The value of simulation-based learning in pre-licensure nurse education: A state-of-the-art review and meta-analysis

Simulation-Based Teaching and Learning in Respiratory Care Education: A Narrative Review

Simulation-based pedagogy has become an essential aspect of healthcare education. However, there is a significant gap in the literature regarding the application of simulation-based modalities in respiratory care education. This review aims to address this gap by providing insight into the theory and current uses of simulation, its effectiveness in respiratory care education, and strategies to enhance faculty development. The study utilizes a narrative synthesis approach to review relevant literature and provide a comprehensive understanding of the topic. The research involved comprehensive searches of electronic databases, including PubMed and Google Scholar, to identify relevant literature, encompassing original articles, reviews, and other pertinent content, focusing on simulation-based teaching and learning in respiratory care education published between 1990 and 2022. Findings suggest that simulation-based education is an effective tool for improving respiratory care education and can enhance the clinical skills of learners. The study concludes by discussing the future of simulation in respiratory care education and the potential benefits it may offer.

Outcomes of scenario-based simulation courses in nursing education: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the effects of scenario-based simulation courses on nursing students' professional knowledge, clinical practice skills, and self-confidence in learning.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

A literature search of six databases including CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science was performed on 28 February 2023.

REVIEW METHODS

The methodological quality of the studies included was assessed using RoB 2. A random-effects model was used for pooling effect size. The heterogeneity of each pooled analysis was quantified with I2. Egger's regression test was performed to assess publication bias in each pooled analysis.

RESULTS

Sixteen trials conducted between 2011 and 2022 were included in the final analysis. Scenario-based simulation courses significantly improved nursing students' professional knowledge (pooled SMD 0.66; 95 % CI 0.33-0.98; p < 0.001), clinical practice skills (pooled SMD 1.45; 95 % CI 0.96-1.94; p < 0.001), and self-confidence in learning (pooled SMD 0.37; 95 % CI 0.12-0.63; p < 0.001). Substantial heterogeneity was observed in the pooled analyses of professional knowledge and clinical practice skills.

CONCLUSION

Scenario-based simulation courses appeared to be beneficial for increasing nursing students' professional knowledge, clinical practice abilities, and self-confidence in learning. Therefore, simulation-based learning should be regarded as an essential component of the nursing curriculum as it improves nursing students' skills and prepares them for real-world practice.

Simulation Use in Respiratory Therapy Programs in Saudi Arabia: Results of a National Survey

Background

The use of simulation-based methods for teaching and learning in the education of health professions is increasing, but its prevalence in Saudi Arabia among respiratory therapy programs has yet to be investigated. The purpose of this study is to identify the use of simulation-based learning (SBL) in respiratory therapy programs in Saudi Arabia.

Methods

A cross-sectional study was performed by sending Google forms survey via Email to directors of respiratory therapy programs in Saudi Arabia (N=16) to evaluate how each one used simulations as an educational tool.

Results

The survey was returned with a total response of 12 out of all 16 program that were initially contacted (75% response rate). Among the respondents, approximately 75% of the programs are using SBL, while high-fidelity simulation is used by all programs. The present data show that 67% of the respiratory therapy programs has a space for simulation within the department, while 33% utilizes institutional simulation centers. For short simulation scenarios, debriefing is not conducted in 67% of the programs. There is acceptance by program directors that simulation hours should be counted towards clinical hours. About 67% of respondent programs have mandatory simulation learning activities, and 100% agree that simulations should be used more. However, lack of training and shortage of staff are among barriers to increase the use of SBL.

Conclusion

SBL is commonly used and relatively varied among respiratory therapy programs. However, it requires some improvements in several aspects, including the use of debriefing and increasing the number of properly trained staff.

Intrinsic Factors and Psychological Safety Among Nursing Students During Simulation-Based Learning-A Correlational Design

INTRODUCTION

Well-designed simulation-based learning (SBL) experiences enhance students' self-confidence, self-efficacy, clinical judgment, and psychomotor skill development. An emerging concept in SBL research is psychological safety. There is currently no research on factors influencing psychological safety specifically related to the SBL environment, nor is there any literature found to determine whether intrinsic student characteristic, such as self-compassion and resilience, contributes to SBL learning outcomes. The aim of this study is to determine whether there is a relationship between nursing students' intrinsic characteristics (self-compassion, resilience, and anxiety sensitivity) and their psychological safety.

METHODS

Bivariate correlation was used to examine associations among sociodemographic variables and outcome variables. Multiple regression was used to determine the predictive nature of the sociodemographic variables. Assumptions for variables in multiple regression models were tested (normal distribution, heteroscedasticity, multicollinearity). All data were analyzed in SPSS, Version 28. The P value of significance was set at 0.05 for all analyses.

RESULTS

Most of the 118 participants were non-Hispanic (89%), White (65%), and females (95%). Results of the demographic bivariate analysis revealed no significant differences among this diverse group or semester in the curriculum for psychological safety. The multiple regression found self-compassion (β = 29, P = 0.004), anxiety sensitivity (β = -0.16, P = 0.049), and resilience (β = 0.26, P = 0.004) predict psychological safety.

CONCLUSIONS

The importance of creating a psychologically safe learning environment has been recognized as essential to best practices. Our findings suggest that an understanding of student characteristics that impact their perception of psychological safety will allow educators to develop strategies to better support learners in the simulation environment.

Cognitive and Noncognitive Factors Influencing Nursing Students' Academic Success: Structural Equation Model Analysis

AIM

The study aim was to identify and explore relationships among cognitive and noncognitive factors that may contribute to prelicensure baccalaureate nursing students' academic success across their program of study.

BACKGROUND

Nurse educators are challenged to improve students' academic success. With limited evidence, cognitive and noncognitive factors have been identified in the literature as potential factors that influence academic success and may support students' readiness for practice as new graduate nurses.

METHOD

Data sets from 1,937 BSN students at multiple campuses were analyzed using an exploratory design and structural equation modeling.

CONCLUSION

Six factors were conceptualized as contributing equally to the initial cognitive model. The final noncognitive model, with deletion of two factors, yielded the best fit for the four-factor model. Cognitive and noncognitive factors were not significantly correlated. This study provides a beginning understanding of cognitive and noncognitive factors associated with academic success that may support readiness for practice.

A Literature Review of Simulation-Based Nursing Education in Korea

This study reviewed the papers that studied the effect of simulation nursing education in the nursing field and examined the trend of simulation nursing education for nursing college students in Korea.

BACKGROUND

Simulation-based education started receiving attention as a pedagogical method in order to provide medical service of high quality in an ethical and safe environment. This has been of great importance during the coronavirus disease 2019 global pandemic. This literature review was conducted to suggest a direction for simulation-based nursing education in Korea.

METHODS

For literature searches, the authors used the following search terms in the Web of Science, CINAHL, Scopus, PubMed-'utilization', 'simulation,' 'nursing student', 'nursing education'. A final search was conducted on 6 January 2021. The materials for this study were collected through literature searches according to the PRISMA guidelines.

RESULTS

25 papers were selected as the final literature for analysis. The study was conducted for 48 percent of senior students in nursing college students in Korea (N = 12). High fidelity (HF) as the simulation type was 44 percent (N = 11). The simulation education subjects were composed of 52 percent adult health nursing (N = 13). According to educational goals described by Benzamine Bloom (1956), 90% in the psychomotor domain is considered a positive learning achievement.

CONCLUSIONS

Effectiveness in the psychomotor domain through simulation-based training is correlated with expert nursing. It is essential to develop a systematic debriefing model and methods to evaluate performance and learning in the short- and long-term to expand the effectiveness of simulation-based education in nursing.

Using the "Do-Si-Do Simulation Model" to Engage Learners

ABSTRACT

The "Do-Si-Do Simulation Model" was developed to provide simulation experiences for students when resources are limited and provide nursing students insight into health care simulation as a potential nursing career. The aim of this study was to gain insight on student perceptions of the use of the model as an active learning strategy and determine if it should be used in future courses. Twenty-four students who participated in two scenarios as nurses in the simulation room and as patients/operators in the control room agreed that use of the strategy enhanced their learning. They recommended its use in future courses.

Pilot Testing of Virtual Simulation-Based Experiences in an Oncology Nursing Seminar

BACKGROUND

The coronavirus disease 19 (COVID-19) pandemic challenged nurse educators to develop teaching strategies to engage students in a virtual classroom. This pilot study examined the effect of virtually delivered video-recorded (VDVR) simulation-based experiences (SBEs) with standardized participants on the management of clinical emergencies in patients and families affected by cancer on nursing student learning outcomes.

METHOD

A pre- and posttest, one-group, convergent mixed-methods design with questionnaire variant was used. Data were collected before and after SBEs.

RESULTS

Nineteen senior baccalaureate nursing students participated in this pilot study. The VDVR SBEs resulted in a significant increase in self-perceived competence. Participants had positive perceptions about the use of VDVR SBEs as a teaching strategy. Qualitative themes included realism, critical analysis, and preference for hands-on learning.

CONCLUSION

The VDVR SBEs were well-received by prelicensure nursing students as a supplemental teaching strategy to enhance self-perceived competence. Additional research is needed about the effects of VDVR SBEs on learning outcomes. [J Nurs Educ. 2023;62(3):167-170.].

Effect of High-Fidelity Simulation on Self-Satisfaction and Self-Confidence Among Nursing Students

Introduction

Newly graduating nurses should be able to enter clinical practice as safe, accurate, competent, and compassionate professionals in health care settings that necessitate them to be learners who can easily get familiar with a broad diversity of clinical practice settings.

Purposes

The purpose of this study was to evaluate the effect of high-fidelity simulation experiences on self-satisfaction and self-confidence among the pediatric nursing students.

Methods

A quasi-experimental design, post-test, was carried out through the recruitment of a convenience sample of 150 nursing students from Arab American University. The students were randomly assigned to the study (n  =  75) or control (n  =  75) groups. Data were collected using learner satisfaction and self-confidence scales.

Results

The results of the post-test revealed that there was a significant difference between both groups in self-satisfaction (t (148)  =  11.14, P < .001) and self-confidence (t (148)  =  13.04, P < .001). The mean score of self-satisfaction for the study group (22.45  ±  2.27) was higher than control group (16.80  ±  3.76). Also, the study group' mean self-confidence score (35.72  ±  3.49) was higher than the control group (27.28  ±  4.39).

Conclusion

High-fidelity simulation was confirmed to be an helpful tool to keep an effective and safe learning method for pediatric nursing students, thus increasing their satisfaction and confidence.

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.

Effect of Manikin and Virtual Simulation on Clinical Judgment

BACKGROUND

Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood.

METHOD

An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students.

RESULTS

Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model.

CONCLUSION

Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693-699.].

The Effect of Two Different Simulation Modalities in Palliative Care Teaching on Nursing Students' Knowledge, Satisfaction, Self-confidence, and Skills: A Randomized Controlled Trial

Nursing students from developing countries have limited opportunities to experience palliative care. Standardized patient and low-fidelity simulations can provide realistic palliative care experiences for students. However, limited research is available on simulation-based education in Palestine. Testing and using these two types of simulation methods may be the best solution for developing countries that lack adequate resources. This study aimed to test the effects of low-fidelity simulation compared with standardized patient simulation in palliative care teaching on nursing students' knowledge, satisfaction, confidence, and skills. The study was a randomized controlled trial of 70 nursing students in their sophomore year. Students' knowledge was assessed with the Palliative Care Quiz for Nursing test; satisfaction and confidence with the Learner Satisfaction and Self-confidence in Learning; and skills rated by two researchers. Students' knowledge improved significantly on the posttest compared with the pretest, without significant differences between both groups. The findings showed that the utilization of the two methods in students' clinical training for scenario has the same effect on the satisfaction and confidence. The skills of the standardized patient group improved significantly more than the low-fidelity group. The study revealed that both simulation modalities are effective for palliative care nursing students.

The effect of home visit simulation on emotional intelligence, self-efficacy, empowerment, and stress in nursing students. A single group pre-post intervention study

BACKGROUND

Clinical simulation, the teaching methodology used in the Nursing Degree, helps students to acquire certain skills. Home visiting is a complex scenario in community care that requires certain critical skills in order to function successfully.

OBJECTIVES

The aim of this study was to analyze the improvement of self-efficacy, empowerment, management of emotions and perceived stress of nursing students through clinical simulation during home visits.

DESIGN

A quasi-experimental study was carried out.

PARTICIPANTS

A sample of Students of the 2nd year of the Nursing Degree.

METHODS

A high-fidelity simulation programme was implemented in two sessions. The variables that were measured were: self-efficacy (General Self-efficacy Scale), empowerment (Spreitzer Psychological Empowerment Scale), emotional intelligence (Trait Meta-Mood Scale-24), and perceived stress (Perceived Stress Scale).

RESULTS

170 students with a mean age of 22.2 years took part. An increase in general self-efficacy, self-determination, impact, empowerment (total score), and emotional clarity was observed after the intervention.

CONCLUSIONS

Clinical simulation as a teaching methodology allows the development of skills and competencies that are necessary for nursing students to be able to function in community settings such as home care. Therefore, this teaching methodology should be integrated into University Community Nursing training programmes.

Nursing students' transfer of learning from simulated clinical experiences into clinical practice: A scoping review

AIMS

This review aims to map available evidence regarding undergraduate nursing students' transfer of learning from simulation-based experiences into clinical practice.

DESIGN

Scoping review.

DATA SOURCES

We searched MEDLINE, CINAHL, and Google Scholar and conducted manual searches for eligible studies published between January 2016-December 2021.

REVIEW METHODS

We approached our review using Arksey and O'Malley's scoping review framework and collaboratively worked through the screening, selection, and collating processes. We resolved conflicts in search outcomes and data abstraction through discussion to reach a consensus. We reported our methods and results following the PRISMA-ScR reporting guideline. We used narrative review to outline and discuss results.

RESULTS

Thirty-two studies, spanning 9 reviews, 14 qualitative studies, 5 quantitative studies, and 4 mixed methods studies conducted in Aotearoa New Zealand, Australia, Canada, Israel, Norway, Spain, Turkey, the United Kingdom, and the United States, were included. Results are presented under three subheadings: conceptualization, measurement, and sustainability of learning transfer from simulation into clinical practice.

CONCLUSIONS

Although studies generally supported the value of simulation in bridging theory and practice and in developing students' knowledge and skills, there was a predominance of short-term and self-reported measures. Few studies explored distant outcomes of simulation. Further longitudinal research is needed to explore the longer-term processes by which learning transfer and integration occur, as well as the resulting impact on students' and nurses' clinical practice as well as clients' and population health outcomes. This review will be of interest to nursing educators, researchers, and clinicians who wish to support nursing students' learning.

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.

Simulations as a mode of clinical training in healthcare professions: A scoping review to guide planning in speech-language pathology and audiology during the COVID-19 pandemic and beyond

Background

Simulation plays an important role as an alternative method for training of students, particularly in health education. As a result of coronavirus disease 2019 (COVID-19) restrictions of face-to-face interactions, traditional teaching methods have been disrupted, increasing the need for alternative methods to supplement modes of student clinical training in healthcare programmes.

Objectives

The scoping review aimed to determine what has been documented about simulation as a mode of clinical training in healthcare professions (HCPs) in order to guide speech-language pathology and audiology (SLP&A) professions during the COVID-19 pandemic and beyond.

Method

A scoping review was conducted. Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE, ProQuest, Google Scholar and WorldCat were searched to identify peer reviewed publications, published in English, between January 2011 and December 2021, and related to the use of simulation in HCPs clinical training programmes.

Results

A total of 32 articles met the inclusion criteria for this scoping review. Three themes emerged when reviewing the studies: (1) face-to-face simulations as a mode of clinical training, (2) virtual reality simulation and telesimulation as modes of clinical training and (3) simulation as a complementary mode of clinical training. Evidence suggests that whilst simulations are cost-effective, accessible and efficacious as clinical training modes, they need to be combined with other modes of training such as the traditional clinical training to yield better learning outcomes.

Conclusions

Current findings highlight the role and value of simulation as a clinical training mode during COVID-19 and beyond. However, there are aspects that need to be considered to ensure that this mode of clinical training is effective, with endorsement and regulations by the SLP&A Professional Board of the Health Professions Council of South Africa (HPCSA). Simulations need to be complemented with traditional clinical training methods. In the context of SLP&A, particularly in low- and middle-income countries (LMICs), simulation can be used to better prepare students for their clinical placement where clinical training platforms are limited and where simulation combined with teletraining or telesupervision can be utilised to increase access to training.

The Art of Discharge Planning: Teaching Nursing Students to Address Disparities Through Simulation

Background: Discharge planning is crucial to ensuring that patients’ care and recovery needs are addressed. A new nurse graduate must be prepared to enter a clinical practice environment in which hospitals face penalties for patient readmissions. Methods: Student nurses were assigned simulated patients with a variety of health disparities and health-care diagnoses to address. A qualitative research design evaluated student perceptions of discharge planning and cultural competency. Results: Students found the simulation to be vital to their clinical experience. Students were able to develop discharge teaching that was culturally congruent for each simulated patient. Conclusions: Incorporating discharge teaching simulation into the nursing curriculum can positively impact students’ ability to transition to clinical practice and build confidence in a skill that is rarely incorporated into nursing curricula.

State of the evidence on simulation-based electronic health records training: A scoping review

This study synthesized the available evidence of simulation-based electronic health records (EHRs) training in educational and clinical environments for healthcare providers in the literature. The Arksey and O'Malley methodological framework was employed. A systematic search was carried out in relevant databases from inception to January 2020, identifying 24 studies for inclusion. Three themes emerged: (a) role of simulation-based EHR training in evaluating improvement interventions, (b) debriefing and feedback methods used, and (c) challenges of evaluating simulation-based EHR training. The majority of the studies aimed to emphasize the practical skills of individual medical trainees and employed post-simulation feedback as the feedback method. Future research should focus on (a) using simulation-based EHR training to achieve specific learning goals, (b) investigating aspects of clinical performance that are susceptible to skill decay, and (c) examining the influence of simulation-based EHR training on team dynamics.

The affective component of learning in simulation-based education - facilitators' strategies to establish psychological safety and accommodate nursing students' emotions

Background

Active learning situations such as simulation-based education (SBE) are found to trigger a wide range of emotions among students. Facilitators have an important educational role in SBE which include being attentive and adaptive to students’cognitive and affective responses. Although the importance of emotions in SBE is recognized in facilitator guidelines, little is known about how facilitators accommodate student affect. Hence, this study explores facilitators’ strategies for addressing students’ emotions in SBE.

Method

Individual interviews with nine facilitators were performed and transcripts were subjected to qualitative analyses in accordance with interpretive description approach.

Results

Findings show that facilitators are attentive to and continuously assess students’ emotional responses in SBE. Both positive emotions, such as interest and surprise, and negative emotions such as anxiety are cultivated, yet adapted to the perceived needs of the individual student. Psychological safety was seen as a prerequisite for optimal learning, regardless of the students’ previous level of knowledge. Furthermore, significant learning was seen as something that might also arise from uncomfortable experiences, such as students realizing their own mistakes or uncertainty. Hence facilitators were found to balance levels of difficulty, emotional arousal and psychological safety during the various phases of SBE.

Conclusion

Facilitators recognize the emotional dimension of learning in SBE and have numerous strategies for accommodating students’ emotions. This study highlights the complexity of the facilitator’s role in adapting training to individual cognitive and emotional needs. These findings have implications for facilitator training which should include awareness of the role of emotions in learning and strategies for observing and accommodating training to meet emotional needs.

Projected Augmented Reality (P-AR) for Enhancing Nursing Education About Pressure Injury: A Pilot Evaluation Study

PURPOSE

To describe results of a study evaluating a Projected Augmented Reality (P-AR) system for its potential to enhance nursing education about pressure injuries.

DESIGN

Pilot evaluation survey.

SUBJECTS AND SETTING

The sample comprised nursing students and faculty at a school of nursing in a large, Midwestern public university. A total of 32 participants, which included 27 students (30% BSN, 44% MN, and 26% DNP students; 81% female) and 5 faculty members (80% female) participated.

METHODS

The P-AR system was prototyped using commercial-off-the-shelf components and software algorithms, applied to pressure injury nursing education content. After interaction with the P-AR system, participants completed a survey evaluating the following features of the P-AR system for potential: engagement, effectiveness, usefulness, user-friendliness, and realism, and users' overall impression and satisfaction with system features. Evaluation statements used a 5-level Likert-scale; open-ended questions about what was liked, disliked, or anything else offered opportunity for comments.

RESULTS

Student and faculty median evaluation scores were 5 (strongly agree or very satisfied) and 4 (agree or satisfied) for nearly all evaluation and satisfaction statements. Students' satisfaction with "realism" received a median score of 3 (neutral). The P-AR system was refined to include realistic still and animated images.

CONCLUSION

The P-AR system, an innovative technology using 3-dimensional dynamic images, was applied to nursing education content about pressure injury and was evaluated as having potential to enhance pressure injury teaching and learning. Education about complex processes of pressure injury development and management may benefit from using cutting-edge simulation technologies such as P-AR.

Cultivating learning in vitro: A meta-ethnography of learning experiences of nursing students regarding high-fidelity simulation

OBJECTIVES

To synthesise the experience of nursing students in their final years regarding high-fidelity simulation in acute and critical care.

BACKGROUND

For the complex and changing healthcare environment, new tools are required to help health students, educational staff and managers to design and present rewarding educational simulations. Due to the complexity and limited learning opportunities in real settings, high-fidelity simulation enables students to acquire skills for the provision of acute and critical care in a controlled environment that closely imitates reality; however, the literature on students' learning experiences with this education methodology is still limited.

DESIGN

This study followed Noblit and Hare's interpretive meta-ethnography, which was written and reviewed for reporting clarity against the EQUATOR checklist using the eMERGe.

DATA SOURCES

A comprehensive systematic search strategy was carried out in five databases: PubMed, Scopus, CINAHL, Web of Science and PsycINFO.

REVIEW METHODS

Ten studies met the research objective and inclusion criteria.

RESULTS

The metaphor 'Cultivating learning in vitro' and four themes were developed to describe the learning experiences of nursing students regarding high-fidelity simulation in acute and critical care. The themes were as follows: Learning roots-Ways to learn during high-fidelity simulation; Learning stimulants-Elements that favour learning; Learning impairments-Elements that hinder learning; and Learning flourishing-Results after high-fidelity simulation.

CONCLUSIONS

Seeing, doing and reflecting constituted the main sources of learning. Students identified the stimulating and debilitating aspects of learning which could help in the design of simulation sessions and promote their incorporation into nursing curricula. Finally, 'the flowering of the plant' represents the learning outcomes developed in a controlled and safe environment.

RELEVANCE TO CLINICAL PRACTICE

The results of this meta-ethnography provide keys to promote change in teaching planning in relation to acute and critical care.

Safety Competency, Certification, and Practical Drift

Safety is one of the top priorities in transport nursing because of the unpredictable nature of moving critically ill or injured patients by air or ground. The purpose of this study was to determine the relationship between certification status and the transport nurse's self-rated safety competency. Safety competency was measured with an adapted version of the 22-item Critical Care Nursing Competence Questionnaire for Patient Safety (C3Q-safety) scale. To adapt the C3Q-safety scale for transport nursing, we matched the 22 items with the Air and Surface Transport Nurses Association safety standards. Then, 5 transport nursing experts reviewed the 22 items for face validity and relevance to Air and Surface Transport Nurses Association safety standards. The C3Q-safety scale assesses 4 safety factors: decision making, collaboration, nursing intervention, and principles of nursing care. This was a cross-sectional survey with 432 respondents; t-tests and linear regression were used to examine the data. Our findings indicated a lack of relationship between certification status and safety competency. However, we found that more experienced transport nurses had lower safety competency scores (β = -0.150, P = .037). Practical drift (ie, the failure to follow established rules and regulations, which leads to deviations from policies and procedures) may explain why experienced nurses scored lower. The practice implications of this work include the need for a robust safety culture with a focus on nonpunitive reporting and the use of simulation for reducing possible errors and limiting practical drift.

Nursing and midwifery students' perspectives of using digital systems on placement: A qualitative study

AIM

To explore undergraduate nursing and midwifery student perspectives of using digital patient systems on clinical placements.

DESIGN

This was an interpretative qualitative design study.

METHODS

Undergraduate nursing and midwifery students in a large Australian metropolitan university were invited to participate in two focus groups from April to June 2019. Twenty (20) students participated and data on their perspective of using digital systems on placement were collected. Thematic analysis using NVivo 12 software was undertaken.

FINDINGS

Students identified benefits and challenges when moving between paper records and digital systems. Whilst paper reporting was more efficient for some processes, the students recognised the advantages of digital technology, such as enabling greater confidentiality and consolidation of patient data in one place. However, they also reported difficulty with student access and the size of the portal digital workstation at the bedside. Generally, the lack of preparation and access was considered frustrating and mitigated some of the benefits described when using digital systems.

CONCLUSIONS

Nursing and midwifery students prefer to be prepared for both paper and digital record keeping. Whilst students identify the benefits of digital platforms, not having direct access mitigates the benefits of these systems. Students identified the use of simulation and interactive modules prior to commencement of clinical practice to enable them to feel more confident with using the systems in patient care.

IMPACT

Health care students require direct access to digital health platforms whilst on clinical placement to facilitate their learning. Higher Education Institutions (HEIs) are in a unique position to work with health care providers to better prepare health care professionals, including nurses and midwives, to work with digital health care systems. Further research is needed to develop the educational preparation for nurses, midwives, and other health care professionals to work with digital systems in practice.

Simulation-based education and the effect of multiple simulation sessions - A randomised controlled study

BACKGROUND

Simulation-based education may improve clinical decision-making skills and supplement clinical placement of nursing students to prepare them for real healthcare settings. Exposing students to several simulation sessions could maximise learning, but longitudinal randomised studies are lacking regarding the effects of simulation-based education.

OBJECTIVE

In this randomised study, we followed a class of nursing students to assess the effect of multiple simulations on the students' self-reported clinical decision-making skills and self-confidence.

DESIGN

A randomised controlled trial, collecting data four times throughout a 3-year nursing program; at the beginning of the second semester as baseline and at the end of each of the following academic years. Students experienced either a single (control) or a double (intervention) set of simulation scenarios in four simulation days, including several simulation scenarios for each session.

SETTING

A university in Norway, 2018-2020.

PARTICIPANTS

The study included 146 baccalaureate nursing students who volunteered to participate.

METHODS

The participants completed two validated instruments, the 24-item Nurse Decision-Making Instrument and the Self-Confidence Scale, and demographic data were collected. Analysis of covariance and linear mixed-effect models were applied to analyse the effect of the double compared to the single scenario simulations.

RESULTS

Complete data were obtained for 71 participants. The results showed no significant differences between double vs single scenario sessions on clinical decision-making scores (B = -0.2; 95% confidence interval, -2.1 to 1.7; p = 0.806) or self-confidence score (B = -0.1; 95% confidence interval, -0.4 to 0.2; p = 0.467). However, the overall self-confidence scores increased significantly over time.

CONCLUSION

In this randomised study, we found no effects of double vs single scenario simulations on clinical decision-making or self-confidence scores among nursing students during their 3-year program.

Effects of a Patient Experience-Based Virtual Reality Blended Learning Program on Nursing Students

When provided with opportunities to view the world from the patients' perspective, nursing students can experience the same practical occurrences and feelings that patients encounter, consequently becoming more aware of their discomfort and pain. This study aimed to evaluate the performance of the patient experience virtual reality blended learning program developed for nursing students. This study is significant in that it presents a program that enables nursing students to not only experience being perioperative patients themselves but also experience their conditions in places other than hospitals, which are generally used as training locations. The analytical results of this study indicated that nursing students who virtually experienced the conditions of perioperative patients through virtual reality blended learning showed increased levels of empathy, positive attitudes toward patient safety treatment, confidence in nursing care, and clinical skill performance. The developed program in this study blended various teaching methods with a virtual reality platform to help junior nursing students with practical and effective perioperative training increase their levels of empathy by simulating the experiences and perspectives of perioperative patients.

Students and teachers' satisfaction and perspectives on high-fidelity simulation for learning fundamental nursing procedures: A mixed-method study

BACKGROUND

High-fidelity clinical simulation enables skills to be acquired safely and securely by bridging the gap between theory and clinical practice. This method has traditionally been used to address complex clinical scenarios. Students often report high levels of satisfaction and self-confidence, as this method allows them to put techniques and procedures into practice in a safe environment. Most studies assess simulation solely from the students' perspective, disregarding the opinions of teaching staff.

OBJECTIVES

To assess the implementation of high-fidelity simulation as a teaching tool for fundamental nursing procedures from the perspectives of students and teachers.

DESIGN

A two-phase mixed-methods study.

SETTING

A simulation centre environment at the University of the Balearic Islands (Spain) during the 2018 academic year.

PARTICIPANTS

Second-year nursing students and staff teaching practical classes on basic patient assessment and monitoring of vital signs.

METHODS

Satisfaction with clinical experience simulation scale, including an open-ended question for students, was used. A focus group session was also held with teachers.

RESULTS

A total of 91 students completed the scale, yielding an overall satisfaction score of 9.3 out of 10. The practical dimension attained the highest scores. Motivation to attend class was the lowest-rated aspect of this dimension, although students' expectations and satisfaction increased during the class. In the open-ended question and the debriefing session, students described the simulation as a playful learning method allowing them to put their theoretical knowledge into practice and helping them to manage their fears before coming into contact with real care settings. In the focus group session, teachers analysed their own experiences and described how they perceived students' satisfaction and practical skills.

CONCLUSIONS

High-fidelity simulation produces good academic outcomes and is highly satisfying for students and teachers.

Responding to a simulated disaster in the virtual or live classroom: Is there a difference in BSN student learning?

AIM

This study aim was to investigate if prelicensure baccalaureate nursing students gained more knowledge from a live or virtual disaster simulation. The study goal was to inform the use of e-learning or traditional textbooks in undergraduate nursing population health courses.

BACKGROUND

Weather-related disasters have increased in frequency and severity in the past ten years, with 2020 being the most active storm season ever seen (National Oceanographic and Atmospheric Administration, 2021.) Even with advances in early warning systems and mitigation efforts, educating student nurses in disaster response remains a priority. Due to the impact of Covid-19 quarantine policies, many in-person student learning labs and clinical experiences were cancelled. However, virtual simulation offers an alternative to developing nursing student skills and clinical reasoning ability (Aebersold, 2018; Fogg et al., 2020).

DESIGN

A randomized quasi-experimental, repeated measures 2 × 2 crossover design (Kim, 2018) was applied, which allowed students to participate in both the live and virtual simulations.

METHODS

Analysis was conducted using paired samples t-test to evaluate knowledge gains. To measure students' self-assessment of knowledge, Unver et al. (2018) 12-item survey was administered. To explore students' own perceptions about the disaster simulations, semi-structured interview questions were offered through private Wiki postings. The responses were analyzed using Saldaña's in vivo coding (2015) and thematic analysis.

RESULTS

Students retained more empirical knowledge following the virtual assignment as compared to the disaster simulation, except in two items addressing triage. Neither age, years of education, or GPA impacted test results. However, students' own assessment of learning did not differ between live and virtual simulations. In all but three items, students perceived a significant increase (p < .05) in their learning following the simulation, regardless whether it was live or virtual. In narrative responses, students overwhelmingly cited the benefit of an in-person simulation. However, they did not believe that they were prepared adequately for the live simulation. They also expressed that they would be more prepared if the simulation was repeated. Students expressed discomfort, even distress, regarding not being able to care adequately for everyone, even though it was a simulation (See Table 5). This highlighted that live simulations can affect students emotionally, and follow-up debriefing is essential to help in both acknowledging and processing student feelings.

CONCLUSION

These findings, which support the use of virtual disaster training in nursing education, are especially important in the light of Covid-19 and increasing threat of storm disasters.

Nursing students first experience on high fidelity simulation: A phenomenological research study

AIM/OBJECTIVE

This study aimed to explore the perceptions of nursing students towards their first experience with high-fidelity simulation (HFS) in a Spanish university.

BACKGROUND

Simulation experiences are becoming more popular in nursing education, allowing students to practice clinical skills before encountering actual patients.

METHODS

A phenomenological approach was used. Sixteen in-depth, semi-structured, qualitative one-on-one interviews were conducted among second-year undergraduate nursing students who had completed a scheduled HFS training program. The interview transcripts were analyzed using Colaizzi's phenomenological method.

RESULTS

Four themes were identified: "Learning through simulation"; "Acting like a nurse instead of being a student"; "Facilitators and barriers of learning"; and "Transition from simulation to reality."

CONCLUSION

This study provides support for including high-fidelity simulation programs in the nursing curricula to enhance student preparedness for clinical placements.

Impact of palliative care simulation on nursing students' learning outcomes and reported use in hospital placement

Aim

Nursing students report emotional distress and feelings of inadequacy to the complexity of palliative care. This study aimed to examine nursing students’ attainment of learning outcomes in palliative care through simulation and hospital placement.

Design

A longitudinal, intervention study.

Methods

Fifty‐five second‐year bachelor nursing students participated. Three waves of assessments were performed: (1) pretest; (2) postsimulation test and (3) postplacement test after the completion of the placement. Non‐parametric Wilcoxon's signed‐rank test for paired samples was used to test for differences between assessments of knowledge, skills and competence before and after simulation, and between postsimulation and post hospital placement.

Results

The results showed positive differences between pre‐ and postsimulation, indicating that learning outcomes were attained through simulation. However, negative differences between the postplacement test and postsimulation test scores indicated that the participants had practiced learning outcome from the simulation to a small degree during placement.

Academic Electronic Health Records in Undergraduate Nursing Education: Mixed Methods Pilot Study

BACKGROUND

Teaching students about electronic health records presents challenges for most nursing programs, primarily because of the limited training opportunities within clinical practice settings. A simulated electronic health record is an experiential, learner-centered strategy that enables students to acquire and apply the informatics knowledge needed for working with electronic records in a safe learning environment before the students have encounters with real patients.

OBJECTIVE

The aim of this study is to provide a preliminary evaluation of the Lippincott DocuCare simulated electronic health record and determine the feasibility issues associated with its implementation.

METHODS

We used one-group pretest-posttest, surveys, and focus group interviews with students and instructors to pilot the DocuCare simulated electronic health record within an undergraduate nursing program in Western Canada. Volunteering students worked through 4 case scenarios during a 1-month pilot. Self-reported informatics knowledge and attitudes toward the electronic health record, accuracy of computerized documentation, satisfaction, and students' and educators' experiences were examined. Demographic and general information regarding informatics learning was also collected.

RESULTS

Although 23 students participated in this study, only 13 completed surveys were included in the analysis. Almost two-thirds of the students indicated their overall understanding of nursing informatics as being fair or inadequate. The two-tailed paired samples t test used to evaluate the impact of DocuCare on students' self-reported informatics knowledge and attitudes toward the electronic health record revealed a statistically significant difference in the mean score of knowledge before and after using DocuCare (before: mean 2.95, SD 0.58; after: mean 3.83, SD 0.39; t 12=5.80, two-tailed; P<.001). There was no statistically significant difference in the mean scores of attitudes toward the electronic health record before and after using DocuCare (before: mean 3.75, SD 0.40; after: mean 3.70, SD 0.34; t 12=0.39, two-tailed; P=.70). Students' documentation scores varied from somewhat accurate to completely accurate; however, performance improved for the majority of students as they progressed from case scenarios 1 to 4. Both the faculty and students were highly satisfied with DocuCare and highly recommended its integration. Focus groups with 7 students and 3 educators revealed multiple themes. The participants shared suggestions regarding the DocuCare product customization and strategies for potential integration in undergraduate nursing programs.

CONCLUSIONS

This study demonstrated the feasibility and suitability of the DocuCare program as a tool to enhance students' learning about informatics and computerized documentation in electronic health records. Recommendations will be made to academic leadership in undergraduate programs on the basis of this study. Furthermore, a controlled evaluation study will be conducted in the future.

Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study

Introduction

Simulation-based learning is a relatively new concept in public health nursing education, and little is known about the efficacy of this approach for teaching of health guidance. Objective: The aim of this study was to evaluate the effectiveness of health guidance simulation in community settings for public health nursing students.

Methods

Using a pre/post-test design, 29 public health nursing students in their third year participated in a high-fidelity simulation program with standardized patients. We developed six scenarios on health guidance for three themes (mother and child, tuberculosis, and adult occupational health) and practice guidelines for the standardized patients to act and assist in understanding of the purpose of the course. Data were collected at baseline and after the simulation sessions through evaluation sheets that the students placed in a designated box on campus. Changes in the level of self-confidence of the students were evaluated based on the “practical skills required for public health nurses and achievement level at graduation” of the Ministry of Health, Labor and Welfare, and the skills in the minimum requirements for public health nurse education defined by the Japan Association of Public Health Nurse Educational Institutions.

Results

The total score for self-confidence and the mean self-confidence scores for health guidance skills for mother and child, tuberculosis, and adult occupational health nursing were significantly higher post-test compared to pre-test (p < 0.001).

Conclusion

These results indicate that high-fidelity simulation focused on health guidance in community settings can bridge the gap between theoretical knowledge and practice of students.

Nursing students' experience and training in healthcare aid during the COVID-19 pandemic in Spain

BACKGROUND

During the COVID-19 pandemic health crisis, in some countries such as Spain, nursing students have offered to provide health assistance, but the role they have played, their degree of preparedness to face the situation, and what must be improved in their training to be ready for these situations is unknown.

OBJECTIVE

Describe the experience and perceptions of students of the Nursing university degree during their participation as health support in the COVID-19 health crisis in Spain.

DESIGN

We conducted a cross-sectional survey study.

METHOD

503 students enrolled in the 4th course of the Nursing degree in Spain during the months of March and April 2020. An online questionnaire was developed, based on a pilot study and distributed through the Nursing Association, students' unions and students' associations. Variables were used to describe their participation, degree of preparedness and training needs to determine how to improve training through descriptive statistics, as well as nonparametric tests to analyse the relationship between training and degree of preparedness nursing students. Results are reported according to the STROBE Statement.

RESULTS

73.2% (368) of students offered to participate in healthcare aid, of which 225 were actively involved. 27.8% carried out nursing tasks without supervision, and 47.7% assisted COVID-19 patients as any other nurse. Only 3.4% felt very prepared to work in the field of intensive care, finding that those students who perceived a higher degree of preparedness had received previous training in personal protective equipment and mechanical ventilation (p < 0.005). The highest scores for training activities that may improve their preparedness were simulations to improve levels of anxiety and stress when managing critical patients, simulation in ventilatory support and mandatory practices in services where ventilators are used.

CONCLUSIONS

Although three out of four students were willing to provide health assistance, they recognise that they were not specially prepared in the field of intensive care and demand training with simulation to improve anxiety and stress levels in the management of critical patients and simulation in ventilatory support.

RELEVANCE TO CLINICAL PRACTICE

Students have been vital resources for our health system and society when they have been needed. It is now up to us, both teachers and health authorities, to share their efforts by implementing the necessary improvements in training and safety measures not only because these affects the health and safety of the patient, but because they will be essential parts in future pandemics.

The effect of multiple exposures in scenario-based simulation-A mixed study systematic review

Aims

To examine the use and effects of multiple simulations in nursing education.

Design

A mixed study systematic review. Databases (CINAHL, Medline, PubMed, EMBASE, ERIC, Education source and Science Direct) were searched for studies published until April 2020.

Method

Researchers analysed the articles. Bias risk was evaluated using the Critical Appraisal Skills Programme and Cochrane Risk of Bias tool.

Results

In total, 27 studies were included and four themes identified. Students participated in multiple simulation sessions, over weeks to years, which included 1-4 scenarios in various nursing contexts. Simulations were used to prepare for, or partly replace, students' clinical practice. Learning was described in terms of knowledge, competence and confidence.

Conclusion

Multiple scenario-based simulation is a positive intervention that can be implemented in various courses during every academic year to promote nursing students' learning. Further longitudinal research is required, including randomized studies, with transparency regarding study design and instruments.

Midwifery students' satisfaction with perinatal simulation-based training

BACKGROUND

Simulation-based training has proved to be an effective teaching and learning approach in healthcare. Nevertheless, any assessment of its effectiveness should also take the students' perspective into account.

AIM

To validate the Satisfaction with Simulation Experience Scale (SSES) for use with midwifery students and evaluate midwifery students' satisfaction with perinatal simulation-based training.

METHODS

Satisfaction with simulation was assessed using the SSES, a measurement tool translated from English to Dutch. Data was collected in four consecutive years (2016-19). A mixed methods design was used to capture both qualitative and quantitative data. Using the quantitative data, factor analysis was performed to assess the construct validity, while Cronbach's alpha was used to assess internal consistency. Qualitative data was assessed using thematic content analysis.

FINDINGS

367 SSES questionnaires were completed by 251 students. The exploratory factor analysis resulted in a three-factor model covering debriefing and reflection, clinical reasoning and clinical learning. Cronbach's alpha showed good internal consistency. Students were very satisfied with perinatal simulation-based training for all three factors: 4.30 (SD=0.47) for debriefing and reflection, 3.97 (SD=0.55) for clinical reasoning and 4.10 (SD=0.46) for clinical learning. Satisfaction scores remained high and stable over the years investigated. Thematic content analysis identified 6 categories: simulation-based training is valuable, the need for more simulation-based training, fidelity, students, negative feelings, and preparation is vital.

CONCLUSION

Students were satisfied with the simulation-based training, experiencing it as providing added value to their education. Simulations gave them the opportunity to make and learn from mistakes in a safe learning environment.

Baccalaureate nursing students' experiences with high-fidelity simulation: protocol for a qualitative systematic review

INTRODUCTION

High-fidelity simulation (HFS) can bridge the gap between theoretical knowledge and nursing practice and improve safety and quality of patient care in baccalaureate nursing education. Although inconsistent assessment instruments or lack of high-quality research designs affect the strength of the evidence and limit the generalisability of the results, quantitative studies generally demonstrate the effectiveness of HFS in baccalaureate nursing education. Synthesis of the existing evidence of baccalaureate nursing students' experiences with HFS is crucial for the improvement and revision of simulation design and teaching.

METHODS AND ANALYSIS

A comprehensive search for qualitative studies on baccalaureate nursing students' experiences with HFS will be conducted in the following databases: PubMed, Embase, CINAHL, ProQuest, Web of Science, PsycINFO, the Cochrane library, China Biology Medicine disc, China National Knowledge Infrastructure and VIP Database for Chinese Technical Periodicals. This review considered studies reported in English or Chinese, and studies that were conducted between January 2000 and December 2019 in view of the launch of International Nursing Association for Clinical Simulation and Learning. The literature search will be conducted by two independent reviewers, and any disagreement will be adjudicated by discussion or with a third reviewer. The two independent reviewers will use the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research to assess the methodological validity, following which the JBI standardised data extraction tools will be used to extract relevant data. The JBI meta-aggregation method will be subsequently used to synthesise the data, eventually forming themes, categories and synthesised findings. The final synthesised findings will establish confidence levels based on the JBI ConQual approach.

ETHICS AND DISSEMINATION

This review does not require formal ethical review since it is based on available published literature. Findings will be disseminated through publication in a peer-reviewed journal, and, if possible, presented in scientific conferences.

Computer based simulation in CT and MRI radiography education: Current role and future opportunities

OBJECTIVE

The use of Computer-based simulation (CBS), a form of simulation which utilises digital and web based platforms, is widely acknowledged in healthcare education. This literature review explores the current evidence relating to CBS activities in supporting radiographer education in CT and MRI.

KEY FINDINGS

Journal articles published between 2010 and 2020 were reviewed (n = 663). The content was evaluated and summarised with the following headings; current utility, overview of CBS types, knowledge acquisition and evaluation, and student perspective. CBS utility in CT and MRI radiography education is limited. Its current use is for pre-registration education, and the interfaces used vary in design but are predominantly used as a preclinical learning tool to support the training of geometric scan planning, image acquisition and reconstruction, and associated technical skills. CBS was positively acknowledged by student radiographers; based on its inherent flexibility, self-paced learning and the ability to practice in a safe environment. Nonetheless, the educational validation of CBS in CT and MRI education pertaining to knowledge and skill acquisition has not been fully assessed through rigorous academic assessments and metrics.

CONCLUSION

The current use of CBS in CT and MRI education is limited. The development of software programmes with functionality and capability that correlates with current clinical practice is imperative; and to enable more research in CBS utility to be undertaken to establish the efficacy of this pedagogical approach.

IMPLICATIONS FOR PRACTICE

Due to limited placement opportunities, the use of simulation is increasing and evolving; in line with the approach to design and deliver high quality Simulation Based Education (SBE) in Diagnostic Radiography education. The continued development, utility and evaluation of CBS interfaces to support student radiographers at pre and post registration level is therefore essential.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning

AIMS AND OBJECTIVES

To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes.

BACKGROUND

The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed.

DESIGN

A scoping review was conducted using the Arksey and O'Malley framework.

METHOD

CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used.

RESULTS

Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation.

CONCLUSION

The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes.

RELEVANCE TO CLINICAL PRACTICE

Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.