seventeen nursing students were in an experimental group that had access to a virtual reality-based simulation combined with clinical practice. Seventeen nursing students were in a control group that only participated in routine clinical practice. The virtual reality-based nursing education program effectively improved students' severity classification competency, performance confidence, and clinical decision-making ability. Although the pandemic continues, the virtual reality-based nursing education program provides realistic indirect experiences to nursing students in situations where clinical nursing practice is not possible. In particular, it will serve as basic data for the expansion and utilization strategy of virtual reality-based nursing education programs to improve nursing capabilities.
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Affiliation(s)
- Eunju Lee
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Gyuli Baek
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
| | - Yeonhui Hwang
- Nursing College, Keimyung University, Daegu 42601, Republic of Korea
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Huang HM, Fang YW. The effectiveness of designing and evaluating i-STAR applications in pediatric nursing courses. Heliyon 2023; 9:e13010. [PMID: 36711263 PMCID: PMC9876946 DOI: 10.1016/j.heliyon.2023.e13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/07/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
To apply the App to the curriculum could improve students' motivation and concentration, and also strengthen the effectiveness of professional knowledge of nursing students. OBJECTIVES To construct and evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses. METHODS Quasi-experimental study and two-group repeated-measure design were used to evaluate the effectiveness of smartphone applications (i-STAR) in pediatric nursing courses. The "i" means "interactive", students had to log into App and finish four steps, including "Situation(S), Task(T), Action(A), and Reflection(R). A total of 163 nursing students in the third grade of associate's degree in nursing (ADN) participated in the study. The experimental group consisted of 77 participants, whereas the control group consisted of 86 participants. The instruments included the clinical reasoning readiness scale (CRRS), self-directed learning instrument (SDLI), and learning satisfaction of students. The 1st phase was the development, construction, and testing of the "i-STAR App", including hyperbilirubinemia, pneumonia, and urinary tract infection (UTI). In the 2nd phase, students operated and applied the App in the classroom. The 3rd phase was to evaluate the effectiveness of the "i-STAR App" in the course. RESULTS The average scores of CRRS and SDLI were not significantly different between the two groups in the T0 andT1 (p > .05). The experimental group of CRRS and SDLI were better than the control group in T0-T1, T1-T2, and T0-T2 (p < .001). The experimental group showed better CRRS and SDLI scores than the control group in T0-T1, and T0-T2 with Repeated measures ANOVA. Also, the experimental group showed prolonged learning effectiveness. The experimental group (41.22 ± 6.08) was more satisfied than the control group (37.29 ± 7.40) (p < .05), although their academic performance was about the same (p > .05). CONCLUSION "i-STAR App" could enhance students' interest in pediatric nursing courses, strengthen nursing students' clinical reasoning and self-directed learning ability.
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Frey-Vogel AS, Ching K, Dzara K, Mallory L. The Acceptability of Avatar Patients for Teaching and Assessing Pediatric Residents in Communicating Medical Ambiguity. J Grad Med Educ 2022; 14:696-703. [PMID: 36591423 PMCID: PMC9765906 DOI: 10.4300/jgme-d-22-00088.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/08/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Simulation offers a means to assess resident competence in communication, but pediatric standardized patient simulation has limitations. A novel educational technology, avatar patients (APs), holds promise, but its acceptability to residents, educational relevance, and perception of realism have not been determined. OBJECTIVE To determine if APs are acceptable, provide a relevant educational experience, and are realistic for teaching and assessment of a complex communication topic. METHODS Pediatric residents at one academic institution participated in an AP experience from 2019 to 2021 consisting of 2 scenarios representing issues of medical ambiguity. After the experience, residents completed a survey on the emotional relevance, realism, and acceptability of the technology for assessment of their communication competence. RESULTS AP actor training required approximately 3 hours. Software and training was provided free of charge. Actors were paid $30/hour; the total estimated curricular cost is $50,000. Sixty-five of 89 (73%) pediatric residents participated in the AP experience; 61 (93.8%) completed the survey. Forty-eight (78.7%) were emotionally invested in the scenarios. The most cited emotions evoked were anxiety, uncertainty, concern, and empathy. The conversations were rated by 49 (80.3%) as realistic. APs were rated as beneficial for learning to communicate about medical ambiguity by 40 (65.5%), and 41 (66.7%) felt comfortable having APs used to assess their competence in this area. CONCLUSIONS Pediatric residents were emotionally invested in the AP experience and found it to be realistic. The experience was rated as beneficial for learning and acceptable to be used for assessment of how to communicate medical ambiguity.
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Affiliation(s)
- Ariel S. Frey-Vogel
- Ariel S. Frey-Vogel, MD, MAT, is Director, Pediatric Education, Innovation and Research Center, and Associate Program Director, Pediatric Residency Program, Harvard Medical School and Mass General for Children
| | - Kevin Ching
- Kevin Ching, MD, is Medical Director, Weill Cornell Medicine New York Presbyterian Simulation Center
| | - Kristina Dzara
- Kristina Dzara, PhD, MMSc, is Assistant Dean for Educator Development and Director, Center for Leadership and Innovation in Medical Education, Department of Biomedical Informatics and Medical Education, and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine
| | - Leah Mallory
- Leah Mallory, MD, is Medical Director, The Hannaford Center for Safety, Innovation, and Simulation, The Barbara Bush Children's Hospital at Maine Medical Center
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Zhang W, Jia X, Yao X, Zhang X, Liang Y, Zhang Y, Zhang X, Su P, Zhang X, Du S, Yin Z. Exploring the perceptions and barriers of nurses working in remote areas on tele-educational delivery of pharmacy knowledge in Henan, China: a qualitative study. BMJ Open 2022; 12:e051365. [PMID: 35135766 PMCID: PMC8830228 DOI: 10.1136/bmjopen-2021-051365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There are insufficient educational resources and opportunities available to nurses at county-level medical institutions in China to receive pharmacy knowledge education. Video conference pharmacy education (VCPE) has become a solution. However, a few studies have explored the perceptions of nurses participating in VCPE. The study was aimed to explore the perceptions of nurses participating in VCPE at county-level medical institutions in remote areas in China. The barriers and suggestions to improve the VCPE were also assessed. SETTING The study was conducted in two county-level hospitals in Henan, China. DESIGN AND PARTICIPANTS This qualitative study comprises two focus group discussions. Twenty-three nurses from two county-level hospitals in Henan province participated in the interview in May 2019. RESULTS The average age of our participants was 34.83±6.24 years old (from 26 to 55 years old). By deeply analysing the data, the following four domains were extracted: Four themes were extracted on VCPE from this qualitative study: (1) the pharmacy knowledge gains from VCPE, (2) the shortcomings VCPE, (3) the advantages of the VCPE and (4) the expectations and suggestions for the VCPE. CONCLUSION The results of this study indicate VCPE is a valuable tool to provide education to nurses working at remote area county-level institutions. The results contribute to improvements in future VCPE deliveries.
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Affiliation(s)
- Wan Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xuedong Jia
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiali Yao
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiang Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yan Liang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yingjie Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiao Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Pei Su
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Xiaojian Zhang
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Shuzhang Du
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Zhao Yin
- Department of Pharmacy, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
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Gebreheat G, Whitehorn LJ, Paterson RE. Effectiveness of Digital Simulation on Student Nurses' Knowledge and Confidence:An Integrative Literature Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:765-775. [PMID: 35923540 PMCID: PMC9343169 DOI: 10.2147/amep.s366495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/13/2022] [Indexed: 05/18/2023]
Abstract
Digital simulation is an emerging innovation with the potential to address the limitations to traditional clinical simulation. The pandemic has accelerated teaching on digital platforms, which is now embedded in pedagogic practice. This integrative review will evaluate the effectiveness of digital simulation on nursing students' knowledge and/or confidence. The electronic database search carried out between October 3 and 7, 2021. We included primary research articles published in English language between January 2012 and October 2021. From 14,369 citations, 10 full-text documents were included in our final analysis and synthesis. Results suggest that digital simulation with realistic, immersive and interactive characters had a positive impact on students' learning outcome in terms of knowledge acquisition and self-confidence. Therefore, combining digital simulation with face-to-face simulation will enhance learning.
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Affiliation(s)
- Gdiom Gebreheat
- Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Correspondence: Gdiom Gebreheat, Tel +447723005590, Email
| | - L Jane Whitehorn
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ruth E Paterson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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Chen L, Jiang WJ, Zhao RP. Application effect of Kolb's experiential learning theory in clinical nursing teaching of traditional Chinese medicine. Digit Health 2022; 8:20552076221138313. [PMCID: PMC9669681 DOI: 10.1177/20552076221138313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to explore the practical application and effect of Kolb's experiential learning theory in the clinical nursing training of traditional Chinese medicine (TCM). Methods This study is a quasi-experimental study. Eighty clinical nurses from a class-III grade-A general hospital were enrolled in 2020 and 2021, respectively, as research subjects. The subjects in the control group were trained in “theory explanation, clinical practice, summary and Q&A, [and] centralized examination.” The subjects in the experimental group were first grouped according to Kolb's experiential learning style. The training followed a “problem–exploration–practice–exploration–theory–explanation–summary–centralized examination” structure based on Kolb's experiential learning cycle, the training place is Conference Room 1 of the hospital. The training time is from February to August 2020 and 2021. The application effect of the experiential learning theory was evaluated by analyzing course evaluation questionnaires and the final examination results. Results The total score of the course evaluation questionnaire of the experimental group was 112.23 ± 5.88. The difference compared with the control group was statistically significant ( P < .01). In the experimental group, the theoretical score was 85.27 ± 3.29, and the operational score was 85.36 ± 3.01. The differences compared with the control group were statistically significant ( P < .01). Conclusion The application of Kolb's experiential learning theory to the training of TCM clinical nursing can make the clinical practice of TCM nursing more “scientific” and the training more effective, and it can improve the subjective initiative of students.
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Affiliation(s)
- Lu Chen
- Emergency ward of Taizhou People’s Hospital, Taizhou, China
| | - Wen-Juan Jiang
- Emergency ward of Taizhou People’s Hospital, Taizhou, China
| | - Ru-Ping Zhao
- Gynecology and pediatrics of Taizhou People’s Hospital, Taizhou, China
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Richardson CL, Chapman S, White S. Establishing the acceptability and usability of an animated virtual patient simulation. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 4:100069. [PMID: 35479841 PMCID: PMC9031081 DOI: 10.1016/j.rcsop.2021.100069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022] Open
Abstract
Background An animated, video-based, virtual patient (VP) has been developed to allow pharmacists to learn how, and practice how, to advise patients taking non-vitamin K oral anticoagulants, a group of high-risk medicines. VPs are well-established resources but have historically only been accessed within specific online teaching sessions or at university sites; this new VP represents a mobile design that can be accessed from anywhere. Objective To investigate the usability and acceptability of the VP application with a focus on exploring perspectives on accessibility. Methods The study used an exploratory sequential mixed method design consisting of a satisfaction survey and interviews. Survey data were analysed descriptively to assess satisfaction with the application and to identify interview discussion areas. Interview data were analysed using the Framework Approach to thematic analysis. Participants were hospital or community pharmacists, or pre-registration pharmacists. Results A total of 94 survey responses were collected and 22 respondents went on to take part in an interview. Participants reported liking the concept and delivery of the VP, particularly the high-quality technology. They also reported finding it usable, and appeared to favour its mobility and accessibility, particularly as the VP can be used on any internet accessible device, including mobile phones, with no specific requirements. Amendments that were suggested included quickening the delivery of some animations and improving navigation within the application, possibly through a button to return to the previous step should a mistake be made. Conclusions The mobile VP appeared to be functional and usable, with the majority of users reporting satisfaction with use across a range of devices. Users reported positively about the VP's remote access, but navigation around the application requires development.
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Affiliation(s)
- Charlotte Lucy Richardson
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, NE1 7RU, UK
- Corresponding author.
| | - Stephen Chapman
- School of Pharmacy and Bioengineering, Keele University, ST5 5BG, UK
| | - Simon White
- School of Pharmacy and Bioengineering, Keele University, ST5 5BG, UK
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Harmon J, Pitt V, Summons P, Inder KJ. Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review. NURSE EDUCATION TODAY 2021; 97:104700. [PMID: 33341064 DOI: 10.1016/j.nedt.2020.104700] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/02/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses. DESIGN A scoping review of published and unpublished research from 2009 to 2019. DATA SOURCES Nine electronic databases and hand-searching of reference lists. REVIEW METHODS Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis. RESULTS The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement. CONCLUSION Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.
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Affiliation(s)
- Joanne Harmon
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, 101 Currie street, Adelaide, SA 5001, Australia.
| | - Victoria Pitt
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Peter Summons
- School of Electrical Engineering and Computing, Faculty of Engineering and Built Environment, The University of Newcastle, NSW, Australia.
| | - Kerry J Inder
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, Australia.
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Chen FQ, Leng YF, Ge JF, Wang DW, Li C, Chen B, Sun ZL. Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis. J Med Internet Res 2020; 22:e18290. [PMID: 32930664 PMCID: PMC7525398 DOI: 10.2196/18290] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 07/26/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes. OBJECTIVE The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. METHODS We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. RESULTS A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI -0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI -0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI -0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=-0.55, 95% CI -2.04 to 0.94, P=.47, I2=97%). CONCLUSIONS The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results.
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Affiliation(s)
- Feng-Qin Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu-Fei Leng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jian-Feng Ge
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Dan-Wen Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Li
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Bin Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhi-Ling Sun
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
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Miles A, Hayden S, Carnell S, Halan S, Lok B. What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:239-245. [DOI: 10.1136/bmjstel-2020-000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/03/2022]
Abstract
BackgroundVirtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF).MethodsEighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy.ResultsConversational turns primarily focused on the ICF component—activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions—swallowing, 7% body functions—associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent.ConclusionSpeech pathology students naturally matched their virtual patient’s health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.
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Redmond C, Hardie P, Davies C, Cornally D, Daly O, O'Sullivan C. Increasing competence in wound care: A cross-sectional study to evaluate use of a virtual patient by undergraduate student nurses. Nurse Educ Pract 2020; 44:102774. [PMID: 32244047 DOI: 10.1016/j.nepr.2020.102774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/10/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
Concerns have arisen internationally over the competency of student nurses to perform wound care. A global shortage of nursing faculty and clinical practice opportunities is regarded as a contributing factor. Virtual simulation offers a possible solution. The aim of this study was to describe the development and educational evaluation of a virtual patient to supplement undergraduate learning of wound care. The National League for Nursing Jeffries model informed the design of the media. Evaluation of the virtual patient by penultimate year nursing students (n = 148) was conducted using a survey design. Findings are presented from statistical and directed content analyses. Most students rated the educational value of the virtual patient and its support of learning highly. They reported a perceived increase in confidence and ability to meet wound care competency outcomes. The virtual patient also provided students with opportunities to develop their clinical reasoning skills. This study provides evidence that virtual patient simulation is an effective pedagogy to increase clinical competence in wound care. It allows nursing students the opportunity to practice skills and utilise theory repetitively in a safe environment, unhampered by a lack of resources such as clinical placement availability and a declining faculty.
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Affiliation(s)
- Catherine Redmond
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Philip Hardie
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Carmel Davies
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | | | - Orla Daly
- School of Nursing, Midwifery & Health Systems, University College Dublin, Ireland.
| | - Cliona O'Sullivan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
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Peddle M. Participant perceptions of virtual simulation to develop non-technical skills in health professionals. J Res Nurs 2019; 24:167-180. [PMID: 34394522 DOI: 10.1177/1744987119835873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Research has identified that virtual simulations may be effective in developing non-technical skills including communication, teamwork and decision making. However, little is known about how participants perceive learning non-technical skills via engagement in virtual simulation. Aims The aim of this research was to investigate participant perceptions and the learning experiences when engaging in virtual simulations focused on developing non-technical skills. Method A descriptive exploratory approach was used. An online voluntary survey collected qualitative extended responses from participants after each virtual simulation. Ethics approval was obtained for the research and guidelines adhered to throughout the study. Results A total of 675 responses were obtained. Participants perceive that engaging with the virtual simulation made them aware of non-technical skills including communication, teamwork, decision making, critical thinking and problem solving, and, to a lesser extent, situational awareness. Additional categories of learning, clinical practice and limitations were identified. Conclusions Engaging in virtual simulation can develop awareness of non-technical skills, as well as confidence and vigilance in practice and mindfulness of a person-centred approach to healthcare. Engaging in virtual simulation may support change in the professional performance of the participants through role modelling and learning through error.
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Affiliation(s)
- Monica Peddle
- Lecturer in Nursing, School of Nursing and Midwifery, La Trobe University, Australia
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Virtual Standardized Patient Simulation: Case Development and Pilot Application to High-Value Care. Simul Healthc 2019; 14:241-250. [PMID: 31116172 DOI: 10.1097/sih.0000000000000373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION High-value care (HVC) suggests that good history taking and physical examination should lead to risk stratification that drives the use or withholding of diagnostic testing. This study describes the development of a series of virtual standardized patient (VSP) cases and provides preliminary evidence that supports their ability to provide experiential learning in HVC. METHODS This pilot study used VSPs, or natural language processing-based patient avatars, within the USC Standard Patient platform. Faculty consensus was used to develop the cases, including the optimal diagnostic testing strategies, treatment options, and scored content areas. First-year resident physician learners experienced two 90-minute didactic sessions before completing the cases in a computer laboratory, using typed text to interview the avatar for history taking, then completing physical examination, differential diagnosis, diagnostic testing, and treatment modules for each case. Learners chose a primary and 2 alternative "possible" diagnoses from a list of 6 to 7 choices, diagnostic testing options from an extensive list, and treatments from a brief list ranging from 6 to 9 choices. For the history-taking module, both faculty and the platform scored the learners, and faculty assessed the appropriateness of avatar responses. Four randomly selected learner-avatar interview transcripts for each case were double rated by faculty for interrater reliability calculations. Intraclass correlations were calculated for interrater reliability, and Spearman ρ was used to determine the correlation between the platform and faculty ranking of learners' history-taking scores. RESULTS Eight VSP cases were experienced by 14 learners. Investigators reviewed 112 transcripts (4646 learner query-avatar responses). Interrater reliability means were 0.87 for learner query scoring and 0.83 for avatar response. Mean learner success for history taking was scored by the faculty at 57% and by the platform at 51% (ρ correlation of learner rankings = 0.80, P = 0.02). The mean avatar appropriate response rate was 85.6% for all cases. Learners chose the correct diagnosis within their 3 choices 82% of the time, ordered a median (interquartile range) of 2 (2) unnecessary tests and completed 56% of optimal treatments. CONCLUSIONS Our avatar appropriate response rate was similar to past work using similar platforms. The simulations give detailed insights into the thoroughness of learner history taking and testing choices and with further refinement should support learning in HVC.
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Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N. Clinical Reasoning in Physical Therapy: A Concept Analysis. Phys Ther 2019; 99:440-456. [PMID: 30496522 DOI: 10.1093/ptj/pzy148] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/29/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy, along with most health professions, struggles to describe clinical reasoning, despite it being a vital skill in effective patient care. This lack of a unified conceptualization of clinical reasoning leads to variable and inconsistent teaching, assessment, and research. OBJECTIVE The objective was to conceptualize a broad description of physical therapists' clinical reasoning grounded in the published literature and to unify understanding for future work related to teaching, assessment, and research. DESIGN/METHODS The design included a systematic concept analysis using Rodgers' evolutionary methodology. A concept analysis is a research methodology in which a concept's characteristics and the relation between features of the concept are clarified. RESULTS Based on findings in the literature, clinical reasoning in physical therapy was conceptualized as integrating cognitive, psychomotor, and affective skills. It is contextual in nature and involves both therapist and client perspectives. It is adaptive, iterative, and collaborative with the intended outcome being a biopsychosocial approach to patient/client management. LIMITATIONS Although a comprehensive approach was intended, it is possible that the search methods or reduction of the literature were incomplete or key sources were mistakenly excluded. CONCLUSIONS A description of clinical reasoning in physical therapy was conceptualized, as it currently exists in representative literature. The intent is for it to contribute to the unification of an understanding of how clinical reasoning has been conceptualized to date by practitioners, academicians, and clinical educators. Substantial work remains to further develop the concept of clinical reasoning for physical therapy, including the role of movement in our reasoning in practice.
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Affiliation(s)
- Karen Huhn
- School of Physical Therapy, Husson University, Bangor, ME 04401-2999 (USA)
| | | | - Lisa L Black
- Department of Physical Therapy, Creighton University, Omaha, Nebraska
| | - Susan F Wainwright
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicole Christensen
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
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LaManna JB, Guido-Sanz F, Anderson M, Chase SK, Weiss JA, Blackwell CW. Teaching Diagnostic Reasoning to Advanced Practice Nurses: Positives and Negatives. Clin Simul Nurs 2019. [DOI: 10.1016/j.ecns.2018.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Holder AG. Clinical Reasoning: A State of the Science Report. Int J Nurs Educ Scholarsh 2018; 15:/j/ijnes.2018.15.issue-1/ijnes-2016-0024/ijnes-2016-0024.xml. [DOI: 10.1515/ijnes-2016-0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/19/2018] [Indexed: 11/15/2022]
Abstract
AbstractClinical reasoning is the cognitive process that nurses use to gather and incorporate information into a larger bank of personal knowledge. This incorporated information guides therapeutic actions, and helps determine client care. Since the process guides therapeutic actions regarding client care, failure to use the process effectively leads to poor clinical decision-making, inappropriate actions, or inaction. Because of the criticality of this process, this paper presents an analysis of the literature that reveals the current state of the science of clinical reasoning, identifies gaps in knowledge, and elucidates areas for future research. A systematic review of the databases the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Educational Resources Information Center (ERIC), PsychInfo, the Education Full Text (H.W. Wilson), and PubMed revealed 873 articles on the topic of clinical reasoning. Quality appraisal narrowed the field to 27 pieces of literature. Appendix A gives the State of the Science Coding Sheet used to identify the selections used in this research. Appendix B contains a summary of this literature. Although analysis of this literature shows that three theories exist on how to utilize most effectively the clinical reasoning process presently; a clear consistent definition is lacking. Additional research should focus on closing gaps that exist in defining the process, understanding the process, establishing linkages to non-clinical reasoning processes, and developing measures to both develop and accurately measure clinical reasoning.
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Affiliation(s)
- Amy Golden Holder
- East Tennessee State University, Nursing, P.O. Box 70551, Johnson City, TN, USA
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Salkowski LR, Russ R. Cognitive processing differences of experts and novices when correlating anatomy and cross-sectional imaging. J Med Imaging (Bellingham) 2018; 5:031411. [PMID: 29795777 DOI: 10.1117/1.jmi.5.3.031411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/23/2018] [Indexed: 01/15/2023] Open
Abstract
The ability to correlate anatomical knowledge and medical imaging is crucial to radiology and as such, should be a critical component of medical education. However, we are hindered in our ability to teach this skill because we know very little about what expert practice looks like, and even less about novices' understanding. Using a unique simulation tool, this research conducted cognitive clinical interviews with experts and novices to explore differences in how they engage in this correlation and the underlying cognitive processes involved in doing so. This research supported what has been known in the literature, that experts are significantly faster at making decisions on medical imaging than novices. It also offers insight into the spatial ability and reasoning that is involved in the correlation of anatomy to medical imaging. There are differences in the cognitive processing of experts and novices with respect to meaningful patterns, organized content knowledge, and the flexibility of retrieval. Presented are some novice-expert similarities and differences in image processing. This study investigated extremes, opening an opportunity to investigate the sequential knowledge acquisition from student to resident to expert, and where educators can help intervene in this learning process.
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Affiliation(s)
- Lonie R Salkowski
- University of Wisconsin, School of Medicine and Public Health, Department of Radiology, Madison, Wisconsin, United States.,University of Wisconsin, School of Medicine and Public Health, Department of Medical Physics, Madison, Wisconsin, United States
| | - Rosemary Russ
- University of Wisconsin, School of Education, Department of Curriculum and Instruction, Madison, Wisconsin, United States
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Gupta A, Singh S, Khaliq F, Dhaliwal U, Madhu SV. Development and validation of simulated virtual patients to impart early clinical exposure in endocrine physiology. ADVANCES IN PHYSIOLOGY EDUCATION 2018; 42:15-20. [PMID: 29341815 DOI: 10.1152/advan.00110.2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the country presently, preclinical medical students are not routinely exposed to real patients. Thus, when they start clinical postings, they are found to have poor clinical reasoning skills. Simulated virtual patients (SVPs) can improve clinical skills without endangering real patients. This pilot study describes the development of two SVPs in endocrine physiology and their validation in terms of acquisition of clinical knowledge and student engagement. Two SVPs, Nandini Sharma (unintentional weight gain) and Sunil Yadav (polyuria), were created and published on the i-Human Patients platform through an iterative, interdisciplinary, and transdisciplinary collaborative process using the conceptual framework of Kim et al. (Kim S, Phillips WR, Pinsky L, Brock D, Phillips K, Keary J. Med Educ 40: 867-876, 2006). After internal and external peer validation, the SVPs were piloted on 40 students (20 students per virtual patient) over 2 wk. A cognitive pretest was conducted before exposure, and a posttest soon after. Faculty and student feedback were collected. Faculty found SVPs authentic, helpful as teaching-learning tools, and useful for giving feedback and for assessment. Students found SVPs more engaging than paper cases and helpful in developing clinical reasoning and in imparting clinical exposure. Pretest and posttest scores indicated knowledge gain ( P < 0.01). Although challenging to create, SVPs created on the i-Human Patients platform improved learning in endocrine physiology and were well accepted by students and faculty as a means to provide early clinical exposure. More SVPs can be developed through collaboration between stakeholder departments and integrated into the curriculum for greater benefit.
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Affiliation(s)
- Akriti Gupta
- Department of Physiology, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
| | - Satendra Singh
- Department of Physiology, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
- Medical Education Unit, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
| | - Farah Khaliq
- Department of Physiology, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
| | - Upreet Dhaliwal
- Department of Ophthalmology, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
- Medical Education Unit, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
| | - S V Madhu
- Centre for Diabetes, Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital , Delhi , India
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Washburn M, Parrish DE, Bordnick PS. Virtual Patient Simulations for Brief Assessment of Mental Health Disorders in Integrated Care Settings. SOCIAL WORK IN MENTAL HEALTH 2018; 18:121-148. [PMID: 32952451 PMCID: PMC7500537 DOI: 10.1080/15332985.2017.1336743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This mixed methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrated care setting. A two by three factorial design was employed to evaluate three different simulated training conditions with a sample of 22 Masters level behavioral health students. Results support engagement in virtual patient simulation training to increase students' self-efficacy in brief clinical assessment, and support the use of virtual patient simulations to improve diagnostic accuracy. Results further indicate that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training. Future directions and next steps for the integration of technology enhanced simulations in clinical social services education are explored.
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Affiliation(s)
- Micki Washburn
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - Danielle E Parrish
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
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ten Cate O, Durning SJ. Approaches to Assessing the Clinical Reasoning of Preclinical Students. INNOVATION AND CHANGE IN PROFESSIONAL EDUCATION 2018. [DOI: 10.1007/978-3-319-64828-6_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Hutchinson M, Hurley J, Kozlowski D, Whitehair L. The use of emotional intelligence capabilities in clinical reasoning and decision-making: A qualitative, exploratory study. J Clin Nurs 2017; 27:e600-e610. [DOI: 10.1111/jocn.14106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marie Hutchinson
- School of Health and Human Sciences; Southern Cross University; Coffs Harbour NSW Australia
| | - John Hurley
- School of Health and Human Sciences; Southern Cross University; Coffs Harbour NSW Australia
| | - Desirée Kozlowski
- School of Health and Human Sciences; Southern Cross University; Coffs Harbour NSW Australia
| | - Leeann Whitehair
- School of Health and Human Sciences; Southern Cross University; Coffs Harbour NSW Australia
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Urresti-Gundlach M, Tolks D, Kiessling C, Wagner-Menghin M, Härtl A, Hege I. Do virtual patients prepare medical students for the real world? Development and application of a framework to compare a virtual patient collection with population data. BMC MEDICAL EDUCATION 2017; 17:174. [PMID: 28938884 PMCID: PMC5610434 DOI: 10.1186/s12909-017-1013-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/14/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND An important aspect of virtual patients (VPs), which are interactive computer-based patient scenarios, is authenticity. This includes design aspects, but also how a VP collection represents a patient population and how a patient is presented in a VP scenario. Therefore, our aim was to analyze VP scenarios integrated into the combined internal medicine and surgery curriculum at the University of Munich (LMU) and compare the results with data from the population in Germany. METHOD We developed a coding framework with four main categories: patient data, patient representation, diagnoses, and setting. Based on the framework we analyzed 66 VP and compared the results with data from the German healthcare system. RESULTS Especially in the categories of patient data and patient representation, the VPs presented an unrealistic image of the real world; topics such as unemployment, disability, or migration background were almost non-existent. The diagnoses of the VPs and the onset of diseases were comparable with the healthcare data. CONCLUSIONS An explanation for the lack of representativeness of the patient data and representation might be a trend to create VPs based on fictional patient stories with VP authors trying to minimize complexity and cognitive load for the students. We suggest raising awareness among VP authors concerning personalized representations of patients without overwhelming their students. Our framework can support educators to assess the authenticity and diversity of a VP collection.
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Affiliation(s)
- M. Urresti-Gundlach
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - D. Tolks
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - C. Kiessling
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - A. Härtl
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
| | - I. Hege
- Institute for Medical Education, University Hospital of LMU Munich, Munich, Germany
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