Effects of simulation-based learning on nursing student competences and clinical performance

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

OBJECTIVES

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

DESIGN

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship of high-fidelity simulation experience, clinical reasoning, and clinical competence of new nurses: A cross-sectional study

AIM

This study aimed to determine which high-fidelity simulation (HFS) experiences were associated with clinical reasoning and clinical competence among new nurses.

BACKGROUND

HFS has been actively used in nursing education. It is necessary to verify the effects of HFS transfer to the clinical environment.

DESIGN

A cross-sectional study reported following STROBE criteria.

METHODS

Data were collected on new nurses (n = 224) who experienced HFS in their fourth-year undergraduate courses. The number of HFSs, the inclusion of simulation elements, the importance of elements to learning, clinical reasoning, and clinical competence were measured. Hierarchical regression models examined factors associated with clinical reasoning and clinical competence.

RESULTS

Feedback was the most sufficiently included element of the HFS learning, and participants perceived it as the most important. A significant factor associated with clinical competence was clinical reasoning, and HFS design indirectly affected clinical competence through clinical reasoning.

CONCLUSIONS

HFS learning is one of the best ways to improve clinical reasoning. Improving students' clinical reasoning should be an important goal of HFS learning in undergraduate courses to prepare students to be clinically competent nurses.

IMPLICATIONS FOR NURSING

The ultimate goal of nursing education is to prepare nursing students to be competent nurses. Validating the outcomes of nursing education in the clinical environment setting is an essential task to improve clinical practice.

IMPLICATIONS FOR NURSING POLICY

Nurse educators and leaders can increase nurses' clinical competence by emphasizing education to foster nurses' clinical reasoning in nursing education policies.

The effect of different patient-based learning models on student perceptions of empathy, engagement, knowledge, and learning experience

BACKGROUND

Problem-based learning is used widely in pharmacy and medical programmes, incorporating realistic patient scenarios into regular teaching as a way of linking theory to practice. Routine case-based learning lessons ranges from real patient involvement, scripted patient scenarios, digital simulations (avatars) as well as through media such as Zoom. The existing literature has explored the extensive benefits of using patients in clinical education, but fewer studies have directly compared the efficacy of each model as learning tools.

AIM

To compare student perceptions of patient-based learning models to elicit student empathy, increase engagement, improve knowledge, and enrich learning experience.

METHODS

A questionnaire was distributed to second-year pharmacy students in Swansea University to gather their perceptions on the nine different patient-based learning models in their routine teaching (SUMS RESC 2023-0011). Students were asked to rank their experience of the models explicitly against each other, based on the four pillars of (1) eliciting student empathy, (2) increasing engagement, (3) improving knowledge and (4) enriching the learning experience. Students were also asked to rate the significance of realism (i.e. knowing the patient demographics/having a visual representation of the patient) to their experience.

RESULTS

Altogether, 31 student rankings of the nine learning models were weighted (9 = highest rank; 1 = lowest ranked). The data showed clear preferences for real-patient involvement over fictional cases, especially for eliciting empathy. Interestingly, scripted scenarios were rated highly for both engagement and learning experience only when avatars were involved, which suggests a role of animated visual representation of the patient in facilitating these outcomes.

CONCLUSION

Whilst it is useful to have multiple patient-based learning models, this study serves as a guide for educators in preparing case-based learning sessions for achieving the desired outcomes of any of the four pillars above.

Pre-service nurses' experiences of simulated health education classes: A phenomenological study

With the growing demand for health education, enhancing nurses' ability to deliver such education is vital. This phenomenological qualitative study, employing convenience sampling, investigates pre-service nurses' experiences in simulated health education classes. The study included 32 fourth-year pre-service nurses from the Department of Nursing at a South Korean university. Between April 20 and June 30, 2022, these participants documented their perceptions of the simulated classes in self-reflection journals. The researcher utilized the phenomenological research method as proposed by Colaizzi (1978) to analyze the data. The findings suggest that simulated health education classes offer an opportunity to bolster pre-service nurses' practical knowledge, fostering their growth as nursing educators. The pre-service nurses reported gaining confidence in their roles as educators and enhancing their professionalism through these simulated classes. Therefore, as public health promotion becomes increasingly crucial and the demand for health education rises, simulated health education classes serve as a valuable adjunct to teaching methods in health education.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods

OBJECTIVES

This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.

INTRODUCTION

Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.

INCLUSION CRITERIA

Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.

METHODS

The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.

RESULTS

Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.

CONCLUSION

This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

Using palliative and end-of-life simulation to enhance pre-licensure nursing students' emotional intelligence, palliative care knowledge and reflective abilities: A single group, pretest-posttest study

BACKGROUND

Nursing students have reported that they lack skills and knowledge in palliative and end-of-life care, and as a result, they faced numerous challenges caring for patients and families receiving palliative and end-of-life care during clinical attachments.

OBJECTIVES

To develop a palliative and end-of-life care simulation program and evaluate its effects on nursing students' emotional intelligence, palliative care knowledge and reflective abilities.

DESIGN

A single group, pretest-posttest quasi-experimental study.

SETTINGS

A simulation center in a Singapore university.

PARTICIPANTS

A convenience sample of 135 third-year undergraduate nursing students.

METHODS

Students attended a two-day simulation program consisting of four scenarios in total. Outcomes were measured before and after the study. Palliative care knowledge was measured using the Palliative Care Knowledge Test, emotional intelligence using the Trait Meta-Mood Scale-24, and reflective abilities using the Groningen Reflective Ability Scale. Outcome and demographic data were analyzed using descriptive and inferential statistics.

RESULTS

Total Palliative Care Knowledge Test scores (p = 0.003) and total Trait Meta-Mood Scale-24 scores (p < 0.001) improved significantly, but there was no significant change in Groningen Reflective Ability Scale scores (p = 0.650). Demographic characteristics did not significantly influence most outcome variables. Students' highest education level and experience with caring for a person receiving palliative or end-of-life care significantly affected the posttest scores of the Palliative Care Knowledge Test. Students with prior experience in caring for a person receiving palliative or end-of-life care scored significantly better in the Palliative Care Knowledge Test post-simulation compared to those who did not (p = 0.011).

CONCLUSIONS

The palliative and end-of-life simulation program significantly improved nursing students' emotional intelligence and palliative care knowledge. Further research is needed on developing a reliable tool to measure nursing students' palliative care knowledge. Future simulations should include structured and deliberate reflection features aside from debriefings to enhance reflective abilities, which is an important nursing competency. More research is needed on the effect of palliative and end-of-life care simulations on emotional intelligence and reflective abilities, and the influence of demographic variables on nursing students' outcomes.

Is Virtual Patient Simulation Superior to Human Patient Simulation: A Randomized Controlled Study

Virtual and human patient simulation methods offer an effective way to increase patient safety, reduce the incidence of errors, and improve clinical decision-making skills. The study was conducted to compare the effects of virtual and human patient simulation methods on performance, simulation-based learning, anxiety, and self-confidence with clinical decision-making scores of nursing students. A quasi-experimental, stratified, randomized controlled study was conducted with third-year nursing students. The students (n = 166) were divided into experimental and control groups. The difference between the pretest-posttest scores of intragroup nursing anxiety and self-confidence with clinical decision-making and total and sub-scale scores of in-group simulation-based learning were statistically significant ( P < .05). Performance scores were found to be statistically significantly high in the virtual patient simulation group ( P < .001). It was determined that virtual patient simulation was superior to other methods in terms of nursing anxiety and self-confidence with clinical decision-making, simulation-based learning, and performance scores.

Effect of Online Case-Based Teaching Method on Professional Development of Nursing Students

Objective: This study was conducted to determine the effect of online case-based education, as part of distance education, on nursing students’ professional values, professional behavior, problem-solving, critical-thinking skills, and self-directed learning skills. Methods: The study was conducted using a single-group pretest-posttest quasi-experimental design. A total of 58 3rd grade nursing students participated in this study The data before the study were collected electronically with the Google forms application using the personal information forms and scales (Self-Directed Learning Skills Scale, Problem Solving Inventory, California Critical Thinking Disposition Scale, Nurses Professional Values Scale, Nursing Students Professional Behaviors Scale). Results: After online case-based nursing process teaching, the difference in the total mean score of the students in all scales was found to be statistically significant (p< 0.01). It was found that, after the training had been provided through case-based education, the score average of students’ professional values, professional behaviors, problem-solving, critical thinking skills and self-directed learning increased. Conclusion: Use of online case-based teaching is useful for increasing nursing students’ nursing skills in distance education.

Impact of high-fidelity simulation exposure of nursing students with their objective structured clinical examination: A quasi-experimental study

AIM

The study aimed to establish the impact of high-fidelity simulation (HFS) in the objective structured clinical examination (OSCE) of nursing students enrolled in four undergraduate courses (medical-surgical, critical-care, maternal-health and paediatric nursing).

DESIGN

This quasi-experimental research study was performed during the midterm and final OSCEs of nursing students at the institution, and their OSCE performance was assessed.

METHODS

The students were divided into two: those who were exposed to HFS in addition to their clinical training and the other group who underwent clinical training without HFS exposure.

RESULTS

The combined mean midterm and final OSCE results of the group of nursing students with HFS exposure and those without HFS exposure were 92.58 and 82.66, respectively, with a mean between-group difference of 9.92% (p < .01). Our findings reveal that the HFS exposure in addition to clinical training enhanced the students' OSCE performance.

Efficacy of simulated video on test anxiety in objective structured clinical examination among nursing and midwifery students: A quasi-experimental study

AIM

This research investigated the effectiveness of simulated video on test anxiety in the Objective Structured Clinical Examination (OSCE) among nursing and midwifery students.

DESIGN

A quasi-experimental study with a two-group pre-test and post-test design.

METHODS

This study was conducted on 118 nursing and midwifery students in Shahroud northeast of Iran in 2019 using the census sampling method. The intervention group received a 15-minute OSCE simulation video half an hour before the test. Data were collected using the Sarason test anxiety questionnaire in two stages: one week before the test and after the simulation film was screened. Data were analysed using descriptive and inferential statistics (Independent t-test, Chi-square, Exact fisher and Paired t-test).

RESULTS

At baseline, no significant difference was observed between groups in the total mean score of test anxiety. The mean score of test anxiety significantly decreased in the OSCE simulation video group after the intervention.

Can a high-fidelity simulation tutorial improve written examination results? Review of a change in teaching practice

BACKGROUND

Undergraduate nursing students prefer technology-based learning. Simulation has been used in nursing education to provide skills acquisition and clinical exposure. Can high-fidelity simulation (HFS) be used to teach tutorial content to prepare students for a written examination?

AIMS

To design a pilot HFS tutorial.

METHOD

203 second year undergraduate nurses were timetabled to attend an HFS tutorial. Examination results at first attempt were compared with the previous cohort's results.

RESULTS

81% of the students from the HFS tutorial cohort passed at the first attempt compared with 85% from the previous cohort.

CONCLUSION

The HFS tutorial needs to be developed further, incorporating simulation standards, to further assess its ability to improve a student's written examination results. Students found the post-simulation discussion difficult and wanted guidance in how to participate. Involvement of the university's skills and simulation team would be recommended for future cohorts to assist with design and facilitation.

Effects of simulation problem-based learning based on Peplau's Interpersonal Relationship Model for cesarean section maternity nursing on communication skills, communication attitudes and team efficacy

BACKGROUND

In the coronavirus disease-impacted era, many medical institutions have not permitted clinical practice at hospitals or have operated their training on a restricted basis. The effective strategy for improving therapeutic communication and team cooperation as a nursing core competency is required.

OBJECTIVES

The study aimed to verify the effects of simulation problem-based learning on nursing students' communication skills, communication attitudes, and team efficacy.

DESIGN

Non-equivalent control group pretest-posttest design.

SETTINGS

A university in South Korea.

PARTICIPANTS

Nursing students who were classified as advanced beginners were randomly allocated to the control group (n = 46) or the experimental group (n = 47).

METHODS

The experimental group's students participated in the simulation problem-based learning for cesarean section maternity nursing. The control group's students participated in a conventional type of maternity nursing clinical practice. The communication skills, communication attitudes, and team efficacy were measured by using a self-reported questionnaire.

RESULTS

As compared with the pretest, the communication attitudes increased significantly (t = 2.41, p = .020) in the posttest for the experimental group. The communication skills (t = 1.47, p = .150) and team efficacy (F = 3.30, p = .073) were not statistically significant.

CONCLUSIONS

The simulation problem-based learning in clinical practice is recommended to improve communication attitudes for nursing students and to apply the learned knowledge in simulated nursing situations through experiential learning. Future research is particularly needed the standardized educational program to identify the long-term effects in various cases and settings.

Use of simulation to improve nursing students' medication administration competence: a mixed-method study

Background

Medication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students’ perceptions of this activity.

Methods

Second-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018–2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the ‘six rights’. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students’ tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question.

Results

The simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care.

Conclusions

Simulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.

The Role of Fundamental Nursing Practices Simulation on Students’ Competencies and Learning Satisfaction: Repeated Measured Design

Few studies have examined the simulation of fundamental nursing practices regarding nursing competencies and learning satisfaction via repeated measured methods. Objectives: To evaluate a simulation of fundamental nursing practices on nursing students’ competencies and learning satisfaction in three time points: before (T1), immediately after (T2), and one month after simulation (T3), and to examine nursing students’ competency predictors to learning satisfaction, immediately after conducting the simulation and one month after. Methods: The study design was a one-group, repeated measures study. Ninety-three undergraduate nursing students were convenience sampled and conducted a simulation of fundamental nursing practices. The students completed a questionnaire at T1, T2, and T3. The Competency Inventory for Registered Nurses questionnaire was distributed, and question about the level of learning satisfaction were asked. Results: All nursing competencies and learning satisfactions increased significantly. Only the legal/ethical practice competency succeeded in predicting the learning satisfaction in T2 and in T3 after conducting simulations. Conclusions: This study has established that a simulation of fundamental nursing practices is effective not just immediately after performing the simulation but also one month after the simulation. Therefore, it is recommended to implement a pedagogical structure of simulations of fundamental nursing practices in other nursing education areas.

Self-efficacy, burnout and academic success in nursing students: A counterfactual mediation analysis

AIM

To test the mediating role of burnout in the relationship between self-efficacy and academic success in nursing students.

DESIGN

This was a cross-sectional secondary analysis of longitudinal research aimed at exploring the academic success of nursing students.

METHODS

We enrolled a convenience sample of nursing students attending 21 Italian baccalaureate nursing degree programmes. Data were collected from 2014 to the 2018-2019 academic year. We analysed the wave of data collected during the third year of the programme. The measurements were the Academic Nurse Self-Efficacy scale (ANSEs) and the Scale of Work Burnout (SWEBO). A mediation analysis with a counterfactual approach was performed.

RESULTS

The participants (n = 556) had a median age of 20 years (IQR 19-22) and the majority was female [70.5% (392/556)]. Academic success was reached by 51.97% (289/556) of the students. The findings reveal a significant direct effect of self-efficacy on academic success and also a significant indirect effect of this relationship via burnout.

CONCLUSION

The mechanism by which self-efficacy influences academic performance in nursing students is more complex than a simple direct relationship. Universities should consider screening students for variables affecting academic success to decrease academic costs and increase ranking systems classification.

IMPACT

Nurses' professors should be engaged in strategies to promote self-efficacy. The area of intervention should be structured both during classes and internships, in tandem with the mentor and the clinical nurse.

Effectiveness of Incorporating Situation-Background-Assessment-Recommendation (SBAR) methods into simulation-based education for nursing students: A quasi-experimental study

BACKGROUND

Situation-Background-Assessment-Recommendation reporting is a structured communication tool. In other studies of simulation-based education, learning was found to increase with increases in the level of flow during scenarios. Also, communication using SBAR was found to facilitate more focus on clinical situations. However, the generalizability of those findings in nursing education and the specific benefits of combining SBAR with simulation remain unclear.

OBJECTIVES

The aims of this study are to incorporate SBAR reporting into simulation-based nurse education, and measure its effects on the students' flow, communication competence, and communication self-efficacy among nursing students, to collect basic data for the development of effective nursing curricula.

DESIGN

This study used a non-equivalent, quasi-experimental pre-post parallel design.

SETTING

The intervention was administered in a simulation center at a nursing school in South Korea.

PARTICIPANTS

One hundred and twenty fourth-year nursing students were recruited through convenience sampling.

METHODS

The participants were quasi-randomly allocated to the control (n = 52) and SBAR (n = 68) groups. The integrated simulation course was conducted twice each week. Learning and reporting SBAR was included as a component of simulation-based education for the intervention group in each session (three scenarios). The dependent variables were communication competence, communication self-efficacy, and flow in the simulation.

RESULTS

SBAR did not affect communication competence or communication self-efficacy in simulation-based education. In contrast, while flow increased in both groups, the increase was greater in the SBAR group.

CONCLUSIONS

SBAR can increase nursing students' flow in simulations. Further studies should focus on how SBAR during simulation-based education affects nursing students' practical competency.

Effects of simulation technology-based learning on nursing students' learning outcomes: A systematic review and meta-analysis of experimental studies

BACKGROUND

Gaps between theory and clinical practice represent challenges for nursing students during their learning processes. Providing simulation technology-based learning for nursing students is essential for modern nurse education, but evidence of efficacy remains scarce.

OBJECTIVES

To determine the effects of simulation technology-based learning for nursing students.

DESIGN

A systematic review and meta-analysis.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Five databases (CINAHL, Embase, MEDLINE, PubMed, and Web of Science) were electronically searched through May 30, 2021. Eligibility criteria included nursing students, simulated technology-based learning as the primary intervention, and randomised controlled trials or quasi-experimental studies published in English. The methodological quality of included studies was evaluated by the Cochrane risk-of-bias tool. Comprehensive Meta-Analysis Version 3.0 was used to conduct a meta-analysis using the random-effects model. Begg's and Egger's tests were performed to assess publication bias, and sensitivity analysis performed using a remove one study method.

RESULTS

A total of 17 studies were included in this study. Simulated technology-based learning significantly increased nursing student knowledge acquisition (standard mean difference [SMD]: 0.72, 95% confidence interval [CI]: 0.25-1.18, p < 0.001), enhanced student's confidence (SMD: 0.50, 95% CI: 0.02-0.99, p = 0.043), and increased student's satisfaction in learning (SMD: 0.81, 95% CI: 0.61-1.00, p < 0.001). Subgroup analyses showed that receiving simulation by manikins simulator had a greater effect on knowledge acquisition (SMD: 1.01, 95% CI: 0.27-1.74, p = 0.007).

CONCLUSIONS

Simulation technology use may meet the expectations of undergraduate nursing students and prepare them for clinical practice, representing an opportunity to fill gaps between theory and clinical practice while simultaneously developing new teaching scenarios.

Examining predictive factors of nursing students' self-confidence in multiple simulation sessions: A randomized controlled study

AIM

The aim of this study was to examine and describe predictors of self-confidence among nursing students attending multiple simulation-based education sessions during a bachelor program.

DESIGN

This was a randomized controlled longitudinal study.

METHODS

Participants (n = 146) were randomly assigned to a single or double set of acute care scenarios in each session. Participants attended 4 days of simulation sessions throughout a 3-year bachelor program. At four separate time points, both groups answered a survey including the Self-confidence scale and The Kolb Learning Style Inventory version 3.1. Descriptive statistics, cross-tabulations and linear models were employed to analyze the data.

RESULTS

No significant interaction effects were found between the students' self-confidence at the end of the educational program and predictive factors favoring a double set of simulation scenarios. Most third-year students (n = 52, 85%) preferred a concrete learning mode at baseline.

CONCLUSIONS

No significant predictive factors increasing self-confidence in favor of a double set of simulation scenarios could be demonstrated in this study. Hence, the continuous search for how to effectively implement SBE is of major importance for the development of SBE as a pedagogical method and remains a challenge.

Effect of simulation-based teaching on nursing skill performance: a systematic review and meta-analysis

Objective

To summarize and produce aggregated evidence on the effect of simulation-based teaching on skill performance in the nursing profession. Simulation is an active learning strategy involving the use of various resources to assimilate the real situation. It enables learners to improve their skills and knowledge in a coordinated environment.

Methods

Systematic literature search of original research articles was carried out through Google Scholar, Medline, and Cochrane Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Studies conducted on simulation-based teaching and skill performance among nursing students or clinical nursing staff from 2010 to 2019, and published in the English language, were included in this study. Methodological quality was assessed by Joanna Briggs Institute, and the risk of bias was also assessed by Cochrane risk of bias and the risk of bias assessment tool for non-randomized studies (ROBINS-I) checklists.

Results

Initially, 638 titles were obtained from 3 sources, and 24 original studies with 2209 study participants were taken for the final analysis. Of the total studies, 14 (58.3%) used single group prep post design, 7 (29.1%) used high fidelity simulator (HFS), and 7 (29.1%) used a virtual simulator (VS). Twenty (83.3%) studies reported improved skill performance following simulation-based teaching. Simulation-based teaching improves skill performance among types of groups (single or double), study regions, high fidelity (HF), low fidelity (LF), and standard patient (SP) users. But the effect over virtual and medium fidelity simulators was not statistically significant. Overall, simulation-based teaching improves the skill performance score among the experimental group (d = 1.01, 95% confidence interval [CI] [0.69–1.33], Z = 6.18, P < 0.01, 93.9%). Significant heterogeneity and publication bias were observed during the pooled analysis.

Conclusions

Simulation did improve skill performance among the intervention groups, but the conclusion is uncertain due to the significant heterogeneity. The large extent of difference among original research has necessitated the development of well-defined assessment methods for skills and standardized simulation set-up for proper assessment of their effects.

Undergraduate nursing students' transformative learning through disorientating dilemmas associated with end-of-life care simulation: A narrative inquiry study

BACKGROUND

Despite attempts, there remains a theory practice gap for undergraduate nursing students transitioning to clinical practice on graduation, especially for specialty areas of clinical practice, such as palliative care, where there are limited opportunities to gain specialty knowledge and skills. As a result, undergraduate nursing students largely feel unprepared for end-of-life care in clinical practice. End-of-life care simulation is gaining momentum for helping prepare students to undertake this important care. However, little is known of whether end-of-life care simulation is a transformative learning strategy that can be transferred to clinical practice.

AIM

The aim of this paper is to report on undergraduate nursing students transformative learning through end-of-life care simulation.

DESIGN

A qualitative research design using narrative inquiry was used with data collected through semi-structured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry.

METHODS

Eighteen 3rd year undergraduate nursing students enrolled in a compulsory palliative care unit, at an Australian university participated in an immersive end-of-life care simulation. Data were collected through semi-structured interviews and analysed using Clandinin and Connelly's three dimensions of narrative inquiry.

RESULTS

This study revealed that transformative learning occurred through three disorientating dilemmas of: caring for a dying patient; approaching difficult conversations; and witnessing death for the first time. Knowledge of palliative care and clinical skills were also found to be transferred to clinical practice.

CONCLUSIONS

End-of-life care simulation can be an effective method of promoting transformative learning and can help to reduce the gap from nursing theory to clinical practice.

Evaluation of undergraduate students’ nursing assessment and communication skills through an objective structured clinical examination within a high-fidelity simulation using a student-simulated patient†

Objective

To evaluate nursing students’ assessment and communication skills through an objective structured clinical examination (OSCE) within a high-fidelity simulation using a student-simulated patient (SSP) and analyze the validity, reliability, degree of difficulty, and discriminability of the OSCE.

Methods

A descriptive study was conducted at one nursing school in Macao. All scenarios were designed using a high-fidelity simulator combined with SSPs. A convenience sample of 54 baccalaureate nursing students completed the OSCE. The nursing assessment OSCE checklist (NAOC) and the communication evaluation rubric (CER) were used as observational measurements with three-point Likert scales (2 = Achieved, 1 = Partly achieved, 0 = Not completed/Incorrect).

Results

Difficulty coefficients of the exam were 0.63 for nursing assessment skills and 0.56 for communication skills. The discrimination index of the majority items of the NAOC (86.4%) was >0.20, showing a better to good discriminability. The items of the CER had satisfactory indexes of item discrimination (from 0.38 to 0.84). Students received high scores in conducting blood oxygen saturation and cardiac and lung auscultation but low scores in vomiting and diarrhea assessment. Students presented good communication skills in eye contacting and listening, but culture assessment needs to be improved. The students with experiences in simulation or simulated patient (SP) interactions had better assessment and communication skills than students without those experiences. There was a positive relationship between nursing assessment and communication skills (r = 0.67, P = 0.000).

Conclusions

SSPs were involved in enhancing the realism of interactions in simulated scenarios. Nursing students can conduct nursing assessments specific to patient conditions, explain the conditions to the patient, and ensure that the patient remains informed at all times of the precautions to be taken. However, students’ cultural awareness and some communication skills need further training. With moderate difficulty and high discrimination index, OSCE showed satisfactory reliability and validity.

An integrative review of simulation, senior practicum and readiness for practice

Readiness for practice (RFP) is essential as new nurses will practice in a nursing shortage climate, with high acuity patients and complex technology. Nurse educators are challenged to foster readiness for practice.

AIM

The aim of this integrative review was to explore the impact of simulation and senior practicum on graduating senior nursing students' readiness for practice.

BACKGROUND

Readiness for practice has been a point of concern for healthcare for quite some time. This has led to a need for better understanding for what RFP means including their perceptions of various stakeholders. Further, it is important to address what teaching and learning strategies can be implemented to assist in ensuring the graduating senior nursing student is ready for practice on graduation and for their first professional practice. Readiness for practice is defined as the ability to safely and competently care for patients by synthesizing theory, skills, attitudes and values in applying clinical reasoning in practice settings.

METHOD

An integrative review identified 48 published papers on simulation and senior practicum that met the inclusion criteria.

RESULTS

Themes identified from the senior practicum/preceptor literature included clinical reasoning, skills, barriers to the senior practicum and transition. Themes identified regarding simulation as a strategy included preparation, competence development, clinical reasoning and the number of human patient simulators used.

CONCLUSION

Although the evidence is not conclusive, simulation and senior practicums have the promise of preparing graduating nursing students for their first professional practice. However, nurse educators must ensure simulations are well-organized with clear objectives and that preceptors are supported in teaching and assessing students.

Clinical judgment model-based nursing simulation scenario for patients with upper gastrointestinal bleeding: A mixed methods study

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner’s clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the “noticing” clinical judgment phase was the most frequently observed phase, while “reflection” was the least frequently observed phase. Additionally, “education” was the most frequently observed nursing domain, and “anxiety” was the least frequently observed domain. Although further simulation repetitions are required to reinforce students’ self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students’ clinical judgment skills, especially “reflecting” and “emotional care.”

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation: a Delphi consensus study†

Objective

This study is aimed to develop student simulated patient (SSP) training content and evaluation indicators, and further explores their validity and reliabilities.

Methods

Delphi consultations with 20 nursing experts were conducted. The weights of indicators were calculated through the analytic hierarchy process. SSP training was conducted with a high-fidelity nursing simulation.

Results

The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation. The expert authority coefficient was reported as 0.87. The training included role and responsibility of simulated patient (SP), script interpretation, plot performance, and training for a rater, with a total of 17 indicators. SSP evaluation consisted of disease knowledge, role portrayal, and performance fidelity and since being a rater, it consists of 20 indicators in total. The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918. The content validity of SSP evaluation indicators was 0.95. The inter-rater reliability was reported as 0.866, and the internal consistency established using Cronbach’s α was 0.727.

Conclusions

Students as SPs should have first-hand knowledge and experience within the simulated scenarios. SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process. The evaluation indicators were valid and reliable, and provided the objective and quantifiable measurements for SSP training in nursing.

Effects of simulation-based learning on nursing students' perceived competence, self-efficacy, and learning satisfaction: A repeat measurement method

BACKGROUND

Simulation-Based Learning is beneficial to nursing education. Nevertheless, recent studies have shown a side effect of being overwhelmed by repeated exposures to simulation. Thus, how many times simulation scenarios should be provided to students remains a question for nursing faculty.

OBJECTIVES

The objectives of this study were to (1) explore the changes in nursing students' perceived competence, self-efficacy, and learning satisfaction after repeated exposures to simulations, and (2) determine the acceptable frequency of SBL in the 'Integrated Care in Emergency and Critical Care' course.

DESIGN

A one-group repeated measurement experimental design with self-administered questionnaires in a convenient sample of senior nursing undergraduate students was used.

SETTINGS

Department of Nursing at a nonprofit university in southern Taiwan.

PARTICIPANTS

Seventy-nine out of 84 senior nursing students who enrolled in the course in 2019 volunteered to complete all measurements.

METHODS

After taking the baseline measurements (T0), students were exposed to 75-min simulation scenarios from Time 1 (T1) to Time 3 (T3) three weeks apart throughout the semester. Students' nursing competence, self-efficacy, and learning satisfaction were measured immediately after each exposure. Descriptive statistics, t-test and repeated measurement analysis of variance were used for data analysis.

RESULTS

There were statistically significant improvements from T0 to T3 (p < .001) in nursing competence, self-efficacy, and learning satisfaction scores after repeated exposures to simulation. When comparing scores from T1 to T2 and from T2 to T3, there was no significant difference.

CONCLUSION

Simulation based learning is effective in improving nursing students' perceived competence, self-efficacy, and learning satisfaction. While the primary changes occur at the first simulation effort, it is the accumulated multiple exposure experiences collectively improve students' learning outcomes. Multiple instructional strategies besides simulation are recommended to maintain nursing students' learning interests to achieve optimal learning outcomes of the course across a semester.

Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences.