Evidentiary and theoretical foundations for virtual simulation in nursing education

Analysis of Knowledge and Satisfaction in Virtual Clinical Simulation among Nursing Students: A Mixed Study

Virtual simulation offers a powerful educational tool with considerable, albeit underexplored potential. This technology immerses students in lifelike digital scenarios, fostering the acquisition of knowledge and skills necessary for their future careers. This study aimed to assess knowledge acquisition and satisfaction outcomes among students using a virtual simulation teaching approach. The specific objectives were (1) to compare pre-and posttest knowledge acquisition, (2) to investigate the influence of prior professional experience on knowledge, and (3) to explore satisfaction levels with virtual simulation. One hundred and fifty-nine nursing students participated in a virtual simulation-based clinical intervention, entailing the resolution of a virtual adult patient hospitalized with respiratory pathology. Sociodemographic data and prior professional experience were collected, and knowledge was evaluated through pre-to-post tests. Satisfaction levels were assessed using open-ended questions. Quantitative data were analyzed using descriptive statistics, Wilcoxon, Mann-Whitney U, and Cohen's tests, while qualitative data underwent keyword-in-context analysis. Significant differences were noted between pre- and posttest knowledge levels, with prior experience showing no significant impact on knowledge acquisition. Participants reported high levels of satisfaction. Lexicometric analysis identified four clusters of words related to the key terms "simulation", "learn", "activity", and "knowledge". Virtual clinical simulation effectively enhances knowledge acquisition and fosters satisfaction, with students recognizing the positive impact of this approach on their learning. Consequently, virtual simulation contributes to the training of competent health professionals.

Enhancing professional competency in clinical procedures using head-mounted display virtual reality - a mixed method study

BACKGROUND

The maintenance of nursing professional competency is essential to ensure patients' health outcomes. With the current shortage of nursing workforce, a novel approach is necessary to refresh clinical skills and update practice.

OBJECTIVE

This study aims to examine the effectiveness of using head-mounted display virtual reality to refresh knowledge and skills and explore nurses' perceptions towards using this technology for refresher training.

DESIGN

A pre-test post-test mixed-method experimental design was employed.

RESULTS

Participants (n = 88) were registered nurses with a diploma in nursing. The intravenous therapy and subcutaneous injection procedures were implemented using head-mounted display virtual reality. The study showed significant improvement in knowledge for the procedures, cognitive absorption, online readiness, self-directed learning, and motivation for learning. In the qualitative focus group discussions, three themes were identified using thematic analyses: enjoyable way to refresh clinical knowledge; learning outside classroom and limitations in maneuver.

CONCLUSION

Using head-mounted display virtual reality is promising in refreshing clinical skills for nurses. Training and refresher courses can explore using this novel technology, which may be a viable alternative to ensure professional competence with reduced manpower and resources used by the healthcare institution.

Research on the learning experience of virtual simulation class experimental teaching and learning based on the perspective of nursing students

BACKGROUND

The enrichment of information technology has impacted traditional teaching modes. The emergence of virtual simulation class experimental teaching software has effectively improved the quality of nursing experiment teaching. The learning experience of virtual simulation class experiment teaching and learning based on the perspective of nursing students is explored to provide a basis for improving related learning effects in the future.

METHODS

Fourteen undergraduate nursing students were selected using the purposive sampling method for semi-structured interviews. The Colaizzi seven-step analysis method was used to collate and analyse the interview data.

RESULTS

Two themes and six sub-themes were considered during the data analysis. The two themes were positive experiences and negative experiences. In the positive learning experience, undergraduate nursing students showed a deep memory of authentic and diverse scenes, which presented knowledge in a clearly logical, visualised and stereoscopic manner. Negative experiences are manifested as significantly different learning efficiencies in different grades and subjects, and timing the delivery of teaching feedback is difficult.

CONCLUSION

Virtual simulation experimental teaching can promote the subjective initiative of nursing students' learning and promote better coordination and unity in their image and theoretical thinking. Some advantages can be augmented by following the national educational policy, strengthening the information construction, combining the construction of virtual simulation experiments with the discipline's characteristics and optimising the resources. This paper provides a reference for the future exploration of nursing education and further improving the construction of virtual simulation experimental teaching tools and resources.

Mid-career switch nursing students' perceptions and experiences of using immersive virtual reality for clinical skills learning: A mixed methods study

BACKGROUND

There has been an increase of mid-career professionals joining nursing. These adult students possess significant expertise in other areas and may benefit substantially in deliberate practice to acquire skills competency using immersive virtual reality (IVR) for clinical procedures before they practise in actual clinical settings.

OBJECTIVES

This study aims to (1) examine the impact of IVR clinical procedures on mid-career switch students in knowledge, game perception and user reaction; (2) to explore the mid-career switch students' perceptions and experiences in using the IVR clinical procedures.

DESIGN

A mixed methods feasibility study was used.

SETTING AND PARTICIPANTS

This study was conducted at a university in Singapore with 34 first-year mid-career switch students.

METHODS

This study is a single-group pre-test and post-test experimental study on learning clinical procedures using IVR in the home setting. The study took place from September to November 2021. Focus group discussions were conducted and analysed verbatim using thematic analysis.

RESULTS

The students demonstrated significant improvement of knowledge for subcutaneous insulin, but overall, the increase in combined scores for both intravenous therapy and subcutaneous insulin were not statistically significant. Three overarching themes included: 1) Learning and practice, 2) Challenges and barriers, and 3) Personal attributes. Most of the participants found the experiences to be engaging, relevant, and satisfying. Some reported experiencing giddiness, headache, and lack of familiarity with technologies.

CONCLUSIONS

IVR simulation can potentially be used as a supplementary learning tool to improve knowledge of clinical procedures in mid-career switch students.

Virtual Clinical Simulation Adoption and Use by Licensed Practical Nurse/Licensed Vocational Nurse Education Programs During the COVID-19 Pandemic

Background

In the early stages of the COVID-19 pandemic, as clinical site restrictions were implemented, education programs leading to licensed practical nurse/licensed vocational nurse (LPN/LVN) degrees increasingly relied on virtual simulation-based experiences to provide clinical training to their students. However, scant evidence exists regarding the extent of this change and the various modalities employed by LPN/LVN programs across the United States.

Purpose

We sought to identify the degree to which virtual clinical simulation was adopted by LPN/LVN education programs during the early stages of the COVID-19 pandemic to address clinical site restrictions. In addition, we hoped to identify the practices and activities that educators included under the broad umbrella definition of virtual clinical simulation.

Methods

All active U.S. prelicensure LPN/LVN nursing education programs were contacted in September 2020. Program leaders were asked to estimate the proportion of clinical hours completed in virtual clinical simulation before the pandemic and the proportion anticipated for the fall 2020 term. Descriptive statistics were generated, with repeated measures analysis of covariance applied to evaluate the average change in virtual simulation within programs stratified by reported clinical restrictions.

Results

Representatives from 265 LPN/LVN programs in 44 U.S. jurisdictions responded to the survey. Responding programs significantly increased the proportion of clinical hours completed in virtual clinical simulation between fall 2019 (M = 10.7, SD = 15.3) and fall 2020 (M = 35.3, SD = 27.6, p < .001). Furthermore, there was an interaction between clinical site restrictions and term, with a more pronounced uptick in virtual simulation usage among programs that indicated they found identifying clinical sites “very difficult” (M = 41.1, SD = 28.9) relative to those who found it “somewhat more difficult” (M = 23.9, SD = 18.8, p < .001). Programs adopted a range of modalities, including simply watching videos and participating in virtual or augmented reality, online software packages, or other forms of screen-based learning.

Conclusion

As the adoption of virtual simulation increases, clear definitions of what constitutes clinical virtual simulation must be established. Additionally, rigorous inquiry to support evidence-based regulatory guidelines is needed.

Assessing the Impact of the COVID-19 Pandemic on Nursing Education: A National Study of Prelicensure RN Programs

Background

The COVID-19 pandemic has had a profound impact on prelicensure nursing education, leading to widespread disruptions that may have implications for nursing students' learning and engagement outcomes. Understanding how the rapid shift to online and simulation-based teaching methods has affected new graduates' clinical preparedness is critical to ensure patient safety moving forward.

Purpose

To assess the impact of institutional, academic, and demographic characteristics on prelicensure nursing students' academic, initial postgraduation, and early career outcomes during the COVID-19 pandemic.

Methods

We conducted a mixed-methods longitudinal study focused on prelicensure registered nurse (RN) students entering the core of their didactic and clinical nursing coursework during the pandemic. This study uses a combination of real-time student and faculty self-report data, including externally validated instruments, within and end-of-program standardized test scores, and focus group findings. Various statistical methods, ranging from simpler descriptive and non-parametric methods to Generalized Estimating Equation (GEE) models and detailed textual analysis, are applied to assess student, faculty, and institution-level data.

Results

The final sample includes more than 1,100 student and faculty participants affiliated with 51 prelicensure RN programs located across 27 states. Leveraging more than 4,000 course observations collected from fall 2020 to spring 2022 and supplemented by the rich personal narratives of over 60 focus group participants, this study illuminates the breadth, scale, and ever-evolving nature of prelicensure RN programs' efforts to maintain the continuity of nursing students' education during the public health crisis. In doing so, it captures the many ways in which nursing administrators, faculty, and students sought to address the unparalleled challenges they confronted on a day-to-day basis. In particular, the findings provide critical insights into the efficacy of the changes nursing programs made to their course delivery formats to adjust to the confluence of rapidly evolving federal, state, and private restrictions to stem the spread of COVID-19.

Conclusion

This study stands as the most comprehensive assessment of prelicensure nursing education in the United States since the onset of COVID-19. It extends knowledge by linking potential deficiencies in students' didactic and clinical education during the pandemic and their early career preparedness, clinical competence, and the patient safety implications therein.

The Effect of COVID-19 on Nursing Program Passing Scores

The COVID-19 pandemic greatly challenged nursing education. Nursing programs had to continue providing quality nursing education in an altered environment where much of what was traditionally face-to-face learning was forced online and into simulation. The purpose of this quantitative comparative ex post facto designed study, using secondary data and guided by Knowles's adult learning theory, was to determine the effect of the COVID-19 pandemic on nursing students' nursing program passing scores before and during the pandemic. The results of the independent t test were a statistically significant decrease (p < .001) in the nursing program passing scores for students during the COVID-19 pandemic compared to before the COVID-19 pandemic. The implications of this analysis provide information to nursing educators, and nursing programs can use this study to recognize there are students requiring extra support in the face of a challenge such as the COVID-19 pandemic.

Student-centered case-based teaching and online-offline case discussion in postgraduate courses of computer science

This study explores a student-centered teaching method in postgraduate courses. Teacher-centered classroom teaching cannot fully stimulate learning initiative and enthusiasm of students. Student-centered means that students actively learn and construct knowledge by participating in teaching activities. This study presents a student-centered online-offline hybrid teaching method, which adopts student-centered case-based teaching and online-offline case discussion in the postgraduate courses of computer science. The latest engineering cases are integrated into teaching and a case library is constructed. Taking the digital image processing course as an example, student-centered teaching allows students to choose what to learn and how to learn. Case-based teaching makes students better understand the application of theory of knowledge. It can introduce multiple perspectives, promote understanding and reflection on problems, and help students develop higher-level thinking, analysis, and synthesis skills. This study explores online-offline case discussion method in the student-centered teaching and proposes the principles of case design of postgraduate courses. Revised Bloom's taxonomy is used for teaching assessment. The actual teaching effect shows that student-centered case-based teaching and online-offline case discussion have achieved better teaching effect.

Nursing Handoff Education Using Experiential and Virtual Innovations

BACKGROUND

Seventy percent of serious medical errors are the result of ineffective communication, including handoff errors.

PROBLEM

Nursing students have cited a need for more experience on how to give handoff; yet, handoff education remains variable.

APPROACH

Two innovative curricular approaches were implemented on the basis of Bloom's taxonomy to teach handoff education: experiential and virtual. The outcomes of the 2 curricular innovations were evaluated for handoff completion, handoff accuracy, and handoff quality, based on context.

OUTCOMES

During the experiential approach, students demonstrated average handoff completion rates of 84%. During the virtual approach, students' handoff completion rates rose from 25% to 63% and accuracy handoff rates rose from 13% to 31%.

CONCLUSIONS

Evaluations support that varying educational methods successfully teach nursing students how to give handoffs. Complementary innovations grant educators flexibility to tailor innovations to curriculum and course context, as supported by Bloom's taxonomy.

Finding the right balance: student perceptions of using virtual simulation as a community placement

OBJECTIVES

Finding appropriate community clinical placements has been challenging in recent years, most especially during the COVID-19 pandemic. During the 2020-2021 semesters, a university in the province of Alberta, Canada chose to use the community health virtual simulation program, Sentinel City®3.1, to provide clinical placements for three groups of undergraduate students. This expository paper, co-authored by students and faculty, sought to further explore how virtual simulation can be used to best support student learning by identifying practices that students find most helpful.

METHOD

Jeffries' (2005) simulation framework was used to guide a quality improvement analysis which explored feedback received from 16 students regarding the use of Sentinel City®3.1 as a clinical placement, with additional contributions from the student co-authors.

RESULTS

Students felt Sentinel City®3.1 was an effective tool to learn community and population health concepts, however, all students indicated that they would have preferred more opportunities to work with real communities.

CONCLUSION

Virtual simulation programs like Sentinel City®3.1 might be best as a learning supplement rather than as students' sole clinical placement experience.